Stephanie B Wheeler1, Tzy-Mey Kuo2, Danielle Durham3, Brian Frizzelle4, Katherine Reeder-Hayes5, Anne-Marie Meyer6. 1. Department of Health Policy and Management, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill; UNC Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. stephanie_wheeler@unc.edu. 2. Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. 3. Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. 4. Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. 5. Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill; Division of Hematology/Oncology, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. 6. Integrated Cancer Information and Surveillance System (ICISS), Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill; Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Abstract
BACKGROUND: Distance to oncology service providers and rurality may affect receipt of guideline-recommended radiation therapy (RT), but the extent to which these factors affect the care of Medicare-insured patients is unknown. METHODS: Using cancer registry data linked to Medicare claims from the Integrated Cancer Information and Surveillance System (ICISS), we identified all women aged 65 years or older who were diagnosed with stage I, II, or III breast cancer from 2003 through 2005, who had Medicare claims through 2006, and who were clinically eligible for RT. We geocoded the address of each RT service provider's practice location and calculated the travel distance from each patient's residential address to the nearest RT provider. We used ZIP codes to classify each patient's residence as rural or urban according to rural- urban commuting area codes. We used generalized estimating equations models with county-level clustering and interaction terms between distance categories and rural-urban status to estimate the effect of distance to care and rural-urban status on receipt of RT. RESULTS: In urban areas, increasing distance to the nearest RT provider was associated with a lower likelihood of receiving RT (odds ratio [OR] = 0.54; 95% confidence interval [CI], 0.30-0.97) for those living more than 20 miles from the nearest RT provider compared with those living less than 10 miles away. In rural areas, those living within 10-20 miles of the nearest RT provider were more likely to receive RT than those living less than 10 miles away (OR = 1.73; 95% CI, 1.08-2.76). LIMITATIONS: Results may not be generalizable to areas outside North Carolina or to non-Medicare populations. CONCLUSION: Coordinated outreach programs targeted differently to rural and urban patients may be necessary to improve the quality of oncology care.
BACKGROUND: Distance to oncology service providers and rurality may affect receipt of guideline-recommended radiation therapy (RT), but the extent to which these factors affect the care of Medicare-insured patients is unknown. METHODS: Using cancer registry data linked to Medicare claims from the Integrated Cancer Information and Surveillance System (ICISS), we identified all women aged 65 years or older who were diagnosed with stage I, II, or III breast cancer from 2003 through 2005, who had Medicare claims through 2006, and who were clinically eligible for RT. We geocoded the address of each RT service provider's practice location and calculated the travel distance from each patient's residential address to the nearest RT provider. We used ZIP codes to classify each patient's residence as rural or urban according to rural- urban commuting area codes. We used generalized estimating equations models with county-level clustering and interaction terms between distance categories and rural-urban status to estimate the effect of distance to care and rural-urban status on receipt of RT. RESULTS: In urban areas, increasing distance to the nearest RT provider was associated with a lower likelihood of receiving RT (odds ratio [OR] = 0.54; 95% confidence interval [CI], 0.30-0.97) for those living more than 20 miles from the nearest RT provider compared with those living less than 10 miles away. In rural areas, those living within 10-20 miles of the nearest RT provider were more likely to receive RT than those living less than 10 miles away (OR = 1.73; 95% CI, 1.08-2.76). LIMITATIONS: Results may not be generalizable to areas outside North Carolina or to non-Medicare populations. CONCLUSION: Coordinated outreach programs targeted differently to rural and urban patients may be necessary to improve the quality of oncology care.
Authors: Lisa P Spees; Wendy R Brewster; Mahesh A Varia; Morris Weinberger; Christopher Baggett; Xi Zhou; Victoria M Petermann; Stephanie B Wheeler Journal: Cancer Epidemiol Biomarkers Prev Date: 2019-02-07 Impact factor: 4.254
Authors: Gabrielle B Rocque; Courtney P Williams; Harold D Miller; Andres Azuero; Stephanie B Wheeler; Maria Pisu; Olivia Hull; Rodney P Rocconi; Kelly M Kenzik Journal: J Clin Oncol Date: 2019-06-11 Impact factor: 44.544
Authors: Jennifer C Spencer; Jason S Rotter; Jan M Eberth; Whitney E Zahnd; Robin C Vanderpool; Linda K Ko; Melinda M Davis; Melissa A Troester; Andrew F Olshan; Stephanie B Wheeler Journal: J Natl Cancer Inst Date: 2020-06-01 Impact factor: 13.506
Authors: Parijatham S Thomas; Caleb A Class; Tanmay R Gandhi; Arvind Bambhroliya; Kim-Anh Do; Abenaa M Brewster Journal: Cancer Causes Control Date: 2019-03-13 Impact factor: 2.506
Authors: Lisa P Spees; Stephanie B Wheeler; Mahesh Varia; Morris Weinberger; Christopher D Baggett; Xi Zhou; Victoria M Petermann; Wendy R Brewster Journal: Gynecol Oncol Date: 2018-11-12 Impact factor: 5.482
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