Access to care in cancer: Barriers and challenges.

Abstract

33 Background: In the current climate of health care reimbursement, coverage reform, and escalating health care costs, navigating cancer care becomes increasingly complex for patients and caregivers. Given the truly fluid marketplace and many payment and care models being established sans engagement with or even information from the patient, it is imperative to assess the ongoing reality of patient access to comprehensive, quality cancer care: care that includes biomedical as well as psychosocial care. Methods: We launched an online research survey project to further explore the cancer patient experience as it relates to accessing health care and living within a new and evolving system of health care. The analysis is based upon a cross-sectional survey of adults (18 years old and older) affected by cancer. The survey was conducted online between June and August of 2016. 1,218 cancer survivors completed survey questions regarding access to insurance, services, and providers as well as direct and indirect costs of care. Results: 78% of patients with cancer either have not or do not recall discussing costs with their health care team prior to treatment. 53.5% of survey respondents reported not knowing the meaning of the term “Clinical Practice Guidelines,” and 73% of participants had never heard the term “Clinical Pathway.” 25% of patients experienced delays in accessing cancer care, 18% of patients reported that costs inhibited them from filling prescription drugs to treat their cancer, 22% of patients chose not to get some of the healthcare services they needed due to high out-of-pocket costs, and 53% reported not receiving social or emotional support. Conclusions: These findings demonstrate that despite progress being made in expanding access to health care, many patients still experience significant barriers and challenges to accessing care. We also find there is a gap in patient knowledge about practice guidelines and payment policies. To create a system where all patients have access to high-quality and comprehensive cancer care, educational efforts are needed to enhance patient understanding of information about practice guidelines and payment policies, including information regarding health risk and benefits, costs, patient health, and quality-of-life outcomes.

Assessment of Health Care Utilization and Cost of Targeted Drug Delivery and Conventional Medical Management vs Conventional Medical Management Alone for Patients With Cancer-Related Pain

“…32 The decision criteria for managing cancer pain are complicated because treatment planning for the best medical outcome includes assessment of patient and caregiver capacity to logistically, psychologically, and economically facilitate ongoing care access. 33 Targeted drug delivery should be considered as an option to alleviate caregiver burden and limit societal cost.…”

Remoteness from urban centre does not affect gastric cancer outcomes with established care pathway to specialist centre

“… 13 – 15 In addition, many patients from rural areas choose not to avail themselves of necessary health care services when out-of-pocket costs are high. 16 For patients with cancer in particular, a lack of service coordination can lead to fragmented care, loss of patients to follow-up and failure to access appropriate services. 14 …”

Disparities in Refusal of Locoregional Treatment for Prostate Adenocarcinoma

“…34,35 In addition to race-associated factors, our findings highlight that residence in a poorer county and noninsurance status or Medicaid insurance were also associated with increased odds of LT refusal, suggesting that barriers to care may lead patients to refuse treatment. [36][37][38] For example, even when treatment itself is covered, some patients-such as those in poorer counties or who qualify for Medicaid-confronted with the other costs of treatment may opt out of treatment for fear of the economic ramifications of cancer care. [39][40][41][42][43] Studies among patients with cancer have demonstrated reduced racial disparities in receipt of treatment among the insured compared with noninsured.…”