{"id":"https://openalex.org/W7225628778","doi":"https://doi.org/10.1200/op-26-00772","title":"Geographic Disparities in Oncology Access: A National Geospatial Analysis of Workforce Distribution and Fellowship Expansion","display_name":"Geographic Disparities in Oncology Access: A National Geospatial Analysis of Workforce Distribution and Fellowship Expansion","publication_year":2026,"publication_date":"2026-11-09","ids":{"openalex":"https://openalex.org/W7225628778","doi":"https://doi.org/10.1200/op-26-00772","pmid":"https://pubmed.ncbi.nlm.nih.gov/43002724"},"language":"en","primary_location":{"id":"doi:10.1200/op-26-00772","doi":"https://doi.org/10.1200/op-26-00772","is_oa":false,"landing_page_url":"https://doi.org/10.1200/op-26-00772","pdf_url":null,"source":{"id":"https://openalex.org/S4210202425","display_name":"JCO Oncology Practice","issn_l":"2688-1527","issn":["2688-1527","2688-1535"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core","dongbi-b","jufo-1","ki-jl-1","medline","norway-1","poland-20","russia-white-list-3"],"host_organization":"https://openalex.org/P4310315671","host_organization_name":"Lippincott Williams & Wilkins","host_organization_lineage":["https://openalex.org/P4310315671","https://openalex.org/P4310318547"],"host_organization_lineage_names":["Lippincott Williams & Wilkins","Wolters Kluwer"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"JCO Oncology Practice","raw_type":"journal-article"},"volume":null,"type":"article","is_traditional":true,"indexed_in":["crossref","pubmed"],"open_access":{"is_oa":false,"oa_status":"closed","oa_url":null,"any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5045900400","display_name":"Ryan J. Crowley","orcid":"https://orcid.org/0000-0002-1482-5631","observed_orcids":["https://orcid.org/0000-0002-1482-5631"]},"institutions":[{"id":"https://openalex.org/I4210137306","display_name":"Stanford Medicine","ror":"https://ror.org/03mtd9a03","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I4210137306","https://openalex.org/I97018004"]},{"id":"https://openalex.org/I97018004","display_name":"Stanford University","ror":"https://ror.org/00f54p054","country_code":"US","type":"education","lineage":["https://openalex.org/I97018004"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Ryan J. Crowley","raw_affiliation_strings":["Department of Medicine, Stanford University School of Medicine, Stanford, CA"],"raw_orcid":"https://orcid.org/0000-0002-1482-5631","affiliations":[{"raw_affiliation_string":"Department of Medicine, Stanford University School of Medicine, Stanford, CA","institution_ids":["https://openalex.org/I4210137306","https://openalex.org/I97018004"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5112355035","display_name":"Jag S. Lally","orcid":"https://orcid.org/0009-0004-8096-4084","observed_orcids":["https://orcid.org/0009-0004-8096-4084"]},"institutions":[{"id":"https://openalex.org/I28792581","display_name":"University of Rochester Medicine","ror":"https://ror.org/00trqv719","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I28792581","https://openalex.org/I5388228"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Jag S. Lally","raw_affiliation_strings":["University of Rochester Medical Center, New York, NY"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"University of Rochester Medical Center, New York, NY","institution_ids":["https://openalex.org/I28792581"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5004094924","display_name":"Natalie J. Klar","orcid":"https://orcid.org/0000-0002-5972-2265","observed_orcids":["https://orcid.org/0000-0002-5972-2265"]},"institutions":[{"id":"https://openalex.org/I4390039310","display_name":"NYU Langone\u2019s Laura and Isaac Perlmutter Cancer Center","ror":"https://ror.org/00sa8g751","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I4210086933","https://openalex.org/I4390039310"]},{"id":"https://openalex.org/I57206974","display_name":"New York University","ror":"https://ror.org/0190ak572","country_code":"US","type":"education","lineage":["https://openalex.org/I57206974"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Natalie Klar","raw_affiliation_strings":["Perlmutter Cancer Center, NYU Grossman School of Medicine, New York, NY"],"raw_orcid":"https://orcid.org/0000-0002-5972-2265","affiliations":[{"raw_affiliation_string":"Perlmutter Cancer Center, NYU Grossman School of Medicine, New York, NY","institution_ids":["https://openalex.org/I4390039310","https://openalex.org/I57206974"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5067848940","display_name":"David