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Published on: April 20, 2018
Transportation considerations in underserved patient populations receiving multidisciplinary head and neck cancer
Luke Stanisce1,2,3, Donald H Solomon1,2,3, Liam O'Neill2
1Division of Otolaryngology - Head & Neck Surgery, Cooper University Health Care, Camden, NJ, USA.
Background:
Underinsured patients with advanced head and neck cancer experience worse outcomes compared to their well-insured peers.
Methods:
Retrospective logistic regression analysis testing associations between demographic, geospatial, transportation, disease, and treatment factors in 50 government insured or uninsured patients receiving curative-intent, multidisciplinary cancer care.
Results:
Forty percent of patients missed at least one treatment or surveillance appointment within the first year. Thirty-two percent reported using public transportation; 42% relied on caregivers. Patients who used public transportation were 3.3 and 4.6 times more likely to miss treatment (p = 0.001) and surveillance (p = 0.014) visits, respectively. The median one-way travel duration for such routes was 52 minutes (range: 16-232 minutes) and included 0.7 miles of walking. Physical distance to care was not associated with transportation type, missed appointments, or disease recurrence.
Conclusions:
Underserved, underinsured patient populations face significant logistical challenges with transportation, which may be mitigated by alternative models of care delivery, such as multidisciplinary clinics.
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