Abstract B140: Interstate travel, travel time, and access barriers in pediatric oncology care across the United States
Abstract
Access to pediatric oncology care may require long travel time due to uneven distribution of specialized centers. For some patients, the nearest treatment facility is in a neighboring state. However, interstate travel may introduce additional barriers, including reduced interstate care coverage through Medicaid and other insurance plans. We examined interstate travel and travel time to treatment facilities in a large national cohort of pediatric cancer patients. We included patients ages 0–21y at diagnosis who enrolled in the Children's Oncology Group (COG) Childhood Cancer Research Network (2007–2017). Residential addresses at diagnosis were geocoded and census tract-level Social Vulnerability Index (SVI) quintiles and rurality were assigned. We summarized travel times using median and interquartile range (IQR). Logistic regression estimated odds ratios (OR) and 95% confidence intervals (CI) for predictors of interstate and long travel (≥60min each way), including race/ethnicity (referent: Non-Hispanic White), SVI quintile (referent: Q1 [lowest vulnerability]), rurality (referent: urban core), and region of residence (referent: Northeast). Of 49,434 patients, 13.3% crossed state borders for treatment and 32.4% traveled ≥60min to their treatment institution. Adjusting for region, rurality, race/ethnicity, SVI, time to nearest COG institution, and cancer type (leukemia, lymphoma, CNS, other solid tumors), patients with the highest social vulnerability (SVIQ5) were least likely to receive interstate care (OR [CI]: 0.38 [0.33, 0.43]). Median [IQR] travel times were longest for American Indian/Alaska Native patients (87 [29-201] min) and small town/rural residents (108 [75-170] min); by region, patients in the South (42 [24-92] min) and Midwest (41 [22-83] min) had the longest travel. In multivariable models, identification as American Indian/Alaska Native (1.32 [0.98,1.78]), residence in the West (OR [CI]: 1.94 [1.80,2.10]), in small town/rural areas (OR [CI]: 21.64 [19.56,23.94]), and higher vulnerability areas (OR [CI]: SVIQ2 1.48 [1.37,1.59]; SVIQ3 1.66 [1.54,1.79]; SVIQ4 1.65 [1.53,1.79]; SVIQ5 1.78 [1.64,1.93]) were predictors of travel ≥60min. Over one in eight children with cancer crossed state lines and one in three traveled >60min for treatment, reflecting the regionalized nature of pediatric oncology care. Furthermore, patients with high levels of social vulnerability were less likely to receive out of state care. While long travel time remains an important source of time and financial toxicity, interstate care may represent a distinct challenge, exposing families to fragmented, state-based health insurance systems, barriers to telehealth due to provider licensure requirements, and challenges in care coordination. Our observations underscore the need for policies that reduce administrative barriers to interstate cancer care and improve geographic access through regional care networks and telehealth flexibility. Erin L. Marcotte, Yueqi Li, Theresa Keegan, Brenda Weigel, Helen Parsons, David Van Riper, Xu Ji, Rohini Jain, Timothy Ohlsen, Kara Kelly, Sharon Castellino, Mallorie Heneghan, Justine Kahn. Interstate travel, travel time, and access barriers in pediatric oncology care across the United States [abstract]. In: Proceedings of the 19th AACR Conference on the Science of Cancer Health Disparities; 2026 Oct 18-21; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2026;35(10 Suppl):Abstract nr B140.