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Cancer. 2008 Feb 15;112(4):909-18. doi: 10.1002/cncr.23229.

Geographic access to cancer care in the U.S.

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The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Medical School, Lebanon, New Hampshire 03756, USA.



Although access to cancer care is known to influence patient outcomes, to the authors' knowledge, little is known regarding geographic access to cancer care, and how it may vary by population characteristics. This study estimated travel time to specialized cancer care settings for the continental U.S. population and calculated per capita oncologist supply.


The closest travel times were estimated using a network analysis of the road distance weighted by travel speeds from the population or geographic centroid of every ZIP area in the continental U.S. to that of the nearest cancer care setting under consideration: National Cancer Institute (NCI)-designated Cancer Centers, academic medical centers, and oncologists. Alaska and Hawaii were excluded because travel in these states is often not road-based. Population and geographic characteristics including race/ethnicity, income, education, and region were derived from U.S. Census 2000 data and from rural-urban commuting area classifications. Oncologist supply per 100,000 residents in Hospital Referral Regions (pHRRs) was estimated by region.


Travel times of <or=1 hour were estimated for 45.2% of the population to the nearest NCI Cancer Center, 69.4% to the nearest academic-based care, and 91.8% to any specialized cancer care. Native Americans, nonurban dwellers, and residents in the South had the longest travel times to the nearest NCI Cancer Center compared with the overall U.S. population (median [interquartile range (IQR)] in minutes: 155 [62-308], 173 [111-257], and 164 [70-272], vs 78 [27-172], respectively). Travel burdens persisted for Native Americans and nonurban populations across all 3 cancer care settings. For all population strata, travel times markedly increased as the degree of cancer care specialization increased. The median oncologist supply for pHRRs was 2.83 per 100,000 individuals.


There are population groups with limited access to the most specialized cancer care settings.

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