# Geographic Inequities in Advanced Cancer Treatment: A Call for Innovation

## Introduction

The realm of cancer treatment has seen significant strides in recent times, especially with the emergence of cutting-edge therapies such as theragnostics and transarterial radioembolization (TARE). Nonetheless, patients do not all enjoy equal access to these therapies. In a recent **KevinMD podcast**, **physician leader Shamar Young** addressed the **geographic inequalities in advanced cancer treatment** and how innovative care delivery could potentially close this divide.

## Comprehending Geographic Inequities in Cancer Treatment

The place of residence for a patient **greatly affects** the nature of cancer treatment they can obtain. According to **Shamar Young**, an interventional radiologist, **individuals diagnosed with liver cancer in various regions encounter different treatment pathways** due to disparities in available expertise, technology, and resources.

For example, a patient diagnosed with **hepatocellular carcinoma (HCC)** at a **leading medical center** with a robust interventional radiology (IR) department is more likely to receive **localized therapy** (like TARE) than a patient receiving care at a **small rural facility**, where surgery or systemic therapy might be the standard option due to the unavailability of IR specialists and advanced dosimetry technologies.

### Factors Contributing to Geographic Inequities

1. **Insufficient Specialized Expertise**
– The number of interventional radiologists is relatively **limited**, with many concentrated in **high-density urban hospitals** rather than **smaller or rural healthcare settings**.
– Certain treatments, such as **radioembolization**, necessitate **advanced training**, which many rural facilities do not possess.

2. **Significant Costs and Limited Resources**
– Advanced treatment tools, including **specialized software for radiation dosimetry**, can be prohibitively expensive.
– Smaller hospitals managing **only a few relevant cases** may not opt to invest in such costly technology.

3. **Disparities in Treatment Methodologies**
– As Young points out, **even within interventional radiology, treatment methodologies vary**.
– Numerous centers do not implement **evidence-based advanced dosimetry** techniques that have demonstrated improvements in survival rates for liver cancer patients.

## Drawing Insights from Global Cancer Care Models

Shamar Young highlights **Europe** as a model for a healthcare system that **centralizes expertise through “Centers of Excellence.”** Under this framework, patients with specific conditions are directed to specialized hospitals equipped with robust infrastructure and expertise to deliver **consistent, high-quality care.**

However, **replicating this model in the U.S.** is challenging due to its **vast expanse and decentralized healthcare system.** Individuals in rural regions may lack the financial resources to travel to large medical facilities, necessitating alternative solutions.

## Closing the Gap: Innovative Approaches

### 1. **External Expertise Services**
– Platforms such as **TeleDaaS** (Telemedicine and Data-as-a-Service) can offer **remote assistance to physicians** managing complex cancer situations.
– For procedures like **radioembolization**, third-party services can take charge of the **complicated dosimetry required for optimal radiation treatment.**

### 2. **Targeted Deployment of Specialists**
– Interventional radiologists might **periodically visit smaller hospitals** (e.g., once weekly) to ensure that patients benefit from **advanced therapies** without needing to relocate to larger facilities.

### 3. **Investment in AI and Automation**
– AI-driven tools such as **DAX Copilot by Microsoft** can enhance radiology workflows, streamline documentation, and bolster **clinical decision support** for hospitals with limited access to specialists.

### 4. **Policy-Level Reforms and Workforce Growth**
– Increasing **residency training slots for interventional radiology** could **boost the number of specialists** in rural communities.
– Medicare and insurance providers could offer **financial incentives for hospitals to integrate advanced oncologic therapies** in underserved areas.

## Major Insights

– **Geographic disparities in cancer treatment** result in unacceptable discrepancies in access to **advanced therapies like theragnostics and radioembolization.**
– **Access to interventional radiology is uneven**, with rural hospitals facing significant disadvantages.
– **Technological advancements such as telemedicine and AI-assisted automation** have the potential to bridge the expertise gap.
– Learning from **European centralized cancer care models** could provide valuable insights, but logistical challenges **must be navigated.**

### Concluding Thoughts

Guaranteeing **equal access to advanced cancer treatments** remains a critical challenge in contemporary medicine. As Shamar Young stresses, addressing these disparities will necessitate **collaboration among specialists, policymakers, and healthcare innovators**. By **utilizing technology and reimagining care delivery**, we can strive toward a system where **all patients—regardless of their geographical location—receive optimal care.**