Geographic Access to Cancer Care and Breast Cancer Treatment in Low-Income Women

Little is known about the role of geographic access to oncologists in breast cancer treatment among low-income patients.

Using Missouri Cancer Registry-Medicaid claims data, we identified Medicaid enrollees aged 18-64 with newly diagnosed breast cancer from 2007 to 2015 (n=3930). Census tract-level geographic access to radiation oncologists (ROs), medical oncologists (MOs), and primary care physicians (PCPs) was quantified using the 2-step floating catchment area approach and categorized into tertiles. Logistic regression was used to estimate odds ratios (ORs) of undergoing mastectomy (vs. breast-conserving surgery), utilizing (yes/no), timely initiating (≤90 d post-surgery), and completing radiotherapy and chemotherapy, as well as being adherent to (medication possession ratio ≥80%) and continuing (<90-consecutive day gap) endocrine therapy (ET) in the first year.

Compared with patients in census tracts with the greatest access to ROs, those in census tracts with the lowest access to ROs had higher odds of mastectomy (OR=1.23, 95% CI: 1.02-1.48, Ptrend =0.04), lower odds of radiotherapy completion (OR=0.68, 95% CI: 0.49-0.95, Ptrend =0.02), and similar odds of utilization and timely initiation of radiotherapy. Patients in census tracts with the lowest (vs. highest) access to MOs had comparable odds of utilization and timely initiation of chemotherapy but lower odds of chemotherapy completion (OR=0.71, 95% CI: 0.51-0.97, Ptrend =0.06). Geographic access to MOs and PCPs was unrelated to ET.

Geographic access to oncologists was associated with choice of surgery and completion of radiotherapy/chemotherapy for breast cancer among Medicaid enrollees, highlighting the importance of addressing geographic barriers to oncologists to improve their treatment adherence.