Butensky Samuel D, Schultz Kurt S, Godfrey Elizabeth L, Kim Jihoon, Johnson Caroline H, Leeds Ira, Khan Sajid A
Yale New Haven Hospital.
Yale University.
Res Sq. 2025 Jul 29:rs.3.rs-6855375. doi: 10.21203/rs.3.rs-6855375/v1.
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.
A retrospective analysis using the 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.
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.
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.
胃肠道（GI）癌症患者常常面临护理延迟以及与费用相关的未满足需求，这增加了治疗不依从和不良后果的可能性。在诊断后的前三个月内，这些障碍的程度尚不清楚。我们旨在确定护理的早期障碍，以便进行有针对性的干预。
使用该数据库进行回顾性分析，纳入了患有食管癌、胃癌、小肠癌、胰腺癌、肝细胞癌、胆管癌、结直肠癌或肛门癌的患者。根据调查完成情况，将患者分为两个队列。护理延迟的原因和与费用相关的未满足需求作为因变量。倾向得分匹配（PSM）和逻辑回归评估了诊断时间的影响。
在45061例胃肠道癌症患者中，89.4%在生物医学研究中的代表性不足。在诊断后三个月内接受调查的患者护理延迟率较高（16.9%对14.0%，p<0.001），原因是费用负担、儿童照料和交通问题（均p<0.001）。总体而言，与费用相关的未满足需求没有显著差异（<3个月为20.9%，>3个月为19.7%，p = 0.204），但未满足的处方需求和替代疗法需求仍存在差异。经过PSM后，早期诊断的患者在护理延迟方面没有差异，但更有可能报告为省钱而采取的节省费用行为，如使用低成本处方（OR 1.28，95%CI 1.05 - 1.54）和替代疗法（OR 1.48，95%CI 1.08 - 2.01）。
在胃肠道癌症诊断后的前三个月存在与费用相关的未满足需求。本研究强调了在癌症护理早期解决健康的社会决定因素的重要性。
