Transportation issues linked to increased mortality risk among cancer survivors
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Key takeaways:
- ED use appeared 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 associated with a lack of timely transportation resulted in increased ED use and risk for all-cause mortality among adult cancer survivors, study results showed.
Findings published in Journal of the National Cancer Institute revealed associations of transportation access with ED use and mortality and among adults with and without a cancer history, but those who had both a history of cancer and barriers to timely transportation had the greatest risk, investigators noted.
“Cancer survivors are a population with high health care needs and increased risk for developing comorbid illnesses and secondary cancers,” Xuesong Han, PhD, scientific director of health services research at American Cancer Society, told Healio. “Timely access to care is critical for them to optimize their health outcomes.”
Background
Previous research demonstrated that transportation barriers occurred more frequently among cancer survivors than among adults with no history of cancer, according to Han. What remained unknown is whether having issues obtaining timely transportation among cancer survivors contributes to worse outcomes.
“We conducted this study to examine the association of delays in care because of transportation barriers with emergency room use and mortality risk among cancer survivors in comparison with adults without a cancer history, using data from a large, nationally representative cohort,” Han said.
Methodology
Researchers at American Cancer Society and Roswell Park Comprehensive Cancer Center conducted a retrospective cohort analysis using data on adults with and without a cancer history from the 2000-2018 U.S. National Health Interview Survey. They linked patient data to vital status using mortality files through 2019.
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 of transportation barriers with ED use and all-cause mortality risk, including adjusted multivariate analyses for age, sex, race/ethnicity, education, health insurance status, comorbidities, functional limitations and region.
Key findings
A higher proportion of cancer survivors reported ED visits in the previous 12 months compared with those with no history of cancer (27.5% vs. 18.7%).
Nearly one-quarter (23.9%) of adults with a history of cancer died during the study period, compared with 7.2% of adults without a history of cancer.
Investigators found that adults with a history of cancer and transportation barriers had the highest ED use compared with those who had no cancer history or transportation issues (adjusted OR = 2.77; 95% CI, 2.34-3.27). Likewise, those with a history of cancer and transportation barriers had the highest all-cause mortality risk compared with adults with no cancer history or transportation delays (adjusted HR = 2.28; 95%CI, 1.94-2.68).
Adults without a history of cancer and transportation barriers had higher ED use (adjusted OR = 1.98; 95% CI, 1.87-2.1) and all-cause mortality (adjusted HR = 1.57; 95% CI, 1.46-1.7) compared with those who had no history or transportation issues. Adults with cancer history and no transportation barriers also had higher ED use (adjusted OR = 1.39; 95% CI, 1.34-1.44) and all-cause mortality (adjusted HR = 1.59; 95% CI, 1.54-1.65) than those who had no history of cancer or transportation barriers.
Clinical implications
Patients often face numerous barriers to adequate health care, and addressing transportation issues is crucial among them, according to Changchuan “Charles” Jiang, MD, MPH, medical oncology fellow at Roswell Park Comprehensive Cancer Center.
“A comprehensive psychosocial assessment enables health care professionals to identify and address various barriers to care, thus narrowing health disparities among cancer patients and survivors,” he told Healio.
Physicians and their clinics can deploy solutions to help alleviate the disparities revealed through this study, Jiang added. He recommended an approach that identifies a patient’s transportation needs immediately 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 access health care facilities,” Jiang said.
He also suggested improvement of telehealth and remote care options when available to augment survivor care and reduce the number of missed appointments due to a lack of adequate transportation.
“By connecting the patient with appropriate transportation resources, financial assistance programs, support groups and mental health resources, clinicians can holistically address the patient's needs,” Jiang said. “This comprehensive approach ensures that patients receive well-rounded care, ultimately improving their health outcomes and reducing disparities.”
For more information:
Xuesong Han, PhD, can be reached at xuesong.han@cancer.org.
Changchuan “Charles” Jiang, MD, MPH, can be reached at changchuan.jiang@roswellpark.org.
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