No Car, no Care? Assessing Transportation-Related Barriers to Specialized Oncology in Rural Germany

BackgroundAccess to precision oncology not only depends on the provision of medical services but also on the practical ability of patients to reach their cancer center. Transportation barriers may substantially limit this access, particularly for patients living in rural areas. MethodsWe analyzed travel times to the four sites of the German WERA cancer center network (Wurzburg, Erlangen, Regensburg, and Augsburg) for private car use and public transportation. To assess clinical relevance, we calculated travel times for a real-world cohort of WERA cancer patients from 2024 (n=63,524). Taxi accessibility was evaluated for given transportation budgets. ResultsWithin a 2-hour travel time, private cars provided access to our cancer centers from nearly all areas of Bavaria and several neighboring regions, connecting 98.1% of our patients to WERA. In contrast, public transportation provided access to at best 74.5% of patients (2-hour travel time). Moreover, public transportation accessibility was highly time-dependent - with connectivity rates dropping sharply in the evening, particularly in rural areas. Finally, our analysis of taxi services showed that, for a round-trip budget of {euro}100, 45.9% of our patient cohort had access to their closest WERA site. For virtual budgets of {euro}200 and {euro}300, accessibility rates rose to 71% and 87.5%, respectively. ConclusionsPublic transportation to our cancer centers is limited, especially during evening and nighttime hours. Switching to taxi services may bridge accessibility gaps but often entails a financial burden for patients and the healthcare system. Future outreach measures should "mind the gap" of public transportation. Implications for PracticeReceiving care from a tertiary cancer center often requires regular site visits. Patients from distant and rural areas face considerable travel burdens, particularly when they lack access to a private car. Measures aimed to improve patient access should consider the limited accessibility of our centers via public transportation - especially during nighttime.