Transportation considerations in underserved patient populations receiving multidisciplinary head and neck cancer care

Luke Stanisce; Donald H Solomon; Liam O'Neill; Nadir Ahmad; Brian Swendseid; Gregory J Kubicek; Yekaterina Koshkareva; Luke Stanisce; Donald H Solomon; Liam O'Neill; Nadir Ahmad; Brian Swendseid; Gregory J Kubicek; Yekaterina Koshkareva

doi:10.3934/publichealth.2024058

AIMS Public Health

2024, Volume 11, Issue 4: 1125-1136. doi: 10.3934/publichealth.2024058

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Research article Special Issues

Transportation considerations in underserved patient populations receiving multidisciplinary head and neck cancer care

1.
Division of Otolaryngology – Head & Neck Surgery, Cooper University Health Care, Camden, NJ, USA
2.
Cooper Medical School of Rowan University, Camden, NJ, USA
3.
Head & Neck Cancer Center, MD Anderson Cancer Center at Cooper, Camden, NJ, USA
4.
Department of Radiation Oncology, University of Miami Health Systems, Miami, FL, USA

Received: 06 April 2024 Revised: 27 May 2024 Accepted: 05 July 2024 Published: 03 December 2024

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.
- social determinants,
- transportation,
- underserved,
- multidisciplinary,
- head and neck cancer
Citation: Luke Stanisce, Donald H Solomon, Liam O'Neill, Nadir Ahmad, Brian Swendseid, Gregory J Kubicek, Yekaterina Koshkareva. Transportation considerations in underserved patient populations receiving multidisciplinary head and neck cancer care[J]. AIMS Public Health, 2024, 11(4): 1125-1136. doi: 10.3934/publichealth.2024058

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Abstract

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.

Authors' contribution

Luke Stanisce: Concept and design; Acquisition, analysis, and interpretation of data; Article drafting; Critical revision; Final approval; Donald H Solomon: Concept and design; Acquisition, analysis, and interpretation of data; Article drafting; Critical revision; Final approval; Liam O'Neill: Concept and design; Acquisition, analysis, and interpretation of data; Article drafting; Critical revision; Final approval; Nadir Ahmad: Concept and design; Interpretation of data; Critical revision; Final approval; Bria Swendseid: Concept and design; Interpretation of data; Critical revision; Final approval; Gregory Kubicek: Concept and design; Interpretation of data; Critical revision; Final approval; Yekaterina Koshkareva: Concept and design; Acquisition, analysis, and interpretation of data; Article drafting; Critical revision; Final approval.

Conflict of interest

The authors declare no conflict of interest.

