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Study Shows Nearly 15 Million Women Live Prohibitively Far From Access to Gynecologic Cancer Care

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Key Points

  • In 47 states, at least 1 county is located more than 50 miles from the nearest gynecologic oncologist.
  • Each year, more than 7,000 women with gynecologic cancers experience distance-related barriers to accessing care from a specialist.
  • 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.

More than one-third of counties in the United States are located more than 50 miles from the nearest gynecologic oncologist, making access to specialty care for ovarian and other gynecologic cancers difficult for nearly 15 million women. Although most of these “low-access” counties are located in the Mountain-West and Midwest regions, the findings of a recent study from researchers at the Perelman School of Medicine at the University of Pennsylvania show that 47 states have at least 1 county located more than 50 miles from the nearest gynecologic oncologist. Results of the study were published by Shalowitz et al in Gynecologic Oncology.

“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,” said David Shalowitz, MD, Fellow in the Division of Gynecologic Oncology at Perelman. “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.”

Geographic Barriers Specified

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. 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% 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% of women live in areas that likely limit their access to high-quality care for these potentially deadly conditions,” said Dr. 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. Dr. 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.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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