The impact of transportation barriers on rural cancer patients: A systematic review.

Abstract

e13743 Background: Transportation barriers significantly limit rural cancer patients’ access to potentially life-saving treatments compared to their urban counterparts, highlighting disparities in healthcare accessibility. To evaluate these barriers and their impact on treatment utilization and health outcomes, we conducted a systematic review using a predefined study protocol. The primary endpoints included the characterization of transportation barriers, their correlation with treatment utilization, and health outcomes. Methods: PubMed, CINAHL, SCOPUS, Sociological Abstracts, and Academic Search Complete were systematically searched using MeSH search terms related to “rurality,” “transportation,” and “cancer.” A pilot screening trial in Covidence confirmed the final set of 80 search terms, yielding 532 abstracts for abstract screening and 94 articles for full-text screening under independent review. Inclusion criteria focused on studies of rural U.S. populations addressing transportation barriers (e.g. travel distance, cost, access) related to cancer treatments or clinical trials. Exclusion criteria eliminated studies on non-U.S. populations, cancer screening, and non-transportation barriers. Data extracted included demographic information, travel distance/time, reported health outcomes, and results of univariate/multivariate analyses. Quality assessment adhered to JBI guidelines. Results: 20 articles met inclusion criteria. 76.2% of articles utilized RUCA or RUCC to define rural-urban residence. Number of articles addressing each negative health outcomes are as follows: disparities in access to treatment (7), risk of death (6), overall survival (5), stage of cancer (5), mortality risk (4), risk of death (4), and comorbidities (4). Results were mixed with some articles demonstrating rural patients traveled longer distances and times, contributing to delays in care, reduced treatment adherence, and worse survival rates while other studies found no significant association between travel times and such negative health outcomes. Breast cancer studies particularly highlighted these disparities, noting increased mastectomy rates and decreased utilization of breast-conserving surgery for rural patients due to travel burdens. Conclusions: This study’s significance is underscored by the newly established ICD-10 Z-codes for transportation insecurity, which formally recognize transportation as a social determinant of health. Our findings emphasize the urgent need to address transportation barriers to mitigate disparities in cancer treatment access and improve health outcomes for rural populations.