Changchuan Jiang, MD, MPH, on Transportation Barriers, Delays in Cancer Care, and Increased Mortality for Patients With Cancer
2022 ASCO Quality Care Symposium
Changchuan Jiang, MD, MPH, of Roswell Park Comprehensive Cancer Center, discusses the lack of transportation as a potentially modifiable barrier to care for patients with cancer. Timely intervention may reduce visits to hospital emergency departments, lower costs, and improve outcomes (Abstract 70).
Disclaimer: This video transcript has not been proofread or edited and may contain errors.
We know that cancer survivor are a very unique population, where is going very rapidly, over the past few years, due to the aging trend and advancing cancer treatment. On the same time, this is a really a vulnerable group with increased medical needs, more comorbidities, and increased health service use. Notably, our previous studies suggest that cancer survivor experience more difficulty with transportations, compared to adults without a cancer history.
In this study, we really look at the cancer survivor and their transportation barrier and how these barriers impact their clinical outcomes. For example, we focus on their transportation barrier as the patient self-report delay in care, due to lack of transportation, and we also look at if they have a routine place for care and if they visit emergency room over the past 12 months. And we also look at their overall survival and cause-specific mortality, including cancer-specific mortalities.
We find that cancer survivors experience a way higher risk of visiting emergency room and the lack of routine place for care when they experiencing difficulty with transportation. At same times, this vulnerable group of patients, once facing the transportation barrier, experience the highest risk of dying from any disease, and cancer, specifically.
Our studies suggest it's very important to pay attention to the transportation, a issue that faced by patient and physician every single day. And really look at this and ask our patients, "Are you experiencing any difficulty getting to the clinic?" We don't want them to stay at home just because they don't have transportation. Then this problem will get larger, and they will experience worse outcome after that.
We believe it's very important for us to screen, identify, and mitigate these barriers, and it will potentially improve the patients' outcome, reduce the health service use, and potentially save cost.
Sandra L. Wong, MD, of the Dartmouth-Hitchcock Medical Center, discusses her study findings showing that when patients with cancer who have had surgery reported severe symptoms via an electronic patient-reported outcomes questionnaire at six cancer centers, it appeared to be beneficial without overtaxing clinicians. There were few strong predictors of severe symptoms, which suggests population surveillance may be preferable to targeted surveillance (Abstract 243).
Jensa C. Morris, MD, of the Yale School of Medicine, Smilow Hospitalist Service, discusses her findings on the benefits of hospitalist co-management of patients with cancer: It reduced the length of hospital stay by 1 day, increased early discharge (before 11:00 AM) by threefold; raised the educational rankings of house staff, and lowered oncologists’ stress level, improving their ability to manage competing responsibilities (Abstract 1).
Justin M. Barnes, MD, of the Washington University School of Medicine, discusses the ways in which Medicaid expansion under the Affordable Care Act seems to affect distant diagnoses and cancer deaths per year, the differences in the impact of expansion between Black and White patients in the United States, and why insurance alone appears to be insufficient to overcome structural barriers to care for some populations.
Joannie M. Ivory, MD, MSPH, of The University of North Carolina at Chapel Hill, discusses ways to raise the number of Black patients with cancer who take part in clinical trials. More successful accrual may be linked to conducting trials where Black patients live and designing studies to recruit a concrete target percentage of marginalized populations.
Christopher E. Jensen, MD, of the University of North Carolina School of Medicine, talks about older adults with acute myeloid leukemia who receive high-intensity chemotherapy. Although they may live longer, much of their survival gains may be spent engaged in oncology care (Abstract 376).