3041 - Missed Radiotherapy Visits Following Initiation of Systematic Assessment of Patients' Transportation Need
Presenter(s)
K. L. Cui1, W. S. Chen2, K. Lichter3, A. Witztum3, J. Frank2, N. D. Prionas3, S. E. Braunstein3, and J. J. Chen2; 1School of Medicine, University of California San Francisco, San Francisco, CA, 2Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA, 3Department of Radiation Oncology, University of California San Francisco, San Francisco, CA
Purpose/Objective(s): Treatment interruptions impact oncologic outcomes among patients receiving radiotherapy (RT). We hypothesized that standardized transportation need screening with provision of transportation assistance may decrease missed RT visits.
Materials/Methods: We enacted systematic transportation need screening at new patient consultations in a single academic institution (9/2023-3/2024), querying planned transport mode to RT visits, transport-related concerns, and interest in resources. If need was identified, electronic medical record (EMR) smart phrases prompted review of cause of need, geographic location, and other social needs. In parallel, we prospectively identified a cohort of 552 consecutive patients receiving RT. Patients with transportation need who met geographic and income criteria received rideshare services and/or taxi vouchers. Missed RT visits were computed by a patient not arriving for a scheduled visit due to un-planned, pre-planned, or logistical causes. Clinical data were extracted from the EMR system. Logistic regression analyzed associations between demographic variables and receipt of transportation assistance. Fisher’s exact test compared missed visits between patients with and without assistance.
Results: Median age was 66 years (IQR: 54-74). Most patients were English-speaking (85.1%), male (54.0%), and white (51.8%). Among 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 in 17.6% of patients, the most common being housing (80.3%). Of patients with transportation need, 38.2% received rideshare/taxi vouchers for RT visits. There was no difference in the frequency of missed RT visits between unassisted patients with transportation need (40.3%) versus assisted patients (40.0%) (p=1.000). Additional social needs were found in 45.5% of patients with transportation need. On univariable analysis, there was increased receipt of assistance among patients identifying as non-English speaking (OR=3.02, 95% CI 1.49-5.89, p=0.002), Latinx (OR=3.04, 95% CI 1.26-7.10, p=0.011), Asian (OR=2.81, 95% CI 1.26-6.23, p=0.011), unknown race/ethnicity (OR=3.64, 95% CI 1.22-9.79, p=0.013) and with Medicaid insurance (OR=3.95, 95% CI 1.63- 9.48, p=0.001). On multivariable analysis, there was a trend toward increased receipt of assistance among patients with unknown race/ethnicity compared to white non-Latinx (OR=2.72, 95% CI 0.81-7.94, p=0.080).
Conclusion: Transportation assistance alone may not fully address barriers to RT access faced by patients with transportation need. Access-related initiatives may benefit from the development and evaluation of additional supportive measures, with attention to this population’s high burden of concurrent social needs.