Delineation of Cancer Service Areas Anchored by Major Cancer Centers in the USA

Keywords: Cancer service areas (CSAs), Association of American Cancer Institutes (AACI) cancer centers, localization index (LI), spatially constrained Leiden method, network community detection
Session Type: Virtual Paper Abstract
Day: Saturday
Session Start / End Time: 2/26/2022 03:40 PM (Eastern Time (US & Canada)) - 2/26/2022 05:00 PM (Eastern Time (US & Canada))
Room: Virtual 19

Abstract

Background: Defining a reliable geographic unit pertaining to cancer care is essential in its assessment, planning, and management. This study aimed to delineate and characterize the cancer service areas (CSAs) in the USA accounting for the presence of major cancer centers.
Methods: A spatial network between ZIP code areas was built for inpatient and outpatient care of cancer-directed surgery, chemotherapy, and radiation based on the 2014-2015 Medicare claims. Excluding those without clinical care or outside of the USA, 94 National Cancer Institute designated and other academic cancer centers were identified from the members of the Association of American Cancer Institutes (AACI). The spatially constrained Leiden method, a network community detection method accounting for spatial adjacency and other constraints, was used to delineate coherent CSAs so that the service volumes were maximal within the CSAs and minimal between them.
Results: The derived 110 CSAs had a high mean localization index (LI) (=0.83) with a narrow variability (SD=0.10). The variation of LI across the CSAs was positively associated with population, median household income, and area size, and negatively with travel time. On average, patients traveled less and were more likely to receive cancer care within the CSAs anchored by AACI cancer centers than their counterparts without AACI cancer centers.
Conclusion: This paper refined the state-of-art network community detection method for defining CSAs by explicitly incorporating existing specialized cancer referral centers. The CSAs can be used as a reliable unit for studying cancer care and informing more evidence-based policy.