Self-reported Transportation Barriers to Health Care Among US Cancer Survivors

Jiang, Changchuan; Yabroff, K. Robin; Deng, Lei; Wang, Qian; Perimbeti, Stuthi; Shapiro, Charles L.; Han, Xuesong

doi:10.1001/jamaoncol.2022.0143

Cited by 32 publications

(23 citation statements)

References 8 publications

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“…In this cross-sectional study using a large data set, implementation of telemedicine was estimated to result in substantial savings in carbon emissions due to driving. While previous studies have been limited to smaller sample sizes, [14][15][16][17][18][19][20][21][22][23] our study included a large sample size and focused on oncology patients when large-scale telemedicine implementation was undertaken during COVID-19 pandemic.…”

Section: Discussionmentioning

confidence: 99%

“…Telemedicine can help address diagnostic and treatment delays and improve access to high-quality care, [18][19][20][21][22][23] as seen during COVID-19 pandemic. Telemedicine also provides significant advantages for patients who live farther away from treatment centers by improving access to care, reducing financial toxic effects, and subsequently reducing CO 2 emissions.…”

Section: Discussionmentioning

confidence: 99%

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Estimated Carbon Emissions Savings With Shifts From In-Person Visits to Telemedicine for Patients With Cancer

et al. 2023

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ImportanceWhile the health care community advocates broadly for climate change policy, medical professionals can look within care practices to assess their contribution to carbon dioxide (CO2) emissions, and provide solutions wherever possible. Telemedicine can help in mitigating climate change by providing care from a distance.ObjectiveTo assess the carbon savings achieved from telemedicine visits.Design, Setting, and ParticipantsThis cross-sectional study of telemedicine visits was conducted at a single-institution National Cancer Institute (NCI)-designated comprehensive cancer center. Eligible patients were aged 18 years and above, completed telemedicine visits from April 1, 2020, to June 20, 2021, and had a Florida mailing address documented in their electronic medical record. Groups were divided between those within driving time of 60 minutes (1-way) to the cancer center vs those living beyond 60 minutes of drive time. Data were analyzed between April 2020 and June 2021.Main Outcomes and MeasuresCarbon emission savings from telemedicine, measured in total and average per-visit savings.ResultsA total 49 329 telemedicine visits with 23 228 patients were conducted from April 1, 2020, to June 30, 2021. A total 21 489 visits were for patients with driving time of 60 minutes or less (median [IQR] age, 62.0 [52.0-71.0] years; 12 334 [57.4%] female; 1685 [7.8%] Black, 1500 [7.0%] Hispanic, 16 010 [74.5%] non-Hispanic White), while 27 840 visits were for patients with driving time greater than 60 minutes (median [IQR] age, 67.0 [57.0-74.0] years; 14 372 [51.6%] female; 1056 [3.8%] Black, 1364 [5.0%] Hispanic, 22 457 [80.7%] non-Hispanic White). For patients living within a driving time of 60 minutes from the cancer center, 424 471 kg CO2 emissions were saved (mean [SD] emissions savings, 19.8 [9.4] kg CO2 per visit) due to telemedicine—equivalent to 91.5 passenger vehicles driven for 1 year. For patients whose driving distance was greater than 60 minutes, 2 744 248 kg CO2 emissions were saved (mean emissions savings, 98.6 [54.8] kg CO2 per visit)—equivalent to 591 passenger vehicles driven for 1 year.Conclusions and RelevanceUsing a large data set, this cross-sectional analysis highlighted the carbon emissions savings due to telemedicine in oncology. This has important implications in reducing health care–related carbon footprint.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Estimated Carbon Emissions Savings With Shifts From In-Person Visits to Telemedicine for Patients With Cancer

et al. 2023

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“…Participants appreciated the convenience of the telehealth model, which reduced travel time and facilitated attending the programme alongside participants other commitments and activities. Eliminating travel-related barriers to rehabilitation is a fundamental strength of the telehealth approach [ 71 ]. In the in-person model of ReStOre, a primary reason for declining participation was travel being too arduous [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Telehealth Delivery of a Multi-Disciplinary Rehabilitation Programme for Upper Gastro-Intestinal Cancer: ReStOre@Home Feasibility Study

