Determinants of NCI Cancer Center Attendance in Medicare Patients with Lung, Breast, Colorectal, or Prostate Cancer |
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Authors: | Tracy Onega PhD Eric J Duell PhD MS Xun Shi PhD Eugene Demidenko PhD David Goodman MD MS |
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Institution: | (1) The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Medical School, HB 7927, One Medical Center Dr, Hanover, NH 03756, USA;(2) Department of Community and Family Medicine, Dartmouth Medical School, HB 7927, One Medical Center Dr, Hanover, NH 03756, USA;(3) Norris Cotton Cancer Center, Dartmouth Medical School, HB 7927, One Medical Center Dr, Lebanon, NH 03756, USA;(4) Department of Geography Dartmouth College, HB 7927, One Medical Center Dr, Hanover, NH 03756, USA;(5) International Agency for Research on Cancer (IARC), Lyon, France |
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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. |
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Keywords: | attendance determinants cancer centers Medicare |
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