UC Irvine

Cancer health disparities in people with disability have received limited attention. This study aimed to investigate the barriers to accessing timely healthcare and health-related outcomes in cancer patients with disability. Cancer patients with a diagnosis of breast cancer, lung cancer, colorectal cancer, skin cancer, pancreatic cancer, gastric cancer and oesophageal cancer were extracted from the NIH All of Us Research Program. Participants were stratified by disability status and then matched by propensity scores. Survey responses were compared using Pearson’s chi-squared tests for categorical variables and t-tests for continuous variables. Patients with disability (N=4,546) were more likely to be non-White, unemployed for wages, uninsured, had less annual household income and less advanced education. Propensity score matching resulted in 4,437 participants in each cohort. The disability cohort was more likely to report delayed medical care due to high out-of-pocket (15%), feeling nervous about seeing a provider (12.2%), lacking transportation (10.8%), co-pay (7.1%) and distance (4.2%). In addition, the financial burden of accessing healthcare was more profound in patients with disability. Dental care (20.5%) was the most common unaffordable service, followed by eyeglasses (15.5%), prescription medicines (14.5%), specialty care (10.6%), follow-up care (8.1%), mental health care or counselling (7.1%) and emergency care (4.5%). Also, cost-related medical non-adherence was more frequent in the disability cohort, including delaying filling prescriptions (11.1%) and skipping doses (6.5%). Further, the disability cohort reported worse physical health, mental health and quality of life. In conclusion, this study demonstrated that cancer patients with disability face significant disadvantages and encounter significant barriers in accessing and affording healthcare, resulting in poorer overall health and quality of life.