Travel time, insurance, and specialized cancer care for adolescents and young adults with acute lymphoblastic leukemia
6 affiliations
- 1Division of Blood and Marrow Transplantation and Cellular Therapy, Stanford University, Stanford, CA; Correspondence: Lori Muffly, Department of Medicine, Stanford University, 780 Welch Rd, CJ250B, Stanford, CA 94305;
- 2Quantitative Sciences Unit, Section of Biostatistics, Department of Medicine, Stanford University, Stanford, CA
- 3Division of Pediatric Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Stanford University, Stanford, CA
- 4Minnesota Population Center, University of Minnesota, Minneapolis, MN
- 5Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN
- 6Division of Hematology and Oncology, UC Davis Comprehensive Cancer Center, Sacramento, CA
Abstract
Adolescents and young adults (AYAs) with acute lymphoblastic leukemia (ALL) have superior outcomes after treatment at specialized cancer centers (SCCs), but many do not receive care at these centers. We evaluated whether travel time or health insurance was a barrier to treatment at SCCs. AYAs aged 15 to 39 years with ALL were identified from California (CA), New York (NY), and Texas (TX) cancer registries. Logistic regression models were adjusted for age, sex, race/ethnicity, diagnosis year, and poverty quintile. Among 4211 AYAs with ALL, 54.5% were treated at an SCC; more in CA (61.5%) and NY (60.9%) than in TX (27.3%). Among AYAs treated at non-SCCs, 52% lived equidistant or closer to an SCC than to their treating facility. Longer 1-way driving time (in minutes) was associated with significantly decreased odds of treatment at an SCC in NY (>30 to 60 vs <15: odds ratio [OR], 0.4 [95% confidence interval or CI, 0.3-0.7]; >60 vs <15: OR 0.1 [95% CI, 0.1-0.3]), but not in CA or TX. Across states, most patients had private insurance (47.1%) or Medicaid (30.7%); 6% were uninsured. Uninsured (vs private) was associated with significantly decreased odds of treatment at an SCC in CA (OR, 0.4; 95% CI, 0.2-0.7), NY (OR, 0.4; 95% CI, 0.2-0.9), and TX (OR, 0.3; 95% CI, 0.2-0.6). Medicaid and Medicaid Managed Care were associated with significantly decreased odds of treatment at an SCC in NY and TX. In summary, we found that travel time was a barrier in NY, whereas insurance coverage was a consistent barrier to SCC care across states.
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BibTeX
@article{muffly2026travel,
title = {{Travel time, insurance, and specialized cancer care for adolescents and young adults with acute lymphoblastic leukemia}},
author = {Lori Muffly and Kate Miller and Amy Zhang and Jerry Luo and David Van Riper and Helen M. Parsons and Theresa Keegan},
journal = {Blood Neoplasia},
year = {2026},
month = sep,
doi = {10.1016/j.bneo.2026.100314},
url = {https://doi.org/10.1016/j.bneo.2026.100314},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Travel time, insurance, and specialized cancer care for adolescents and young adults with acute lymphoblastic leukemia
AU - Lori Muffly
AU - Kate Miller
AU - Amy Zhang
AU - Jerry Luo
AU - David Van Riper
AU - Helen M. Parsons
AU - Theresa Keegan
PY - 2026
DA - 2026/09/21
JO - Blood Neoplasia
DO - 10.1016/j.bneo.2026.100314
UR - https://doi.org/10.1016/j.bneo.2026.100314
AB - Adolescents and young adults (AYAs) with acute lymphoblastic leukemia (ALL) have superior outcomes after treatment at specialized cancer centers (SCCs), but many do not receive care at these centers. We evaluated whether travel time or health insurance was a barrier to treatment at SCCs. AYAs aged 15 to 39 years with ALL were identified from California (CA), New York (NY), and Texas (TX) cancer registries. Logistic regression models were adjusted for age, sex, race/ethnicity, diagnosis year, and poverty quintile. Among 4211 AYAs with ALL, 54.5% were treated at an SCC; more in CA (61.5%) and NY (60.9%) than in TX (27.3%). Among AYAs treated at non-SCCs, 52% lived equidistant or closer to an SCC than to their treating facility. Longer 1-way driving time (in minutes) was associated with significantly decreased odds of treatment at an SCC in NY (>30 to 60 vs <15: odds ratio [OR], 0.4 [95% confidence interval or CI, 0.3-0.7]; >60 vs <15: OR 0.1 [95% CI, 0.1-0.3]), but not in CA or TX. Across states, most patients had private insurance (47.1%) or Medicaid (30.7%); 6% were uninsured. Uninsured (vs private) was associated with significantly decreased odds of treatment at an SCC in CA (OR, 0.4; 95% CI, 0.2-0.7), NY (OR, 0.4; 95% CI, 0.2-0.9), and TX (OR, 0.3; 95% CI, 0.2-0.6). Medicaid and Medicaid Managed Care were associated with significantly decreased odds of treatment at an SCC in NY and TX. In summary, we found that travel time was a barrier in NY, whereas insurance coverage was a consistent barrier to SCC care across states.
SN - 2950-3280
ER -