Addressing disparities by implementing a supportive care program in oncology.

Abstract

11082 Background: Financial toxicity, transportation needs, and emotional strain are known barriers to receipt of cancer care and cause for disparities in cancer outcomes. We sought to evaluate the implementation of a supportive care program (SCP) on the delivery of cancer care, its associated health care utilization outcomes and cost. Methods: From May 2022-Nov 2024, SCP included a standardized social determinant of health (SDOH) screening tool, financial navigation, transportation ridesharing, and peer-support program in the 5 gynecologic oncology practices within a NCI Comprehensive Cancer Center. Patients were referred through the SDOH screener or usual clinical care referrals. We report descriptive statistics on the mechanism for referral for SCP, associated health care utilization, and costs. We assessed differences in SCP financial and transportation sub-groups with bivariable non-parametric testing (p-value< .05 considered statistically significant). Results: Of 7159 patients encompassing 22041 encounters, 259 received SCP (41 financial navigation, 177 transportation, 3 transportation + financial navigation, 18 peer-support program). Only 73 (28.7%) were referred through the SDOH screening tool, and the rest through usual clinical care. Most SCP recipients (60.6%) were Black/Asian/Other, in contrast to our general clinical population (63% White). Only 65 (25.6%) of SCP patients were employed, and 72.8% had Medicare or Medicaid. Nearly all SCP patients resided in the MidAtlantic tristate area. Patients receiving financial navigation were younger (p<0.001), more likely to be privately insured (p<0.001), and less likely to reside in the metropolitan area (43.9% v. 63.8%, p=0.05) compared to those receiving transportation. A total of 1770 rides were completed, costing $51885.20 which included the ride and administrative scheduling fee. A total of 14 SCP participants were clinical trial participants; of these, 78.6% utilized transportation assistance. Following receipt of SCP, the total scheduled visits for SCP patients included 7768 visits. Patients receiving transportation assistance had higher rates of unplanned admission (43.5% v. 22.0%, p=0.011), and no-show rates (4.6% vs 1.2%, p<0.001) compared to those receiving financial navigation. Conclusions: Our SCP served primarily racial-minority and publicly insured patients. Only 25% were employed during active cancer treatment. Transportation was the most frequently used SCP service, including by our clinical trial participants. Patients with transportation needs had higher rates of unplanned admissions and no-shows than those receiving financial navigation. Financial toxicity affected younger patients including those privately insured. SCP facilitates cancer care delivery, but requires infrastructural development, substantial investment in resources, and further analyses of health care utilization, outcomes and cost.