2076 - Transportation Insecurity among Patients with Cancer Undergoing Radiation Therapy

K. Lapen¹, E. C. Dee¹, J. M. Barnes², E. M. Aviki³, B. Thom^4,5, and F. Chino¹; ¹Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, ²Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, MO, ³Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, New York University Langone Health Long Island, Mineola, NY, ⁴School of Social Work, University of North Carolina, Chapel Hill, NC, ⁵Department of Nursing, Memorial Sloan Kettering Cancer Center, New York, NY

Purpose/Objective(s): Radiation therapy (RT) improves cancer survival, yet often requires weeks of daily treatments. Transportation needs can contribute significantly to financial toxicity (FT), treatment adherence, and cancer outcomes. Herein, we evaluate transportation insecurity among a diverse cohort of patients with cancer. Materials/

Methods: From 2022 to 2023, a health-related social-risks (HRSR) assessment was piloted at an urban comprehensive cancer center to determine transportation insecurity, FT via Comprehensive Score for Financial Toxicity (COST) (0-44, lower scores indicating worse FT), and quality of life (QOL) (0-10, 0 defined as “as bad as it can be”). Multivariable logistic regression analysis (MVA) evaluated predictors of transportation insecurity, adjusting for demographic and clinical variables.
Results: HRSR assessments were sent to 70,983 unique patients, of whom 38,249 responded (54% response rate); 4,314 (11%) had received RT within 120 days of assessment. Mean age was 61.1 years (SD 13.1) overall and 62.0 years (SD 12.7) in the RT cohort. The majority were female (74%), White (78%), and non-Hispanic (87%). Patients had breast (34%), gastrointestinal (GI) (30%), gynecologic (GYN) (15%), and thoracic (14%) cancers. Mean COST was lower in the RT cohort indicating worse FT (22.7 RT vs. 25.0 non-RT, t=11.3, p<0.001). More patients in the RT cohort were unable to afford transportation in the last month (13% RT vs. 12% non-RT, p<0.001). Only 44% of those who reported transportation insecurity accepted a referral to financial assistance. On MVA, patients in the RT cohort were more likely to report transportation insecurity (OR 1.17, 95% CI 1.05-1.31, p=0.006), have more advanced disease [stage 3 (OR 1.46, 95% CI 1.21-1.77, p<0.001); stage 4 (OR 1.54, 95% CI 1.27-1.86, p<0.001)], be a non-English speaker (OR 1.31, 95% CI 1.07-1.60, p=0.008), and identify as Asian (OR 1.21, 95% CI 1.05-1.39, p=0.010), compared to patients receiving other therapies. Patients receiving RT were less likely to have GI (OR 0.44, 95% CI 0.40-0.50, p<0.001) and GYN (OR 0.47, 95% CI 0.41-0.54, p<0.001) cancers. MVA within the RT cohort found that Asian (OR 3.24, 95% CI 2.37-4.42, p<0.001), Black (OR 1.47, 95% CI 1.03-2.09, p=0.034), and Hispanic (OR 2.34, 95% CI 1.64-3.34, p<0.001) patients were more likely to experience transportation insecurity. Transportation insecurity did not differ by cancer type, however those with transportation insecurity had a lower QOL compared to those who did not (mean QOL 5.6 vs. 7.1, t=12.1, p<0.001).
Conclusion: Routine screening for transportation insecurity was feasible among a large cohort of patients. Transportation insecurity was associated with lower QOL and was identified in 1 out of every 8 surveyed patients who received RT, with historically and presently marginalized populations at higher risk. Future work should focus on understanding barriers and facilitators to financial assistance.