Disparities in Geographic Accessibility of National Cancer Institute Cancer Centers in the United States


The National Cancer Institute (NCI) Cancer Centers form the backbone of the cancer care system in the United States since their inception in the early 1970s. Most studies on their geographic accessibility used primitive measures, and did not examine the disparities across urbanicity or demographic groups. This research uses an advanced accessibility method, termed “2-step floating catchment area (2SFCA)” and implemented in Geographic Information Systems (GIS), to capture the degree of geographic access to NCI Cancer Centers by accounting for competition intensity for the services and travel time between residents and the facilities. The results indicate that urban advantage is pronounced as the average accessibility is highest in large central metro areas, declines to large fringe metro, medium metro, small metro, micropolitan and noncore rural areas. Population under the poverty line are disproportionally concentrated in lower accessibility areas. However, on average Non-Hispanic White have the lowest geographic accessibility, followed by Hispanic, Non-Hispanic Black and Asian, and the differences are statistically significant. The “reversed racial disadvantage” in NCI Cancer Center accessibility seems counterintuitive but is consistent with an influential prior study; and it is in contrast to the common observation of co-location of concentration of minority groups and people under the poverty line.

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  1. 1.

    CDC, Statistics for Different Kinds of Cancer. https://www.cdc.gov/cancer/dcpc/data/types.htm (last accessed on 10–24-2017), 2017.

  2. 2.

    Onega, T., Duell, E.J., Xun, S., Wang, D., Demidenko, E., and Goodman, D., Geographic access to cancer care in the U.S. Cancer. 112(4):909–918, 2008.

    Article  PubMed  Google Scholar 

  3. 3.

    Ananthakrishnan, A.N., Hoffmann, R.G., and Saeian, K., Higher physician density is associated with lower incidence of late-stage colorectal cancer. J. Gen. Intern. Med. 25(11):1164–1171, 2010.

    Article  PubMed  PubMed Central  Google Scholar 

  4. 4.

    Gumpertz, M.L., Pickle, L.W., Miller, B.A., and Bell, B.S., Geographic patterns of advanced breast cancer in Los Angeles: Associations with biological and sociodemographic factors (United States). Cancer Causes Control. 17(3):325–339, 2006.

    Article  PubMed  Google Scholar 

  5. 5.

    Celaya, M.O., Rees, J.R., Gibson, J.J., Riddle, B.L., and Greenber, E.R., Travel distance and season of diagnosis affect treatment choices for women with early-stage breast cancer in a predominantly rural population (United States). Cancer Causes Control. 17(6):851–856, 2006.

    Article  PubMed  Google Scholar 

  6. 6.

    Avis, N.E., Smith, K.W., Link, C.L., Hortobagyi, G.N., and Rivera, E., Factors associated with participation in breast cancer treatment clinical trials. Proc. Am. Soc. Clin. Oncol. 24(12):1860–1867, 2006.

    Article  Google Scholar 

  7. 7.

    Agency for Healthcare Research and Quality, 2014 National healthcare quality and disparities report. U.S. Department of Health and Human Services, Rockville, MD, 2015.

    Google Scholar 

  8. 8.

    Finlayson, S.R.G., Birkmeyer, J.D., Tosteson, A.N.A., and Nease, R.F., Patient preferences for location of care: Implications for regionalization. Med. Care. 37(2):204–209, 1999.

    CAS  Article  PubMed  Google Scholar 

  9. 9.

    Shi, X., Alford-Teaster, J., Onega, T., and Wang, D., Spatial access and local demand for major cancer care facilities in the United States. Ann. Assoc. Am. Geogr. 102(5):1125–1134, 2012.

    Article  Google Scholar 

  10. 10.

    Wang, F., Fu, C., and Shi, X., Planning towards maximum equality in accessibility of NCI cancer centers in the U.S. spatial analysis in health geography. Henry Ling Limited, United Kingdom, pp. 261–274, 2015.

    Google Scholar 

  11. 11.

    Meilleur, A., Subramanian, S., Plascak, J.J., Fisher, J.L., Paskett, E.D., and Lamont, E.B., Rural residence and cancer outcomes in the US: Issues and challenges. Cancer Epidemiol. Biomark. Prev. 22(10):1657–1667, 2013. https://doi.org/10.1158/1055-9965.EPI-13-0404.

    Article  Google Scholar 

  12. 12.

    Charlton, M., Schilchiting, J., Chioreso, C., Ward, M., and Vikas, P., Challenges of Rural Cancer Care in the United States. Oncology. 29:633–640, 2015.

