Patient-reported barriers for accessing supportive care among patients with metastatic cancer treated at a public cancer center in Mexico.

Abstract

124 Background: Although referral to supportive care (SC) services improves quality of life in patients with cancer, several barriers can hamper access to SC, particularly in developing countries with limited resources. We studied patient-reported barriers for accessing SC in a cancer center in Mexico City, and factors associated with those barriers. Methods: Patients with metastatic cancer enrolled in a randomized clinical trial of patient navigation to improve access to SC in a public cancer center in Mexico City (NCT03293849) were included. At baseline, sociodemographic and clinical characteristics were collected, and patients answered a survey in which they reported barriers to obtain cancer treatment and SC. We analyzed the frequency of reported barriers using descriptive statistics, and explored if sociodemographic factors were associated with a higher likelihood of reporting any barrier. Results: 134 patients were included between 08/17 and 04/18. Median age was 60 years (range 23-93; 51.5% male); 89.5% lived in urban areas; 42.5% had less than high school education; 12% had formal employment; and 27.3% had no insurance coverage. 61% had gastrointestinal, 16 % genitourinary, and 23 % other tumors. Home-to-hospital time was < 2 hours (h) in 60%, 2-6 h in 27%, and ≥6 h in 13%. 47.7% of the patients reported a household income of less than 630 USD/month. The mean number of reported barriers was 1.96 (Standard Deviation 1.77). 78% identified at least one barrier to care, and 35% reported ≥3 barriers (range 1-8). The most commonly reported barriers were: financial burden (47%), beliefs about treatment (28%), lack of transportation (22%), fear (19%), home-to-hospital distance (16%), patient-provider communication (13%), employment (9%), and caregiving for other people (3%). Patients living in rural areas more often reported home-to-hospital distance as a barrier than those living in urban areas (69 vs 11%, p < .01). Conclusions: Most patients with metastatic cancer seen at a cancer center in Mexico identified at least one barrier to cancer care, with some reporting up to 8. Many of the reported barriers are potentially modifiable through patient navigation or SC interventions.