What is the clinical evidence from this study?

Study design: Cohort. Population: Cancer (n=31126). Intervention: Decreased public transit access (>15 minutes away) vs. Adequate public transit access. Primary outcome: Low Quality of Life (aOR 1.09, 95% CI 1.00-1.19, p=0.04).

What does this research mean for the field?

Decreased public transit access is significantly associated with worse quality of life, increased pain and fatigue, and higher rates of care delays among adults with cancer. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

What question did this study set out to answer?

This research aims to investigate how public transit access affects quality of life, pain, and fatigue in cancer patients.

May 29, 2026

Transportation access as a structural determinant of quality of life and symptom burden among cancer patients.

Key Result

Decreased public transit access was associated with higher odds of low quality of life (aOR 1.09; 95% CI 1.00-1.19; P=0.04), moderate/high pain, and fatigue among adults with cancer.

Key Points

This research aims to investigate how public transit access affects quality of life, pain, and fatigue in cancer patients.
Analyzed data from 31,126 cancer patients in the NIH All of Us cohort.
Used multivariable ordinal logistic regression to assess associations between public transit distance and QoL, pain, and fatigue adjusted for key demographics.
Examined sociodemographic factors influencing transportation-related healthcare delays.
Decreased public transit access correlates with lower quality of life, increased pain, and fatigue (p<0.001).
Transportation-related care delays were significantly more prevalent among older adults (aOR=0.30, p=0.02) and populations with lower income (aOR=7.60, p<0.001).
Higher odds of delays were reported by Black (aOR=1.65, p<0.01) and Hispanic patients (aOR=1.27, p<0.01).

Study Design

Type

Cohort (n=31,126)

Multicenter

Yes

Structured PICO

Does decreased public transit access worsen quality of life, pain, and fatigue in adults with cancer?

Population

31,126 adults with cancer enrolled in the NIH All of Us cohort

Intervention

Decreased public transit access (public transit stop >15 minutes away)

Comparator

Better public transit access (public transit stop ≤15 minutes away)

Outcome

Self-reported quality of life (QoL), pain, and fatiguepatient reported

Decreased public transit access is significantly associated with worse quality of life, increased pain and fatigue, and more frequent care delays among adults with cancer.

Main Result

Effect estimate: aOR 1.09 (95% CI 1.00-1.19)

p-value: p=0.04

Abstract

1536 Background: Growing evidence links the built environment to cancer outcomes, with NCCN recommendations emphasizing the importance of transit access in cancer care. Cancer patients, especially at advanced ages, are vulnerable to inadequate transit access due to frequent medical appointments and treatment-related physical and financial toxicity. This study examined the relationship between public transit access, quality of life (QoL), pain, and fatigue among adults with cancer. Methods: We analyzed data from 31,126 adults with cancer enrolled in the NIH All of Us cohort, which is designed to include populations historically underrepresented in biomedical research. Cancer cases were identified using ICD and SNOMED codes. Multivariable ordinal logistic regression was used to assess associations between distance to public transit and self-reported QoL, pain, and fatigue adjusted for age, sex, race/ethnicity, income, education, and insurance. Similar models examined sociodemographic predictors of transportation-related healthcare delays. Results: Decreased public transit access was associated with worse QoL, pain, and fatigue (Table 1). Transportation-related delays in care were more likely among older adults aged 65+ (aOR=0.30, p=0.02) compared to 18-25 year olds; women (aOR=1.13, p=0.03); unemployed individuals (aOR=1.13, p15 minutes away. *p < 0.05, ****p ≤ 0.001.

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