Transportation access as a structural determinant of quality of life and symptom burden among cancer patients.

Abstract

1536 Background: Growing evidence links the built environment to cancer outcomes, with NCCN recommendations emphasizing the importance of transit access in cancer care. Cancer patients, especially at advanced ages, are vulnerable to inadequate transit access due to frequent medical appointments and treatment-related physical and financial toxicity. This study examined the relationship between public transit access, quality of life (QoL), pain, and fatigue among adults with cancer. Methods: We analyzed data from 31,126 adults with cancer enrolled in the NIH All of Us cohort, which is designed to include populations historically underrepresented in biomedical research. Cancer cases were identified using ICD and SNOMED codes. Multivariable ordinal logistic regression was used to assess associations between distance to public transit and self-reported QoL, pain, and fatigue adjusted for age, sex, race/ethnicity, income, education, and insurance. Similar models examined sociodemographic predictors of transportation-related healthcare delays. Results: Decreased public transit access was associated with worse QoL, pain, and fatigue (Table 1). Transportation-related delays in care were more likely among older adults aged 65+ (aOR=0.30, p=0.02) compared to 18-25 year olds; women (aOR=1.13, p=0.03); unemployed individuals (aOR=1.13, p<0.001); and those with lower income (aOR=7.60, p<0.001). Participants identifying as Black (aOR=1.65, p<0.01), Hispanic (aOR=1.27, p<0.01), or multiracial (aOR=1.73, p<0.01) also reported higher odds of transportation-related delays. Conclusions: Reduced public transit access is associated with worse quality of life, symptom burden, and care delays among adults with cancer. Providers can utilize transportation coordination as a tool for improving patient outcomes, particularly in the functional domains of pain and fatigue and among underserved populations. Further, policymakers should identify and address gaps in public transit access, yielding downstream benefits for population health, quality of life, and survivorship among cancer patients. Consideration for transportation should be integrated into treatment plans for all cancer patients to reduce financial toxicity and treatment costs while improving outcomes. Adjusted odds of worse health outcomes by decreased transit access: Adjusted association between public transit access and pain, fatigue, and quality of life among adults with cancer. a Outcome aOR (95% CI) b P-value Low Quality of Life 1.09 (1.00, 1.19) 0.04* Moderate/High Pain 1.12 (1.06, 1.18) <0.001**** Moderate/High Fatigue 1.14 (1.08, 1.20) <0.001**** a Adjusted for age group, sex, race/ethnicity, employment, income, insurance. b Public transit stop >15 minutes away. *p < 0.05, ****p ≤ 0.001.