Abstract 1009: Direct partnering with employers and unions diversifies cancer center access
Authors: Waters Michele , Crewse Greg , Manship Cole , Baldwin-Medsker Abigail , Fong Chris , Schultz Nikolaus , Giralt Sergio , Roman Benjamin , Johnson Michelle , Gany Francesca , Brown Carol , Li Bob T. , Jee Justin 
Published: March 2024

Abstract
Treatment at academic cancer centers can further research and improve patient outcomes. Interventions improving access to treatment across racial, ethnic, and socioeconomic boundaries might increase the generalizability of studies conducted at such centers and reduce healthcare inequities. Memorial Sloan Kettering (MSK) is an academic cancer center based in New York and New Jersey (NY/NJ). Like many other NCI-designated cancer centers, it has historically served a population within its geographic catchment, with limited diversity. MSK Direct is a national cancer benefits program that partners with employers and unions to provide a direct referral service for their employees or members and their families, including in-person care and remote second opinions outside NY/NJ. Whether such programs diversify access to academic cancer care is understudied.
To evaluate whether the service diversifies access to academic cancer care, we examined the self-identified race and ethnicity, geographic composition, and imputed socioeconomic status (Yost Index) of MSK Direct and non-MSK Direct (Control) patients with at least one assessment note at MSK since program inception in 2016 until September 21, 2023. We further stratified MSK Direct patients based on referral by employers vs. unions. Groups were compared using Chi-square or Student T tests.
The MSK Direct patient population (N=8,604) was more racially diverse than the Control population (N=283,434), with 9.0% Black/African American patients compared to 6.9% Control (p&lt;0.001) patients and 9.3% Asian-Far East/Indian Subcontinental patients compared to 7.5% Control patients (p&lt;0.001). Of MSK Direct patients, 10.5% identified as Hispanic or Latino vs. 7.5% of Control patients (p&lt;0.001). Among MSK Direct patients, 14.2% of union-member patients self-identified as Black vs. 6.1% of non-union members, while Asian patients comprised 12.1% of company-referral patients vs. 5.8% of union patients. Hispanic patients represented 17.4% of union-referral patients vs. 6.5% of company referrals. The median Yost Index of union MSK Direct patients was 25 vs. 12 (non-union) and 17 (Control, p&lt;0.001), signifying a less privileged socioeconomic status for union-referred patients. A total of N=336 MSK Direct patients received guidance through remote second opinions across 41 states, with the most common home states being Georgia, Arizona, and Florida.
Addressing healthcare disparities in diverse populations is a complex and systemic challenge. Direct partnerships with employers and unions are a new paradigm that may expand access to academic cancer care outside a center’s usual geographic and sociodemographic catchment. Different partnering strategies may enhance the representation of specific patient populations.
Citation Format: Michele Waters, Greg Crewse, Cole Manship, Abigail Baldwin-Medsker, Chris Fong, Nikolaus Schultz, Sergio Giralt, Benjamin Roman, Michelle Johnson, Francesca Gany, Carol Brown, Bob T. Li, Justin Jee. Direct partnering with employers and unions diversifies cancer center access [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 1009.