Navigating Access to Cancer Care: Identifying Barriers to Precision Cancer Medicine

Abstract

Objective: Precision medicine is revolu­tionizing cancer treatment. However, there has been limited investigation of barriers patients endure to access precision cancer medicine. This study aims to report the experiences of underserved patient popula­tions with limited access to genomic testing, clinical trials, and precision cancer treat­ment.Methods: A mixed-method study was employed to quantitatively evaluate patients (N=300) seeking precision cancer medi­cine between January 2014- August 2017. Qualitatively, we conducted semi-structured interviews with eight case managers who navigate the health care and health insur­ance systems to provide patients with access to precision cancer medicine care. All inter­views were analyzed to identify themes.Results: Within our patient cohort, 69% were diagnosed in stage I of cancer disease. Overall, 27 patients (9%) were denied treat­ment as a final outcome of their case due to insurance denials, 35 patients (12%) died before gaining access to precision cancer medicine, and 6 patients (2%) received precision cancer medicine through clinical trials. Four broad thematic areas emerged from the qualitative analysis: 1) lack of patient, provider and insurer knowledge of precision cancer medicine; 2) barriers to clinical trial participation; 3) lack of patient health literacy; and 4) barriers to timely access to care.Conclusion: Our combined analyses sug­gest that both system-level and patient-level barriers limit patient access to precision cancer medicine options. Additionally, we found that these barriers may exist not only for traditionally underserved patients, but also for resourced and insured patients trying to access precision cancer medicine. Ethn Dis. 2022;32(1):39-48; doi:10.18865/ed.32.1.39