In a study reported in a research letter in JAMA Oncology, Changchuan Jiang, MD, MPH, and colleagues found that U.S. cancer survivors were more likely to report delays in health care due to transportation barriers than persons without a history of cancer, with the difference driven by barriers among younger cancer survivors.
Changchuan Jiang, MD, MPH
The study involved survey data from 11,586 adult cancer survivors and 136,609 adults with no cancer history from the 2014–2018 National Health Interview Survey. Participants were asked: “Have you delayed getting care in the past 12 months because you did not have transportation?”
Key Findings
Delays in care in the preceding 12 months due to transportation barriers were reported by 3.1% of cancer survivors vs 1.8% of respondents without cancer history; the 3.1% figure translates into approximately 476,000 cancer survivors in 2018 based on survey weight.
Survivors aged 18 to 64 years were more likely to report barriers than respondents of the same age without a cancer history. No difference in reporting of barriers was found between survivors and persons without a cancer history aged ≥ 65 years.
In adjusted analysis, factors significantly associated with reporting of transportation barriers among survivors aged 18 to 64 years included younger age (odds ratio [OR] = 1.85 for 18–44 years vs 55–64 years), female sex (OR = 1.77), not being married (OR = 2.55), not being employed (OR = 2.17), having public insurance (OR = 2.38), poverty (ORs of 3.76 and 2.67 among those with household income < 100% and 100%–199% vs ≥ 400% of federal poverty level), any functional limitation (OR = 3.00), and comorbid illnesses (ORs of 3.29 and 3.90 for 1–2 and ≥ 3 vs 0).
In adjusted analysis among survivors aged ≥ 65 years, significant factors were age (OR = 1.83 for 65–74 vs ≥ 75 years), being unmarried (OR = 1.99), being unemployed (OR = 3.31), insurance status (ORs of 2.77 for Medicare or Medicaid and 2.63 for Medicare only or other vs Medicare and private [except private HMOs]), poverty (ORs of 4.94, 2.51, and 2.50 for household income < 100%, 100%–199%, and 200%–399% vs ≥ 400% of the federal poverty level), any functional limitation (OR = 5.23), and comorbid illnesses (ORs of 2.68 and 4.23 for 1–2 and ≥ 3 vs 0).
The investigators stated, “In this cross-sectional study, transportation barriers to care were disproportionately reported by cancer survivors, especially working-age survivors (generally < 65 years). Delays in care due to transportation barriers were more prevalent among survivors who were poor, underinsured, unmarried, or with self-reported physical functional limitations…. More comprehensive approaches are needed for early identification and mitigation of transportation barriers to care, with involvement of all potential stakeholders (eg, patients and their families, physicians, nurses, social workers, payers) and consideration of related systemic barriers (eg, financial hardships, food, or housing insecurity). Telemedicine may also alleviate some transportation burdens.”
Dr. Jiang, of the Department of Medicine, Roswell Park Comprehensive Cancer Center, is the corresponding author for the JAMA Oncology article.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
