Providers' and Survivors' Perspectives on Affordability Challenges for Gastrointestinal Cancer Treatment in Two Low Socioeconomic Status States of the Southern United States

IF 3.1 2区医学 Q2 ONCOLOGY

Cancer Medicine Pub Date : 2025-07-30 DOI:10.1002/cam4.71105

Maria Pisu, Nataliya V. Ivankova, Jessica Morgan, Courtney P. Williams, Nathan C. English, Burkely P. Smith, Bayley A. Jones, Wendelyn M. Oslock, Yu-Mei Schoenberger, Ivan I. Herbey, Daniel I. Chu

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Abstract

Introduction

Affordability is an access to care domain contributing to disparities in gastrointestinal (GI) cancer outcomes and care, including surgical care. Affordability challenges for GI cancer care in socioeconomically disadvantaged and diverse states of the southern United States are unknown: this paper addresses this knowledge gap.

Methods

We conducted semi-structured interviews with 32 providers (13 surgeons and 19 other) and 36 survivors (53% colorectal, 19% pancreatic, and 28% esophageal cancer) in Alabama and Mississippi. Questions were about barriers and facilitators to surgical care along five domains, including affordability, that is, the relationship between health care costs, patients' income, health insurance coverage, and the resulting ability to afford care. Verbatim transcripts were analyzed using thematic and content analysis.

Results

Themes were about: (1) affordability-related underlying context, that is, (i) patients' limited means and competing basic needs priorities, (ii) scarcity of quality medical services, and (iii) rural hospitals' limited means; (2) barriers to medical decision-making, that is, (i) guideline-concordant care unfeasible due to poverty and (ii) insurance authorizations and coverage delaying and making care costlier; (3) economic burdens from (i) many types of needed expenses and (ii) billing; and (4) strategies to improve affordability, that is, (i) care adjustments to reduce patients' costs, (ii) community organizations' support, and (iii) burdensome access to resources.

Conclusions

Underlying poverty, scarce quality medical services, and restrictive insurance provisions significantly impact medical decision-making, access to quality and prompt care, and economic and administrative burdens. Future research should quantify the extent of these challenges and identify programs and policies to address them.

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提供者和幸存者对美国南部两个低社会经济地位州胃肠道癌症治疗的可负担性挑战的看法

可负担性是导致胃肠道（GI）癌症预后和护理（包括手术护理）差异的一个医疗领域。在美国南部的社会经济弱势和不同的州，胃肠道癌症治疗的可负担性挑战是未知的：本文解决了这一知识差距。方法我们对阿拉巴马州和密西西比州的32名医疗服务提供者（13名外科医生和19名其他医生）和36名幸存者（53%结直肠癌，19%胰腺癌和28%食管癌）进行了半结构化访谈。问题涉及五个领域的手术护理障碍和促进因素，包括可负担性，即保健费用、患者收入、健康保险覆盖面和由此产生的负担保健能力之间的关系。使用主题和内容分析对逐字记录进行分析。结果：(1)与可负担性相关的潜在背景，即(i)患者经济能力有限和基本需求优先级竞争；（ii）优质医疗服务稀缺；（iii）农村医院经济能力有限；(2)医疗决策的障碍，即(i)由于贫困而无法实现与指导方针一致的护理，（ii）保险授权和覆盖范围延迟并使护理成本更高；(3)来自(i)多种所需费用和（ii）账单的经济负担；(4)提高可负担性的策略，即(i)调整护理以降低患者成本，（ii）社区组织的支持，以及（iii）繁重的资源获取。潜在的贫困、缺乏优质医疗服务和限制性保险条款显著影响医疗决策、获得优质和及时的护理以及经济和行政负担。未来的研究应该量化这些挑战的程度，并确定解决这些挑战的计划和政策。

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来源期刊

Cancer Medicine ONCOLOGY-

CiteScore

5.50

自引率

2.50%

发文量

907

审稿时长

19 weeks

期刊介绍： Cancer Medicine is a peer-reviewed, open access, interdisciplinary journal providing rapid publication of research from global biomedical researchers across the cancer sciences. The journal will consider submissions from all oncologic specialties, including, but not limited to, the following areas: Clinical Cancer Research Translational research ∙ clinical trials ∙ chemotherapy ∙ radiation therapy ∙ surgical therapy ∙ clinical observations ∙ clinical guidelines ∙ genetic consultation ∙ ethical considerations Cancer Biology: Molecular biology ∙ cellular biology ∙ molecular genetics ∙ genomics ∙ immunology ∙ epigenetics ∙ metabolic studies ∙ proteomics ∙ cytopathology ∙ carcinogenesis ∙ drug discovery and delivery. Cancer Prevention: Behavioral science ∙ psychosocial studies ∙ screening ∙ nutrition ∙ epidemiology and prevention ∙ community outreach. Bioinformatics: Gene expressions profiles ∙ gene regulation networks ∙ genome bioinformatics ∙ pathwayanalysis ∙ prognostic biomarkers. Cancer Medicine publishes original research articles, systematic reviews, meta-analyses, and research methods papers, along with invited editorials and commentaries. Original research papers must report well-conducted research with conclusions supported by the data presented in the paper.