Long and Interstate Travel May Be a Barrier to Care for Certain Pediatric Cancer Patients

Patients with the greatest social vulnerability were least likely to cross state lines to receive medical care

ATLANTA – One in five pediatric cancer patients in a large national cohort lived more than 90 minutes away from their treatment center, and patients with the highest social vulnerability were least likely to access out-of-state medical care, according to research presented at the 19th AACR Conference on The Science of Cancer Health Disparities, held October 18-21, 2026.

The distance between a patient’s home and a well-equipped health care facility may prevent patients from receiving quality care. “Pediatric cancer requires highly specialized care and can create profound financial burden for affected families. Access to care has implications for timely diagnosis, financial and time toxicity, and, ultimately, outcomes for pediatric patients,” said Erin Marcotte, MPH, PhD, associate professor in the Department of Pediatrics at the University of Minnesota and presenter of the study.

Compared with adult cancer care, dedicated pediatric cancer hospitals are less common, which can result in lengthy travel times for treatment. For some patients, the nearest center is in a neighboring state, creating additional burdens for patients and their families. “Prior research has shown that parents often experience lost wages, childcare expenses for siblings, and expenses related to travel and accommodation—expenses that are not incurred by many adult cancer patients. Furthermore, for adult patients who do not need advanced therapy, oncology care is typically available at local community hospitals, but this is not usually an option for children with cancer,” explained Marcotte.

Marcotte and colleagues wanted to characterize the burden of travel time and distance to specialized pediatric cancer care. Specifically, they wanted to identify patients who are disproportionately affected by long commutes and interstate travel.

To address this, the researchers used data from pediatric and adolescent patients (aged 0-21) enrolled between 2007 and 2017 in the Children’s Oncology Group Childhood Cancer Research Network, which is a centralized registry that tracks clinical and demographic information on children diagnosed with cancer across the United States. The team used statistical modeling to determine how a patient’s address, social vulnerability, race/ethnicity, and rurality may impact access to cancer care.

Out of nearly 50,000 patients, 32.4% of patients lived at least 60 minutes away from their treatment center, and about 20% lived more than 90 minutes away from their treatment center. Travel times were longest for American Indian/Alaska Native patients, residents of small towns or rural areas, and individuals living in the western United States.

Additionally, nearly 50% of patients lived more than 90 minutes from a Children’s Oncology Group hospital that routinely offers phase I/II clinical trials. “This finding is particularly important because it indicates that travel time may be a more significant barrier to accessing novel treatments than previously recognized,” said Marcotte.

The study reported that 13.3% of patients crossed state borders for treatment. Patients with the highest social vulnerability, which were ranked based on the Centers for Disease Control and Prevention’s Social Vulnerability Index, a database and mapping tool used to identify and rank community-level disaster risk, were least likely to receive interstate care, with approximately 62% lower odds.

Long travel time remains an important source of time and financial toxicity, Marcotte said. However, interstate care may represent a distinct challenge. This includes navigating state-based health insurance systems, barriers to telehealth due to provider licensing requirements, and difficulties in care coordination.

“The pediatric cancer community needs to be very intentional about increasing accessibility to both routine care and clinical trials,” she said. “We should actively pursue upstream interventions such as improved infrastructure, partnerships with community hospitals and clinics to decentralize aspects of care when possible, and advocacy for federal policies that remove barriers to timely care.”

Limitations of the study include a lack of patient- or caregiver-reported outcomes on the impact of increased travel time on financial and psychological strain or cancer outcome. Also, this analysis does not fully capture all childhood cancer patients and it’s likely that certain populations are underrepresented.

The study was funded by Blood Cancer United, the Children’s Cancer Research Fund, and the National Cancer Institute’s National Clinical Trials Network. Marcotte discloses no conflicts of interest.

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