Background: Cancer survivors have greater comorbidity burden, health care use, and mortality risk than individuals without a cancer history. Cancer survivors are also more likely to experience transportation barriers to care in the US. This study examines associations between transportation barriers and cancer survivors' care utilization and outcomes in a nationally representative sample. Methods: We identified cohorts of cancer survivors (n = 28,606) and adults without a cancer history (n = 469,860) from the 2000-2018 National Health Interview Survey (NHIS) linked to the recently released NHIS Mortality Files. Transportation barriers were measured as medical care delays during the past 12 months due to lack of transportation. Outcomes included lack of routine place for care, emergency room (ER) use during the past 12 months, all-cause, and cancer-specific mortality. Their association with transportation barriers was estimated using weighted multivariable logistic, and Cox’s proportional hazards regressions, respectively. Models were adjusted for age, sex, race, educational attainment, comorbidities, region, year of survey, and functional limitations, as well as time since cancer diagnosis, and cancer types (breast, colorectal, prostate, and others). Health insurance coverage was added sequentially to models. Results: 2.8% of cancer survivors and 1.7% of adults without cancer history reported delays in care due to transportation barriers. Cancer survivors with transportation barriers had the strongest associations with lack of routine place for care and ER use; followed by survivors without transportation barriers; and adults without a cancer history with and without transportation barriers (Table). Similarly, transportation barriers were associated with the highest risk of all-cause and cancer-specific mortality risk among cancer survivors. Further adjustment for health insurance reduced the magnitude of association between transportation barriers and mortality. Conclusions: Cancer survivors who delayed care due to lack of transportation were more likely to use the ER. They also had the highest risks of all-cause and cancer-specific mortality. Efforts are needed to mitigate transportation barriers in the rapidly growing but vulnerable cancer survivor community.

*Odds Ratio (95%CI). **Hazard Ratio (95% CI).