Abstract C076: Experiences of oncologists caring for Hispanic older adults with colorectal cancer and multiple chronic conditions
Authors: Castaneda-Avila Maira A. , Latoni Daniela , Sabatino Meagan J. , Ortiz-Ortiz Karen J. , Lapane Kate 
Published: December 2023

Abstract
Background: In Puerto Rico, colorectal cancer (CRC) is the leading cause of cancer deaths. Patients with CRC often present with multiple chronic conditions (MCC), making it difficult for oncologists to coordinate their care. This qualitative study explores oncologists' perspectives of care among patients with CRC and MCC in Puerto Rico. Methods: Semi-structured interviews (n=9) were conducted with oncologists providing care for Hispanic older adults with CRC in Puerto Rico. Thematic analysis was employed to identify key themes and subthemes. Results: We identified several key themes related to social determinants of health, diagnosis pathways, treatment decisions, survivorship, end-of-life care, and care coordination. Oncologists reported a high prevalence of MCC, including comorbidities such as diabetes, high blood pressure, cholesterol problems, and hypothyroidism. Limited social support was identified as a care coordination challenge, as many patients undergo treatments without adequate support networks. Access to healthcare providers was a noted concern, due to a provider shortage and the absence of specialized cancer care. The health insurance system has been identified as having several issues, particularly concerning the requirement of pre-authorization for different procedures and treatments. These challenges can be especially problematic for older adults, who often lack a strong support system and may experience difficulties comprehending the process. Transportation issues and a lack of nearby services were noted as barriers for patients requiring specialized care. Diagnosis pathways varied, with some patients having undergone routine screenings when CRC was identified, while others presented with suspected CRC symptoms. Oncologists noted that the cancer stage was the most important factor when making treatment decisions, in addition to the diagnosis of MCC and the patient's ability to tolerate treatment. Other factors influencing treatment decisions included the patient's age, physical condition, and appointments attendance. For patients in advanced stages, end-of-life planning and palliative care were crucial for ensuring a dignified and comfortable transition, with discussions around hospice care and managing pain and symptom relief being essential components. Care coordination and communication were identified as challenging to manage when multiple providers and procedures were needed, often requiring patients to schedule appointments with different specialists themselves. Inter-provider communication and collaboration relied on various methods; however, phone calls or notes sent through the patient were the primary methods. Conclusions: Oncologists caring for Hispanic older adults with CRC and MCC face multiple, complex challenges influenced by social determinants of health and the presence of comorbidities. Tailored approaches to address disparities, culturally sensitive care, and improved coordination among healthcare providers are needed to enhance the quality of care in this patient population.
Citation Format: Maira A. Castaneda-Avila, Daniela Latoni, Meagan J. Sabatino, Karen J. Ortiz-Ortiz, Kate Lapane. Experiences of oncologists caring for Hispanic older adults with colorectal cancer and multiple chronic conditions [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C076.