A Survey of the National Comprehensive Cancer Network on Approaches Toward Addressing Patients’ Transportation Insecurity

Authors:
Krisda H. ChaiyachatiVerily Life Science, South San Francisco, California

Search for other papers by Krisda H. Chaiyachati in
Current site
Google Scholar
PubMed
Close
 MD, MPH, MSHP
,
Diana KrauseNational Comprehensive Cancer Network, Plymouth Meeting, Pennsylvania

Search for other papers by Diana Krause in
Current site
Google Scholar
PubMed
Close
 MHA
,
Jessica SugalskiNational Comprehensive Cancer Network, Plymouth Meeting, Pennsylvania

Search for other papers by Jessica Sugalski in
Current site
Google Scholar
PubMed
Close
 MPPA
,
Evan M. GraboyesMedical University of South Carolina, Charleston

Search for other papers by Evan M. Graboyes in
Current site
Google Scholar
PubMed
Close
 MD, MPH
, and
Lawrence N. ShulmanPerelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
Penn Center for Cancer Care Innovation, University of Pennsylvania, Philadelphia, Pennsylvania
Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania

Search for other papers by Lawrence N. Shulman in
Current site
Google Scholar
PubMed
Close
 MD

Background: Addressing patients’ social determinants of health is a national priority for cancer treatment centers. Transportation insecurity is one major challenge for patients undergoing active cancer treatment, and missing treatments can result in worse cancer treatment outcomes, including worse morbidity and mortality. How cancer treatment centers are addressing transportation insecurity is understudied. Methods: In January and February 2022, the NCCN Best Practices Committee conducted a survey of NCCN’s 31 Member Institutions (currently 32 member institutions as of April 2022) to assess how centers were addressing patient transportation insecurity: how they screen for transportation insecurity, coordinate transportation, and fund transportation initiatives, and their plans to address transportation insecurity in the future. Results: A total of 25 of 31 (81%) NCCN Member Institutions responded to the survey, of which 24 (96%) reported supporting the transportation needs of their patients through screening, coordinating, and/or funding transportation. Patients’ transportation needs were most often identified by social workers (96%), clinicians (83%), or patients self-declaring their needs (79%). Few centers (33%) used routine screening approaches (eg, universal screening of social risk factors) to systematically identify transportation needs, and 54% used the support of technology platforms or a vendor to coordinate transportation. Transportation was predominantly funded via some combination of philanthropy (88%), grants (63%), internal dollars (63%), and reimbursement from insurance companies (58%). Over the next 12 months, many centers were either going to continue their current transportation programs in their current state (60%) or expand existing programs (32%). Conclusions: Many NCCN Member Institutions are addressing the transportation needs of their patients. Current efforts are heterogeneous. Few centers have systematic, routine screening approaches, and funding relies on philanthropy more so than institutional dollars or reimbursement from insurers. Opportunities exist to establish more structured, scalable, and sustainable programs for patients’ transportation needs.

Submitted April 15, 2022; final revision received August 18, 2022; accepted for publication September 8, 2022.

Author contributions: Conceptualization: Chaiyachati, Graboyes, Shulman. Survey creation: Krause, Sugalski. Formal analysis: All authors. Data interpretation: Chaiyachati, Graboyes, Shulman. Writing—original draft: All authors. Writing—review & editing: All authors.

Disclosures: Dr. Chaiyachati has disclosed receiving grant/research support from PCORI, the RAND Corporation, Roundtrip, Inc., and Independence Blue Cross, Inc.; serving on a board for Primary Care Progress, Inc.; serving as a consultant for Verily Life Sciences, Inc.; and being employed by Verily Life Sciences, Inc. Dr. Graboyes has disclosed receiving grant/research support from and serving as a consultant for Castle Biosciences. Dr. Shulman has disclosed receiving grant/research support from the Breast Cancer Research Foundation. The remaining authors have disclosed being employed by the National Comprehensive Cancer Network.

Correspondence: Diana Krause, MHA, National Comprehensive Cancer Network, 3025 Chemical Road, Suite 100, Plymouth Meeting, PA 19462. Email: Krause@nccn.org
  • Collapse
  • Expand
  • 1.

    Gould-Werth A, Griffin J, Murphy AK. Developing a new measure of transportation insecurity: an exploratory factor analysis. Surv Pract 2018;11:0024.

    • Search Google Scholar
    • Export Citation
  • 2.

    Gravity Project. Introducing the Gravity Project. Accessed on March 21, 2022. Available at: https://thegravityproject.net/

  • 3.

    Alderwick H, Gottlieb LM. Meanings and misunderstandings: a social determinants of health lexicon for health care systems. Milbank Q 2019;97:407419.

  • 4.

    Whitman A, De Lew N, Chappel A, et al. Addressing Social Determinants of Health: Examples of Successful Evidence-Based Strategies and Current Federal Efforts. Washington, DC: US Department of Health and Human Services, Office of Health Policy: 2022.

    • Search Google Scholar
    • Export Citation
  • 5.

    Guidry JJ, Aday LA, Zhang D, et al. Transportation as a barrier to cancer treatment. Cancer Pract 1997;5:361366.

  • 6.

