Proximity Is Not Access: Geographic Distance and Chemotherapy Receipt for Colon Cancer Requiring Surgery

Abstract

Background Access to health care facilities presents an obstacle to receiving appropriate cancer treatment. This retrospective cohort study analyzes how access to care by geographic distance and patient demographics affect receipt of chemotherapy in colon cancer patients requiring resection. Methods 342,779 patients with stages 2-4 colon cancer requiring surgery who were recommended to receive either neoadjuvant or adjuvant chemotherapy were analyzed using the NCDB from 2012 to 2021. Patients who refused chemotherapy were excluded. A logistic regression evaluated demographic and cancer-related factors. Results Patients who were non-Hispanic Black (RR = 0.83, P < 0.001), unknown or other race (RR = 0.78, P < 0.001), uninsured (RR = 0.45, P < 0.001), Medicaid (RR = 0.67, P < 0.001), unknown insurance (RR = 0.22, P < 0.001), living in a metropolitan area (RR = 0.74, P < 0.001), and with lower high school education rates (RR = 0.61, P < 0.001) were less likely to receive chemotherapy especially at closer distances to their facility. Patients who lived closest to the diagnostic facility (<10 miles) were less likely to receive chemotherapy when compared to patients living 10-20 (RR = 1.33, P < 0.001), 20-50 (RR = 1.77, P < 0.001), 50-100 (RR = 1.56, P < 0.001) or 100-250 miles (RR = 1.31, P = 0.010). Conclusions Race, insurance, and education disparities associated with non-receipt of chemotherapy were greatest when <10 miles from reporting facility.