Emergence of Integrated Urology-Radiation Oncology Practices in the State of Texas

Abstract

Purpose-Integrated urology-radiation oncology (RO) practices have been advocated as a means to improve community-based prostate cancer care by joining urologic and radiation care in a single-practice environment. However, little is known regarding the scope and actual physical integration of such practices. We sought to characterize the emergence of such practices in Texas, their extent of physical integration, and their potential effect on patient travel times for radiation therapy.Methods and Materials-A telephone survey identified integrated urology-RO practices, defined as practices owned by urologists that offer RO services. Geographic information software was used to determine the proximity of integrated urology-RO clinic sites with respect to the state's population. We calculated patient travel time and distance from each integrated urology-RO clinic offering urologic services to the RO treatment facility owned by the integrated practice and to the nearest nonintegrated (independent) RO facility. We compared these times and distances using the Wilcoxon-Mann-Whitney test.Results-Of 229 urology practices identified, 12 (5%) offered integrated RO services, and 182 (28%) of 640 Texas urologists worked in such practices. Approximately 53% of the state population resides within 10 miles of an integrated urology-RO clinic site. Patients diagnosed with prostate cancer at an integrated urology-RO clinic site travel a mean of 19.7 miles (26.1 minutes) from the clinic to reach the RO facility owned by the integrated urology-RO practice versus 5.9 miles (9.2 minutes) to reach the nearest nonintegrated RO facility (P < 0.001). Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Conclusions-Integrated urology-RO practices are common in Texas and are generally clustered in urban areas. In the majority of integrated practices, the urology clinics and the integrated RO facility are not at the same location, and driving times and distances from the clinic to the integrated RO facility exceed those from the clinic to the nearest nonintegrated RO facility. NIH Public Access

Value of Geographical Information Systems in Analyzing Geographic Accessibility to Inform Radiotherapy Planning: A Systematic Review

“…Twenty-four studies used GIS to describe geographic accessibility to RT (Table 3), measured via travel distance 5,[34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49] and travel time 3,4,20,22,35,36,45,48,[50][51][52][53][54][55] to nearest RT centers. These were calculated on the basis of travel by road, 3,4,20,22,[34][35][36]38,40,[42][43][44][45][46][47][48][49][50][51]…”

“…Notably, 18 studies used GIS to describe disparities in geographic accessibility to RT. 3,5,20,34,36,37,[39][40][41][42][43][44]48,56,58 Four studies 3,38,43,48 found that rural-residing patients had to cover larger road distances to the nearest RT center, compared with urban-residing patients, and five studies reported that Indigenous or underserved populations faced inequitable RT access. 36,37,41,56,58 Yao et al 56 and Shafiq et al 58 found that, relative to surrounding areas, RT facilities in areas with vulnerable were inadequate.…”