Barriers to Accessing Optimal Esophageal Cancer Care for Socioeconomically Disadvantaged Patients
Barriers to Accessing Optimal Esophageal Cancer Care for Socioeconomically Disadvantaged Patients
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DOI：
10.1016/j.athoracsur.2016.08.085
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发表时间：
2017-02-01
影响因子：
4.6
通讯作者：
Reddy, Rishindra M.
中科院分区：
文献类型：
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作者：
Lineback, Christina M.;Mervak, Colin M.;Reddy, Rishindra M.
背景低社经地位食管癌患者的5年生存率明显低于高社经地位食管癌患者。人们对造成这些更糟糕结果的原因知之甚少。我们假设，一个定性的方法可以阐明这些差异的根本原因。通过地区癌症中心的传单以及癌症支持团体和报纸上的Facebook广告招募诊断为食道癌的患者;他们参加了1小时的半结构化面试或完成了在线调查。患者被分为低SES组和高SES组，并对他们的健康史和获得癌症护理的情况进行调查。根据参与者的回答将数据编码为共同主题。80名患者完成了访谈或调查，其中高SES组38名，低SES组42名。两组之间的合并症和癌症分期没有临床显著差异。SES低的患者接受手术治疗的比率明显较低（19/42 [44.7%]对比29/38 [76.3%]; p = 0.0048），第二意见率下降（42人中有10人[23.8%]对38人中有25人[65.8%]; p = 0.00016），更有可能失去工作（14/42 [33.3%]对比1/38 [2.6%]; p = 0.00044）。主题分析发现，沟通困难，缺乏对治疗的理解，和经济困难，一贯报告更突出的低社会经济地位组。有一个促进者（如社会工作者）通过帮助患者导航复杂的治疗和财务问题来改善护理。存在经济和沟通障碍，这可能导致低SES患者的癌症结局差异。迫切需要医疗倡导者帮助资源有限的患者。(C)2017胸外科医师协会
Background. The 5-year survival of patients with low socioeconomic status (SES) and esophageal cancer is significantly lower than that in patients with high SES. It is poorly understood what causes these worse outcomes. We hypothesized that a qualitative approach could elucidate the underlying causes of these differences.Methods. Patients with a diagnosis of esophageal cancer were recruited through flyers in regional cancer centers as well as through Facebook advertisements in cancer support groups and newspapers; they participated in a 1-hour semistructured interview or completed an online survey. Patients were stratified into low-and high-SES groups and were surveyed about their health history and access to cancer care. Data were coded into common themes based on participant responses.Results. Eighty patients completed the interviews or surveys, with 38 in the high-SES group and 42 in the low-SES group. There were no clinically significant differences between the groups in comorbidities and cancer staging. Patients with low SES were offered operative treatment at significantly lower rates (19 of 42 [44.7%] versus 29 of 38 [76.3%]; p = 0.0048), had a decreased rate of second opinions (10 of 42 [23.8%] versus 25 of 38 [65.8%]; p = 0.00016), and were more likely to lose their jobs (14 of 42 [33.3%] versus 1 of 38 [2.6%]; p = 0.00044) than their high-SES counterparts. Thematic analysis found that communication difficulties, lack of understanding of treatment, and financial troubles were consistently reported more prominently in the lower-SES groups. Having a facilitator (eg, social worker) improved care by helping patients navigate complex treatments and financial concerns.Conclusions. Financial and communication barriers exist, which may lead to disparities in cancer outcomes for patients with low SES. There is a critical need for medical advocates to assist patients with limited resources. (C) 2017 by The Society of Thoracic Surgeons