The Impact of Delays in Low-Income Women’s Breast Cancer Experiences

Abstract

Background Low-income, underinsured and uninsured women are less likely to be diagnosed via mammogram and more often diagnosed at later stages, with a resultant negative impact on survival. The New Jersey Cancer Education and Early Detection Program provides access to cancer screening services for low-income, underinsured and uninsured individuals. This program was recently evaluated, and it was found that enrollees were more likely to be diagnosed at later stages than nonenrollees, which may be related to delays in diagnosis and treatment Objective The aim of this study was to determine if there were delays in diagnosis and treatment for program enrollees and, if so, what were the causes of these delays. Methods A qualitative methodology was used incorporating in-depth interviews with 20 women diagnosed with breast cancer through the New Jersey Cancer Education and Early Detection Program. Qualitative content analysis was used for data analysis. Results Three themes emerged: poor access to healthcare, lack of knowledge, and sense of spirituality. Nineteen of 20 women experienced delays in care; 9 were diagnosed with late stage (III or IV) disease. Conclusions While the lack of insurance was a factor, fear, family needs, and a tendency to not prioritize their own health were additional reasons for delays in diagnosis and treatment. Implications for Practice Programs such as this are integral to the care of low-income, uninsured individuals. However, such programs are not sufficient to meet the needs of low-income women. The lack of a usual source of care is likely to be a factor in the delays these women experienced.

Factors affecting timely breast cancer treatment among black women in a high-risk urban community: a qualitative study

“…The focus of participants’ comments in the paper was almost exclusively on timeliness of screening and follow-up of abnormal screening results [ 15 ]. Jerome-D’Emilia and colleagues [ 16 ] interviewed 20 low-income New Jersey women affiliated with the New Jersey Cancer Education and Early Detection Program who had been diagnosed with breast cancer. They used semi-structured interviews to examine factors affecting timeliness of diagnosis and treatment (without distinguishing between the two).…”

“…A small number of earlier qualitative studies have provided some insight into the causes of delays in breast cancer care [ 15 , 16 ]. The focus of these studies, however, has been on the causes of diagnostic delay; and the subjects of these studies have been breast cancer patients and survivors exclusively.…”

Barriers to cancer treatment for people experiencing socioeconomic disadvantage in high-income countries: a scoping review

“…Insurance coverage for cancer treatment was largely driven by the conditions set forth by political environments, and was identified as a fundamental barrier to accessing care [ 64 ]. Within the context of the mixed healthcare (i.e., public and private) system in the United States, for example, inadequate or no insurance coverage to cover medical costs resulted in poor access to treatment [ 65 ], poor adherence [ 66 ], greater delays in receiving treatment [ 38 , 64 , 67 , 68 ], having to receive substandard treatment options based on cost, [ 69 , 70 ] or foregoing treatment altogether [ 37 ]. Many people who experience socioeconomic disadvantage are also faced with precarious working environments.…”

“…Nearly half of the included studies ( n = 9) cited barriers that originated at the cancer care organizational level [ 65 , 66 , 68 , 71 – 74 , 77 , 78 ]. Treatment is often less accessible for people who have greater health and social care needs in part because of how cancer treatment is organized, designed, and delivered.…”

“…For example, providing coverage for other out-of-pocket expenses associated with treatment such as a lunch voucher, parking ticket, or transportation are small gestures with a potentially large impact on accessing treatment [ 72 ]. Adherence to systemic therapy regimens may be impacted when people cannot afford their supportive care medications [ 66 ]. In other cases, additional resources are often required to get people out of ‘crisis mode’ such as access to lodging.…”