Kline","orcid":"https://orcid.org/0000-0001-6183-3303","observed_orcids":["https://orcid.org/0000-0001-6183-3303"]},"institutions":[{"id":"https://openalex.org/I4405269449","display_name":"Wake Forest University Health Sciences","ror":"https://ror.org/046r1r105","country_code":"US","type":"nonprofit","lineage":["https://openalex.org/I4405269449","https://openalex.org/I47251452"]},{"id":"https://openalex.org/I47251452","display_name":"Wake Forest University","ror":"https://ror.org/0207ad724","country_code":"US","type":"education","lineage":["https://openalex.org/I47251452"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"David M. Kline","raw_affiliation_strings":["Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC"],"raw_orcid":"https://orcid.org/0000-0001-6183-3303","affiliations":[{"raw_affiliation_string":"Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC","institution_ids":["https://openalex.org/I4405269449","https://openalex.org/I47251452"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5034186270","display_name":"Amanda M. Bunting","orcid":"https://orcid.org/0000-0002-2103-9655","observed_orcids":["https://orcid.org/0000-0002-2103-9655"]},"institutions":[{"id":"https://openalex.org/I57206974","display_name":"New York University","ror":"https://ror.org/0190ak572","country_code":"US","type":"education","lineage":["https://openalex.org/I57206974"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Amanda M. Bunting","raw_affiliation_strings":["Department of Population Health, New York University Grossman School of Medicine, New York, NY"],"raw_orcid":"https://orcid.org/0000-0002-2103-9655","affiliations":[{"raw_affiliation_string":"Department of Population Health, New York University Grossman School of Medicine, New York, NY","institution_ids":["https://openalex.org/I57206974"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":7,"corresponding_author_ids":[],"corresponding_institution_ids":[],"apc_list":null,"apc_paid":null,"fwci":0.0,"has_fulltext":false,"cited_by_count":0,"citation_normalized_percentile":{"value":0.0,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":null,"issue":null,"first_page":"OP2600772","last_page":"OP2600772"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T11990","display_name":"Global Health Workforce Issues","score":0.923799991607666,"subfield":{"id":"https://openalex.org/subfields/2739","display_name":"Public Health, Environmental and Occupational Health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T11990","display_name":"Global Health Workforce Issues","score":0.923799991607666,"subfield":{"id":"https://openalex.org/subfields/2739","display_name":"Public Health, Environmental and Occupational Health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T13123","display_name":"Advances in Oncology and Radiotherapy","score":0.03099999949336052,"subfield":{"id":"https://openalex.org/subfields/2741","display_name":"Radiology, Nuclear Medicine and Imaging"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10391","display_name":"Healthcare Policy and Management","score":0.02710000053048134,"subfield":{"id":"https://openalex.org/subfields/2002","display_name":"Economics and Econometrics"},"field":{"id":"https://openalex.org/fields/20","display_name":"Economics, Econometrics and Finance"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/geographic-disparities","display_name":"geographic disparities","score":0.7799999713897705},{"id":"https://openalex.org/keywords/access-to-cancer-care","display_name":"access to cancer care","score":0.7990000247955322},{"id":"https://openalex.org/keywords/rural-health-care","display_name":"rural health care","score":0.6740000247955322},{"id":"https://openalex.org/keywords/medicaid-expansion","display_name":"Medicaid expansion","score":0.7200000286102295},{"id":"https://openalex.org/keywords/health-workforce-planning","display_name":"health workforce planning","score":0.6240000128746033}],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.6862999796867371},{"id":"https://openalex.org/C2778139618","wikidata":"https://www.wikidata.org/wiki/Q13440398","display_name":"Workforce","level":2,"score":0.6554999947547913},{"id":"https://openalex.org/C2776534028","wikidata":"https://www.wikidata.org/wiki/Q1141363","display_name":"Medicaid","level":3,"score":0.5656999945640564},{"id":"https://openalex.org/C9770341","wikidata":"https://www.wikidata.org/wiki/Q1938983","display_name":"Geospatial analysis","level":2,"score":0.5220999717712402},{"id":"https://openalex.org/C512399662","wikidata":"https://www.wikidata.org/wiki/Q3505712","display_name":"Family