Patient-Reported Barriers to Healthcare Access Among Patients with Gastrointestinal Cancer: Insights from 45,000 Participants in the All of Us Research Program.
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BACKGROUND: Gastrointestinal (GI) cancer patients often face care delays and cost-related unmet needs, increasing the probability for treatment nonadherence and adverse outcomes. The extent of these barriers within the first three months of diagnosis remains unclear. We aimed to identify early barriers to care for targeted interventions. METHODS: A retrospective analysis using the All of Us database included patients with esophageal, stomach, small intestine, pancreatic, hepatocellular, biliary, colorectal, or anal cancer. Patients were stratified into two cohorts based on survey completion. Reasons for delays in care and cost-related unmet needs were included as dependent variables. Propensity score matching (PSM) and logistic regression evaluated the impact of time from diagnosis. RESULTS: Among 45,061 GI cancer patients, 89.4% were underrepresented in biomedical research. Patients surveyed within three months of diagnosis had higher rates of delays in care (16.9% vs. 14.0%, p < 0.001), driven by affordability, childcare, and transportation (all p < 0.001). Overall cost-related unmet needs did not differ significantly (< 3 months 20.9% vs. >3 months 19.7%, p = 0.204), but differences in unmet prescription and alternative therapy needs persisted. After PSM, early-diagnosis patients had no differences in delays in care but were more likely to report cost-saving behaviors such as using lower-cost prescriptions (OR 1.28, 95% CI 1.05-1.54) and alternative therapies (OR 1.48, 95% CI 1.08-2.01) to save money. CONCLUSION: Cost-related unmet needs exist in the first three months after GI cancer diagnosis. This study underscores the importance of addressing social determinants of health early in cancer care.