Access to head and neck cancer specialists: a geospatial analysis of U.S. travel time

TL;DR

This study maps access to head and neck cancer specialists in the U.S., finding significant regional and socioeconomic disparities in travel time.

Contribution

A new disparity index combining cancer incidence, social vulnerability, and travel time is developed to identify high-need areas.

Findings

Non-metropolitan and non-Northeast regions have longer travel times to H&N specialists.

Lower income and insurance coverage correlate with increased travel times.

Southern and Western U.S. counties show the highest access disparities.

Abstract

Head and neck (H&N) cancers, a diverse group of epithelial malignancies, significantly impact patients' quality of life and require complex, multidisciplinary care. Despite the need for specialized care, access to H&N cancer specialists is uneven across the United States, leading to disparities in patient outcomes and health equity. To assess geographic disparities in access to H&N cancer specialists in the U.S. and to identify factors contributing to these disparities, with the goal of informing targeted interventions and policies that promote equitable healthcare access.

This geospatial analysis utilized data from various public databases, including the National Provider Identifier Registry, American Society of Clinical Oncology, and U.S. News and World Report, to examine the distribution of H&N cancer specialists relative to incident cancer cases. The study analyzed county-level data across the United States, incorporating demographic factors such as race/ethnicity, age, education, and socioeconomic status. Travel time to the nearest H&N specialist was estimated using the Travel Time API. The analysis included 1,112 H&N specialists (453 surgical oncologists, 346 medical oncologists, and 308 radiation oncologists) identified through self-reported data and relevant fellowships. The primary outcome was the estimated travel time to the nearest H&N specialist, with secondary measures including a disparity index that combined cancer incidence, social vulnerability, and travel time to highlight regions with the greatest access disparities.

Significant regional disparities in access to H&N specialists were identified, with non-metropolitan areas and regions outside the Northeast showing notably longer travel times. Socioeconomic and demographics factors, including lower household income, lower insurance coverage, and higher median age, were associated with increased travel times. Disparity Index scores highlighted counties in the South and Western regions as having the highest access disparities.

Geographic and socioeconomic disparities in access to H&N cancer specialists contribute to health inequities in the U.S. The disparity index developed in this study provides a valuable tool for identifying high-need areas and guiding policy interventions. Addressing these disparities through targeted resource allocation, mobile clinics, and provider incentives is essential for improving access to specialized care and promoting health equity.

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