Access to Chemotherapy Services by Availability of Local and Visiting Oncologists
Access to Chemotherapy Services by Availability of Local and Visiting Oncologists
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DOI：
10.1200/jop.2013.001217
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发表时间：
2014-01-01
影响因子：
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通讯作者：
Lynch, Charles F.
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文献类型：
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作者：
Ward, Marcia M.;Ullrich, Fred;Lynch, Charles F.
目的：地理差异提出了与治疗选择和旅行时间相关的因素的重要问题，这些因素可能影响获得癌症护理的机会。患者和方法：接受化疗的爱荷华州居民，无论在哪里诊断或治疗，都是通过爱荷华州癌症登记处 (ICR)（SEER 计划的成员）进行识别的。通过爱荷华州医生信息系统跟踪肿瘤科医生及其执业地点，包括就诊咨询诊所 (VCC)。肿瘤科医生、VCC 和患者被映射到医院服务区 (HSA)。 结果：2004 年至 2010 年间，113,885 例新诊断的浸润性癌症被纳入 ICR；在诊断出这些癌症的患者中，31.6% 的患者接受了化疗作为第一个疗程。在此期间，106 名爱荷华州肿瘤学家在 14 个城市执业，82 名肿瘤学家参与了 77 个农村社区 85 个 VCC 的外展活动。在接受化疗的患者中，63.0% 居住在有当地肿瘤科医生的 HSA，平均需要 21 分钟接受治疗。相比之下，29.3% 接受化疗的患者居住在有 VCC 的 HSA 中，7.7% 的患者居住在没有肿瘤医生的 HSA 中。后两组患者平均需要 58 分钟才能接受化疗。肿瘤科医生和 VCC 的可用性会影响患者接受化疗的地点。 VCC 的建立增加了农村社区获得肿瘤科医生的机会，并将农村社区化疗的比例从 10% 提高到 24%，显着增加了当地的获得率。结论：获得癌症护理的机会取决于提供者的绝对数量，但也取决于其地理分布。
Purpose: Geographic disparities have raised important questions about factors related to treatment choice and travel time, which can affect access to cancer care.Patients and Methods: Iowa residents who received chemotherapy regardless of where they were diagnosed or treated were identified through the Iowa Cancer Registry (ICR), a member of the SEER program. Oncologists and their practice locations, including visiting consulting clinics (VCCs), were tracked through the Iowa Physician Information System. Oncologists, VCCs, and patients were mapped to hospital service areas (HSAs).Results: Between 2004 and 2010, 113,885 newly diagnosed invasive cancers were entered into ICR; among patients in whom these cancers were diagnosed, 31.6% received chemotherapy as a first course of treatment. During this period, 106 Iowa oncologists practiced in 14 cities, and 82 engaged in outreach to 85 VCCs in 77 rural communities. Of patients receiving chemotherapy, 63.0% resided in an HSA that had a local oncologist and traveled 21 minutes for treatment on average. In contrast, 29.3% of patients receiving chemotherapy resided in an HSA with a VCC, and 7.7% resided in an HSA with no oncology provider. These latter two groups of patients traveled 58 minutes on average to receive chemotherapy. Availability of oncologists and VCCs affected where patients received chemotherapy. The establishment of VCCs increased access to oncologists in rural communities and increased the rate that chemotherapy was administered in rural communities from 10% to 24%, a notable increase in local access.Conclusion: Access to cancer care is dependent on the absolute number of providers, but it is also dependent on their geographic distribution.