Nearly 10 percent of women live too far from access to gynecologic cancer care

"This is the first national study to identify specific regions of the United States where residents may be at an increased risk for poor clinical outcomes -- including misdiagnoses and late detection -- as a result of limited access to specialized gynecologic cancer care," says David Shalowitz, MD, a fellow in the division of Gynecologic Oncology at the Perelman School of Medicine at the University of Pennsylvania, and lead author on the study. "Based on our estimates, it's likely that more than 7,000 women with gynecologic cancers per year experience distance-related barriers to accessing appropriate care from a specialist. Increased travel time to a specialty center likely prevents many patients from being appropriately evaluated, and may decrease their likelihood of receiving the standard of care, or accessing clinical trials for ovarian, uterine and cervical cancers."

Using spatial analysis, the authors determined how many gynecologic oncologists were located within 50, 100, and 150 miles of county borders for more than 3,000 counties in the United States. Thirty-six percent of counties were located more than 50 miles from the closest gynecologic oncologist, affecting 14.8 million women. Results reveal that all states except North Dakota and Wyoming contain a primary professional address for at least one gynecologic oncologist, though all states but three have at least one county further than 50 miles from the closest specialty care center. Further, the entirety of the state of North Dakota is located more than 50 miles from the nearest primary address of these providers. The counties with the greatest number of gynecologic oncologists within 50 miles are located near major metropolitan areas, primarily along the Atlantic coast between Atlanta and Boston.

Additional results of the analysis reveal that 15 percent of women may also experience barriers to care based on their referral network. The study showed 123 referral networks nationally that do not have access to a gynecologic oncologist, suggesting women would have to travel outside of their referral network to be connected with a specialist.

"Nine to 15 percent of women live in areas that likely limit their access to high-quality care for these potentially deadly conditions," said Shalowitz. "While we don't yet know how access correlates to health outcomes, referral networks need to be structured in a way that alleviates the burden of travel for women in need of a specialist."

In 2011, 20,797 cases of ovarian cancer, 47,824 cases of uterine cancer, and 12,187 cases of cervical cancer were reported nationally. Shalowitz and colleagues suggest future studies should focus on defining areas with poor clinical outcomes attributed to geographic factors, and creating a comprehensive national, geographically-linked database on the utilization of gynecologic cancer care and clinical outcomes.