Geographic disparities in residential proximity to colorectal and cervical cancer care providers

Abstract

Background Persistent rural‐urban disparities for colorectal and cervical cancers raise concerns regarding access to treatment providers. To the authors knowledge, little is known regarding rural‐urban differences in residential proximity to cancer specialists. Methods Using the 2018 Physician Compare data concerning physician practice locations and the 2012 to 2016 American Community Survey, the current study estimated the driving distance from each residential zip code tabulation area (ZCTA) centroid to the nearest cancer provider of the following medical specialties involved in treating patients with colorectal and cervical cancer: medical oncology, radiation oncology, surgical oncology, general surgery, gynecological oncology, and colorectal surgery. Using population‐weighted multivariable logistic regression, the authors analyzed the associations between ZCTA‐level characteristics and driving distances >60 miles to each type of specialist. ZCTA‐level residential rurality was defined using rural‐urban commuting area codes. Results Nearly 1 in 5 rural Americans lives >60 miles from a medical oncologist. Rural‐urban differences in travel distances to the nearest cancer care provider(s) increased substantially for cancer surgeons; greater than one‐half of rural residents were required to travel 60 miles to reach a gynecological oncologist, compared with 8 miles for their urban counterparts. Individuals residing within ZCTAs with a higher poverty rate, those of American Indian/Alaska Native ethnicity, and/or were located in the South and West regions were more likely than their counterparts to be >60 miles away from any of the aforementioned providers. Conclusions The substantial travel distances required for rural, low‐income residents to reach a cancer specialist should prompt a policy action to increase access to specialized cancer care for millions of rural residents.

Associations between geographic residence and US adolescent and young adult cancer stage and survival

“…In general, disparities in survival rates by geographic area of residence at diagnosis among AYAs could arise at several points along the pathway from symptoms, to diagnosis, to treatment, to cure, remission, or death and may depend on cancer type 35,37,38 . Diagnosis delays that ultimately impact treatment efficacy and cure could arise for several reasons, including: low cancer suspicion among both AYA patients and providers because of its rarity, greater health care avoidance among rural than urban residents, 9,39 difficulties in accessing a specialist in rural areas, 40‐44 lower rates of insurance among rural than among metro and urban residents, 45,46 and employment barriers to access (eg, loss of income needed to seek care 44 ). Once the diagnosis is made, there may be delays in starting treatment because of provider availability, insurance issues, the need to take time off from employment, and the need to travel for treatment 44,47,48 .…”

“…Cancer October 1, 2021 in rural areas, [40][41][42][43][44] lower rates of insurance among rural than among metro and urban residents, 45,46 and employment barriers to access (eg, loss of income needed to seek care 44 ). Once the diagnosis is made, there may be delays in starting treatment because of provider availability, insurance issues, the need to take time off from employment, and the need to travel for treatment.…”

Inequalities in access to minimally invasive general surgery: a comprehensive nationwide analysis across 20 years

“…In contrast, the role of residential area and geographical location has just recently come into focus. Recent studies reported impaired access to laparoscopic surgery for diverticular disease and colorectal cancer [40][41][42] as well as modern surgical oncological care for patients living in rural areas in the US [43]. However, little is known how differences in residential areas within other countries influence surgical practice.…”

Extent of Inclusion of “Rural” in Comprehensive Cancer Control Plans in the United States

“…They also have higher incidence rates of cancers that have mechanisms for primary and secondary prevention, such as lung, colorectal, and human papillomavirus-associated cancers (3). Factors that contribute to these disparities include high rates of poverty, lack of health insurance, and lack of access to primary and specialty care (4)(5)(6)(7)(8).…”