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Research Grants Awarded
Quantifying Transportation Barriers in Accessing Health Facilities for Breast Cancer Diagnosis and Treatment
Breast Cancer Disparities
Background. Studies have found that distance between patient residence and health care facilities can impact cancer care. Comparatively few studies, however, have incorporated information about actual travel distance or time, because of the difficulty in acquiring this information. Objective. (1) Develop a driving time and distance calculator software program to address barriers affecting access to quality cancer care and (2) pilot the software in two breast cancer research projects on disparities in access to care. Specific Aims. (1) Develop a shortest route finder using a roadmap network to process breast cancer patient lists from cancer registries and calculate actual travel distance and travel time between the residence of all patients and the facilities visited for diagnosis and treatment; (2) pilot test the software in assessing time and distance disparities between urban and rural breast cancer patients and patients residing in economically deprived, compared with affluent, areas. Study Design. In the first year, we will develop a software program that will calculate driving time and distance travel from patients? home to their cancer care facilities using TeleAtlas road network geographic information. We will collaborate with the GIS Research Lab in California, who will write the software program under the guidance of the NAACCR GIS Committee. We will pilot the software by recruiting interested NAACCR cancer registries to participate in two breast cancer projects and staff as an advisory group to the projects and utility of the software program. Benefits of Research. The benefits of this project are: (1) We will develop, test and release a publicly available software program that will calculate driving time and distance travel measures of access; (2) Using this software, disparity studies on access will be able to be conducted in a population-based setting (cancer registries) that will enhance the generalizability of their study findings; (3) We will address several specific disparities in access to breast cancer care and assess their importance in light of differences in driving time and distance measures in access care in the outcomes of their disease and in treatment patterns; and (4) This project will give a tool to local Komen affiliates for grantees to assess and improve access in specific local settings and to state comprehensive cancer coalitions to identify access to care barriers, such as those associated with travel and transportation, so that interventions can be developed to address them. It will also be a useful tool for other applications, even outside the health services field.
Cancer registries collect information about the incidence of cancer, the extent of disease at the time of diagnosis, and patient treatments. All cancers are reported under state mandates to the state public health surveillance entity, a state cancer registry. All breast cancers are included in the reportable diseases definition and thus all newly diagnosed breast cancer cases are included in reporting to state cancer registries. Data collected by cancer registries enable public health professionals to better understand and address cancer burden and contribute to cancer control efforts. Cancer registries are used by researchers for population-based information about breast cancer patients, and increasingly, requests are received to use these data to identify barriers, disparities and inequalities in access to breast cancer care. Of interest among health service researchers is the impact of driving travel distance and time on patients? access to appropriate cancer care and whether travel differences create disparities and inequalities in the care received. The technology is available to create a resource for all U.S. and Canadian cancer registries that would calculate driving travel distances and times between a patient?s residence and the health care facilities used for diagnosis and treatment. We will develop a platform-independent software program to calculate driving travel distance and times in batch mode, comparable to the distance and time outputs from online, interactive mapping programs (like MapQuest, for example). Using this resource, we will then conduct two breast cancer studies focused on access disparities in breast cancer diagnosis and treatment due to differences in driving time and distance. Finally, at the end of the project, the software program will be made available to any interested party or research group through the NAACCR Website.