Access to cancer care in Native American reservations in the US

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.

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).

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).

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.