Determinants of NCI Cancer Center attendance in Medicare patients with lung, breast, colorectal, or prostate cancer

J Gen Intern Med. 2009 Feb;24(2):205-10. doi: 10.1007/s11606-008-0863-y. Epub 2008 Dec 6.

Abstract

Background: Geographic access to NCI-Cancer Centers varies by region, race/ethnicity, and place of residence, but utilization of these specialized centers has not been examined at the national level in the U.S. This study identified determinants of NCI-Cancer Center attendance in Medicare cancer patients.

Methods: SEER-Medicare (Surveillance Epidemiology and End Results) data were used to identify individuals with an incident cancer of the breast, lung, colon/rectum, or prostate from 1998-2002. NCI-Cancer Center attendance was determined based on utilization claims from 1998-2003. Demographic, clinical, and geographic factors were examined in multilevel models. We performed sensitivity analyses for the NCI-Cancer Center attendance definition.

Results: Overall, 7.3% of this SEER-Medicare cohort (N = 211,048) attended an NCI-Cancer Center. Travel-time to the nearest NCI-Cancer Center was inversely related to attendance, showing 11% decreased likelihood of attendance for every 10 minutes of additional travel-time (OR = 0.89, 95%CI 0.88-0.90). Receiving predominantly generalist care prior to diagnosis was associated with a lower likelihood of attendance (OR = 0.79, 95%CI 0.77-0.82). The other factors associated with greater NCI-Cancer attendance were later stage at diagnosis, fewer comorbidities, and urban residence in conjunction with African-American race.

Conclusions: Attendance at NCI-Cancer Centers is low among Medicare beneficiaries, but is strongly influenced by proximity and general provider care prior to diagnosis. Other patient factors are predictive of NCI-Cancer Center attendance and may be important in better understanding cancer care utilization.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Breast Neoplasms / epidemiology*
  • Breast Neoplasms / ethnology
  • Breast Neoplasms / therapy
  • Cancer Care Facilities / statistics & numerical data
  • Colorectal Neoplasms / epidemiology*
  • Colorectal Neoplasms / ethnology
  • Colorectal Neoplasms / therapy
  • Female
  • Health Services Accessibility
  • Humans
  • Lung Neoplasms / epidemiology*
  • Lung Neoplasms / ethnology
  • Lung Neoplasms / therapy
  • Male
  • Medicare / statistics & numerical data*
  • National Cancer Institute (U.S.) / statistics & numerical data*
  • Prostatic Neoplasms / epidemiology*
  • Prostatic Neoplasms / ethnology
  • Prostatic Neoplasms / therapy
  • United States / epidemiology