    PubMed  Google Scholar 

  13. 13.

    UNC, 82 Rural Hospital Closures: January 2010 – Present. Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, Chapel Hill, NC, 2017.

    Google Scholar 

  14. 14.

    National Cancer Institute, Cancer Health Disparities. https://www.cancer.gov/about-nci/organization/crchd/cancer-health-disparities-fact-sheet (last accessed on 11-3-2017), 2017.

  15. 15.

    Esnaola, N.F., and Ford, M.E., Racial differences and disparities in cancer care and outcomes: Where’s the rub? Surg. Oncol. Clin. N. Am. 21(3):417–437, 2012.

    Article  PubMed  PubMed Central  Google Scholar 

  16. 16.

    Wang, F., McLafferty, S., Escamilla, V., and Luo, L., Late-stage breast cancer diagnosis and health care access in Illinois. Prof. Geogr. 60:54–69, 2008.

    Article  PubMed  PubMed Central  Google Scholar 

  17. 17.

    McLafferty, S., Wang, F., Luo, L., and Butler, J., Rural-urban inequalities in late-stage breast cancer: Spatial and social dimensions of risk and access. Environ. Plann. B. Plann. Des. 38:726–740, 2011.

    Article  PubMed  PubMed Central  Google Scholar 

  18. 18.

    National Cancer Institute, http://cancercenters.cancer.gov/Center/CancerCenters (last access on 10–24-2017), 2017.

  19. 19.

    In, H., Neville, B.A., Lipsitz, S.R., Corso, K.A., Weeks, J.C., and Greenberg, C.C., The role of National Cancer Institute–designated cancer center status. Ann. Surg. 255(5):890–895, 2012.

    Article  PubMed  PubMed Central  Google Scholar 

  20. 20.

    Onega, T., Duell, E.J., Shi, X., Demidenko, E., Gottlieb, D., and Goodman, D.C., Influence of NCI cancer center attendance on mortality in lung, breast, colorectal, and prostate cancer patients. Med. Care Res. Rev. 66(5):542–560, 2009.

    Article  PubMed  PubMed Central  Google Scholar 

  21. 21.

    National Cancer Institute, NCI Budget and Appropriations. https://www.cancer.gov/about-nci/budget (last accessed 11-3-2017), 2017.

  22. 22.

    Lewis, B. A., Gibson, D., and Cunningham, N. A., NCI Comprehensive Cancer Centers. Springer Health Advisory Summit 2013. https://library.mskcc.org/sites/library.mskcc.org/media/pictures/about/staff/SpringerHealthSummit_2013.pdf (last accessed on 10–24-2017), 2013.

  23. 23.

    Lin, C.C., Bruinooge, S.S., Kirkwood, M.K., Olsen, C., Jemal, A., Bajorin, D., Giordano, S.H., Goldstein, M., Guadagnolo, B.A., Kosty, M., Hopkins, S., JB, Y., Arnone, A., Hanley, A., Stevens, S., and Hershman, D.L., Association between geographic access to cancer care, insurance, and receipt of chemotherapy: Geographic distribution of oncologists and travel distance. J. Clin. Oncol. 33(28):3177–3185, 2015.

    Article  PubMed  PubMed Central  Google Scholar 

  24. 24.

    Massarweh, N.N., Chiang, Y.-J., Xing, Y., Chang, G.J., Haynes, A.B., You, Y.N., Feig, B.W., and Cormier, J.N., Association between travel distance and metastatic disease at diagnosis among patients with colon cancer. Proc. Am. Soc. Clin. Oncol. 32:942–948, 2014.

    Article  Google Scholar 

  25. 25.

    Wang, E.H., Mougalian, S.S., Soulos, P.R., Rutter, C.E., Evans, S.B., Haffty, B.G., Gross, C.P., and JB, Y., Adoption of hypofractionated whole-breast irradiation for early-stage breast cancer: A national cancer data base analysis. Int. J. Radiat. Oncol. 90(5):993–1000, 2014.

    Article  Google Scholar 

  26. 26.

    Onega, T., Alford-Teaster, J., and Wang, F., Population-based geographic access to National Cancer Institute (NCI) cancer center parent and satellite facilities. Cancer. 123(17):3305–3311, 2017.

    Article  PubMed  Google Scholar 

  27. 27.

    Guagliardo, M.F., Spatial accessibility of primary care: Concepts, methods and challenges. Int. J. Health Geogr. 3:3, 2004.

