Disparities observed in geographic access to pediatric cancer care

Approximately 83% of children, adolescents and young adults within the continental United States have access to pediatric cancer care within a 60-minute travel distance, according to a study published in JAMA Network Open.

However, certain racial and ethnic groups, as well as residents in rural areas, face disparities in access that may require innovative approaches to reduce, researchers wrote.

Background

Although the implications of access to pediatric cancer care on care and patients outcomes have been reported, little is known regarding variations in geographic accessibility to such care.

Most pediatric care centers are located in urban areas, creating a challenge for families in rural or remote areas.

Increased travel distance and time can impede the timeliness, frequency and duration of care for children, adolescents and young adults with cancer while also increasing the financial burden.

“The goal of this cross-sectional study was to estimate the travel time to pediatric cancer care settings in the continental U.S.,” Xiaohui Liu, PhD, of the department of population health sciences at Huntsman Cancer Institute at University of Utah, and colleagues wrote. “Furthermore, to identify potential disparities among subgroups of children and adolescents and young adults, we compared the travel time for these subgroups based on demographic and geographic characteristics.”

Methodology

Researchers collected and reviewed data from pediatric oncologists’ service locations in 2021. They obtained demographic characteristics for younger children and adolescents and young adults (AYAs) aged 0 to 21 years from the 2015 to 2019 American Community Survey 5-year estimates.

The study included 90,498,890 children and AYAs (60% white, 22.3% Hispanic or Latino, 12.6% Black or African American, 4.2% Asian, 0.9% American Indian or Alaska Native).

Results

Researchers estimated that 63.6% of the study population traveled less than 30 minutes to the nearest pediatric oncologist, whereas an estimated 19.7% traveled between 30 and 60 minutes.

In total, an estimated 83.3% of children and AYAs traveled no more than an hour to reach their nearest respective pediatric oncologist.

Researchers noted the longest median travel times for the American Indian or Alaska Native pediatric population (46 minutes; interquartile range [IQR], 16-104) and residents of rural areas (95 minutes; IQR, 68-135).

Residents of areas with high deprivation levels (median, 36 minutes; IQR, 13-72) and the South (median, 24 minutes; IQR, 13-47) and the Midwest regions (median, 22 minutes; IQR, 11-51) also reported higher travel times than the general population of children and AYAs (median, 20 minutes; IQR, 10-42).

Younger children (aged 0-14 years) and AYAs (aged 15-21 years) had similar estimated median travel times (20 minutes vs. 21 minutes).

Among states, Wyoming had the lowest pediatric oncologist supply (0 oncologists per 100,000 pediatric population) and Washington, D.C., had the highest supply (53.3 per 100,000). Among U.S. Census divisions, the Mountain division had the lowest supply of pediatric oncologists (3.3 per 100,000) and the New England division had the highest supply (8.1 per 100,000).

Next steps

According to the researchers, disparities in geographic access to pediatric cancer care among certain subgroups, such as American Indian or Alaska Native individuals and rural residents, mirrored those identified in a study of adult cancer care setting.

However, the travel burden for pediatric cancer care is much greater for children and young AYAs, researchers wrote, because pediatric cancer care is typically delivered at children’s hospitals in urban areas.

“While complex social determinants of health likely underlie these differences, reducing disparities in geographic access may require innovative approaches,” Liu and colleagues wrote. “Given the small number of patients with cancer that would fully use such a service in remote locations or through the Indian Health Service, establishing more Children’s Oncology Group sites in rural areas might not be feasible. However, expanding the capabilities of local facilities to include services, such as central line access, antibiotic administration, blood transfusion and laboratory evaluation, may alleviate the travel burden for patients.”