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Disparities in Cancer Stage Outcomes by Catchment Areas for a Comprehensive Cancer Center.

Michael R Desjardins1, Norma F Kanarek2,3, William G Nelson4,3

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Patients outside comprehensive cancer center (CCC) catchment areas and those with disadvantaged backgrounds, including non-Hispanic Black individuals and those with Medicaid or no insurance, face higher odds of late-stage cancer diagnoses. These findings highlight potential barriers to cancer screening and treatment.

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Area of Science:

  • Oncology
  • Public Health
  • Spatial Epidemiology

Background:

  • National Cancer Institute Comprehensive Cancer Centers (CCCs) require spatial and temporal evaluations of their designated catchment areas to identify potential disparities.
  • Understanding cancer stage at diagnosis relative to proximity to CCCs is crucial for improving patient outcomes.

Purpose of the Study:

  • To identify disparities in cancer stage at diagnosis within and outside a CCC's catchment area over a 10-year period.
  • To analyze spatial and statistical associations between CCC catchment areas and cancer diagnosis stage.

Main Methods:

  • A cross-sectional, population-based study using cancer registry data from the Johns Hopkins Sidney Kimmel CCC (SKCCC) between 2010 and 2019.
  • Geocoding patient zip code tabulation areas (ZCTAs) to define catchment areas based on distance from SKCCC.
  • Multinomial logistic regression to assess associations between catchment area, sociodemographic factors, and cancer stage at diagnosis.

Main Results:

  • Living outside the main SKCCC catchment area was associated with higher odds of late-stage cancer diagnoses for patients receiving only diagnosis or treatment at SKCCC.
  • Non-Hispanic Black patients, and those with Medicaid or no insurance, exhibited significantly higher odds of late-stage cancer diagnoses.
  • The study analyzed data from 94,007 participants, with 20.73% diagnosed with late-stage cancer.

Conclusions:

  • Disparities in late-stage cancer diagnoses exist based on geographic location relative to CCCs and socioeconomic factors.
  • Patients residing outside catchment areas and those from disadvantaged backgrounds may encounter barriers to timely cancer screening and treatment.
  • Care-sharing agreements among CCCs may be a strategy to mitigate these identified disparities.