Abstract C096: Influence of primary care connectedness on early-stage cancer diagnosis among vulnerable patients in an integrated, safety-net setting
Authors: Austin Jessica D , Chansard Matthieu , Lee Simon C , Balasubramanian Bijal A 
Published: September 2020

Abstract
Introduction. Vulnerable populations, such as minorities, under-, and uninsured patients receiving care from safety-net settings, are more likely to receive a late-stage cancer diagnosis, resulting in higher mortality rates. Studies have shown that being connected to a primary care provider can play a vital role in timely diagnosis of early-stage cancer. Yet, vulnerable populations often have difficulty accessing primary care services and resources in most safety-net settings where care is fragmented. Receiving care in an integrated health system may help to reduce stage disparities by providing the infrastructure to support continuity and coordination of care. Yet, the degree to which vulnerable patients are connected to a primary care provider within an integrated setting is uncertain. A better understanding of the role of primary care connectedness among vulnerable patient populations receiving care in an integrated, safety-net hospital setting is needed to address the issue of stage disparity. We hypothesize that vulnerable patients connected to a primary care provider prior to their cancer diagnosis will have increased odds of early-stage cancer diagnosis. Methods. As part of an ongoing prospective study, we examined a cross-sectional sample of 66 patients diagnosed with Stage I-III colorectal and breast cancer receiving care within an integrated, safety-net hospital system during the years 2017 and 2018. We analyzed medical records data to generate descriptive statistics to characterized patient demographics, cancer-related demographics, and primary care connectedness - defined as having a primary care provider listed in the medical record prior to diagnosis. Using logistic regression, we calculated the odds of early-stage disease, according to the American Joint Commission on Cancer (AJCC) (stages I and II vs. III) as a function of primary care connectedness. Results. The majority of the sample was non-white (58%) and nearly half reported having no insurance (47%). Females comprised nearly 80% of the sample and one-third of the sample was diagnosed with colorectal cancer. In addition, nearly 60% had a primary care provider listed in the medical record prior to their cancer diagnosis and 60% received an early-stage diagnosis. Preliminary findings from the logistic regression support our hypothesis that vulnerable patients connected to a primary care provider prior to a cancer diagnosis had significantly higher odds of early-stage diagnosis (OR = 3.9, 95% CI 1.2-13.0). Conclusion. Being connected to a primary care provider may help to reduce stage disparities among vulnerable populations receiving care from an integrated safety-net setting. Integrated safety-net settings may facilitate early-stage diagnosis through clear referral pathways that ensure more timely diagnosis after screening abnormalities and prevent diagnostic delay.
Citation Format: Jessica D Austin, Matthieu Chansard, Simon C Lee, Bijal A Balasubramanian. Influence of primary care connectedness on early-stage cancer diagnosis among vulnerable patients in an integrated, safety-net setting [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C096.