Transportation access as a structural determinant of quality of life and symptom burden among cancer patients.

1536 Background: Growing evidence links the built environment to cancer outcomes, with NCCN recommendations emphasizing the importance of transit access in cancer care. Cancer patients, especially at advanced ages, are vulnerable to inadequate transit access due to frequent medical appointments and treatment-related physical and financial toxicity. This study examined the relationship between public transit access, quality of life (QoL), pain, and fatigue among adults with cancer. Methods: We analyzed data from 31,126 adults with cancer enrolled in the NIH All of Us cohort, which is designed to include populations historically underrepresented in biomedical research. Cancer cases were identified using ICD and SNOMED codes. Multivariable ordinal logistic regression was used to assess associations between distance to public transit and self-reported QoL, pain, and fatigue adjusted for age, sex, race/ethnicity, income, education, and insurance. Similar models examined sociodemographic predictors of transportation-related healthcare delays. Results: Decreased public transit access was associated with worse QoL, pain, and fatigue (Table 1). Transportation-related delays in care were more likely among older adults aged 65+ (aOR=0.30, p=0.02) compared to 18-25 year olds; women (aOR=1.13, p=0.03); unemployed individuals (aOR=1.13, p15 minutes away. *p < 0.05, ****p ≤ 0.001.