M.A. Sierra1,2, P.A. Borowsky1,2, A.E. Hernandez1,2, E.D. Reguero Hernandez1,2, C.J. Taub4, L.Y. Min3, N. Goel1,2 1University Of Miami Miller School of Medicine, Department Of Surgery, Division Of Surgical Oncology, Miami, FL, USA 2University Of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL, USA 3University Of Miami Miller School Of Medicine, Miami, FL, USA 4University Of Alabama at Birmingham Heersink School of Medicine, Department Of Medicine, Division Of Preventive Medicine, Birmingham, Alabama, USA
Introduction: Despite advances in clinical care, racial and ethnic minorities and socioeconomically disadvantaged breast cancer patients lack equitable access to care, thus impacting outcomes. This study aims to better understand patient-reported barriers to care in a diverse population.
Methods: From 2019-2023 patients were prospectively enrolled at an NCI-designated cancer center and sister safety-net hospital. Patients were administered surveys examining barriers to care. Multinomial regression analysis evaluated the association between sociodemographic factors on patient scheduling of follow-up appointments. Multiordinal logistic regression analyses assessed the association between sociodemographic variables and perceived barriers to care, which were measured via likert scales.
Results: 468 women with mean (SD) age of 58.5 (12.3) were included. 35.3% were Hispanic and 70.3% were not born in the US. 69.9% identified as White and 12.4% as Black. 43.8% graduated college and 17.7% made >$100,000. Black compared to White women were more likely to schedule appointments in-person (OR 6.75, 95% CI 2.49-18.37, p< 0.001) or be contacted by the office (OR 2.62, 95% CI 1.07-6.44, p= 0.035) rather than calling. Similarly, Hispanics (OR 2.40, 95% CI 1.20-4.80, p= 0.13) and socioeconomically disadvantaged women making $12,000-$24,999 (OR 3.80, 95% CI 1.46-9.89, p= 0.006) were more likely to be contacted by the office compared to non-Hispanics and those making >$100,000, respectively. Black patients were more likely to use patient navigators for scheduling compared to Whites (OR 3.03, 95% CI 1.20-7.66, p= 0.019). When evaluating barriers beyond scheduling, women with an income below the poverty level stated that “lack of transportation” was a barrier compared to those making >$100,000 ($5,000-$11,999: B= 2.43, 95% CI 1.26-3.60, p< 0.001; $12,000-24,999: B=1.95, 95% CI 0.76-3.15, p= 0.001). In addition, women with an income below the poverty level were more likely to report they were “unsure how to get there” compared to those who make >$100,000 (B= 1.44 95% CI 0.09-2.79, p =.037). Not graduating college was associated with lower scores on “no time off work” (B= -0.75, 95% CI -1.28 – -0.21, p= 0.007). Those making <$100,000 vs. >100,000/year stated that the “copay is too expensive.” Black vs. White race was associated with “no family or friend to accompany you” (B=1.29, 95% CI 0.43-2.14, p= 0.003).
Conclusion: Social determinants of health impact women’s access to care. Minority patients and those of lower socioeconomic status were less independent when scheduling appointments and more likely to report barriers to attending appointments. This study highlights the importance of developing navigation programs tailored to the unique needs of diverse communities.