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
{"title":"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","authors":"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","doi":"10.1002/cam4.71105","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Introduction</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>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.</p>\n </section>\n </div>","PeriodicalId":139,"journal":{"name":"Cancer Medicine","volume":"14 15","pages":""},"PeriodicalIF":3.1000,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cam4.71105","citationCount":"0","resultStr":"{\"title\":\"Providers' and Survivors' Perspectives on Affordability Challenges for Gastrointestinal Cancer Treatment in Two Low Socioeconomic Status States of the Southern United States\",\"authors\":\"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. 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Verbatim transcripts were analyzed using thematic and content analysis.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>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.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusions</h3>\\n \\n <p>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. 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Providers' and Survivors' Perspectives on Affordability Challenges for Gastrointestinal Cancer Treatment in Two Low Socioeconomic Status States of the Southern United States
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.
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.
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