Abstract A130: Stakeholder perspectives of the multi-level barriers to treatment among rural endometrial cancer patients: A qualitative study
Authors: Spees Lisa P. , Biru Blen M. , Brewster Wendy R. , Leeman Jennifer , Taffe Brianna , Wheeler Stephanie B. 
Published: December 2023

Abstract
Purpose. Rural individuals with endometrial cancer (EC) have an 8-17% higher mortality risk than their urban counterparts. EC patients have distinct needs, such as requiring treatment to be directed by gynecologic oncologists who are often located in urban areas or at academic medical centers. Our objective was to identify barriers to treatment of rural EC patients. Methods. We conducted semi-structured interviews with 25 providers (e.g. gynecologic oncologists, nurses, pharmacists), and healthcare administrators who provided services to EC patients. Participants represented three large and geographically-diverse, integrated healthcare systems located across North Carolina. A semi-structured interview guide was developed to examine the treatment process and then probe on multi-level barriers to treatment. Initial codes were derived from an adapted multi-level conceptual framework of rural cancer control. We used template analysis to analyze transcribed interviews. Results. The majority of interview participants were gynecologic oncologists (n=7) and nurses (n=7). Participants highlighted barriers at multiple levels, including the patient-, provider/clinic-, and community-levels. At the patient-level, common barriers included patients’ anxiety and fears about undergoing treatment as well as patients’ low medical literacy. Patients without a support network or caregiver often encountered logistical problems when it came to traveling and planning their treatment; in some cases, interviewees said patients would have to hire someone to take them to their treatment appointments. At the provider/clinic-levels, interviewees reported that providers were not always made aware of supportive resources, such as gas cards, that were available to patients; this was particularly a problem since, to access these resources, patients often had to be referred by a provider. At the same time, however, providers who were aware of these supportive resources said that only a limited amount was available and insufficient in meeting patients’ needs. Finally, at the community-level, treatment services for patients with gynecologic malignancies were often only available at large urban or academic medical centers; consequently, EC patients frequently faced geographic barriers and had to travel long distances for treatment. This travel burden for treatment created financial hardship for patients, due to the increased temporary housing and travel costs. Furthermore, even if there were oncology-related providers within a patient’s community, most did not have appropriate experience or feel comfortable in treating patients with EC. Among the few community-based oncology-related providers that would treat EC patients, interviewees expressed concerns about the quality of care received by these patients as they could not oversee or direct the patient’s treatment plan. Conclusions. To achieve equitable outcomes among EC patients, those living in rural areas may require more intensive outreach, support, and resources that can effectively target multi-level barriers.
Citation Format: Lisa P. Spees, Blen M. Biru, Wendy R. Brewster, Jennifer Leeman, Brianna Taffe, Stephanie B. Wheeler. Stakeholder perspectives of the multi-level barriers to treatment among rural endometrial cancer patients: A qualitative study [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 A130.