Lack of Access to Gynecologic Oncology Care Exposed in National Study

Specific areas in the US may be at health risk due to limited access of specialized gynecologic cancer care.

David Shalowitz, MD

Specific areas in the US may be at health risk due to limited access of specialized gynecologic cancer care, according to data from a national study conducted by the University of Pennsylvania, Perelman School of Medicine.

“Previous studies were either limited by state borders or did not specifically study access to gynecologic oncologists,” said the study’s lead author David Shalowitz, MD, a fellow of the division of Gynecologic Oncology at UPenn, in an interview withTargeted Oncology. Shalowitz and his colleagues conducted this study because many gynecologic oncologists have expressed concern that some women who have gynecologic cancers tend to do worse than others. These women may not receive the proper treatment from the subspecialists that they need.

“We felt that it was important to look into the connection between where women live and the care they end up receiving,” Shalowitz explained. Access disparities pose a major threat; one in every four women with ovarian cancer is treated at a hospital that does not typically see that type of cancer.

Although mostly Mountain-West and Midwest regions currently have the least amount of access, 14.8 million women nationwide have difficulty with access to the care centers that specialize in gynecologic cancers. In fact, more than one-third of US counties, within 47 states, are located over 50 miles from the closest gynecologic oncologist.

This lack of access could potentially affect the health of patients, according to Shalowitz, with misdiagnoses, delayed detection, and incorrect chemotherapy and surgery plans. Each year about 7000 women may not receive the appropriate attention and standard care that they need because of long distances to appropriate care.

Shalowitz and his team of co-researchers used spatial analysis, as well as demographics from the US Census and information from the Centers for Disease Control and Prevention, to determine the number of gynecologic oncologists within 50, 100, and 150 miles of more than 3000 county borders in the United States.

Results showed that counties near major metropolitan areas were discovered to have the biggest amount of care facilities. In addition, 36% of counties were more than 50 miles from the nearest gynecologic oncologist, and not a single gynecologic oncologist was found to be primarily based in North Dakota or Wyoming.

Many women use referral networks in the process of selecting their oncologist. The results of the study also showed that these women might run into a problem because 123 referral networks in the United States do not provide access to gynecologic cancer care. These women would be forced to travel outside of their referral network, in order to be connected to a proper specialist.

Shalowitz and his team stressed the need for access to the proper care specialists and hospitals. “It’s important to figure out how [they] we can reach out to these low-access areas to make sure that all women with gynecologic cancers have access to high-quality care, regardless of where they live.”

Shalowitz DI., Vinograd, AM, Giuntoli, RL II. Geographic access to gynecologic cancer care in the United States. July 10, 2015.