Journal of General Internal Medicine

, Volume 24, Issue 2, pp 205–210

Determinants of NCI Cancer Center Attendance in Medicare Patients with Lung, Breast, Colorectal, or Prostate Cancer

  • Tracy Onega
  • Eric J. Duell
  • Xun Shi
  • Eugene Demidenko
  • David Goodman
Original Article

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.

Key Words

attendance  determinants cancer centers Medicare 

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Copyright information

© Society of General Internal Medicine 2008

Authors and Affiliations

  • Tracy Onega
    • 1
    • 2
    • 3
  • Eric J. Duell
    • 1
    • 2
    • 3
    • 5
  • Xun Shi
    • 4
  • Eugene Demidenko
    • 2
    • 3
  • David Goodman
    • 1
    • 2
  1. 1.The Dartmouth Institute for Health Policy and Clinical PracticeDartmouth Medical SchoolHanoverUSA
  2. 2.Department of Community and Family MedicineDartmouth Medical SchoolHanoverUSA
  3. 3.Norris Cotton Cancer CenterDartmouth Medical SchoolLebanonUSA
  4. 4.Department of Geography Dartmouth CollegeHanoverUSA
  5. 5.International Agency for Research on Cancer (IARC)LyonFrance

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