e18646 Background: Native Americans (NA) have some of the highest mortality rates from cancer in the US. Despite that, they face significant geographic barriers to access to cancer care. However, little study addresses disparities in accessibility in NA population. This study aims to estimate the travel distance to National Cancer Institute (NCI)-designated cancer center for NA patients in Utah and the continental US. Methods: We first retrospectively collected geographic information of patients with genitourinary cancer (NA vs. white) from Feb 1, 2013, to Jan 31, 2023. The travel distance from patients’ home zip code to Huntsman Cancer Institute (HCI) at the University of Utah was calculated using GeoData ZIP Code Distance Calculations Matrix Template. Then, the shapefile was downloaded from the NCI website. Area Deprivation Index (ADI) state decile was used to match between NA reservations and the control block groups within the same state. The travel time was calculated using Google map. Locations were mapped in ArcGIS 10.7 using coordinates and a 5-digit zip code tabulation area (ZCTA). Results: During the ten-year period of time, a total of 468 NA patients were seen in our cancer clinic. The median travel distance for NA patients vs. white patients to HCI is 190.6 mi (range: 1.1-596.4 mi) vs. 21.6 mi (range: 1.1-269 mi, p< 0.0001). In the continental US, the median travel distance from NA reservations vs. ADI-matched block groups to the nearest NCI-designated cancer centers is 186.5 mi (range 77.8-629 mi) vs. 159 miles (range 1.9-671.3 mi, p< 0.01) (Table). Map data and travel time will be presented at the meeting. Conclusions: The travel distance to HCI for NA cancer patients in Utah was almost nine times longer than that of white cancer patients. It is also significantly longer from most NA reservations to the nearest NCI-designated cancer centers compared to ADI-matched block groups. This study highlights the significant disparity in cancer care accessibility faced by Native American communities and the urgent need for action to address this issue. [Table: see text]