Trends in the Geospatial Distribution of Adult Inpatient Surgical Cancer Care Across the United States

Introduction The relationship and trends of geography and travel distance to access surgical cancer care has been poorly characterized. The objective of the study was to define the geographic distribution of access to hospital-based operative cancer care across the USA. Methods A cohort analysis was performed using the 2005 and 2015 American Hospital Association Annual Survey, Census Bureau Data for 2010, and the American Community Survey 5-year estimates for 2011 to 2016. Results The number of hospitals that provided surgical services with an approved American College of Surgeons (ACS) cancer program slightly increased over the time periods examined (2005,n = 1203 vs. 2015,n = 1284;p = 0.7210). Based on geospatial analysis, 18,214,994 (5.9%) people lived more than 60 min from a hospital with a cancer program in 2005 compared with 34,630,516 (11.2%) by 2015. Communities within a 60-min drive time were more likely to be composed of individuals who completed high school (85.9% vs. 84.2%), were employed (62.7% vs. 57.1%), had a higher median household income ($67.4 k vs. $53.2 k), and lived within states that had expanded Medicaid (62.5% vs. 48.9%) (allp < 0.0001). In contrast, communities outside of a 60-min drive time had a greater proportion of individuals below the federal poverty level (18.3% vs. 16.5%;p < 0.0001). Conclusions While the number of hospitals with ACS approved cancer program designation increased over the last decade, the number of people living greater than 60 min from an approved cancer programs nearly doubled. These data highlight worrisome geospatial trends that may make access to cancer care for certain patient populations increasingly challenging.