title: Obstacles to cancer care: focus on the economically disadvantaged.
abstract: OBJECTIVE
  To provide additional documentation of the unmet cancer prevention and control needs of poor Americans.
  
  
  METHODS
  Qualitative analysis of testimony provided at American Cancer Society hearings on cancer and the poor.
  
  
  METHODS
  46 economically disadvantaged individuals with personal experiences with cancer.
  
  
  METHODS
  Review of transcription of oral testimony and qualitative analysis for recurrent themes to identify common obstacles to cancer care.
  
  
  RESULTS
  Six major obstacles were identified: care was deferred because of costs; care was described as "fragmented," "impersonal," and "symptomatic;" patients were discouraged from worrying about bodily changes; patients were discouraged from seeking state-of-the-art care; poor patients experienced difficulty communicating their needs and concerns; and poverty interfered with efforts to participate in volunteer activities.
  
  
  CONCLUSIONS
  Testimony is suggestive of the problems that poor patients with cancer face. Challenges to improve the situation include expanding and extending diagnostic, treatment, and rehabilitative services to the poor; facilitating education and prevention; and further research to document the scope of the problem.
  
  
  CONCLUSIONS
  Nurses should engage in the debate over healthcare reform and take advantage of the opportunities to define and participate in the development of procedures, strategies, and systems for removing obstacles to quality cancer prevention and care for the poor.
authors.affiliation: University of Wisconsin-Milwaukee School of Nursing.
authors.forename: S M
authors.initials: SM
authors.lastname: Underwood
authors.forename: D
authors.initials: D
authors.lastname: Hoskins
authors.forename: T
authors.initials: T
authors.lastname: Cummins
authors.forename: K
authors.initials: K
authors.lastname: Morris
authors.forename: A
authors.initials: A
authors.lastname: Williams
mesh_terms: D000328:Adult; D000368:Aged; D000570:American Cancer Society; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D003266:Continuity of Patient Care / Q000191:economics; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D018166:Health Care Reform; D006297:Health Services Accessibility / Q000191:economics*; D006301:Health Services Needs and Demand; D006801:Humans; D007182:Income; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000191:economics / Q000451:nursing / Q000517:prevention & control* / Q000523:psychology; D010353:Patient Education as Topic; D011203:Poverty; D011369:Professional-Patient Relations; D014481:United States; D014838:Volunteers