Impact of free hospital-provided rideshare service on radiation therapy completion rates: A matched cohort analysis.
Authors: Chen Eric , Sun Yilun , Kim Uriel , Kyasaram Ravi Kumar , Yammani Deepthi , Deshane Alok , Damico Nicholas , Bhatt Aashish D. , Choi Serah , McClelland Shearwood 
Published: June 2023

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Background: Radiation therapy (RT) is generally given in consecutive daily sessions over multiple weeks. This poses challenges for patients who face barriers such as limited access to public or private transportation, limited financial resources, lack of social support, and long distances to healthcare facilities. Delayed or incomplete RT increases risk for worse clinical outcomes. The potential of rideshare service, which uses a private vehicle for hire arranged through a phone-based application or website, to facilitate timely RT is understudied. Methods: Retrospective data was collected on patients who received RT at a single institution from 2017-2022. Patient demographic and treatment characteristics were compared between those who did and did not utilize free hospital-provided rideshare service. RT completion rates were analyzed for a 1:1 matched non-rideshare cohort using optimal matching with the scaled Euclidean distance metric, to balance age, sex, race, performance status, number of fractions prescribed, Area Deprivation Index (ADI), distance to treatment center, year of diagnosis, treatment site, intent, and modality. ADI is a validated composite measure of community-level socioeconomic deprivation. Results: Of 2,906 patients who underwent RT, 58 utilized free hospital-provided rideshare service. Rideshare utilizers had a lower median age (60 vs 66, p = .02), and were more likely to identify as Black or African American (60 vs 22%, p < .0001) compared to non-rideshare utilizers. Rideshare utilizers also had higher ADI scores (median 9 vs 5, p < .0001), indicating higher socioeconomic disadvantage, and travelled shorter distances for treatment (median 5.0 vs 14.7 miles, p < .0001). More rideshare utilizers underwent RT for curative intent (79 vs 50%, p < .0001), concordant with a higher number of fractions prescribed (median 28 vs 5, p < .0001) as well as longer treatment course duration (median 39 vs 13 days, p < .0001). The most common treatment sites were head and neck (31%) and breast / chest wall (22%) for rideshare utilizers, and pelvis (27%) and brain (21%) for non-rideshare utilizers (p < .0001). Volumetric modulated arc therapy followed by 3D conformal were the most common treatment modalities in both groups. The matched cohort analysis revealed that RT completion rates were significantly higher for rideshare vs non-rideshare utilizers at 96 vs 81% (p = .01) overall, and 98 vs 78% (p = .01) for patients undergoing treatment with curative intent. Conclusions: Even after adjustment for socioeconomic, clinical, and treatment characteristics, utilization of free hospital-provided rideshare service was associated with improved RT completion rates. These findings are notable as the majority of rideshare utilizers come from socioeconomically marginalized communities, and would otherwise be expected to face significant barriers to RT completion.