    Article  PubMed  PubMed Central  Google Scholar 

  28. 28.

    Alford-Teaster, J., Lange, J.M., Hubbard, R.A., Lee, C.I., Haas, J.S., Shi, X., Carlos, H.A., Henderson, L., Hill, D., Tosteson, A.N.A., and Onega, T., Is the closest facility the one actually used? An assessment of travel time estimation based on mammography facilities. Int. J. Health Geogr. 15:8, 2016.

    Article  PubMed  PubMed Central  Google Scholar 

  29. 29.

    Henry, K.A., Boscoe, F.P., Johnson, C.J., Goldberg, D.W., Sherman, R., and Cockburn, M., Breast cancer stage at diagnosis: Is travel time important? J. Community Health. 36(6):933–942, 2011.

    Article  PubMed  Google Scholar 

  30. 30.

    GAO, Health care shortage areas: designation not a useful tool for directing resources to the underserved. Vol. HEHS-95-200. General Accounting Office, Washington, DC, 1995.

    Google Scholar 

  31. 31.

    Wang, F., Quantitative methods and socio-economic applications in GIS. CRC Press, Boca Raton, 2014.

    Google Scholar 

  32. 32.

    Luo, W., and Wang, F., Measures of spatial accessibility to health care in a GIS environment: Synthesis and a case study in the Chicago region. Environ. Plann. B. Plann. Des. 30:865–884, 2003.

    Article  Google Scholar 

  33. 33.

    Wang, F., Measurement, optimization, and impact of health care accessibility: A methodological review. Ann. Assoc. Am. Geogr. 102(5):1104–1112, 2012.

    Article  PubMed  PubMed Central  Google Scholar 

  34. 34.

    National Cancer Institute, NCI-Designated Cancer Centers. https://www.cancer.gov/research/nci-role/cancer-centers (last accessed on 11-3-2017), 2017.

  35. 35.

    Fotheringham, A.S., and Wong, D.W.S., The modifiable areal unit problem in multivariate statistical analysis. Environ. Plan. A. 23(7):1025–1044, 1991.

    Article  Google Scholar 

  36. 36.

    ESRI, ESRI demographic and business data list. Census 2010, 2016.

  37. 37.

    National Center for Health Statistics. 2013 Urban-Rural Classification Scheme for Counties. https://www.cdc.gov/nchs/data_access/urban_rural.htm (last accessed on 10–24-2017), 2013.

  38. 38.

    United States Census Bureau, 2010 Census Urban and Rural Classification and Urban Area Criteria, 2015.

  39. 39.

    Delamater, P.L., Messina, J.P., Grady, S.C., WinklerPrins, V., and Shortridge, A.M., Do more hospital beds lead to higher hospitalization rates? a spatial examination of Roemer’s law. PLoS ONE. 8(2):e54900, 2013.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  40. 40.

    Shen, Q., Spatial technologies, accessibility, and the social construction of urban space. Comput. Environ. Urban. Syst. 22(5):447–464, 1998.

    Article  Google Scholar 

  41. 41.

    Larson, E., Lin, S.X., and Gomez-Durate, C., Antibiotic use in Hispanic households, New York City. Emerg. Infect. Dis. 9(9):1096–1102, 2003.

    Article  PubMed  PubMed Central  Google Scholar 

  42. 42.

    Xu, Y., and Wang, F., Built environment and obesity by urbanicity in the U.S. Health Place. 34:19–29, 2015.

    Article  PubMed  PubMed Central  Google Scholar 

  43. 43.

    Fu, C., Planning towards equal spatial accessibility of NCI cancer centers across geographic areas and demographic groups in the U.S., LSU doctoral dissertation, 2015.

  44. 44.

    Ikram, S.Z., Hu, Y., and Wang, F., Disparities in spatial accessibility of pharmacies in Baton Rouge, Louisiana. Geogr. Rev. 105(4):492–510, 2015.

    Article  Google Scholar 

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Correspondence to Fahui Wang.

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This article is part of the Topical Collection on Systems-Level Quality Improvement

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Xu, Y., Fu, C., Onega, T. et al. Disparities in Geographic Accessibility of National Cancer Institute Cancer Centers in the United States. J Med Syst 41, 203 (2017). https://doi.org/10.1007/s10916-017-0850-0

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  • Geographic access
  • Cancer care
  • National Cancer Institute Cancer Centers
  • Disparity
  • 2-step floating catchment area (2SFCA) method
  • Weighted ordinary-least-squares regression
  • Reversed racial disadvantage