Insufficient Logistical Resources
Even when patients have the information, knowledge, and skills to cope with their illness, a lack of logistical and material resources, such as transportation, medical equipment, and supplies, can prevent their use. As described above, the high costs of medical care (for those with and without health insurance), together with work reductions and job loss with a concomitant decrease in income, can make obtaining the needed resources difficult if not impossible. Families, friends, and other informal sources of support can provide or help secure many of these resources (Eakin and Strycker, 2001), but sometimes such sources are unavailable or overwhelmed by patients’ needs. Oncology physicians, nurses, and social workers report that transportation in particular is a “paramount concern” of patients (Matthews et al., 2004:735).
Lack of Transportation
In a 2005 survey, members of AOSW identified transportation as the third greatest barrier14 to patients and their families receiving good-quality cancer care (AOSW, 2006). The inability to get to medical appointments, the pharmacy, the grocery store, health education classes, peer support meetings, and other out-of-home resources can hinder health care, illness management, and health promotion. Indicative of this problem, ACS reports receiving more than 90,000 requests for transportation services in 2006.15 CancerCare reports that 14,919 patients requested and were provided $3,005,679 in financial grants in fiscal year 2006 to pay for transportation. These grants (typically $100–200) were used for transportation to cancer-related medical appointments (47 percent), pharmacies or other places to pick up medications (27 percent), other medical or mental health appointments or an emergency room (8 percent), case management/client advocacy appointments (1 percent), and other destinations (17 percent). In the first 8 months of fiscal year 2007, 10,102 patients received $1,621,282 to help pay for transportation.16
Weak Social Support
Also, as described above, patients’ informal social supports (family members and friends) provide substantial emotional, informational, and logistical support. When an individual has sufficient family members or other informal supports, such as neighbors, friends, or church groups,
14Behind inadequate health insurance and inability to pay for treatment-related expenses.
15Personal communication, Katherine Sharpe, American Cancer Society, March 20, 2007.
16Personal communication, Diane Blum, Executive Director, CancerCare, March 8, 2007.