Cancer Care Resources in Appalachia: Breast Cancer as An Example

Background: A growing body of researchers are investigating the cancer care in Appalachia without assessing the cancer care resources in this area and its geographic variation. Using breast cancer as an example, this study is to compare the cancer care resources in Appalachia to non-Appalachian counties and also describe the spatial clustering of its regional variation. Methods: This study uses county-level data extracted from the Area Resource File 2007. 420 counties in thirteen states are classifies as Appalachian counties. I measured cancer-care-related providers and cancer care facilities who/which are involved in breast cancer screening, diagnosing, treatment, and survivorship care. Frequency analysis, mean analysis, T-tests, and exploratory spatial data analysis were applied. Results: Compared to the non-Appalachian counties, Appalachian counties (especially Central and Southern Appalachia) had significant fewer physicians per capita in primary care, Obstetrics &Gynecology, Diagnosing Radiology, Surgery, Anesthesia, Clinical Pathology, Radiation Oncology, Radiology, and Internal Medicine Subspecialty in 2006. In contrast, Appalachian counties had more hospitals per capita with women health service, mammography, adult surgery, oncology service, and chemotherapy were than non-Appalachian counties. However, Appalachian counties had significant fewer hospitals per 1000 square miles with oncology service, and chemotherapy than non-Appalachian counties. Central Appalachia had fewest physician and facility resources per square miles, and spatial analysis also showed clustering of scarce breast cancer care resource in Central Appalachia. Conclusions: Compared to the non-Appalachian counties, overall breast cancer care resource is scarce in Appalachia especially Central Appalachia.