    Zullig LL, Jackson GL, Provenzale D, et al. Transportation: a vehicle or roadblock to cancer care for VA patients with colorectal cancer? Clin Colorectal Cancer 2012;11:6065.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Jazowski SA, Sico IP, Lindquist JH, et al. Transportation as a barrier to colorectal cancer care. BMC Health Serv Res 2021;21:332.

  • 8.

    Jiang C, Deng L, Wang Q, et al. Transportation barriers to health care and mortality risk among the U.S. adults with history of cancer [abstract]. J Clin Oncol 2021;39(Suppl):Abstract 121.

    • Search Google Scholar
    • Export Citation
  • 9.

    Jiang C, Yabroff KR, Deng L, et al. Self-reported transportation barriers to health care among US cancer survivors. JAMA Oncol 2022;8:775778.

  • 10.

    Barrington WE, DeGroff A, Melillo S, et al. Patient navigator reported patient barriers and delivered activities in two large federally-funded cancer screening programs. Prev Med 2019;129(Suppl):105858.

    • Search Google Scholar
    • Export Citation
  • 11.

    Jankowski C, Berger AM, Aranha O, et al. NCCN Clinical Practice Guidelines in Oncology: Cancer-Related Fatigue. Version 2.2022. Accessed March 21, 2022. To view the most recent version, visit https://www.nccn.org

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Ramsey S, Blough D, Kirchhoff A, et al. Washington State cancer patients found to be at greater risk for bankruptcy than people without a cancer diagnosis. Health Aff (Millwood) 2013;32:11431152.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Guy GP Jr, Ekwueme DU, Yabroff KR, et al. Economic burden of cancer survivorship among adults in the United States. J Clin Oncol 2013;31:37493757.

  • 14.

    Bhanvadia SK, Psutka SP, Burg ML, et al. Financial toxicity among patients with prostate, bladder, and kidney cancer: a systematic review and call to action. Eur Urol Oncol 2021;4:396404.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Herb JN, Dunham LN, Mody G, et al. Lung cancer surgical regionalization disproportionately worsens travel distance for rural patients. J Rural Health 2020;36:496505.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Siegel J, Engelhardt KE, Hornor MA, et al. Travel distance and its interaction with patient and hospital factors in pancreas cancer care. Am J Surg 2021;221:819825.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Syed ST, Gerber BS, Sharp LK. Traveling towards disease: transportation barriers to health care access. J Community Health 2013;38:976993.

  • 18.

    Etminani-Ghasrodashti R, Kan C, Mozaffarian L. Investigating the role of transportation barriers in cancer patients’ decision making regarding the treatment process. Transp Res Rec 2021;2675:175187.

    • Search Google Scholar
    • Export Citation
  • 19.

    Yabroff KR, Reeder-Hayes K, Zhao J, et al. Health insurance coverage disruptions and cancer care and outcomes: systematic review of published research. J Natl Cancer Inst 2020;112:671687.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Sheridan R, Oliver SE, Hall G, et al. Patient non-attendance at urgent referral appointments for suspected cancer and its links to cancer diagnosis and one year mortality: a cohort study of patients referred on the Two Week Wait pathway. Cancer Epidemiol 2019;63:101588.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Etminani-Ghasrodashti R, Khan MA, Mozaffarian L. Modeling the structural relationships between travel distance, built environment, and cancer outcomes. J Urban Plann Dev 2022;148:05022016.

    • Search Google Scholar
    • Export Citation
  • 22.

    Transit Cooperative Research Program. Guidebook and Research Plan to Help Communities Improve Transportation to Health Care Services. Washington, DC: National Academies Press; 2021.

    • Search Google Scholar
    • Export Citation
  • 23.

    Transit Cooperative Research Program. Dialysis Transportation: The Intersection of Transportation and Healthcare. Washington, DC: National Academies Press; 2019.

    • Search Google Scholar
    • Export Citation
  • 24.

    Byhoff E, De Marchis EH, Hessler D, et al. Part II: a qualitative study of social risk screening acceptability in patients and caregivers. Am J Prev Med 2019;57(Suppl 1):S3846.

    • Search Google Scholar
    • Export Citation
  • 25.

    De Marchis EH, Hessler D, Fichtenberg C, et al. Part I: a quantitative study of social risk screening acceptability in patients and caregivers. Am J Prev Med 2019;57(Suppl 1):S2537.

    • Search Google Scholar
    • Export Citation
  • 26.

    Gottlieb L, Fichtenberg C, Adler N. Screening for social determinants of health. JAMA 2016;316:2552.

  • 27.

    Gottlieb L, Wing H, Adler NE. A systematic review of interventions on patients’ social and economic needs. Am J Prev Med 2017;53:719729.

  • 28.

    Fraze TK, Brewster AL, Lewis VA, et al. Prevalence of screening for food insecurity, housing instability, utility needs, transportation needs, and interpersonal violence by us physician practices and hospitals. JAMA Netw Open 2019;2:e1911514.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Damico N, Deshane A, Kharouta MZ, et al. Rideshare services for patients undergoing daily radiation therapy. Int J Radiat Oncol Biol Phys 2020;108(Suppl):e388.

    • Search Google Scholar
    • Export Citation
  • 30.

    Manning M, Marquez R, Woodruff H, et al. The impact of rideshare transportation in radiation oncology. Int J Radiat Oncol Biol Phys 2020;108(Suppl):S99100.

    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 504 504 504
PDF Downloads 335 335 335
EPUB Downloads 0 0 0