Proximity to a cancer center contributes to the cancer stage at diagnosis, research shows

Location, race and insurance status play a major role in a patient’s likelihood of being diagnosed with early- or late-stage cancer, according to a detailed analysis of medical records of more than 94,000 patients with cancer by researchers at Johns Hopkins Bloomberg School of Public Health and the Johns Hopkins Kimmel Cancer Center.

Patients who lived farther away from a facility designated by the National Cancer Institute (NCI) as a comprehensive cancer center (CCC) and who received only a diagnosis or only treatment at the center had a higher than average likelihood of being diagnosed in a late stage, as well as non-Hispanic black patients and patients with Medicaid or no insurance, regardless of location, the researchers report.

Work, published in JAMA network openedhighlights that significant barriers to cancer screening and treatment remain to be addressed for people living far from a CCC and for disadvantaged populations.

Previous studies have shown that patients who do not receive their initial treatment in a CCC experience worse cancer outcomes. Researchers including Michael Desjardins, Ph.D., an assistant research professor of epidemiology and a core faculty member at the Spatial Science for Public Health Center at the Bloomberg School of Public Health; Frank Curriero, Ph.D., professor of epidemiology and director of the Spatial Science for Public Health Center; and William Nelson, M.D., Ph.D., director of the Kimmel Cancer Center, initiated an exploratory study to determine how proximity to a CCC and other social determinants of health influence the likelihood of receiving a diagnosis of a sooner or later stage. stage cancer.

First, the team considered how to define the region, or “watershed,” served by a CCC. There is no standardized approach for defining a service area among the 54 NCI-designated CCCs at the national level. Some centers identify nearby counties with the highest percentage of their patients with cancer, others define areas based on the number of cancer cases compared to all cancer deaths, and centers use many additional methods.

Desjardins, specialized in geographic information science and health, developed a simple but intuitive approach to define and evaluate a catchment area: focus on the nearest 75% of patients, defined by kilometers along the road network, using a geographic average center of five from Johns Hopkins. hospitals.

The team analyzed health and demographic data for 94,007 patients in the Johns Hopkins Hospital Cancer Registry who had received a cancer diagnosis, cancer treatment, or both a diagnosis and treatment between 2010 and 2019. Significant differences in cancer staging quickly emerged.

Non-Hispanic black patients were more likely than average to have a late-stage cancer diagnosis, even if they lived close to Kimmel Cancer Center. This finding is consistent with a body of work finding lower cancer survival rates for non-Hispanic black patients, and it suggests that healthcare accessibility is more complex than just geographic distance.

Also, people without insurance, unknown insurance, or Medicaid were more likely to receive a late-stage cancer diagnosis. This finding underlines the challenge low-income people face in accessing healthcare, especially for cancer treatment.

Finally, patients living outside the 75% catchment area who received only treatment or only a diagnosis at a CCC were also more likely to have a late-stage diagnosis. Although travel distance may be a factor when seeking a diagnosis alone or a treatment alone, the finding suggests that some CCC patients may rely on more than one facility for their cancer care.

“In the future, we need to ask patients why they choose a particular cancer center for diagnosis or treatment,” says Desjardins. “Maybe they can’t afford treatment in a particular location, or maybe they’re looking for a specific late-stage cancer treatment. There are a lot of nuances we need to try to understand by combining spatial data sets with qualitative studies.”

“NCI-designated cancer centers are committed to improving cancer care and outcomes in their service areas, especially for historically underserved communities and populations,” Nelson added. “To do this, they will need to work with partners and embrace new technologies and tactics.”

The study authors say that diagnosis and treatment should ideally both take place in a CCC, if possible – people diagnosed and treated in a CCC had the lowest chance of a late-stage diagnosis.

Additionally, CCCs across the country can and should adopt a standardized approach to watershed assessment, Desjardins says. Where areas overlap, centers can then communicate with each other to share patient care information.

Other co-authors of the study are Norma Kanarek and Jamie Bachman, both of Johns Hopkins.