Chronic Disease

Medicare beneficiaries with cancer do not frequently use National Cancer Institute Cancer Centers for care

Thirty-two States are home to 63 National Cancer Institute (NCI) Cancer Centers that provide care to patients and reach out to underserved populations, in addition to conducting cancer research. However, less than 10 percent of cancer patients insured by Medicare use cancer center resources, a new study finds.

Just 7.3 percent of the 211,048 patients with breast, lung, colorectal, or prostate cancer who were covered by Medicare received treatment at NCI Cancer Centers from 1998 to 2002, researchers from Dartmouth College found. Travel time was a major determinant for whether a patient would seek care at an NCI Cancer Center, with every 10 minutes of travel time resulting in a 11 percent decreased likelihood of choosing a cancer center for care. Among patients receiving care at an NCI Cancer Center, 61 percent lived 30 minutes or less from the center, 77 percent lived within 1 hour, and 92 percent lived within 2 hours. Creating programs in rural areas that provide travel assistance to NCI Cancer Centers may prompt more Medicare beneficiaries to use those centers, the authors suggest.

Patients with cancer insured by Medicare who received most of their care from generalist physicians also did not seek care at cancer centers. These patients' physicians may have longstanding partnerships with local oncologists, so patients do not feel compelled to travel to an NCI Cancer Center. Patients who had multiple health conditions also tended to stay close to home for treatment.

Patients covered by Medicare who received diagnoses of cancer in later stages were likely to seek treatment at NCI Cancer Centers to gain the clinical advantages the centers offer. Additionally, blacks living in urban areas, where many NCI Cancer Centers are located, were also likely to receive care at cancer centers. This study was funded in part by the Agency for Healthcare Research and Quality (HS00070).

See "Determinants of NCI Cancer Center attendance in Medicare patients with lung, breast, colorectal, or prostate cancer," by Tracy Onega, Ph.D., Eric J. Duell, Ph.D., M.S., Xun Shi, Ph.D, and others in the December 6, 2008, Journal of General Internal Medicine 24(2), pp. 205-210.

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