{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T03:39:20Z","timestamp":1792467560284,"version":"4.5.0"},"reference-count":23,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T00:00:00Z","timestamp":1792368000000},"content-version":"vor","delay-in-days":18,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Patients with metastatic cancer at initial diagnosis have the worst prognosis. Despite their involvement in initial assessment, the relationship between Primary Care Physician availability and metastatic cancer at initial diagnosis remains unexplored. Our objective was to determine whether Primary Care Physician availability is associated with patients having metastatic cancer at initial diagnosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methodology<\/jats:title>\n                    <jats:p>This was a cross\u2010sectional study of patients aged \u2265\u200918 and diagnosed with breast, colorectal, liver, lung, ovarian, pancreatic, or prostate cancer from 2015 to 2019. Population\u2010based Texas and California cancer registries were used for patient data. The main exposure was county\u2010level Primary Care Physician density per 3500 individuals. Additional exposures included demographic factors, insurance, rural\u2013urban continuum codes, county poverty rates, and US State at Diagnosis. The primary outcome was adjusted odds of metastatic cancer at initial diagnosis. Subgroup analyses based on insurance type, age group, and metropolitan residence were performed. Models were stratified by cancer type.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Overall, 708,451 patients were included. On combined multivariable analysis, with each additional Primary Care Physician per 3500 individuals, the odds for primary outcome decreased by 2% to 6%. In a stratified analysis using Primary Care Physician density per 3500 individuals as a categorical variable, compared with counties with &lt;\u20091 Primary Care Physician, counties with 3 or more Primary Care Physicians had reduced odds of primary outcome for multiple cancer types with no statistically significant difference for counties with 1\u20131.9 Primary Care Physicians.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Increased Primary Care Physician availability was associated with a nonlinear decrease in odds for metastatic cancer at diagnosis. Thus, increasing physician density can possibly lower the likelihood of metastatic cancer at initial diagnosis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cam4.72269","type":"journal-article","created":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T02:57:08Z","timestamp":1792465028000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association of Primary Care Physician Density With Metastatic Cancer at Initial Diagnosis: A Population\u2010Based Study of 7 Cancers"],"prefix":"10.1002","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6188-7245","authenticated-orcid":false,"given":"Muhammad Sohaib","family":"Khan","sequence":"first","affiliation":[{"name":"Department of Surgery UT Southwestern Medical Center  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8621-9358","authenticated-orcid":false,"given":"Tammy","family":"Leonard","sequence":"additional","affiliation":[{"name":"Department of Health Economics, Systems, and Policy, Peter O'donnell Jr. School of Public Health UT Southwestern Medical Center  Dallas Texas USA"},{"name":"Harold C. Simmons Comprehensive Cancer Center University of Texas Southwestern Medical Center  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bella","family":"Etingen","sequence":"additional","affiliation":[{"name":"Department of Health Economics, Systems, and Policy, Peter O'donnell Jr. School of Public Health UT Southwestern Medical Center  Dallas Texas USA"},{"name":"Research and Development Service Dallas VA Medical Center  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-0643-9118","authenticated-orcid":false,"given":"Saad","family":"Mallick","sequence":"additional","affiliation":[{"name":"Department of Surgery UT Southwestern Medical Center  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-4436-8026","authenticated-orcid":false,"given":"Natalie","family":"Williams","sequence":"additional","affiliation":[{"name":"Department of Surgery UT Southwestern Medical Center  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Herbert J.","family":"Zeh","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricio M.","family":"Polanco","sequence":"additional","affiliation":[{"name":"Department of Surgery UT Southwestern Medical Center  Dallas Texas USA"},{"name":"Harold C. Simmons Comprehensive Cancer Center University of Texas Southwestern Medical Center  Dallas Texas USA"},{"name":"Department of Surgery Atrium Health Carolinas Medical Center  Charlotte North Carolina USA"},{"name":"Department of Surgery Wake Forest University School of Medicine  Winston\u2010Salem North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,19]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21871"},{"key":"e_1_2_11_3_1","unstructured":"National Cancer Plan\u2010Detect Cancer Early 2025."},{"key":"e_1_2_11_4_1","unstructured":"Organization WH Guide to cancer early diagnosis 2017."},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(19)30595-9"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pmedr.2023.102220"},{"key":"e_1_2_11_7_1","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1093\/jnci\/djab139","article-title":"Behavioral Research in Cancer Prevention and Control: Emerging Challenges and Opportunities","volume":"114","author":"Klein W. 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