Transportation is a major challenge for patients with cancer, many of whom must frequently commute to cancer facilities for treatment. But new research suggests that many elite cancer centers may not be adequately screening patients for transportation insecurity.
A recent survey, which included responses from 25 National Comprehensive Cancer Network (NCCN) institutions, found that 96% implemented processes to support patients’ transportation needs, but only 33% routinely screened patients to identify these needs.
While “most centers have implemented processes for screening, coordinating, or funding transportation … few centers have a standardized approach to routine screening, and there is variability regarding how centers cover transportation assistance services,” the researchers concluded.
People with cancer require lifesaving treatment but when “they have barriers [to] seeking care, like transportation, quite frankly it’s an injustice,” lead author Krisda Chaiyachati, MD, of the University of Pennsylvania, Philadelphia, told Medscape Medical News.
The study was published online last month in the Journal of the National Comprehensive Cancer Network.
Transportation insecurity occurs when patients cannot regularly or safely access their medical care because they lack the resources to do so, which can include limited or no access to a car, money to pay for gas or parking, or public transportation.
Although the prevalence of transportation insecurity among patients with cancer is unclear, these patients remain especially vulnerable to transportation challenges, given the widespread financial burdens associated with cancer care, the potential physical limitations cancer treatment may place on patients as well as the locations and frequency of clinical visits.
“As a result, patients may miss, delay, or change their care plans,” Chaiyachati and coauthors wrote. And “ultimately, these disruptions in care can be associated with higher rates of cancer recurrence, worse mortality, and widened racial and income disparities in cancer treatment outcomes.”
Given the impact transportation insecurity may have on patient care, the authors wanted to better characterize the landscape of how elite cancer centers assess and manage transportation insecurity.
A survey was sent to 31 NCCN facilities between January 12 and February 7, 2022, and included eight questions focused on how centers screen for transportation insecurity, coordinate transportation, and fund transportation initiatives as well as their plans to address transportation insecurity in the upcoming year.
Overall, 25 NCCN centers responded to the survey. The authors found that almost all — 24 (96%) — said they supported the transportation needs of patients by implementing processes for screening, coordinating, or funding transportation.
Among the 24 centers, all said they coordinated patients’ transportation needs, with 54% using technology platforms or vendors such as Uber or Lyft Healthcare to coordinate transportation, but only one had a full-time transportation coordinator. And only one third used routine approaches to identify patients’ transportation needs, such as universally and regularly screening all patients for risk factors.
Researchers also found that patients’ transportation needs were most often identified by social workers (96%), clinicians (83%), or patients self-declaring their needs (79%), and funding for patient transportation was provided through philanthropy (88%), grants (63%), internal dollars (63%), and insurance coverage (58%).
Commenting on the study, Fumiko Chino, MD, who has studied transportation insecurity, explained there isn’t a clear answer to how standardized screening should occur, given resource variability from clinic to clinic.
“A community clinic may not always have a social worker, so it is hard to standardize things when not everyone has the same resources,” said Chino, a radiation oncologist at Memorial Sloan Kettering Cancer Center in New York City, who was not involved in the current research. “But I will say that certain things like evaluating barriers, such as how far someone has to drive and do these people have to work are very tangible assessments that should be included.”
The authors acknowledged that the findings from NCCN centers may not reflect how other cancer treatment centers or clinical practices respond to transportation insecurity. But, they noted, NCCN centers represent important models for setting care standards in the United States and “can influence how policymakers, payers, and other provider organizations choose to improve the care of patients with cancer.”
In addition, “understanding how NCCN Member Institutions are addressing the challenge of transportation insecurity provides a lens into the real-world implementation of transportation interventions for patients undergoing cancer treatment,” the researchers concluded. “Evaluating how these interventions impact patients’ access to cancer treatments and treatment outcomes remains an important next step.”
Chaiyachati disclosed receiving grant/research support from the Patient-Centered Outcomes Research Institute, the RAND Corporation, Roundtrip, Inc., and Independence Blue Cross, Inc., as well as serving on a board for Primary Care Progress, Inc., among other things. Other disclosures can be found in the paper.
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