Geospatial Analysis of Commission on Cancer-Accredited Centers Within Cancer Care Utilization-Based Catchment Areas

The Commission on Cancer (CoC) seeks to expand access to high-quality care through community engagement standards targeting centers' catchment areas and efforts to accredit centers in more areas including rural hospitals. Little is known about the social, environmental, and geographic characteristics of their catchment areas. To support future investigation into the impact of CoC-accredited centers, this study compares characteristics of cancer care utilization-based catchment areas, termed Cancer Service Areas (CSAs), with and without CoC-accredited centers.

Geocoded CoC-accredited centers and cancer care patient flows extracted from Medicare claims data were used to delineate CSAs using a spatially constrained community detection method. Characteristics including environmental justice index (EJI), social vulnerability index (SVI), rurality, travel time, and localization index (LI, a ratio of cancer care received by patients within a CSA) were aggregated by CSA. A logistic regression model was created to evaluate characteristics associated with the presence of a CoC-accredited center within a CSA.

Six hundred sixty-eight CSAs were defined, of which 511 CSAs had at least one CoC-accredited center. CSAs with CoC-accredited centers had lower health vulnerability (odds ratio [OR], 0.65 [95% CI, 0.427 to 0.993]) and lower racial and ethnic minority status vulnerability (OR, 0.61 [95% CI, 0.424 to 0.886]), but no differences for other components of the EJI or SVI. These CSAs also had higher LIs, meaning patients remained in their local CSA for care (OR, 9.00 [95% CI, 2.408 to 33.640] for high v low LIs).

Minority and comorbid populations may have more difficulty accessing cancer center care, further exacerbating observed variations in cancer outcomes. Cancer centers may address this by broadening their outreach into at-risk catchment areas.