Abstract B127: Providers and survivors’ perspectives on affordability challenges for gastrointestinal cancer Black and White patients living in socioeconomically disadvantaged US states
Authors: Pisu Maria , Ivankova Nataliya V. , Morgan Jessica , Schoenberger Yu-Mei M. , English Nathan C. , Smith Burkely P. , Herbey Ivan I. , Williams Courtney , Jones Bayley A. , Oslock Wendelyn M. , Chu Daniel I. 
Published: September 2024

Abstract
Background: Affordability challenges for gastrointestinal (GI) cancer care may be numerous and complex in socioeconomically disadvantages states of the southern US, like Alabama (AL) and Mississippi (MS). Given that a large share of the African American US population lives in the southern US, these challenges may be contributing to observed racial disparities in GI cancer. Methods: Semi-structured interviews were conducted with purposefully selected AL and MS GI cancer providers, other staff, and survivors. Interview guides were developed based on access to care conceptual frameworks to identify barriers and facilitators to surgical and overall cancer care along 5 domains: Availability, Accessibility, Affordability, Acceptability, and Accommodation. Transcripts were analyzed by 3 coauthors using an inductive thematic and content analysis qualitative approach with NVivo 12 Plus software. Intercoder agreement was reached at 91%. This analysis focuses on the Affordability domain. Results: Providers (N=27) were 11 surgeons, 4 medical and radiation oncologists, 1 primary care provider, 6 nurses, and 5 patient navigators, 22% practiced in rural areas, 78% in urban areas. Survivors (N=36) were 44-87 years of age, 42% female, 70% white, 30% African-American, 53% colorectal, 19% pancreatic, 28% esophageal cancer. Providers and survivors discussed affordability challenges at the patient and system level. Patient-level challenges were: 1) High cost burden besides payments to providers (e.g., transportation, ostomy bags, nutritional supplements, non-antineoplastic drugs, feeding tubes, deductibles), and 2) Spending priorities outside of health care (e.g., patients prioritizing what to spend limited incomes on, which bills to pay). System-level affordability barriers included: 1) Care impacted by insurance processes (e.g., delays due to preauthorization or hospital out-of-network, surgery scheduled around deductible), and 2) Logistical burdens to access resources to help patients afford care (e.g., applying for grants). Two additional themes emerged from the providers’ interviews only: 1) Added costs due to scarcity of quality medical services (e.g., cost of repeating imaging procedures that were of poor quality), and 2) Poverty making it unfeasible to deliver guideline-concordant care (e.g., providers unable to provide recommended radiation treatment if patients need to travel long distances and have no money for gas). One more theme emerged from the survivors’ interviews only related to the burden of a confusing billing system (e.g., repeat billing for the same doctor). Conclusions: Many affordability-related challenges exist for the care of GI patients from disadvantaged states of the Deep South, and impact survivors and providers’ decision making about treatment and other needs. Future research should quantify the extent of these challenges and determine how they contribute to observed racial disparities in GI cancer surgery and other treatment.
Citation Format: Maria Pisu, Nataliya V. Ivankova, Jessica Morgan, Yu-Mei M. Schoenberger, Nathan C. English, Burkely P. Smith, Ivan I. Herbey, Courtney Williams, Bayley A. Jones, Wendelyn M. Oslock, Daniel I. Chu. Providers and survivors’ perspectives on affordability challenges for gastrointestinal cancer Black and White patients living in socioeconomically disadvantaged US states [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B127.