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Abstract High-quality cancer data are fundamental for public health research and policy, but cancer data for small geographic units and population subgroups in the United States are rarely available due to small-sample suppression rules, spatial coarsening, and data incompleteness. These limitations hinder high-resolution spatial analyses and precision public health interventions. This study provides a high-resolution cancer incidence dataset for the U.S., generated through a multi-constraint Monte Carlo simulation framework that reconstructs suppressed county-level cancer data and systematically disaggregates them to ZIP Code Tabulation Areas (ZCTAs), guided by demographic constraints. This method integrates population subgroup structures and macro-level incidence rates as constraints, ensuring consistency and reliability across spatial scales. The resulting dataset spans multiple geographic units, from state and county levels to ZCTAs, enabling comprehensive analyses of cancer burden, in-depth spatial analyses, and precision public health interventions across multiple scales. 

ImportancePatients often travel for cancer care, yet the extent to which patients cross state lines for cancer care is not well understood. This knowledge can have implications for policies that regulate telehealth access to out-of-state clinicians. ObjectiveTo quantify the extent of cross-state delivery of cancer services to patients with cancer. Design, Setting, and ParticipantsThis cross-sectional study analyzed fee-for-service Medicare claims data for beneficiaries (aged ≥66 years) with a diagnosis of breast, colon, lung, or pancreatic cancer between January 1, 2017, and December 31, 2020. Analyses were performed between January 1 and July 30, 2024. ExposurePatient rurality. Main Outcomes and MeasuresThe primary outcome of interest was receipt of cancer care across state lines. Frequencies of cancer services (surgery, radiation, and chemotherapy) were summarized by cancer type in relation to in-state vs out-of-state receipt of care based on state of residence for Medicare beneficiaries. Cross-state delivery of cancer services was also quantified by adjacent vs nonadjacent states and overall between-state flows for service utilization. ResultsThe study included 1 040 874 Medicare beneficiaries with cancer. The mean (SD) age of the study population was 76.5 (7.4) years. Most patients were female (68.2%) and urban residing (78.5%); one-quarter (25.9%) were aged between 70 and 74 years. In terms of race and ethnicity, 7.0% of patients identified as Black, 3.4% as Hispanic, and 85.5% as White. Overall, approximately 6.9% of cancer care was delivered across state lines, with the highest proportion (8.3%) occurring for surgical care, followed by radiation (6.7%) and chemotherapy (5.6%) services. Out of all cross-state care, 68.4% occurred in adjacent states. Frequency of cross-state cancer care increased with patient rurality. Compared with urban-residing patients, isolated rural-residing patients were 2.5 times more likely to cross state lines for surgical procedures (18.5% vs 7.5%), 3 times more likely to cross state lines for radiation therapy services (16.9% vs 5.7%), and almost 4 times more likely to cross state lines for chemotherapy services (16.3% vs 4.2%). Conclusions and RelevanceIn this cross-sectional study of Medicare claims data, a notable proportion of cancer services occurred across state lines, particularly for rural-residing patients. These results highlight the need for cross-state telehealth policies that recognize the prevalence of care delivery from geographically distant specialized oncology services.