References

[1]	Ragin CC, Langevin SM, Marzouk M, et al. (2011) Determinants of head and neck cancer survival by race. Head Neck 33: 1092-1098. https://doi.org/10.1002/hed.21584
[2]	Naghavi AO, Echevarria MI, Grass GD, et al. (2016) Having medicaid insurance negatively impacts outcomes in patients with head and neck malignancies. Cancer 122: 3529-3537. https://doi.org/10.1002/cncr.30212
[3]	Naghavi AO, Echevarria MI, Strom TJ, et al. (2016) Treatment delays, race, and outcomes in head and neck cancer. Cancer Epidemiol 45: 18-25. https://doi.org/10.1016/j.canep.2016.09.005
[4]	Liao DZ, Schlecht NF, Rosenblatt G, et al. (2019) Association of Delayed Time to Treatment Initiation With Overall Survival and Recurrence Among Patients With Head and Neck Squamous Cell Carcinoma in an Underserved Urban Population. JAMA Otolaryngol Head Neck Surg 145: 1001-1009. https://doi.org/10.1001/jamaoto.2019.2414
[5]	Agarwal P, Agrawal RR, Jones EA, et al. (2020) Social determinants of health and oral cavity cancer treatment and survival: A competing risk analysis. Laryngoscope 130: 2160-2165. https://doi.org/10.1002/lary.28321
[6]	Kwok J, Langevin SM, Argiris A, et al. (2010) The impact of health insurance status on the survival of patients with head and neck cancer. Cancer 116: 476-485. https://doi.org/10.1002/cncr.24774
[7]	Jindal M, Zheng C, Quadri HS, et al. (2017) Why Do Long-Distance Travelers Have Improved Pancreatectomy Outcomes?. J Am Coll Surg 225: 216-225. https://doi.org/10.1016/j.jamcollsurg.2017.04.003
[8]	Ringstrom MJ, Christian J, Bush ML, et al. (2018) Travel distance: Impact on stage of presentation and treatment choices in head and neck cancer. Am J Otolaryngol 39: 575-581. https://doi.org/10.1016/j.amjoto.2018.06.020
[9]	Altice CK, Banegas MP, Tucker-Seeley RD, et al. (2016) Financial Hardships Experienced by Cancer Survivors: A Systematic Review. J Natl Cancer Inst 109: djw205. https://doi.org/10.1093/jnci/djw205
[10]	Kale HP, Carroll NV (2016) Self-reported financial burden of cancer care and its effect on physical and mental health-related quality of life among US cancer survivors. Cancer 122: 283-289. https://doi.org/10.1002/cncr.29808
[11]	O'Brien KM, Timmons A, Butow P, et al. (2017) Associations between neighbourhood support and financial burden with unmet needs of head and neck cancer survivors. Oral Oncol 65: 57-64. https://doi.org/10.1016/j.oraloncology.2016.12.019
[12]	Graboyes EM, Ellis MA, Li H, et al. (2018) Racial and Ethnic Disparities in Travel for Head and Neck Cancer Treatment and the Impact of Travel Distance on Survival. Cancer 124: 3181-3191. https://doi.org/10.1002/cncr.31571
[13]	Massa ST, Liebendorfer AP, Zevallos JP, et al. (2020) Distance Traveled to Head and Neck Cancer Provider: A Measure of Socioeconomic Status and Access. Otolaryngol Head Neck Surg 162: 193-203. https://doi.org/10.1177/0194599819892015
[14]	Chen MM, Megwalu UC, Liew J, et al. (2019) Regionalization of head and neck cancer surgery may fragment care and impact overall survival. Laryngoscope 129: 1413-1419. https://doi.org/10.1002/lary.27440
[15]	CMS.govNon-Emergency Medical Transportation Toolkit. U.S. Centers for Medicare & Medicaid Services (2024). Available from: https://www.cms.gov/Medicare-Medicaid-Coordination/Fraud-Prevention/Medicaid-Integrity-Education/nemt
[16]	Lyft Concierge, Lyft, Inc. Available from: https://www.lyftbusiness.com/industries/healthcare?utm_source=headernav&utm_medium=web
[17]	Circulation, LogistiCare Solutions, LLC. Available from: https://www.circulation.com/#howitworks
[18]	Powers BW, Rinefort S, Jain SH (2016) Nonemergency Medical Transportation: Delivering Care in the Era of Lyft and Uber. JAMA 316: 921-922. https://doi.org/10.1001/jama.2016.9970
[19]	Massa S, Rohde R, Mckinstry C, et al. (2018) An assessment of patient burdens from head and neck cancer survivorship care. Oral Oncol 82: 115-121. https://doi.org/10.1016/j.oraloncology.2018.04.024
[20]	Graboyes EM, Kompelli AR, Neskey DM, et al. (2018) Association of treatment delays with survival for patients with head and neck cancer: a systematic review. JAMA Otolaryngol Head Neck Surg 145: 166-177. https://doi.org/10.1001/jamaoto.2018.2716
[21]	Light T, Rassi EE, Maggiore RJ, et al. (2017) Improving outcomes in veterans with oropharyngeal squamous cell carcinoma through implementation of a multidisciplinary clinic. Head Neck 39: 11061112. https://doi.org/10.1002/hed.24721
[22]	Patil RD, Meinzen-Derr JK, Hendricks BL, et al. (2016) Improving access and timeliness of care for veterans with head and neck squamous cell carcinoma: a multidisciplinary team's approach. Laryngoscope 126: 627-631. https://doi.org/10.1002/lary.25528
[23]	Townsend M, Kallogjeri D, Scott-Wittenborn N, et al. (2017) Multidisciplinary Clinic Management of Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg 143: 1213-1219. https://doi.org/10.1001/jamaoto.2017.1855
[24]	Squire SE, Gorsuch N, Mullis L, et al. (2018) A Model for Multidisciplinary Care of Patients With Head and Neck Cancer. Int J Radiat Oncol 100: 1402-1403. https://doi.org/10.1016/j.ijrobp.2017.12.245
[25]	Knighton AJ, Brunisholz KD, Savitz ST (2017) Detecting Risk of Low Health Literacy in Disadvantaged Populations Using Area-based Measures. EGEMS 5: 7. https://doi.org/10.5334/egems.191
[26]	Assari S, Zare H (2022) Beyond access, proximity to care, and healthcare use: sustained racial disparities in perinatal outcomes due to marginalization-related diminished returns and racism. J Pediatr Nurs 63: e161-e163. https://doi.org/10.1016/j.pedn.2021.09.021
[27]	Assari S, Cobb S, Cuevas AG, et al. (2020) Diminished Health Returns of Educational Attainment Among Immigrant Adults in the United States. Front Psychiatry 11: 535624. https://doi.org/10.3389/fpsyt.2020.535624

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