Transportation barriers can limit access to care for people with cancer and contribute to suboptimal clinical outcomes. An expert at the recent AONN+ Midyear Conference offered pivotal insights on intervention strategies to address such barriers and improve quality of life for the patients.
Transportation Barriers Impede Cancer Treatment
Transportation barriers, including availability and cost of transportation and distance and time traveled to care, may lead to rescheduled or missed appointments, deferred care, and missed or delayed medication use, resulting in poorer management of chronic illness and thus poorer health outcomes. As the American population grows, the number of people affected by transportation barriers to care between 1997 and 2018 has risen from 4.8 to 5.8 million annually.1
Patients with cancer have increased healthcare needs and are particularly impacted by transportation issues. Research shows that cancer survivors were more likely to report delays in care due to transportation barriers than adults without a cancer history (3.1% vs 1.8%),2 and patients who lived far from hospitals had a more advanced stage at diagnosis, lower adherence to encoded treatments, a worse prognosis, and a worse quality of life.3
Transportation barriers limit access to necessary healthcare services and impact the clinical outcomes for patients with cancer. For example, patients with colorectal cancer who face transportation barriers are less likely to receive or adhere to recommended treatment and specialist care. In turn, non-adherence with care plans—treatment, surveillance, and survivorship—has contributed to shortened survival.4
The distance from the hospital may also influence the choice of appropriate treatment by cancer patients. For example, patients with breast cancer living farther from a radiation treatment facility more often underwent mastectomy instead of breast-conserving surgery (BCS) or did not undergo radiotherapy after BCS.3
Proven Intervention Strategies
In a session titled “Implementing a Transportation Hub: A Holistic Approach to a Systemic Problem” at the 2022 AONN+ Midyear Conference, Rachel Marquez, regional operations leader at Galileo Health, discussed 3 strategies to address the transportation barriers:
- Understand the problem. Get a high-level picture of the community and the resources available. The Centers for Disease Control and Prevention has a Transportation Health Impact Assessment Toolkit that assesses the public transit infrastructure in a community, which will give us an overview of what’s available, such as the location, distance, and walkability of bus stops. We also need to understand patients’ individual transportation needs and identify the issues that may develop into treatment barriers for the patients.
- Identify and evaluate potential solutions. Health institutions may offer transportation access assistances such as bus pass, gas card, and taxi voucher, provide direct transportation services such as hospital-run shuttle services, or work to diminish the need for patient travel with programs such as mobile clinics, telehealth, and prescription mail service. In addition to providing the solutions, we need to evaluate that the solutions are actually moving the needle on closing the disparity gap for the patients.
- Advocacy. Health professionals need to advocate on behalf of the patients to ensure that the transportation solutions that they put in place are accomplishing the goals. We also need to advocate in the local and state governments for additional resources such as longer bus hours or different routes. Sometimes just having the bus stop on the campus instead of across the street can be a big help for some patients who have functional impairments as there is not a crosswalk to worry about.
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- Henning-Smith C. The Public Health Case for Addressing Transportation-Related Barriers to Care. AJPH. 2020;110(6):763-764.
- Shah NN, et al. Self-reported Transportation Barriers to Health Care Among US Cancer Survivors. JAMA Oncology. 2022 May;8(5):775-778.
- Ambroggi M, Biasini C, Giovane CD, et al. Distance as a Barrier to Cancer Diagnosis and Treatment: review of the literature. The Oncologist. 2015;20:1378-1385.
- Jazowski SA, Sico IP, Lindquist JH, et al. Transportation as a barrier to colorectal cancer care. BMC Health Services Research. 2021;21:332.