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

doi:10.3934/publichealth.2024058

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

AIMS Public Health. 2024 Dec 3;11(4):1125-1136. doi: 10.3934/publichealth.2024058. eCollection 2024.

Authors

Luke Stanisce^{1

2

3}, Donald H Solomon^{1

2

3}, Liam O'Neill², Nadir Ahmad^{1

2

3}, Brian Swendseid^{1

2

3}, Gregory J Kubicek⁴, Yekaterina Koshkareva^{1

2

3}

Affiliations

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.

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.

Keywords: head and neck cancer; multidisciplinary; social determinants; transportation; underserved.