Abstract PO-072: Care coordination for older cancer patients with multi-morbidities: Implications for addressing cancer health disparities
Authors: Doose Michelle , Verhoeven Dana , Sanchez Janeth I. , Chollette Veronica , Weaver Sallie J. 
Published: January 2022

Purpose: Newly diagnosed cancer patients with multi-morbidities require a clinical care team of higher complexity due to greater care coordination demands to simultaneously coordinate cancer care and chronic disease management. Whereas teams of lower complexity may streamline care needs by using one clinician or discipline type to manage all care needs. However, this requires clinicians to understand that they are assuming other clinical roles and responsibilities or else care needs go unmanaged leading to poor health outcomes. Given that chronic disease management drops off following the cancer diagnosis, we examined whether cancer patients identifying as non-Hispanic Black, with dual Medicaid coverage, more chronic diseases, and later cancer stage were more likely to have a clinical care team of higher complexity in the 4-months post cancer diagnosis. Methods: Surveillance, Epidemiology and End Results (SEER)-Medicare data were used to identify patients with invasive breast, colorectal, or non-small cell lung cancer with a co-diagnosis of cardiopulmonary disease or diabetes (n=85,876). The data were linked with American Medical Association files to identify clinician's discipline (e.g., oncology, primary care, cardiology) from encounter claims. Using Zaccaro's classification of multi-team systems, we categorized the degree of complexity of the clinical care team: lower (1-2 disciplines and 1-3 clinicians) versus higher (2+ disciplines and 4+ clinicians). We used multivariable logistic regression to examine patient factors associated with having a clinical care team of higher complexity (compared with lower). Results: Among older cancer patients with multi-morbidities, the most common clinical care team composition was oncology with primary care (37%) followed by oncology, primary care, and medical subspecialty (34%). In the adjusted model, cancer patients were less likely to have a clinical care team of higher complexity if they were non-Hispanic Black compared to non-Hispanic White (OR: 0.88; 95% CI: 0.83, 0.93), dual Medicaid-Medicare covered compared with Medicare only (OR: 0.63; 95% CI: 0.61, 0.65), and diagnosed with stage III cancer compared to stage I (OR: 0.87; 95% CI: 0.84, 0.90). Cancer patients were more likely to have a clinical care team of higher complexity if they had cardiopulmonary disease (OR: 1.74; 95% CI: 1.68, 1.81) or diabetes (OR: 1.69; 95% CI: 1.63,1.75) compared with hypertension only. Conclusion: Clinical care teams of lower complexity were associated with identifying as Black, Medicaid coverage, and later stage, which are known factors associated with poorer care outcomes. This warrants further investigation to examine whether clinicians are assuming other clinicians' roles and responsibilities for patient care or if cancer care is taking precedence over other chronic diseases. Future research to address cancer care disparities need to focus on clinical care teams and the healthcare organizational context that provide and optimize care coordination for newly diagnosed cancer patients with multi-morbidities.

Citation Format: Michelle Doose, Dana Verhoeven, Janeth I. Sanchez, Veronica Chollette, Sallie J. Weaver. Care coordination for older cancer patients with multi-morbidities: Implications for addressing cancer health disparities [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-072.