Transportation issues linked to increased mortality risk in cancer survivors

Key points to remember:

• Use of emergency departments appeared to be highest among adults with a history of cancer and transportation barriers.
• Adults with a history of cancer and transportation barriers had the highest all-cause mortality risk.

Delays in health care coupled with a lack of timely transportation have led to an increase in emergency department use and risk of all-cause mortality in adults cancer survivorsthe results of the study showed.

Findings published in Journal of the National Cancer Institute found associations between transportation access and emergency department use and mortality and in adults with and without a history of cancer, but those who had both a history of cancer and barriers to transportation in timely posed the greatest risk, investigators noted.

Xuesong Han

“Cancer survivors are a population with high health care needs and an increased risk of developing comorbid diseases and secondary cancers,” Xuesong Han, PhD, scientific director of health services research at the American Cancer Society, Healio told Healio. “Timely access to care is essential for them to optimize their health outcomes.”

Background

Previous research has shown that transportation barriers occur more frequently in cancer survivors than in adults with no history of cancer, according to Han. What remained unknown is whether having problems getting timely transportation among cancer survivors contributes to poorer outcomes.

“We conducted this study to examine the association of delays in care due to transportation barriers with emergency room use and mortality risk in cancer survivors compared to adults without a history of cancer, using data from a large, nationally representative cohort,” Han said.

Methodology

Researchers from the American Cancer Society and the Roswell Park Comprehensive Cancer Center conducted a retrospective cohort analysis using data on adults with and without a history of cancer from the 2000 US National Health Survey- 2018. They linked patient data to vital status using mortality files up to 2019.

The researchers defined transportation barriers as delays in health care attributed to a lack of timely transportation.

Investigators used Cox proportional hazards models to determine associations between transport barriers and emergency department use and risk of all-cause mortality, including multivariate analyzes adjusted for age, gender, race/ethnicity, education, health insurance status, comorbidities, functional limitations, and region.

Main findings

A higher proportion of cancer survivors reported having visited the emergency room in the previous 12 months compared to those with no history of cancer (27.5% versus 18.7%).

Almost a quarter (23.9%) of adults with a history of cancer died during the study period, compared to 7.2% of adults without a history of cancer.

Investigators found that adults with a history of cancer and transportation barriers had the highest use of emergency departments compared to those without a history of cancer or transportation problems (adjusted OR = 2.77; 95% CI, 2.34-3.27). Similarly, people with a history of cancer and transportation barriers had the highest all-cause mortality risk compared to adults with no history of cancer or transportation delays (adjusted RR = 2.28; 95% CI , 1.94-2.68).

Adults with no history of cancer and no transport barriers had higher emergency department use (adjusted OR = 1.98; 95% CI, 1.87-2.1) and all-cause mortality (adjusted RR = 1.57; 95% CI, 1.46-1.7) compared to those who had no history or transport problems. Adults with a history of cancer and no transportation barriers also had higher emergency department use (adjusted OR = 1.39; 95% CI, 1.34-1.44) and all-cause mortality ( Adjusted RR = 1.59; 95% CI, 1.54-1.65) than those who had no history of cancer or transport obstacles.

Clinical implications

Patients often face many barriers to adequate healthcare, and addressing transportation issues is crucial among them, according to Changchuan “Charles” Jiang, MD, MPH, Fellow in Medical Oncology at Roswell Park Comprehensive Cancer Center.

Changchuan “Charles” Jiang

“A comprehensive psychosocial assessment allows healthcare professionals to identify and overcome various barriers to care, thereby reducing health disparities among cancer patients and survivors,” he told Healio.

Physicians and their clinics can deploy solutions to help mitigate the disparities revealed by this study, Jiang added. He recommended an approach that immediately identifies a patient’s transportation needs and helps connect them to available resources when needed.

“Clinicians and their practices should provide patients with information about existing transportation resources in their communities, such as programs or services that can help them get to health care facilities,” Jiang said.

He also suggested improving telehealth and remote care options when available to increase care for survivors and reduce the number of missed appointments due to a lack of adequate transportation.

“By connecting the patient to appropriate transportation resources, financial assistance programs, support groups, and mental health resources, clinicians can holistically address the patient’s needs,” Jiang said. “This holistic approach ensures that patients receive comprehensive care, improving their health outcomes and reducing disparities.”

For more information:

Xuesong Han, PhD, can be contacted at [email protected].

Changchuan “Charles” Jiang, MD, MPH, can be contacted at [email protected].