Exploring transportation insecurity among cancer patients in urban cancer clinics in Ontario, Canada.

Abstract

1538 Background: Advancements in cancer therapeutics have led to increasing care complexity, higher visit frequency, and increased economic burdens for many patients undergoing cancer treatment. Emerging data suggests that transportation challenges may have an important, and uneven impact on the delivery of cancer care. We completed a cross-sectional survey to better understand the prevalence and impact of transportation insecurity in cancer clinics serving a diverse urban and inner-city patient population in a public-payor system. Objectives: The Care for All Health Equity Pilot aims to explore the barriers that patients experience when engaging with cancer treatment. In a pilot exploratory analysis we identified transportation insecurity as associated with missed oncology appointments. The objectives of this study were to explore factors associated with higher level of transportation insecurity amongst our patient population. Methods: A cross-sectional survey on patient demographics, financial toxicity (COST tool), transportation challenges, housing and food insecurity was delivered to all adult patients attending cancer clinics at two major urban centres in Toronto, Ontario from July – August 2025. We conducted an exploratory, descriptive, and bivariate analysis of factors correlated with higher levels of transportation insecurity amongst survey respondents. Results: 576 patients completed the survey, 48.6% of whom identified as female. 44.8% and 25.0% of respondents had solid tumour or malignant hematologic diagnoses respectively. The most common diagnoses were breast cancer (18.8%), and lymphoma (10.8). Nearly a third (28.8%) of survey respondents endorsed stress related to accessing and paying for transportation to and from their medical appointments. The most common transportation-related stressors preventing patients from attending appointments were parking/travel expenses (26.7%), and the ability to locate accessible parking (13.9%). In an exploratory bivariate analysis patient age, non-English preferred language, access to a personal vehicle, self-identifying with a disability, and living alone emerged as correlates for transportation insecurity. Conclusions: Health-related transportation insecurity is common, impacting nearly a third of adult cancer patients receiving care at major urban cancer clinics in a public-payor system. Transportation related costs, and lack of accessible parking, are key contributors to transportation related stress. A multivariate analysis exploring the impact of transportation insecurity on missed oncology appointments, and healthcare utilization, is underway and further information will be available at the meeting.