New research has revealed disparities in access to cancer care among children, adolescents, and young adults in the United States. 

The study showed that patients living in the South and Midwest, rural areas, and areas with high deprivation levels must travel further to receive care. 

When patients were analyzed by race/ethnicity, American Indian or Alaska Native patients had the longest median travel time, and Asian patients had the shortest.

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These findings were published in JAMA Network Open.

The researchers evaluated data from 90,498,890 patients with cancer. One-third of patients (33.1%) were adolescents and young adults (AYAs), aged 15-21 years, and 66.9% were pediatric patients, aged 0-14 years.

Most patients were White (60.0%), followed by Hispanic or Latino (22.3%), Black or African American (12.6%), Asian (4.2%), and American Indian or Alaska Native (0.9%). The patients lived in urban areas (83.8%), large towns (9.0%), small towns (4.2%), and rural areas (2.6%).  

The majority of pediatric and AYA patients (63.6%) traveled less than 30 minutes to reach their oncologist, but 19.7% traveled between 30 and 60 minutes, and 12.4% traveled between 1 and 2 hours. The rest traveled for longer periods, with 0.5% of patients traveling for 4 hours or more. 

Rural residents had the longest median travel time, at 95 minutes. Residents of small towns traveled a median of 82 minutes, residents of large towns 67 minutes, and urban residents 16 minutes. 

When the researchers examined data on the basis of deprivation level, they found that  patients from areas of high deprivation traveled a median of 36 minutes. Patients in low-deprivation areas traveled a median of 12 minutes, and those in median-level deprivation areas traveled a median of 22 minutes.

By region, the longest median travel times were seen in the South (24 minutes) and the Midwest (22 minutes). Shorter median travel times were seen in the Northeast (11 minutes) and the West (17 minutes).

American Indian or Alaska Native patients had the longest median travel time (46 minutes), followed by White patients (24 minutes), Hispanic/Latino patients (15 minutes), Black/African-American patients (14 minutes), and Asian patients (12 minutes).

Wyoming had the lowest number of pediatric oncologists per capita, at 0 oncologists per 100,000 pediatric population. This was followed by Idaho (1.3 per 100,000) and Montana (1.4 per 100,000). The highest number was in Washington, DC (53.3 per 100,000). 

“Results of this study showed that most children and AYAs in the continental US had adequate access to pediatric cancer care, although disparities existed among racial and ethnic groups and residents in rural areas, areas with high deprivation levels, and some Southern and Midwestern states,” the researchers wrote. “Reducing these disparities may require innovative approaches, such as expanding the capabilities of local facilities and creating partnerships with adult oncology centers and primary care physicians.” 

Reference

Liu X, Fluchel MN, Kirchhoff AC, Zhu H, Onega T. Geographic access to pediatric cancer care in the US. JAMA Netw Open. Published online January 19, 2023. doi:10.1001/jamaoncol.2022.5985