Abstract A092: “It’s not worth it”: A case study of one breast cancer patient’s barriers to treatment adherence

Abstract

Abstract Lower treatment adherence rates are a factor in disparate outcomes for cancer patients of color and cancer patients from lower-income backgrounds. Causes of reduced adherence are less clear. Social determinants of health and systemic racism likely play a role alongside individual and tumor biology, but how they impact individual patients may vary. This case study highlights the intersecting barriers that a post-menopausal, lower-income woman of color faced at a comprehensive cancer care center in the first months of her stage 3 triple negative breast cancer diagnosis. After presenting to her gynecologist with breast cancer symptoms, the patient was able to access same day diagnostic imaging. The next morning, the radiologist contacted her provider with the results: BIRADS 5. The provider referred the patient to the lay navigator partnering with her Federally Qualified Health Center to increase cancer screenings, and the navigator contacted the local comprehensive cancer care center to expedite diagnosis and treatment. The patient was biopsied and diagnosed with stage 3 triple negative breast cancer. She agreed to treatment at the cancer center, including enrollment in a clinical trial. The patient had dodged the disparities around diagnosis and connection to care, but everything seemed to go wrong once she started treatment. She relied on transportation offered by the cancer center, and her scheduled taxis arrived late or not at all, causing her to miss appointments. Her disability paperwork was delayed. Her prescriptions were sent to the wrong pharmacy. Infusion clinic appointments were cancelled or rescheduled at the last minute, without communicating changes to the patient or rescheduling transportation. The patient also struggled with the costs of cancer after losing her steady paycheck. She had difficulty paying for her medications and had to deal with inadequate insurance coverage. Her landlord threatened to evict her. There were delays in processing her Supplemental Nutrition Assistance Program (SNAP) application and subsequent coverage, so she relied on food pantries where fresh food was hard to find. The patient repeatedly faced barriers that were compounded by her socioeconomic status. The navigator supported her when possible, advocating and connecting her to social work, legal aid, and the cancer center’s new financial empowerment lead, who in turn connected the patient to more resources. It was enough to keep the patient in treatment, though she often spoke to the navigator about stopping, saying it was not worth all the difficulties. She was unable to focus on her health and her treatment; there was always another barrier on the horizon. In this case, a lower-income woman of color faced barriers to treatment adherence such as hours late taxis, cancelled appointments, and delays with Disability and SNAP. This patient’s fight to stay in treatment highlights adherence barriers beyond symptom burden and distrust of institutions. Her story is likely many cancer patients’ stories. We must change this broken system. Citation Format: Laura A. Brady, Tameka Brooks, Kathryn Glaser. “It’s not worth it”: A case study of one breast cancer patient’s barriers to treatment adherence [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A092.