Cancer Survivors Need a Ride

Heal, Heal® Summer 2022, Volume 10, Issue 2

Unreliable public transportation or limited access to a working vehicle may lead to delays in important follow-up care for cancer survivors.

Cancer survivors may experience delays in important care due to transportation barriers, which may lead to bigger problems, according to study results.

“We know that cancer survivors are much sicker and have more financial issues compared (with) a patient without a history of cancer. But it’s very important for them to access the health care they need,” Dr. Charles Jiang, lead author on the study, said in an interview with Heal®, a sister publication of CURE®. “And transportation barriers turned out to be one of the key factors contributing to a health disparity in the cancer survivor community.”

Jiang, a medical oncology fellow at Roswell Park Comprehensive Cancer Center in Buffalo, New York, explained that cancer survivors may experience other comorbidities and be at risk for health concerns such as heart disease or a secondary cancer. And it is important for them to keep up with care and doctor’s appointments.

However, this can be difficult for some cancer survivors because of a lack of transportation (not having a car available or not being able to drive) or unreliable public transportation. These barriers can cause them to continuously miss important appointments and follow-ups, which can create a bigger problem.

“Because (cancer survivors) have a lot of issues and tend to be sicker and weaker, they need more help to get them from home to the clinic. Because once they’ve missed their doctors visit, just simply because they cannot get a bus on time or because there’s nobody to drop them off, they don’t get the care they need and end up in the emergency (department) for something bigger,” Jiang explained.

Jiang and colleagues reviewed collected information from 11,856 adult cancer survivors and 136,609 adults without a history of cancer. The results, which were published in JAMA Oncology, demonstrated that cancer survivors were more likely to have experienced delays in health care due to transportation barriers in the preceding 12 months, compared with those without a history of cancer (3.1% versus 1.8%).

Additional results demonstrated that younger cancer survivors (18 to 40 years old) reported more transportation barriers than their peers without cancer. Jiang noted that this is a group that needs a lot of support. They are most likely still working and providing for themselves, as well as raising a family — so for them to receive care without delay is vital, he said.

“(These cancer survivors) need a lot of support and they’re sicker — we have a lot of studies already showing that,” he explained. “But here we’re suggesting that this group of cancer survivors, in addition to having the most financial toxicity and (possibly having difficulty paying) their medical bill, they can’t even find a way to the clinic. And it’s very important, because to (understand) their health care, they need to see their doctor first.”

In an adjusted analysis, cancer survivors who were younger, poorer, uninsured or publicly insured, unmarried or had self-reported physical functioning limitations were more likely to experience transportation barriers.

“This is suggesting it should be a collaboration or at least a discussion involving all of the stakeholders, not only the patient and doctor,” he said. “We really need more help from the social workers and more importantly we need help from the insurance companies. They have to realize that if they (aren’t) providing the transportation coverage or a convenient transportation option for all these patients, we’re going to see them in the emergency (department) and they’re going to have really negative health outcomes at the end of the road.”

One in 6 cancer survivors with public insurance such as Medicaid reported experiencing transportation barriers, which according to Jiang, was quite surprising.

“Medicaid, which is one of the most common (types of) public insurance that our cancer survivors are carrying, actually mandates a method of transportation. So Medicaid patients should not have this issue because they are already covered,” he explained. “This is basically telling us either they’re not getting the resources that are there, they don’t know they are there or that what they are providing might not be accommodating to their needs.”

These are not the only gaps in this space, Jiang said. The survey only asked survivors if they had a delay in health care, not whether they had to forgo it all together, which some may have done. They are often asked to make appointments ahead of time, but they may not know if they are going to have accessible transportation. Or cancer survivors counting on taking a bus to an appointment may arrive late if the bus is delayed. This may cause some to have to reschedule an appointment.

Of note, this was an observational study, meaning Jiang and colleagues looked at past survey results and created their own conclusion.

Jiang suggests that cancer survivors who are experiencing these barriers and delays should talk with their doctors and social workers to see what resources may be available.

“I think it’s just really an understudied issue,” Jiang concluded. “My study is probably one of the few studies in this field, and I think we just need to keep working on this.”

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