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Session: ePoster: Colon and Colorectal Cancer 15 (Mon115)

EP771 - Transportation insecurity and colorectal cancer screening: A systematic review

Monday, May 12, 2025
1:53 PM - 1:58 PM PT
Location: Monitor 2, Sails Pavilion, Upper Level

    ePoster Presenter(s)

  • AP

    Alexa Pohl, MD, PhD

    Resident
    Stanford University
    Palo Alto, California, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    View ePoster

    • Author(s)

  • LH

    Lee C. Horton, BS

    Medical Student
    Dell Medical School, University of Texas at Austin
    Austin, Texas, United States

    Disclosure information not submitted.

  • LC

    Leora Cohen-Tigor, BS, MS

    Research Assistant
    Stanford University
    Palo Alto, California, United States

    Disclosure information not submitted.

  • BS

    Blynn Shideler, MD

    Resident
    Duke University
    Durham, North Carolina, United States

    Disclosure information not submitted.

  • AA

    Aderinsola Aderonmu, MD, MS

    Resident
    Stanford University
    Palo Alto, California, United States

    Disclosure information not submitted.

    • Senior Author(s)

  • Arden Morris, MD, MS

    Professor
    Stanford Hospital
    Stanford University School of Medicine
    Palo Alto, California, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.
Alexa Pohl, MD, PhD: This individual has no financial relationships with ineligible companies.
Arden Morris, MD, MS: This individual has no financial relationships with ineligible companies.
Purpose/Background: Over 4 million US adults miss health care appointments annually – including appointments for cancer screening and treatment – specifically due to transportation insecurity. Manifestations of transportation insecurity include lateness; skipping trips; prolonged planning, waiting or traveling; social isolation; and worrying about transportation. Although there is a burgeoning literature on colorectal cancer outcomes and rural-urban disparities or travel time, neither of these metrics account for the safety, accessibility, reliability, and relative costs of travel. The purpose of this systematic review was to understand whether and how transportation insecurity affects colorectal cancer screening adherence and to make recommendations for measuring travel insecurity in this context.

Methods/Interventions: We searched PubMed, TRID, Embase, Scopus, and Web of Science. Only full-length English-language articles published after 2003 were eligible for inclusion. We included case-control, cross-sectional, and cohort studies that reported a colorectal cancer screening outcome and measured transportation barriers in a quantitative fashion at the patient level. No qualitative studies, systematic reviews, or meta-analyses were considered. Using Covidence (Veritas Health Innovation, Melbourne, Australia), two reviewers reviewed title and abstract, full text, and extracted data. The final papers were assessed for methodologic quality and the final dataset was discussed within the study team until consensus was achieved.

Results/Outcomes: Eight studies that met inclusion criteria. Four were conducted in the US, and the remaining four were conducted in UK, Norway, Saudi Arabia, and China. US studies used screening by any modality as an outcome, and three of the four used travel time as an exposure. There was no relationship between public transit time and screening adherence among safety-net patients in New York City, but odds of adherence significantly decreased for patients living >20 min by car from a colonoscopy provider in Utah. This pattern was broadly replicated in other countries: there was no relationship between public transit time and odds of colonoscopy after +FIT in a densely populated region (Guangzhou, China), but there was a significant negative relationship between colorectal cancer screening and travel time by car across all of England, and in southeastern Norway. Finally, only 2 studies considered aspects of transportation beyond travel time.

Conclusion/Discussion: Understanding of the relationship between colorectal cancer screening and transportation is mostly limited to travel time. Substantial heterogeneity between studies in population density, local screening guidelines, and outcomes (colonoscopy-only vs all modalities), renders travel time a limited and context-dependent measure. Future work in this area would be strengthened by inclusion of additional transportation exposures (e.g. cost, private vehicle ownership) and stratification of results by screening modality.

Studies examining the relationship between transportation insecurity and colorectal cancer screening
Six studies used travel time as an exposure; only two studies considered other aspects of transportation. Outcomes included both multimodality screening and diagnostic colonoscopy following positive FIT. Future work would be strengthened by inclusion of additional transportation exposures (e.g. private vehicle access) and stratification of results by screening modality.