(ChemotherapyAdvisor) – Previously reported unfavorable breast and colorectal cancer outcomes among individuals living in impoverished areas “may have occurred despite an apparent adequate area health care supply,” a study reported in the Journal of Clinical Oncology online August 6.
Elizabeth B. Lamont, MD, MS, of Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA, and colleagues studied the area supply of health services required for providing guideline-recommended care for patients with breast and colorectal cancer.
Area social factors—including poverty, socioeconomic disadvantage, and ethnic isolation—were characterized in 3,096 urban zip code tabulation areas using Census Bureau data and health care supply in the corresponding 465 hospital service areas using American Hospital Association, American Medical Association, and US Food and Drug Administration data.
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They restricted the study to urban social areas because “previous work suggested that area ‘social disadvantage’ in rural settings may manifest differently than in urban settings” and “rural areas of the United States have fewer health services per capita, including those health services related to cancer. Consequently, conflating urban and rural areas might yield results that are not generalizable to either setting,” they wrote.
No clear associations could be found between areas of socioeconomic disadvantage and supply of types of health services deemed essential to providing care for patients with breast and colorectal cancer in urban areas. Measures of health service included physicians who facilitate screening, treatment, and post-treatment care and facilities required for the same services.
Study limitations include that the data were aggregated nationally and therefore may not reflect local variations affecting availability of services; in addition, they did not assess factors that affected accessibility of services or quality of care. “Potential barriers to the use of local health care by individuals could have included a myriad of factors such as inadequate health insurance, cultural barriers, language barriers, neighborhood crime, and inadequacy of transportation and childcare,” they wrote.
“Additional research by studying patient-level outcomes is required to assess the roles of the health care supply as a mediator of sociodemographic variations in patient outcomes,” the investigators recommended.
