Geographic Access to Gynecologic Cancer Care in the United States

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Abstract

This nationwide study was designed to address the critical need to determine the extent of geographic access disparities nationwide to ensure that women with gynecologic cancer have access to high-quality cancer care irrespective of their place of residence. Patients were identified who face a geographic barrier to receiving the standard of care for gynecologic malignancies. The investigators used Geographic Information Systems to identify US counties farther than 50 miles from the closest gynecologic oncologist and hospital referral regions (HRRs) that do not contain the primary professional address of at least 1 gynecologic oncologist. Demographic characteristics of counties were analyzed using data from the 2010 US Census. County-level cancer incidence data were obtained through the Centers for Disease Control and Prevention’s State Cancer Profiles.

A total of 36% (1125/3143) of US counties are farther than 50 miles from the nearest gynecologic oncologist. More than 9% of women (14.8 million women) in the United States live in low-access counties (LACs). Approximately 7663 women with gynecologic cancers per year may experience geography-related disparities in access. Nationwide, 40% (123/306) of HRRs do not contain the primary address of a gynecologic oncologist. Low-access counties have a higher proportion of white and/or Hispanic residents and lower proportion of black residents. Median household incomes are significantly lower in LACs.

These data show that approximately 9% of the female population in the United States with gynecologic cancer may face a significant geographic barrier to access of high-quality care. Future studies should investigate whether residents of LACs utilize high-quality care less often and whether there is a disparity in clinical outcomes. Disparities among residents of LACs in obtaining high-quality treatment could be addressed by ensuring subspecialty care in low-access regions and/or adjusting system structures to minimize the burdens of traveling long distances for cancer care.

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