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Utilization of National Cancer Institute-Designated Cancer Centers by Medicare Beneficiaries with Cancer

  • ASO Research Letter
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Little is known about which patients use National Cancer Institute-designated cancer centers (NCICCs) nationally. This study aimed to identify sociodemographic characteristics associated with decreased NCICC use among Medicare beneficiaries.

Methods

This study examined a national cohort of 534,008 Medicare beneficiaries with cancer in 2017 using multivariable logistic regressions for NCICC use. The covariates in the study were sex, age, cancer type, race/ethnicity, dual-eligibility status for Medicaid and Medicare, and NCICC presence in the home state.

Results

In 2017, 19.5 % of Medicare beneficiaries with cancer used an NCICC at least once. Dual-eligible beneficiaries had 29 % lower adjusted odds of NCICC use than non-dual-eligible beneficiaries (adjusted odds ratio [aOR], 0.71; 95 % confidence interval [CI], 0.70–0.73; p < 0.001). American Indian/Alaska Native beneficiaries had 40 % lower odds of NCICC use than non-Hispanic white (NHW) beneficiaries (aOR, 0.60; 95 % CI, 0.53–0.68; p < 0.001). Compared with NHW beneficiaries, the odds of NCICC use were higher for black beneficiaries by 15 % (aOR, 1.15; 95 % CI, 1.12–1.18; p < 0.001), for Hispanic beneficiaries by 31 % (aOR, 1.31; 95 % CI, 1.26–1.35; p < 0.001), and for Asian/Pacific Islander beneficiaries by 126 % (aOR, 2.26; 95 % CI, 2.16–2.36; p < 0.001). Utilization declined steadily in older groups, with beneficiaries older than 95 years showing 73 % lower odds of NCICC use than beneficiaries younger than 65 years (aOR, 0.27; 95 % CI, 0.24–0.29; p < 0.001).

Conclusions

Medicaid-eligible, American Indian/Alaska Native, and older patients are substantially less likely to use NCICCs. Future research should focus on defining and addressing the barriers to NCICC access for these populations.

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References

  1. NCI-Designated Cancer Centers. National Cancer Institute. Retrieved 18 October 2021 at https://www.cancer.gov/research/infrastructure/cancer-centers.

  2. Wolfson JA, Sun C-L, Wyatt LP, Hurria A, Bhatia S. Impact of care at comprehensive cancer centers on outcome: results from a population-based study. Cancer. 2015;121:3885–93. https://doi.org/10.1002/CNCR.29576.

    Article  PubMed  Google Scholar 

  3. Onega T, Duell EJ, Shi X, Demidenko E, Gottlieb D, Goodman DC. Influence of NCI cancer center attendance on mortality in lung, breast, colorectal, and prostate cancer patients. Med Care Res Rev. 2009;66:542–60. https://doi.org/10.1177/1077558709335536.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Lam MB, Figueroa JF, Zheng J, Orav EJ, Jha AK. Spending among patients with cancer in the first 2 years of accountable care organization participation. J Clin Oncol. 2018;36:2955–60. https://doi.org/10.1200/JCO.18.00270.

    Article  CAS  PubMed  Google Scholar 

  5. Merkow RP, Yang AD, Pavey E, et al. Comparison of hospitals affiliated with PPS-exempt cancer centers, other hospitals affiliated with NCI-designated cancer centers, and other hospitals that provide cancer care. JAMA Intern Med. 2019;179:1043–51. https://doi.org/10.1001/JAMAINTERNMED.2019.0914.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Takvorian SU, Guerra CE, Schpero WL. A hidden opportunity–Medicaid’s role in supporting equitable access to clinical trials. N Engl J Med. 2021;384:1975–8. https://doi.org/10.1056/NEJMP2101627/SUPPL_FILE/NEJMP2101627_DISCLOSURES.PDF.

    Article  PubMed  PubMed Central  Google Scholar 

  7. O’Connor JM, Sedghi T, Dhodapkar M, Kane MJ, Gross CP. Factors associated with cancer disparities among low-, medium-, and high-income US counties. JAMA Netw Open. 2018. https://doi.org/10.1001/JAMANETWORKOPEN.2018.3146.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Onega T, Alford-Teaster J, Wang F. Population-based geographic access to parent and satellite National Cancer Institute Cancer Center facilities. Cancer. 2017;123:3305–11. https://doi.org/10.1002/CNCR.30727.

    Article  PubMed  Google Scholar 

  9. Duma N, Aguilera JV, Paludo J, et al. Representation of minorities and women in oncology clinical trials: review of the past 14 years. J Oncol Pract. 2018;14:e1–10. https://doi.org/10.1200/JOP.2017.025288.

    Article  PubMed  Google Scholar 

  10. Ford JG, Howerton MW, Lai GY, et al. Barriers to recruiting underrepresented populations to cancer clinical trials: a systematic review. Cancer. 2008;112:228–42. https://doi.org/10.1002/CNCR.23157.

    Article  PubMed  Google Scholar 

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Funding

Parsa Erfani was supported by the Fogarty International Center and National Institute of Mental Health of the National Institutes of Health under Award no. D43 TW010543. Fumiko Chino was supported in part through the National Institutes of Health/National Cancer Institute Cancer Center Support grant P30 CA008748. These funding sources were not involved in the collection, analysis, or interpretation of the data. They also did not approve publication of the finished manuscript.

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Authors and Affiliations

  1. Harvard Medical School, Boston, MA, USA

    Parsa Erfani MD & Ayotomiwa Ojo MD, MPP

  2. Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    E. John Orav PhD

  3. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Fumiko Chino MD

  4. Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women’s Hospital, Boston, MA, 02115, USA

    Miranda B. Lam MD, MBA

Authors
  1. Parsa Erfani MD
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  2. Ayotomiwa Ojo MD, MPP
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  3. E. John Orav PhD
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  4. Fumiko Chino MD
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  5. Miranda B. Lam MD, MBA
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Corresponding author

Correspondence to Miranda B. Lam MD, MBA.

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Appendices

Appendix 1

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Table 2 Description of the study population and sources
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2.

Appendix 2

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Table 3 National Cancer Institute-designated cancer centers (NCICCs)a
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3.

Appendix 3

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Table 4 Use of National Cancer Institute-designated cancer centers (NCICCs) by dual-eligible vs non-dual-eligible Medicare beneficiaries with cancer, by state (2017)
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Appendix 4

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Table 5 Sensitivity analysis for beneficiaries with a newly diagnosed cancer in 2017
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5.

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Erfani, P., Ojo, A., John Orav, E. et al. Utilization of National Cancer Institute-Designated Cancer Centers by Medicare Beneficiaries with Cancer. Ann Surg Oncol 29, 7250–7258 (2022). https://doi.org/10.1245/s10434-022-12047-5

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  • DOI: https://doi.org/10.1245/s10434-022-12047-5

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