Abstract
IMPORTANCE: National Cancer Institute (NCI)-designated clinical and comprehensive cancer centers are required to define a geographic catchment area (CA) in which they focus research, outreach, and engagement efforts for the purposes of reducing cancer burden, particularly among certain vulnerable populations. A comprehensive analysis of the cancer burden of these catchment areas and their association with cancer center funding through the Cancer Center Support Grant (CCSG) has not been performed. OBJECTIVE: To examine CA cancer burden indicators and cancer center CCSG funding during the 2023 federal fiscal year (FY23). DESIGN, SETTING, AND PARTICIPANTS: This population-based cross-sectional study assessed cancer center cancer rates, sociodemographic variables, and reported CCSG funding. Participants included NCI-Designated Clinical and Comprehensive Cancer Centers as of FY23. Data were analyzed from August to December 2024. EXPOSURES: Race and ethnicity, socioeconomic status, disability status, urbanicity. MAIN OUTCOMES AND MEASURES: Main outcomes included CA cancer rates with 95% CI and various population percentage estimates, as well as cancer center CCSG direct costs for FY23. Adjusted CCSG funding by CA population size was also assessed. The association between cancer burden indicators and population-adjusted CCSG funding was estimated using Spearman rank correlation. RESULTS: This study included 64 NCI-Designated Cancer Centers (11 clinical [17.2%], 53 comprehensive [82.8%]) with CAs covering 297 040 253 people. Individual CA populations ranged from 1.4 million to 29.9 million people, with substantial variation in sociodemographic compositions. CA cancer incidence ranged from 369.2 (95% CI, 367.5 to 370.8) to 518.7 (95% CI, 514.2 to 523.2) cases per 100 000 persons. Cancer mortality ranged from 115.2 (95% CI, 114.3 to 116.1) to 181.1 (95% CI, 179.5 to 182.7) deaths per 100 000 persons. Population-adjusted CCSG funding showed no association with cancer rates, but was positively associated with rural populations (r = 0.356; 95% CI, 0.119 to 0.555) and persons living with a disability (r = 0.378; 95% CI, 0.143 to 0.572) and negatively associated with populations belonging to a racial or ethnic minority group (r = -0.354; 95% CI, -0.553 to -0.116). CONCLUSIONS AND RELEVANCE: In this cross-sectional study of NCI-Designated Cancer Centers, there were substantial disparities in cancer burden across catchment areas. CCSG funding did not align well with this distribution, raising questions about whether funding allocations effectively support cancer centers serving high-need CAs. In addition to existing criteria, consideration of CA cancer burden and vulnerable populations in determining CCSG funding amounts could enhance efforts to reduce cancer burden and disparities.