medicine","level":1,"score":0.503600001335144},{"id":"https://openalex.org/C2779465365","wikidata":"https://www.wikidata.org/wiki/Q7380600","display_name":"Rurality","level":3,"score":0.49129998683929443},{"id":"https://openalex.org/C151956035","wikidata":"https://www.wikidata.org/wiki/Q1132755","display_name":"Logistic regression","level":2,"score":0.4487999975681305},{"id":"https://openalex.org/C2780920918","wikidata":"https://www.wikidata.org/wiki/Q7280361","display_name":"Radiation oncologist","level":3,"score":0.3840000033378601},{"id":"https://openalex.org/C129047720","wikidata":"https://www.wikidata.org/wiki/Q175185","display_name":"Rural area","level":2,"score":0.34779998660087585},{"id":"https://openalex.org/C2780378061","wikidata":"https://www.wikidata.org/wiki/Q25351891","display_name":"Service (business)","level":2,"score":0.3327000141143799},{"id":"https://openalex.org/C191630685","wikidata":"https://www.wikidata.org/wiki/Q4027615","display_name":"Informatics","level":2,"score":0.3165000081062317},{"id":"https://openalex.org/C2779473830","wikidata":"https://www.wikidata.org/wiki/Q1540899","display_name":"MEDLINE","level":2,"score":0.31369999051094055},{"id":"https://openalex.org/C126322002","wikidata":"https://www.wikidata.org/wiki/Q11180","display_name":"Internal medicine","level":1,"score":0.2930999994277954},{"id":"https://openalex.org/C2776643233","wikidata":"https://www.wikidata.org/wiki/Q1414593","display_name":"Patient Protection and Affordable Care Act","level":4,"score":0.2930000126361847},{"id":"https://openalex.org/C2250968","wikidata":"https://www.wikidata.org/wiki/Q1512929","display_name":"Health equity","level":3,"score":0.2913999855518341},{"id":"https://openalex.org/C509550671","wikidata":"https://www.wikidata.org/wiki/Q126945","display_name":"Medical education","level":1,"score":0.2906999886035919},{"id":"https://openalex.org/C74909509","wikidata":"https://www.wikidata.org/wiki/Q10387","display_name":"Gerontology","level":1,"score":0.28780001401901245},{"id":"https://openalex.org/C39896193","wikidata":"https://www.wikidata.org/wiki/Q380344","display_name":"Descriptive statistics","level":2,"score":0.28529998660087585},{"id":"https://openalex.org/C52130261","wikidata":"https://www.wikidata.org/wiki/Q39825","display_name":"Census","level":3,"score":0.28220000863075256},{"id":"https://openalex.org/C15672241","wikidata":"https://www.wikidata.org/wiki/Q463769","display_name":"American Community Survey","level":4,"score":0.2800999879837036},{"id":"https://openalex.org/C147077947","wikidata":"https://www.wikidata.org/wiki/Q1515895","display_name":"Socioeconomic status","level":3,"score":0.27549999952316284},{"id":"https://openalex.org/C41856607","wikidata":"https://www.wikidata.org/wiki/Q483130","display_name":"Geographic information system","level":2,"score":0.2678000032901764},{"id":"https://openalex.org/C61980418","wikidata":"https://www.wikidata.org/wiki/Q2221906","display_name":"Location","level":2,"score":0.26499998569488525},{"id":"https://openalex.org/C27415008","wikidata":"https://www.wikidata.org/wiki/Q7256382","display_name":"Psychological intervention","level":2,"score":0.26249998807907104},{"id":"https://openalex.org/C47177190","wikidata":"https://www.wikidata.org/wiki/Q207137","display_name":"Curriculum","level":2,"score":0.2612999975681305},{"id":"https://openalex.org/C2779965156","wikidata":"https://www.wikidata.org/wiki/Q5227350","display_name":"Data sharing","level":3,"score":0.2513999938964844}],"mesh":[],"locations_count":2,"locations":[{"id":"doi:10.1200/op-26-00772","doi":"https://doi.org/10.1200/op-26-00772","is_oa":false,"landing_page_url":"https://doi.org/10.1200/op-26-00772","pdf_url":null,"source":{"id":"https://openalex.org/S4210202425","display_name":"JCO Oncology Practice","issn_l":"2688-1527","issn":["2688-1527","2688-1535"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core","dongbi-b","jufo-1","ki-jl-1","medline","norway-1","poland-20","russia-white-list-3"],"host_organization":"https://openalex.org/P4310315671","host_organization_name":"Lippincott Williams & Wilkins","host_organization_lineage":["https://openalex.org/P4310315671","https://openalex.org/P4310318547"],"host_organization_lineage_names":["Lippincott Williams & Wilkins","Wolters Kluwer"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"JCO Oncology Practice","raw_type":"journal-article"},{"id":"pmid:43002724","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/43002724","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"JCO oncology practice","raw_type":"Journal Article"}],"best_oa_location":null,"sustainable_development_goals":[{"score":0.9629999995231628,"id":"https://metadata.un.org/sdg/10","display_name":"Reduced