Characterizing transportation need and missed visits among patients receiving radiotherapy.

Abstract

1527 Background: Patients with cancer receiving radiotherapy (RT) are vulnerable to treatment interruptions, which affect oncologic outcomes. To prioritize program development for improved RT access, we aimed to characterize transportation need via standardized department screening and its association with missed RT visits. Methods: We prospectively identified a cohort of 552 consecutive patients with cancer who received RT at a single academic institution between September 2023 and March 2024, during which a quality improvement program for standardized transportation needs screening was implemented. Missed RT visits were determined computationally and counted if a patient did not arrive for a scheduled RT visit; these missed visits may have been due to pre-planned reasons, unplanned hospital admissions, or other logistical causes. Clinical data were extracted from the electronic medical record system. Univariable and multivariable logistic regression analyses were used to determine associations between demographic variables and transportation need. Fisher’s exact test was used to compare missed RT visits between patients with varying social needs. Results: Median age was 66 years (IQR: 53.75-74). Most patients were English-speaking (85.1%), male (54%), and white (51.8%). Common planned transportation modes were driving (76.2%) and public transit (8%), as well as Veterans Affairs transportation, rideshare, and taxi. Of all patients, 26.4% missed ≥1 RT visit and 19.9% reported transportation need. Overall, 39.1% versus 23.3% of patients with versus without transportation need missed ≥1 RT visit (p = 0.001). Other social needs were found among 17.6% of patients, the most common being housing (80.3%). Of those with transportation need, 45.5% had additional social needs. Frequency of missed RT visits were similar between patients with sole transportation need (41.7%) and those with additional social needs (39.1%) (p = 0.563). On univariable analysis, there was increased transportation need among patients identifying as Asian (OR = 1.87, 95% CI 1.05-3.27, p = 0.030), Latinx (OR = 3.14, 95% CI 1.74-5.63, p < 0.001), unknown/declined race/ethnicity (OR = 2.84, 95% CI 1.29-5.99, p = 0.007), non-English speaking (OR = 3.01, 95% CI 1.80-4.98, p < 0.001), with Medicaid insurance (OR = 3.61, 95% CI 1.94-6.71, p < 0.001), and with Medicare insurance (OR = 1.81, 95% CI 1.11-2.97, p = 0.019). On multivariable analysis, Latinx (OR = 2.18, 95% CI 1.02-4.52, p = 0.040) and Medicaid versus private insurance (OR = 2.28, 95% CI 1.12-4.61, p = 0.022) were independent predictors of transportation need. Conclusions: Our findings support the utility of transportation screening as a tool for anticipating and providing resources to minimize missed RT treatments. Future initiatives toward improving RT access may benefit from proactive assessment and support of social needs, including but not limited to transportation.