title: Factors influencing patient pathways for receipt of cancer care at an NCI-designated comprehensive cancer center.
abstract: BACKGROUND
  Within the field of oncology, increasing access to high quality care has been identified as a priority to reduce cancer disparities. Previous research reveals that the facilities where patients receive their cancer care have implications for cancer outcomes. However, there is little understanding of how patients decide where to seek cancer care. This study examined the factors that shape patients' pathways to seek their cancer care at a National Cancer Institute-designated comprehensive cancer center (NCI-CCC), and differences in these factors by race, income and education.
  
  
  METHODS
  In-depth interviews and survey questionnaires were administered to a random sample of 124 patients at one NCI-CCC in the Northeast US. In-depth interview data was first analyzed qualitatively to identify themes and patterns in patients' pathways to receive their cancer care at an NCI-CCC. Logistic Regression was used to examine if these pathways varied by patient race, income, and education.
  
  
  RESULTS
  Two themes emerged: following the recommendation of a physician and following advice from social network members. Quantitative data analysis shows that patient pathways to care at an NCI-CCC varied by education and income. Patients with lower income and education most commonly sought their cancer care at an NCI-CCC due to the recommendation of a physician. Patients with higher income and education most commonly cited referral by a specialist physician or the advice of a social network member. There were no statistically significant differences in pathways to care by race.
  
  
  CONCLUSIONS
  Our findings show that most patients relied on physician recommendations or advice from a social network member in deciding to seek their cancer care at an NCI-CCC. Due to the role of physicians in shaping patients' pathways to the NCI-CCC, initiatives that strengthen partnerships between NCI-CCCs and community physicians who serve underserved communities may improve access to NCI-CCCs.
authors.affiliation: Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, United States of America.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Gage-Bouchard
authors.affiliation: Cancer Prevention & Population Sciences, Roswell Park Cancer Institute, Buffalo, NY, United States of America.
authors.forename: Elisa M
authors.initials: EM
authors.lastname: Rodriguez
authors.affiliation: Department of Cancer Control Prevention & Population Sciences, Roswell Park Cancer Institute, Buffalo, NY, United States of America.
authors.forename: Frances G
authors.initials: FG
authors.lastname: Saad-Harfouche
authors.affiliation: Department of Biostatistics & Bioinformatics, Roswell Park Cancer Institute, Buffalo, NY, United States of America.
authors.forename: Austin
authors.initials: A
authors.lastname: Miller
authors.affiliation: Department of Cancer Control Prevention & Population Sciences, Roswell Park Cancer Institute, Buffalo, NY, United States of America.
authors.forename: Deborah O
authors.initials: DO
authors.lastname: Erwin
mesh_terms: D002173:Cancer Care Facilities; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D054547:National Cancer Institute (U.S.); D012017:Referral and Consultation; D012944:Social Support; D011795:Surveys and Questionnaires; D014481:United States