Background

Native American people have some of the highest cancer rates in the US. Despite that, they face significant geographic barriers to getting access to cancer care. This study aims to estimate the travel time for cancer care for Native Americans in the continental US.

Methods

This cross-section study collects data between 5/2022 and 11/2022. The main outcome is the travel time from Native American reservations to the nearest hematologists/oncologists. Practice sites throughout the US with at least one hematologist or medical oncologist actively billing for Medicare in the prior year were recorded. The point map using publicly available data from Medicare Care Compare (https://www.cms.gov/medicare) was created. The secondary outcome is the travel time to the nearest NCI designated cancer center. The shapefile was downloaded from the NCI website (https://www.cancer.gov/research/infrastructure/cancer-centers). The travel time was calculated using Google map. Locations were mapped in ArcGIS 10.7 using coordinates and a 5-digit zip code tabulation area (ZCTA).

Results

Figure 1 shows the locations of Native American reservations across the continental US and its distance to the nearest hematologists and oncologists. Figure 2 shows the locations of NCI designated cancer centers. The top ten most populated reservations were chosen for further analysis. Among a total of 267,687 population, there are 33 hematologists/oncologists at the nearest clinic. The median travel distance to these clinics is 90.35 miles (Range 24.9 - 207 miles). The median travel time is 2.15 hours (Range: 0.52 - 3.48 hours) (Table 1). The median travel distance to NCI cancer center is 186.5 miles (Range 77.8 - 629 miles). The median travel time is 3.37 hours (Range 1.32 - 10.42 hours).

Figure 1
Figure 1.Hematologist and medical oncologist practice sites and Native American reservations
Figure 2
Figure 2.NCI cancer center sites and Native American reservations
Table 1.Travel time from Native American reservations to cancer care
Nearest hematologist oncologist sites Travel distance Travel time Nearest NCI cancer center Travel distance Travel time
Navajo Nation (Ariz.-N.M.-Utah) Tuba City Regional Health Care Corporation 187 miles 3 hr 31 min University of New Mexico Comprehensive Cancer Center 202 miles 3 hr 29 min
Pine Ridge Reservation, (S.D.-Nebr.) Regional West Medical Center 138 miles 2 hr 31 min University of Colorado Cancer Center 339 miles 5 hr 44 min
Fort Apache Reservation, (Ariz.) Summit Healthcare Association 34.8 miles 47 min Arizona Cancer Center at University of Arizona 171 miles 3 hr 22 min
Gila River Indian Reservation, (Ariz.) Ironwood Cancer & Research Centers 42.3 miles 41 min Arizona Cancer Center at University of Arizona 86.4 miles 1 hr 19 min
Osage Reservation, (Okla.) Oklahoma Cancer Specialists and Research Institute (OCSRI)/Tulsa Cancer Institute 62.3 miles 1 hr 7 min Stephenson Cancer Center at University of Oklahoma 130 miles 2 hr 16 min
San Carlos Reservation, (Ariz). San Carlos Apache Healthcare Corporation (SCAHC) 24.9 miles 31 min Arizona Cancer Center at University of Arizona 141 miles 2 hr 42 min
Rosebud Indian Reservation and Off-Reservation Trust Land, (S.D.) Great Plains Health/Callahan Cancer Center 207 miles 3 hr 29 min Fred & Pamela Buffett Cancer Center at Nebraska Medicine & the University of Nebraska Medical Center 391 miles 5 hr 41 min
Tohono O'odham Nation Reservation and Off-Reservation Trust Land, (Ariz.) Ironwood Cancer & Research Centers 135 miles 2 hr 15 min Arizona Cancer Center at University of Arizona 77.8 miles 1 hr 31 min
Blackfeet Indian Reservation and Off-Reservation Trust Land, (Mont.) Kalispell Regional Medical Center 111 miles 2 hr 9 min Fred Hutchinson/University of Washington Cancer Consortium 629 miles 10 hr 25 min
Flathead Reservation, (Mont.) RCHP Billings - Missoula 69.7 miles 1 hr 23 min Fred Hutchinson/University of Washington Cancer Consortium 477 miles 7 hr 48 min

Conclusions

This study shows most Native American have access to cancer care, but disparity exist among different regions. There is a need to reduce transportation barriers in some areas.