Proximity to cancer rehabilitation and exercise oncology by geography, race, and socioeconomic status

Schmitz, Kathryn H.; Demanelis, Kathryn; Crisafio, Mary E.; Kennedy, Mary A.; Schwartz, Anna L.; Campbell, Anna; Gorzelitz, Jessica; Wood, Kelley C.; Wilson, Christopher M.; Scalise, Raymond L.; Vincent, Alex

Abstract

Background: Cancer rehabilitation and exercise oncology (CR/EO) have documented benefits for people living with and beyond cancer. The authors examined proximity to CR/EO programs across the United States with respect to population density, race and ethnicity, socioeconomic status, and cancer incidence and mortality rates. Methods: This cross‐sectional study was conducted in 2022–2023. Online searches were initiated to identify CR/EO programs. Geocoding was used to obtain latitudinal and longitudinal geospatial coordinates. Demographic data were abstracted from the 2020 5‐year American Community Survey. Cancer incidence and mortality data were obtained from the Centers for Disease Control and Prevention. US 2013 Rural‐Urban Continuum Code (RUCC) classification was used to define counties as either urban (RUCC 1–3) or rural (RUCC 4–9). Multivariable logistic regression was used to evaluate the association between being far from a program and census‐tract level factors. Results: In total, 2133 CR/EO programs were identified nationwide. The distance from a program increased with decreasing population density: rural tracts were 17.68 ± 0.24 miles farther from a program compared with urban tracts (p < .001). Program proximity decreased as the neighborhood deprivation index increased (p < .001). Exercise oncology programs were less common than cancer rehabilitation programs in tracts with a larger proportion of minority residents (p < .001). Conclusions: Prior research has documented that underrepresented populations have worse cancer‐related symptoms and higher cancer mortality. Herein, the authors document their findings that these same populations are less likely to have proximity to CR/EO programs, which are associated with improved cancer‐related symptoms and cancer mortality outcomes. To realize the positive outcomes from CR/EO programming, efforts must focus on supporting expanded programming and sustainable payment for these services.

Citation

Schmitz, K. H., Demanelis, K., Crisafio, M. E., Kennedy, M. A., Schwartz, A. L., Campbell, A., Gorzelitz, J., Wood, K. C., Wilson, C. M., Scalise, R. L., & Vincent, A. (2025). Proximity to cancer rehabilitation and exercise oncology by geography, race, and socioeconomic status. Cancer, 131(1), e35515. https://doi.org/10.1002/cncr.35515

• Journal Article Type: Article
• Acceptance Date: Jul 12, 2024
• Online Publication Date: Sep 22, 2024
• Publication Date: 2025
• Deposit Date: Sep 23, 2024
• Publicly Available Date: Sep 23, 2024
• Journal: Cancer
• Print ISSN: 0008-543X
• Electronic ISSN: 1097-0142
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 131
• Issue: 1
• Pages: e35515
• DOI: https://doi.org/10.1002/cncr.35515
• Keywords: exercise, equality, health equity, oncology, rehabilitation, social determinants of health