Social Service Barriers Delay Care Among Women with Abnormal Cancer Screening
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Inequity in cancer outcomes for minorities and vulnerable populations has been linked to delays in cancer care that arise from barriers to accessing care. Social service barriers represent those obstacles related to meeting life’s most basic needs, like housing and income, which are often supported by public policy, regulation and services.
To examine the association between social service barriers and timely diagnostic resolution after a cancer screening abnormality.
Secondary analysis of the intervention arm of Boston Patient Navigation Research Program (2007–2008) conducted across six urban community health centers. Subjects with no barriers, other barriers, and social service barriers were compared on their time to diagnostic resolution.
Women ≥ 18 years of age with a breast or cervical cancer screening abnormality.
Social service barriers included: income supports, housing and utilities, education and employment, and personal/family stability and safety. Time to event analyses compared across five groups: those with no barriers, one barrier (other), one barrier (social service), two or more barriers (all other), and two or more barriers (at least one social service).
1,481 navigated women; 31 % Hispanic, 27 % Black, 32 % White; 37 % non-English speakers and 28 % had private health insurance. Eighty-eight women (6 %) had social service barriers. Compared to those without social service barriers, those with were more likely to be Hispanic, younger, have public/no health insurance, and have multiple barriers. Those with two or more barriers (at least one social service barrier), had the longest time to resolution compared to the other four groups (aHR resolution < 60 days = 0.27, ≥ 60 days = 0.37).
Vulnerable women with multiple barriers, when at least one is a social service barrier, have delays in care despite navigation. The impact of patient navigation may never be fully realized if social service barriers persist without being identified or addressed.
KEY WORDSaccess to care cancer disparities vulnerable populations
Our sincere appreciation to the Boston Patient Navigation Research Program (The National Cancer Institute NCI U01CA116892) for providing the data necessary to complete these analyses, and to MLP|Boston for their collaboration on this research. This research was supported by a training grant from Susan G. Komen for the Cure (KG101421). Preliminary findings from this study were previously presented at the American Association for Cancer Research (AACR) Conference on The Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved (October 2012), and at the American Public Health Association Annual Meeting (October 2012).
Conflict of Interest
The authors declare that they do not have a conflict of interest.
- 1.American Cancer Society. Cancer Facts & Figures 2012. Atlanta: American Cancer Society.Google Scholar
- 3.Healthy People 2020. 2013 social determinants of health. Available at: http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=39. Accessed August 20, 2013.
- 4.American Cancer Society. Cancer Facts & Figures 2012. Atlanta: American Cancer Society, 2012. Available at: http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-031941.pdf. Accessed August 20, 2013.
- 5.Retkin RBJ, Bacich C. Impact of legal interventions on cancer survivors. Legal Health 2007. Available at: http://legalhealth.org/wp-content/uploads/2012/07/FinalReportImpactofLegalInterventionsoncancersurvivors.pdf
- 6.The Robert Wood Johnson Foundation. Health Care’s blindside: The overlooked connection between social needs and good health: summary of findings from a survey of America’s physicians. Dec. 2011. Available at: http://www.rwjf.org/content/dam/farm/reports/surveys_and_polls/2011/rwjf71795. Accessed August 20, 2013.
- 8.Epstein RM, Fiscella K, Lesser CS, Stange KC. Why the nation needs a policy push on patient-centered health care. Health Aff (Millwood). 29(8):1489–95.Google Scholar
- 9.Battaglia TA, Bak SM, Heeren T, et al. Boston patient navigation research program: the impact of navigation on time to diagnostic resolution after abnormal cancer screening. Cancer Epidemiol Biomarkers Prev. 21(10):1645–54.Google Scholar
- 10.American College of Surgeons. Commission on Cancer. Cancer Program Standards 2012: Ensuring patient centered care. Available at: http://www.sgmc.org/sites/www/Uploads/COC%20Program%20Stds%202012.pdf. Accessed August 20, 2013.
- 11.American College of Surgeons. National accreditation program for breast centers; 2011 [cited 2011 Mar 28]. Available at: http://accreditedbreastcenters.org/accreditation/application.html. Accessed August 20, 2013.
- 14.Raich PC, Whitley EM, Thorland W, Valverde P, Fairclough D. Patient navigation improves cancer diagnostic resolution: an individually randomized clinical trial in an underserved population. Cancer Epidemiol Biomarkers Prev. 21(10):1629–38.Google Scholar
- 16.American College of Radiology (ACR). Illustrated breast imaging reporting and data System (BI-RADS). 4th ed. Reston VA: American College of Radiology; 2003.Google Scholar
- 17.Paskett ED, Katz ML, Post DM, et al. The Ohio Patient Navigation Research Program: does the American Cancer Society patient navigation model improve time to resolution in patients with abnormal screening tests? Cancer Epidemiol Biomarkers Prev. 21(10):1620–8.Google Scholar
- 18.Hoffman HJ, LaVerda NL, Young HA, et al. Patient navigation significantly reduces delays in breast cancer diagnosis in the District of Columbia. Cancer Epidemiol Biomarkers Prev. 21(10):1655–63.Google Scholar
- 19.National Patient Navigation Consortium. Available at: http://nationalpatientnavigationconsortium.com/. Accessed August 20, 2013.
- 20.National Center for Medical Legal Partnership. MLP Network. (2012) Available at: http://www.medical-legalpartnership.org/. Accessed August 20, 2013.
- 21.Medical Legal Partnership Boston. (2013) Available at: http://www.mlpboston.org/. Accessed August 20, 2013.
- 23.Weintraub D, Rodgers MA, Botcheva L, et al. Pilot study of medical-legal partnership to address social and legal needs of patients. J Health Care Poor Underserved. 21(2 Suppl):157–68.Google Scholar