Proximity to cancer rehabilitation and exercise oncology by geography, race, and socioeconomic status

Kathryn H Schmitz; Kathryn Demanelis; Mary E Crisafio; Mary A Kennedy; Anna L Schwartz; Anna Campbell; Jessica Gorzelitz; Kelley C Wood; Christopher M Wilson; Raymond L Scalise; Alex Vincent

doi:10.1002/cncr.35515

Proximity to cancer rehabilitation and exercise oncology by geography, race, and socioeconomic status

Cancer. 2024 Sep 22. doi: 10.1002/cncr.35515. Online ahead of print.

Authors

Affiliations

¹ Division of Hematology and Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
² Department of Health and Exercise Science, Colorado State University, Fort Collins, Colorado, USA.
³ Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, West Australia, Australia.
⁴ College of Nursing, University of Nebraska Medical Center, Omaha, Nebraska, USA.
⁵ Coleman Health, Parks, Arizona, USA.
⁶ School of Applied Science, Edinburgh Napier University, Edinburgh, Scotland, UK.
⁷ Department of Health and Human Physiology, Department of Obstetrics and Gynecology, University of Iowa, Iowa City, Iowa, USA.
⁸ ReVital Cancer Rehabilitation, Select Medical, Mechanicsburg, Pennsylvania, USA.
⁹ Physical Therapy Program, School of Health Sciences, Oakland University, Rochester, Michigan, USA.

PMID: 39306697
DOI: 10.1002/cncr.35515

Abstract

Background: Cancer rehabilitation and exercise oncology (CR/EO) have documented benefits for people living with and beyond cancer. The authors examined proximity to CR/EO programs across the United States with respect to population density, race and ethnicity, socioeconomic status, and cancer incidence and mortality rates.

Methods: This cross-sectional study was conducted in 2022-2023. Online searches were initiated to identify CR/EO programs. Geocoding was used to obtain latitudinal and longitudinal geospatial coordinates. Demographic data were abstracted from the 2020 5-year American Community Survey. Cancer incidence and mortality data were obtained from the Centers for Disease Control and Prevention. US 2013 Rural-Urban Continuum Code (RUCC) classification was used to define counties as either urban (RUCC 1-3) or rural (RUCC 4-9). Multivariable logistic regression was used to evaluate the association between being far from a program and census-tract level factors.

Results: In total, 2133 CR/EO programs were identified nationwide. The distance from a program increased with decreasing population density: rural tracts were 17.68 ± 0.24 miles farther from a program compared with urban tracts (p < .001). Program proximity decreased as the neighborhood deprivation index increased (p < .001). Exercise oncology programs were less common than cancer rehabilitation programs in tracts with a larger proportion of minority residents (p < .001).

Conclusions: Prior research has documented that underrepresented populations have worse cancer-related symptoms and higher cancer mortality. Herein, the authors document their findings that these same populations are less likely to have proximity to CR/EO programs, which are associated with improved cancer-related symptoms and cancer mortality outcomes. To realize the positive outcomes from CR/EO programming, efforts must focus on supporting expanded programming and sustainable payment for these services.

Keywords: equality, health equity, oncology, rehabilitation; exercise; social determinants of health.

Abstract

Grants and funding