inequalities"},{"score":0.8999999761581421,"id":"https://metadata.un.org/sdg/3","display_name":"Good health and well-being"}],"study_designs":[],"awards":[],"funders":[],"has_content":{"pdf":false,"grobid_xml":false},"content_urls":null,"referenced_works_count":24,"referenced_works":["https://openalex.org/W2180566385","https://openalex.org/W2767601573","https://openalex.org/W2983743160","https://openalex.org/W3027623775","https://openalex.org/W3128123841","https://openalex.org/W4210549916","https://openalex.org/W4319068444","https://openalex.org/W4377138343","https://openalex.org/W4386424627","https://openalex.org/W4388654694","https://openalex.org/W4391304246","https://openalex.org/W4391693398","https://openalex.org/W4396853015","https://openalex.org/W4399042812","https://openalex.org/W4400036504","https://openalex.org/W4401418151","https://openalex.org/W4402721679","https://openalex.org/W4405042541","https://openalex.org/W4408573195","https://openalex.org/W4408921961","https://openalex.org/W4411699540","https://openalex.org/W4412831755","https://openalex.org/W4414901423","https://openalex.org/W7118179976"],"related_works":["https://openalex.org/W7162522487","https://openalex.org/W7162508903","https://openalex.org/W7118179976","https://openalex.org/W4414901423","https://openalex.org/W4224223533","https://openalex.org/W7221713419","https://openalex.org/W2947943191","https://openalex.org/W7162484097","https://openalex.org/W7162531027","https://openalex.org/W3110495704"],"abstract_inverted_index":{"PURPOSE:":[0],"Geographic":[1],"disparities":[2,221],"in":[3,8,129,134,164,178,222,230],"access":[4,224],"to":[5,28,33,62,151,189,255],"oncology":[6,49,223],"care":[7,259],"the":[9,15,67,74,80,130,135],"United":[10],"States":[11],"persist":[12],"because":[13],"of":[14,17,24,39,105,116,161,171,248],"maldistribution":[16],"oncologists":[18,249],"and":[19,43,79,132,137,158,181,193,205,250],"training":[20,251],"programs.":[21],"The":[22,139],"aim":[23],"this":[25],"study":[26],"was":[27,127,214],"identify":[29],"optimal":[30,96],"oncologist":[31,97,125,145,203],"placements":[32,146,162],"maximize":[34],"coverage,":[35],"detect":[36],"large":[37,175],"clusters":[38,104],"unmet":[40,106,172],"patient":[41],"need,":[42,173],"evaluate":[44],"factors":[45],"associated":[46],"with":[47,90,195],"new":[48,117,209],"fellowship":[50,118,184,238],"program":[51,119,210],"establishment.":[52,120],"METHODS:":[53],"We":[54],"performed":[55],"a":[56,91],"national":[57],"geospatial":[58],"analysis":[59],"from":[60,66,187],"2015":[61,192],"2025":[63],"using":[64],"data":[65],"Centers":[68],"for":[69],"Medicare":[70],"&":[71],"Medicaid":[72,206],"Services,":[73],"National":[75],"Resident":[76],"Matching":[77],"Program,":[78],"US":[81],"Census.":[82],"A":[83,108],"maximal":[84],"coverage":[85,126,150],"location":[86],"problem":[87],"(MCLP)":[88],"model":[89,112,141],"40-km":[92],"service":[93],"radius":[94],"identified":[95,142],"placements.":[98],"Hierarchical":[99],"density-based":[100],"clustering":[101],"found":[102],"geographic":[103,220],"need.":[107],"Firth":[109],"logistic":[110],"regression":[111],"assessed":[113],"county-level":[114],"predictors":[115],"RESULTS:":[121],"Median":[122],"baseline":[123],"state-level":[124],"highest":[128],"Northeast":[131],"lowest":[133],"Midwest":[136],"South.":[138],"MCLP":[140],"5,578":[143],"additional":[144],"that":[147],"could":[148,233],"extend":[149],"26.1":[152],"million":[153],"patients":[154],"aged":[155],"55":[156],"years":[157],"older;":[159],"52.2%":[160],"were":[163],"rural":[165,197,231],"counties.":[166],"Clustering":[167],"revealed":[168],"910":[169],"areas":[170],"including":[174],"underserved":[176],"populations":[177],"Nevada,":[179],"California,":[180],"Florida.":[182],"Oncology":[183],"programs":[185,252],"increased":[186],"140":[188],"180":[190],"between":[191],"2025,":[194],"minimal":[196],"growth":[198,239],"(0.6%-1.7%).":[199],"Higher":[200],"income,":[201],"greater":[202],"density,":[204],"expansion":[207,247],"predicted":[208],"establishment,":[211],"while":[212],"rurality":[213],"strongly":[215],"negatively":[216],"associated.":[217],"CONCLUSION:":[218],"Significant":[219],"remain.":[225],"Targeted":[226],"workforce":[227],"expansion,":[228],"particularly":[229],"areas,":[232],"improve":[234],"coverage;":[235],"however,":[236],"current":[237],"patterns":[240],"risk":[241],"reinforcing":[242],"existing":[243],"inequities.":[244],"Strategic,":[245],"data-driven":[246],"is":[253],"needed":[254],"promote":[256],"equitable":[257],"cancer":[258],"access.":[260]},"counts_by_year":[],"updated_date":"2026-11-11T12:16:26.678958","created_date":"2026-11-10T00:00:00"}
