Beyond transportation: Financial hardship, food insecurity, and care access barriers among US cancer survivors with transportation barriers to care

6534 Background: Health care payers and providers increasingly focus on addressing social determinants of health (SDoH) in order to reduce disparities in care and patient outcomes in the US. Transportation barriers to health care, a key SDoH, are associated with increased emergency department use and mortality risk among cancer survivors. Transportation barriers may also be associated with other potentially addressable aspects of SDoH and access barriers. To inform future interventions, we examined financial hardship and barriers to timely care among cancer survivors with transportation challenges in a nationally representative sample. Methods: We identified 18,140 adults with a history of cancer from the 2011-2018 National Health Interview Survey. Transportation barriers were defined as delay in care due to lack of transportation over the past 12 months. Primary outcomes included 1) medical financial hardship (FH) in any of the three following domains: material (problems paying medical bills), psychological (worrying about medical bills), and behavioral hardship (delaying/forgoing care due to cost); 2) food insecurity (worrying food would run out); and 3) delayed care due to other factors (long wait times, inability to get an appointment quickly). We estimated the proportion of survivors who report any financial hardship, food insecurity, or other factors that lead to care delays and compared the age-sex adjusted prevalence of these barriers among cancer survivors by whether or not they reported transportation barriers using logistics regression. Results: Of the 18,123 cancer survivors, 2.9% reported having transportation barriers to care. Survivors with transportation barriers experienced significantly higher financial hardship, food insecurity, or other factors that lead to care delays than survivors without transportation barriers (86.0% vs 45.3%, p<0.001). Additionally, survivors with transportation barriers were more likely to experience medical financial hardship (73.2% vs 38.3%, p<0.001), including material (50.3% vs 27.1%, p<0.001), behavior (57.5% vs 20.4%, p<0.001), and psychological (33.5% vs 15.4%, p<0.001) hardship than survivors without transportation barriers. Additionally, survivors with transportation barriers were more likely to experience food insecurity (43.9% vs 12.0%, p<0.001) and care delays due to other factors (45.6% vs. 11.6%, p<0.001). Conclusions: Most cancer survivors with transportation barriers to care also report struggling financially and experiencing additional barriers to timely care. Findings highlight the importance of screening and addressing social needs and comprehensive interventions to address barriers to care access in this vulnerable population.