At the 2023 ASCO Quality Care Symposium, Bruno Scodari, MD, Dartmouth Geisel School of Medicine, and colleagues presented a study on the characterization of oncologists who travel to treat patients in the US and the effectiveness of this outreach method for improving rural patients’ access to care.

Many rural states in the US are dependent on oncology outreach arrangements, including physician travel, for extended cancer care. In addition, these states have specialized cancer registries to monitor physician travel. However, there is limited data available on the characterization of traveling oncologists and the impact of their outreach on providing access to rural patients and whether it lessens their travel burdens, according to the researchers.

For their cross-sectional study, the authors pulled claims data from a 100% fee-for-service sample of Medicare beneficiaries who had incident breast, colorectal, and lung cancer from 2016 to 2018. They used Part B professional claims to match oncologists with patients and identified traveling oncologists every year by observing their hospital service area (HSA) transition patterns and travel frequency. If the physicians had encounters with patients outside of their primary HSA, this was considered “outreach.” The authors also used hierarchical models to analyze the associations between the outreach and the travel time for patients in rural areas receiving chemotherapy, radiotherapy, or surgery for the first time.

The study found that, on average, 4,333 of 30,069 oncologists traveled for treatment outreach in rural areas. The travel workforce consisted of surgeons, medical oncologists, and radiation oncologists. Of the physicians who traveled across HSA borders the least frequently, at 1-3 times per year (49.5%), 52.3% were surgeons, 34.2% were medical oncologists, and 13.5% were radiation oncologists. For those physicians who traveled across HSA borders the most frequently (23.6%), at >12 times per year, 15% were surgeons, 52% were medical oncologists, and 33% were radiation oncologists. All other physicians (26.9%) traveled at a moderate frequency of 4-12 times per year.

In total, the traveling oncologists administered 6,677 counts of radiotherapy, carried out 4,681 first surgeries, and provided 1,623 first chemotherapy treatments for rural patients. The percentage of these treatments that were completed at outreach locations were 22.5%, 16.8%, and 15% for radiotherapy, first surgery, and chemotherapy, respectively. The authors also found that, in adjusted models, the oncology outreach was associated with a 14% reduction (95% CI, 0.82-0.89) in travel time for rural patients receiving their first radiotherapy treatment and a 13% (95% CI, 0.79-0.95) travel time reduction for those receiving chemotherapy for the first time.

The authors note that these results are “conservative estimates” of the impact of oncology outreach for patients living in rural areas because their analysis was limited to Medicare beneficiaries, and it does not include patients who bypass the outreach services that are available to them.

Scodari BT, Kapadia NS, O’Malley J, Moen EL. Characterization of the nationwide traveling oncology workforce and assessment of its influence on patient travel burden for access to cancer care: A claims-based approach. Presented at: the 2023 ASCO Quality Care Symposium; October 27-28, 2023; Boston, MA, and virtual; Abstract 147.