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. 2025 Jul 31:15:1521370.
doi: 10.3389/fonc.2025.1521370. eCollection 2025.

Access to head and neck cancer specialists: a geospatial analysis of U.S. travel time

Bradley L Goodnight  1 , Glenn J Hanna  2 , Dandan Zheng  3 , Magdiel Habila  3 , Marie Cassese  1 , Alexander Fortman  1 , Harold Walbert  1 , Fred Sieling  1 , Christopher M Black  3
Affiliations

Access to head and neck cancer specialists: a geospatial analysis of U.S. travel time

Bradley L Goodnight et al. Front Oncol. .

Abstract

Introduction: Head and neck (H&N) cancers, a diverse group of epithelial malignancies, significantly impact patients' quality of life and require complex, multidisciplinary care. Despite the need for specialized care, access to H&N cancer specialists is uneven across the United States, leading to disparities in patient outcomes and health equity. To assess geographic disparities in access to H&N cancer specialists in the U.S. and to identify factors contributing to these disparities, with the goal of informing targeted interventions and policies that promote equitable healthcare access.

Methods: This geospatial analysis utilized data from various public databases, including the National Provider Identifier Registry, American Society of Clinical Oncology, and U.S. News and World Report, to examine the distribution of H&N cancer specialists relative to incident cancer cases. The study analyzed county-level data across the United States, incorporating demographic factors such as race/ethnicity, age, education, and socioeconomic status. Travel time to the nearest H&N specialist was estimated using the Travel Time API. The analysis included 1,112 H&N specialists (453 surgical oncologists, 346 medical oncologists, and 308 radiation oncologists) identified through self-reported data and relevant fellowships. The primary outcome was the estimated travel time to the nearest H&N specialist, with secondary measures including a disparity index that combined cancer incidence, social vulnerability, and travel time to highlight regions with the greatest access disparities.

Results: Significant regional disparities in access to H&N specialists were identified, with non-metropolitan areas and regions outside the Northeast showing notably longer travel times. Socioeconomic and demographics factors, including lower household income, lower insurance coverage, and higher median age, were associated with increased travel times. Disparity Index scores highlighted counties in the South and Western regions as having the highest access disparities.

Conclusion: Geographic and socioeconomic disparities in access to H&N cancer specialists contribute to health inequities in the U.S. The disparity index developed in this study provides a valuable tool for identifying high-need areas and guiding policy interventions. Addressing these disparities through targeted resource allocation, mobile clinics, and provider incentives is essential for improving access to specialized care and promoting health equity.

Keywords: access to care; disparity index; geographic disparities; head and neck cancer; health equity; social determinants of health; travel time analysis.

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Conflict of interest statement

Authors BG, MC, AF, HW, and FS were employed by the company Guidehouse, Inc. Authors DZ, MH, and CB were employed by the company Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA and DZ, MH, and CB were shareholders in Merck & Co., Inc., Rahway, NJ, USA. BG, MC, HW, AF, HW, FS, and GH have received consulting fees from Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA. The authors declare that this study received funding from Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA. The funder had the following involvement in the study: all aspects of the study were conducted by employees of Merck & Co., Inc,. and consultants paid by Merck Sharp & Dohme LLC.

Figures

Figure 1
Figure 1
Map of H&N specialists in the U.S.
Figure 2
Figure 2
Distributions of travel time to the nearest H&N specialist by US county, provider specialty, county metro status, and US region: (A) isochrone map of travel time to nearest head and neck cancer specialist from population-weighted county centroid; (B) box plot of access metric by head and neck specialist type; (C) probability density function of county-level drive-time to nearest head and neck cancer specialist by metro status; and (D) box plots of access metric by U.S. Census region.
Figure 3
Figure 3
Histogram of travel time to the nearest H&N specialist from county population-weighted centroids.
Figure 4
Figure 4
Quantile regression for factors associated with travel time to the nearest H&N specialist.
Figure 5
Figure 5
Social determinants of health by head and neck cancer specialist availability.
Figure 6
Figure 6
Disparity index from travel time, cancer incidence & social vulnerability index.
See this image and copyright information in PMC

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