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The Intersection of Cancer and Disability: Improving Cancer Care for Patients with Disabilities
*Jiali Cai, *Oliver Eng, *Maheswari Senthil, Ninh Nguyen, *
Thuy B. TranSurgery, University of California Irvine, Orange, CA
Objective: Much needed awareness of issues and challenges that people with disabilities and cancer face when accessing health-care systems and how their needs differ from those patients without disabilities. These patients face unique barriers that can influence their ability to access timely surgical care for their cancer. The objective of this study is to evaluate barriers to accessing timely health care and health-related outcomes in cancer patients with disabilities.
Methods: Patients with diagnosis of breast, lung, colorectal, melanoma, pancreatic, and esophageal cancer were extracted using the All of Us Research Program. Patients were stratified by disability status based on presence of any of the following impairments: mobility, hearing, vision, communication, and cognition. Propensity score 1:1 matching was performed to balance the groups. Outcomes on healthcare access, financial burden, and emotional and physical health were assessed using patient-reported surveys.
Results: A total of 13,714 patients were identified to have no disability while 4,546 patients had disability reported. Those with disability tended to be older than those without disability (67 vs. 65 years, P<0.001). Higher rates of disability were reported in Hispanic and Black patients (P<0.001). The majority of patients with disability reported lower annual household income less than 50k (59% vs. 25.8%, P<0.001) and higher rates of unemployment (76.5% vs. 46.6%, P<0.001). After propensity score matching, patients with disability reported higher rates of out-of-pocket costs (15% vs. 11.3%, P<0.001) and lack of transportation (10.% vs. 3.8%, P<0.001). Patients with disability also reported difficulty accessing prescription medications (14.5% vs. 7.7%, P<0.001), lack of mental health counseling (7.1% vs. 3.9%, P<0.001), difficulty seeing specialist (10.6% vs 6.2%. P<0.001), and difficulty obtaining follow-up care (8.1% vs. 4.8%, P<0.001). Those with disability also reported higher pain scores and lower quality of life scores (P<0.001).
Conclusions: Cancer patients with disability encounter significant barriers to accessing medical and surgical care, resulting in worse overall health and poor quality of life. Further research is needed to raise awareness of the scale and nature of disabilities impacting access to cancer care as well as identify potential interventions to close the gap in health care inequities for this vulnerable population with cancer.
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