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New findings led by American Cancer Society (ACS) researchers show cancer survivors who delayed care due to lack of transportation were more likely to use the emergency room (ER). They also had the highest risks of all-cause and cancer-specific mortality. The findings will be presented at the annual American Society of Clinical Oncology (ASCO) Quality Care Symposium in Chicago, September 30 - October 1.
In this study researchers led by senior author Dr. Xuesong Han, scientific director, health services research at the American Cancer Society, identified cohorts of close to 30,000 cancer survivors and almost 500,000 adults without a cancer history from the 2000-2018 National Health Interview Survey (NHIS) linked to the recently released NHIS Mortality Files. Transportation barriers were measured as medical care delays during the past 12 months due to lack of transportation. Outcomes included lack of routine place for care, ER use during the past 12 months, all-cause, and cancer-specific mortality. Their association with transportation barriers was estimated using weighted multivariable logistic and Cox proportional hazards regressions, respectively. Models were adjusted for age, sex, race, educational attainment, health insurance, comorbidities, region, year of survey, and functional limitations, as well as time since cancer diagnosis, and cancer types (breast, colorectal, prostate, and others).
Study results showed 2.8% of cancer survivors and 1.7% of adults without a cancer history reported delays in care due to transportation barriers. Cancer survivors with transportation barriers had the strongest associations with ER use; followed by adults without a cancer history with transportation barriers, and individuals without transportation barriers with and without a history of cancer. Similarly, transportation barriers were associated with the highest risk of all-cause and cancer-specific mortality risk among cancer survivors.
Study authors stress efforts are needed to mitigate transportation barriers in vulnerable cancer survivor communities.
Dr. Changchuan Jiang from Roswell Park Comprehensive Cancer Center is lead author of the study. Other ACS authors include Dr. Robin Yabroff.