Identifying the barriers to cancer care at safety-net hospitals: A novel comparison of a safety-net hospital to a neighboring quaternary referral academic institution in the same health care system.

Abstract

59 Background: The three-delays model for vulnerable and minority populations to receive care include delays in seeking, reaching, and receiving care. The dominant delay for vulnerable patients with gastric adenocarcinoma (GAC) is not known. Our aim was to define those patients with GAC who reached care at our regional safety-net hospital compared to academic centers from the National Cancer Database (NCDB). We also aimed to compare survival outcomes of patients who received curative-intent resection at our safety-net hospital to those in a nearby quaternary referral hospital. Methods: Grady-Memorial-Hospital (GMH), a safety-net hospital and Emory-University-Hospital (EUH), a quaternary referral hospital, are within the same healthcare-system. Clinicopathologic data of patients at presentation from NCDB-participating academic centers were compared with GMH from 2004-2014. Patients undergoing curative-intent resection of GAC at GMH were compared to those at EUH during a similar time period. Primary outcome for the latter was overall survival (OS). Results: At presentation, compared to NCDB-participating academic centers (n = 69,662), GMH patients (n = 154) were more likely to be black (85.1 vs 17.2%; p < 0.001), uninsured (30.5 vs 4.7%; p < 0.001), have stage IV disease (43.5 vs 30.1%; p = 0.017), and receive no treatment (40.3 vs 18.4%; p < 0.001). When only comparing those who underwent curative-intent resection at GMH (n = 23) to EUH (n = 137), median OS was similar between both groups (GMH: median not reached; EUH: 59.8mos; p = 0.785). Conclusions: Patients with gastric cancer who reached care at our safety-net hospital are more likely to be uninsured, have stage IV disease, and receive no treatment compared to academic centers. When they receive curative-intent resection, however, overall survival is similar. Efforts must be made to identify and overcome the barriers in seeking and reaching care for this vulnerable patient population, as it appears that outcomes are acceptable in those who receive care.