Presentation (CTI)

OBJECTIVES: For many cancer patients and caregivers, travel distance and transportation challenges are central drivers of financial distress, psychosocial burden, and difficulty adhering to treatment plans. Patient-reported evidence from the Cancer Support Community (CSC) consistently shows that transportation and lodging barriers shape how patients experience care, influence perceived treatment tolerability, and contribute to non-adherence. Despite longstanding policy efforts intended to improve access for underserved populations—such as the 340B Drug Pricing Program—it remains unclear whether oncology site expansion has addressed these patient-identified barriers. Our objective was to evaluate whether oncology-focused 340B hospital child sites are located in communities likely to reduce transportation burdens and improve access for patients most affected by geographic barriers to cancer care.
METHODS: We identified nearly 2,000 oncology-related 340B hospital child sites, including 936 located in ZIP Code Tabulation Areas (ZCTAs) different from their parent hospitals. We compared neighborhood-level socioeconomic and health characteristics of child site locations with those of parent site neighborhoods and nearby alternative locations using American Community Survey and CDC PLACES data. Measures included income, insurance coverage, unemployment, racial composition, and health indicators relevant to cancer burden.
RESULTS: Oncology-focused 340B child sites were located in neighborhoods with significantly higher median income than parent site neighborhoods (+26%) and nearby alternatives (+12%), along with lower uninsured and unemployment rates and less racial diversity. These disparities were larger among sites opened since 2018. Findings suggest that recent oncology expansion has disproportionately occurred in communities with fewer patient-reported access challenges.
CONCLUSIONS: Although patients consistently identify transportation as a critical barrier affecting treatment experience and adherence, oncology-focused 340B site expansion does not appear to prioritize communities where these burdens are greatest. Incorporating patient-reported access barriers into site planning and policy oversight may better align infrastructure investments with patient-centered access goals.