Geographic disparities in care: The Maryland gynecologic oncology experience.

e16546 Background: Women with gynecologic malignancies require highly specialized care that is often unavailable at local centers. Prior reports have suggested that distance from residence to treatment facility is a barrier to care. We hypothesize that insurance status influences the distance women travel to receive gynecologic cancer care. Methods: Patients with incident gynecologic cancer diagnoses at a single urban, academic Institution were identified. Distance from the patients’ homes to the hospital was calculated in miles as well as time. Insurance status at diagnosis was captured as private (P), Medicaid (MA), Medicare (MC) or uninsured (UI). Results: 153 patients were identified. The median distance travelled to the hospital was 18.1 miles with a median time travel of 28 minutes. 48 (31%) of patients were insured by P, 42 (27%) by MA, 35 (23%) by MC and 28 (18%) were UI. Patients with MC were older than those with MA, P or UI (p<0.01). Patients with P were more likely to present with cancer of the uterine corpus (p<0.01). African American women were more likely to be covered by MA than other racial groups (p<0.01). Rates of medical comorbidities (obesity, diabetes and hypertension) were similar between insurance groups, although there was a trend towards higher body mass index in UI (p=0.08). Mean distance and time to the hospital by insurance category is shown in Table 1. The distances and times were different between groups (p=0.04, p=0.03 respectively). These differences remained significant when adjusted for site of primary disease and race (p<0.01). Adherence with treatment recommendations was similar regardless of insurance status or distance travelled. Conclusions: Insurance status plays a role in the distance women travel to receive gynecologic cancer care. The neediest patients may be shouldering an unfair burden in terms of access to specialty oncology treatments. [Table: see text]