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Utilization of National Cancer Institute-Designated Cancer Centers by Medicare Beneficiaries with Cancer

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Little is known about which patients use National Cancer Institute-designated cancer centers (NCICCs) nationally. This study aimed to identify sociodemographic characteristics associated with decreased NCICC use among Medicare beneficiaries.


This study examined a national cohort of 534,008 Medicare beneficiaries with cancer in 2017 using multivariable logistic regressions for NCICC use. The covariates in the study were sex, age, cancer type, race/ethnicity, dual-eligibility status for Medicaid and Medicare, and NCICC presence in the home state.


In 2017, 19.5 % of Medicare beneficiaries with cancer used an NCICC at least once. Dual-eligible beneficiaries had 29 % lower adjusted odds of NCICC use than non-dual-eligible beneficiaries (adjusted odds ratio [aOR], 0.71; 95 % confidence interval [CI], 0.70–0.73; p < 0.001). American Indian/Alaska Native beneficiaries had 40 % lower odds of NCICC use than non-Hispanic white (NHW) beneficiaries (aOR, 0.60; 95 % CI, 0.53–0.68; p < 0.001). Compared with NHW beneficiaries, the odds of NCICC use were higher for black beneficiaries by 15 % (aOR, 1.15; 95 % CI, 1.12–1.18; p < 0.001), for Hispanic beneficiaries by 31 % (aOR, 1.31; 95 % CI, 1.26–1.35; p < 0.001), and for Asian/Pacific Islander beneficiaries by 126 % (aOR, 2.26; 95 % CI, 2.16–2.36; p < 0.001). Utilization declined steadily in older groups, with beneficiaries older than 95 years showing 73 % lower odds of NCICC use than beneficiaries younger than 65 years (aOR, 0.27; 95 % CI, 0.24–0.29; p < 0.001).


Medicaid-eligible, American Indian/Alaska Native, and older patients are substantially less likely to use NCICCs. Future research should focus on defining and addressing the barriers to NCICC access for these populations.

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Parsa Erfani was supported by the Fogarty International Center and National Institute of Mental Health of the National Institutes of Health under Award no. D43 TW010543. Fumiko Chino was supported in part through the National Institutes of Health/National Cancer Institute Cancer Center Support grant P30 CA008748. These funding sources were not involved in the collection, analysis, or interpretation of the data. They also did not approve publication of the finished manuscript.

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Correspondence to Miranda B. Lam MD, MBA.

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Appendix 1

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Table 2 Description of the study population and sources


Appendix 2

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Table 3 National Cancer Institute-designated cancer centers (NCICCs)a


Appendix 3

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Table 4 Use of National Cancer Institute-designated cancer centers (NCICCs) by dual-eligible vs non-dual-eligible Medicare beneficiaries with cancer, by state (2017)


Appendix 4

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Table 5 Sensitivity analysis for beneficiaries with a newly diagnosed cancer in 2017


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Erfani, P., Ojo, A., John Orav, E. et al. Utilization of National Cancer Institute-Designated Cancer Centers by Medicare Beneficiaries with Cancer. Ann Surg Oncol 29, 7250–7258 (2022).

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