Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA.
Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA.
J Natl Cancer Inst. 2022 Dec 8;114(12):1593-1600. doi: 10.1093/jnci/djac134.
Health-care-related transportation insecurity is common in the United States. Patients with cancer are especially vulnerable because cancer care is episodic in nature, occurs over a prolonged period, is marked by frequent clinical encounters, requires intense treatments, and results in substantial financial hardship. As a result of transportation insecurity, patients with cancer may forego, miss, delay, alter, and/or prematurely terminate necessary care. Limited data suggest that these alterations in care have the potential to increase the rates of cancer recurrence and mortality and exacerbate disparities in cancer incidence, severity, and outcomes. Transportation insecurity also negatively impacts at the informal caregiver, provider, health system, and societal levels. Recognizing that transportation is a critical determinant of outcomes for patients with cancer, there are ongoing efforts to develop evidence-based protocols to identify at-risk patients and address transportation insecurity at federal policy, health system, not-for-profit, and industry levels. In 2021, the National Cancer Policy Forum of the National Academies of Science, Engineering, and Medicine sponsored a series of webinars addressing key social determinants of health including food, housing, and transportation among patients with cancer. This commentary summarizes the formal presentations and discussions related to transportation insecurity and will 1) discuss the heterogeneous nature of transportation insecurity among patients with cancer; 2) characterize its prevalence along the cancer continuum; 3) examine its multilevel consequences; 4) discuss measurement and screening tools; 5) highlight ongoing efforts to address transportation insecurity; 6) suggest policy levers; and 7) outline a research agenda to address critical knowledge gaps.
美国的医疗相关交通不安全现象较为普遍。癌症患者尤其脆弱，因为癌症治疗具有间歇性、长期性、频繁的临床就诊、需要强化治疗等特点，同时还会带来巨大的经济负担。由于交通不安全，癌症患者可能会放弃、错过、延迟、改变和/或提前终止必要的治疗。有限的数据表明，这些治疗的改变可能会增加癌症复发和死亡的风险，并加剧癌症发病率、严重程度和结果方面的差异。交通不安全还会对非正式护理人员、提供者、医疗系统和整个社会层面产生负面影响。认识到交通是癌症患者治疗结果的关键决定因素，目前正在从联邦政策、医疗系统、非营利组织和行业层面制定基于证据的协议，以识别有风险的患者并解决交通不安全问题。2021 年，美国国家科学院、工程院和医学研究所的国家癌症政策论坛主办了一系列网络研讨会，探讨了癌症患者的关键健康决定因素，包括食物、住房和交通。本评论总结了与交通不安全相关的正式报告和讨论，内容包括：1）讨论癌症患者交通不安全的异质性；2）描述其在癌症全病程中的普遍性；3）分析其多层次后果；4）讨论测量和筛查工具；5）强调解决交通不安全问题的现有措施；6）提出政策建议；7）制定研究计划，以解决关键知识空白。
