The first step in addressing cancer is getting to your doctors' appointments. But that's not so easy for some patients. Health-related social risks, which can be as simple as whether you have a ride to get to the doctor, increasingly are being recognized as affecting cancer outcomes.
"Food, transportation and housing are probably the three most prevalent health-related social risks, and they often co-occur," said MUSC Hollings Cancer Center researcher Evan Graboyes, M.D. "And when patients with cancer are affected by them, we know that that leads to worse cancer outcomes. I think it's recognizing that these are factors that have nothing to do with the biology of cancer, or the way the immunotherapy is actually working, but they're still critically important factors to consider to ensure that patients with cancer have the best outcomes. Unfortunately, differences in health-related social risks between certain groups are a major reason why we see such disparities in outcomes."
Graboyes is lead author on a recent paper in the Journal of the National Cancer Institute that outlines the current state of knowledge about transportation insecurity as well as potential policy steps and research questions. It's part of a group of papers that came out of a series of National Cancer Policy Forum webinars in 2021 focused on these health-related social risks. Graboyes leapt at the chance to work on the transportation insecurity paper.
"This is something I'm really passionate about," he said. Graboyes, the director of Survivorship and Cancer Outcomes and Research (SCOR) at Hollings, is leading this new clinical and research program that harnesses the expertise of providers and researchers across Hollings and the MUSC colleges of Medicine, Nursing and Health Professions to focus on survivorship care, research and next-generation provider training. Working on the paper, he said, helped him to think through the transportation problems that many patients with cancer in South Carolina experience.
"I think it's recognizing that these are factors that have nothing to do with the biology of cancer, or the way the immunotherapy is actually working, but they're still critically important factors to consider to ensure that patients with cancer have the best outcomes."Dr. Evan Graboyes
"This is a major problem for the patients we serve in South Carolina," he said. "It's a really common problem that we as oncologists, on some level, already know affects our patients. However, cancer center leaders and researchers are now beginning to think about it more systematically. We don't have all the answers yet, but we know enough about the issues to begin addressing the problem while at the same time studying how well different interventions work. Outlining the research agenda really helped us recognize that there's a lot of research that we at Hollings should be helping to lead."
In fact, there is a lot that's unknown about how extensive this problem is across the nation. The few papers that have tried to quantify transportation insecurity among patients with cancer have come up with widely different estimates ranging from 3% to 87% of patients.
However, there's reason to believe that patients with cancer are particularly vulnerable to transportation insecurity. Cancer care doesn't necessarily follow a regular timeline: Appointments pop up unexpectedly to deal with new issues; patients often need frequent labs or scans; patients see a variety of specialists who might offer appointments on different days; and active treatments like radiation therapy are often scheduled on a daily basis, sometimes for weeks at a time. Pain medication and side effects of cancer or treatment can make it difficult to drive oneself.
"Cancer care is not always predictable, like dialysis for example, where you know, 'All right, my dialysis is Monday, Wednesday and Friday,' and then you can plan transportation accordingly," Graboyes explained.
And because patients with cancer may be immunocompromised, depending on the treatment they are undergoing, public transportation, if available, might not be a good choice.
The paper highlights innovative programs and companies, like some tech startups that coordinate rides for patients by partnering with health care organizations, health plans and transportation providers.
In addition, nonprofit groups like the American Cancer Society