Brennan

Sadeghi

O’Neill

et al. 2022

Cancers

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Background: Telehealth has enabled access to rehabilitation throughout the pandemic. We assessed the feasibility of delivering a multi-disciplinary, multi-component rehabilitation programme (ReStOre@Home) to cancer survivors via telehealth. Methods: This single-arm mixed methods feasibility study recruited participants who had completed curative treatment for oesophago-gastric cancer for a 12-week telehealth rehabilitation programme, involving group resistance training, remotely monitored aerobic training, one-to-one dietetic counselling, one-to-one support calls and group education. The primary outcome was feasibility, measured by recruitment rates, attendance, retention, incidents, acceptability, Telehealth Usability Questionnaire (TUQ) and analysis of semi-structured interviews. Results: Characteristics of the twelve participants were: 65.42 ± 7.24 years; 11 male; 10.8 ± 3.9 months post-op; BMI 25.61 ± 4.37; received neoadjuvant chemotherapy 7/12; received adjuvant chemotherapy 4/12; hospital length of stay 16 days (median). Recruitment rate was 32.4%, and retention rate was 75%. Mean attendance was: education 90%; dietetics 90%; support calls 84%; resistance training 78%. Mean TUQ score was 4.69/5. Adaptations to the planned resistance training programme were required. Participants reported that ReStOre@Home enhanced physical and psychological wellbeing, and online delivery was convenient. Some reported a preference for in-person contact but felt that the online group sessions provided adequate peer support. Conclusion: Telehealth delivery of ReStOre@Home was most feasible in individuals with moderate to high levels of digital skills. Low level of digitals skills was a barrier to recruitment and retention. Participants reported high levels of programme adherence and participant satisfaction. Adaptations to future programmes, including introducing elements of in-person contact, are required.

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“…Patients with cancer were also more apt to avoid spending on other areas or healthcare including prescription refills and experienced increased rates of stress with a greater risk of depression compared to the general population (10). Lack of transportation leads to delays in care, especially in patients who are single, have lower income, are underinsured, or have self-reported physical limitations (11). Furthermore, the cumulative costs of parking alone for cancer related appointments is burdensome, with median parking cost of $2 per hour or $5 per day at National Cancer Institute-Designated Cancer Treatment Centers (12).…”

Section: Financial Toxicity In Patients With Cancermentioning

confidence: 99%

Financial toxicity in lung cancer

et al. 2022

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In the United States, lung cancer is the third most common cancer and the overall leading cause of cancer death. Due to advances in immunotherapy and targeted therapy, 5-year survival is increasing. The growing population of patients with lung cancer and cancer survivors highlights the importance of comprehensive cancer care, including recognizing and addressing financial toxicity. Financial toxicity is a term used to contextualize the negative effects of the costs of cancer treatment in terms of patient quality of life. The American Society of Clinical Oncology (ASCO) Value Framework places emphasis on high-value care as it evaluates cancer treatments “based on clinical benefit, side effects, and improvements in patient symptoms or quality of life in the context of cost”. Prior studies have shown that risk factors for financial toxicity in patients with lung cancer include lower household income or savings, inability to afford basic necessities, higher than anticipated out of pocket expenses, and taking sick leave. Among lung cancer survivors, patients experience increased unemployment and lower wages compared to the general population underscoring the lasting effects of financial toxicity. Financial toxicity is associated with increased psychosocial distress and decreased quality of life, and bankruptcy is an independent predictor of mortality in patients with cancer. Despite the negative implications of financial toxicity on patients, standardized screening practices and evidence-based interventions are lacking. The “COmphrensive Score for financial Toxicity (COST)” tool has been validated for assessing financial toxicity with correlation with health-related quality of life. Further research is needed to understand the utility of incorporating routine screening for financial toxicity into clinical practice and the efficacy of interventions. Understanding the relationship between financial toxicity and quality of life and survival is critical to providing high-value cancer care and survivorship care.

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Self-reported Transportation Barriers to Health Care Among US Cancer Survivors

Abstract: Author Contributions: Drs Jiang and Han had full access to all data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Cited by 32 publications

References 8 publications

Estimated Carbon Emissions Savings With Shifts From In-Person Visits to Telemedicine for Patients With Cancer

Estimated Carbon Emissions Savings With Shifts From In-Person Visits to Telemedicine for Patients With Cancer

Telehealth Delivery of a Multi-Disciplinary Rehabilitation Programme for Upper Gastro-Intestinal Cancer: ReStOre@Home Feasibility Study

Financial toxicity in lung cancer

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