Barriers to Accessing Optimal Esophageal Cancer Care for Socioeconomically Disadvantaged Patients.
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.
Section of Thoracic Surgery, University of Michigan Medical School, Ann Arbor, Michigan.
Christina M
CM
Lineback
Section of Thoracic Surgery, University of Michigan Medical School, Ann Arbor, Michigan.
Colin M
CM
Mervak
Department of Surgery, University of Michigan, Ann Arbor, Michigan.
Sha'shonda L
SL
Revels
Section of Thoracic Surgery, University of Michigan Medical School, Ann Arbor, Michigan.
Micheal T
MT
Kemp
Section of Thoracic Surgery, University of Michigan Medical School, Ann Arbor, Michigan; Department of Surgery, University of Michigan, Ann Arbor, Michigan. Electronic address: reddyrm@umich.edu.
Rishindra M
RM
Reddy
D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000191:economics / Q000628:therapy*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008824:Michigan; D008875:Middle Aged; D009367:Neoplasm Staging; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D035862:Vulnerable Populations