Investigators have found that transportation barriers—delayed care as a result of a lack of transportation—may be associated with increased emergency room use and a higher risk of mortality among patients with and without a history of cancer, according to a new study published by Jiang et al in the Journal of the National Cancer Institute. The findings suggested that cancer survivors with transportation barriers may experience the highest risks of hospital admissions and mortality.
Background
“Transportation barriers prevent many patients with cancer from accessing timely and effective care. Lack of reliable and affordable transportation can lead to missed appointments, delayed diagnoses, treatment interruptions, and incomplete follow-up care,” explained senior study author Xuesong Han, PhD, Scientific Director of Surveillance and Health Services Research in the Department of Surveillance & Health Equity Science at the American Cancer Society. “These factors can worsen the prognosis and quality of life of cancer survivors, as well as increase the costs and burdens on the health-care system,” she added.
Study Methods and Results
In the new study, the investigators estimated the associations of transportation barriers with emergency room use and mortality risk by conducting multivariable logistic and Cox proportional hazards models on the data of 28,640 cancer survivors and 470,024 patients without a history of cancer identified through the U.S. National Health Survey—as well as its linked mortality files with vital status through December 31, 2019. The investigators adjusted for age, sex, race/ethnicity, education, health insurance, comorbidities, functional limitations, and region.
The analyses showed that 2.8% of cancer survivors and 1.7% of patients without a history of cancer reported experiencing transportation barriers. Further, 7,324 and 40,793 deaths occurred in cancer survivors and patients without a history of cancer, respectively.
Compared with patients without a history of cancer or transportation barriers, cancer survivors who experienced transportation barriers had the highest likelihood of emergency room use (adjusted odds ratio [AOR] = 2.77) and all-cause mortality risk (adjusted hazard ratio [AHR] = 2.28). Patients without a history of cancer who experienced transportation barriers had the second highest likelihood of emergency room use (AOR = 1.98) and all-cause mortality (AHR = 1.57); followed by cancer survivors who did not experience transportation barriers at (AOR = 1.39) and (AHR = 1.59) for emergency room use and all-cause mortality, respectively.
Conclusions
“Transportation is a critical health-related social need affecting cancer care quality and equitable access to care,” emphasized lead study author Changchuan Jiang, MD, MPH, a hematology-oncology fellow at the Roswell Park Comprehensive Cancer Center. “Our research shows that value-based, patient-centered approaches are needed to address this critical issue and ensure that no one is left behind in their cancer journey,” he highlighted.
“No one should have to go without life-saving cancer treatments because they face transportation barriers,” stressed Lisa Lacasse, MBA, President of the American Cancer Society Cancer Action Network. “That’s why we’re advocating for policies that provide coverage of nonmedical emergency transportation services for patients [with cancer] and others with serious illnesses—particularly for Medicaid enrollees—who do not have the financial means or access to needed transportation,” she concluded.
Disclosure: For full disclosures of the study authors, visit academic.oup.com.
