Financial instability, insurance, and transportation influence timely head and neck cancer care in the United States: Patient and healthcare worker perspectives.

INTRODUCTION

Delays in head and neck cancer (HNC) diagnosis and treatment and financial burdens of care are often rooted in social determinants of health (SDOH), such as financial instability, socioeconomic status (SES), health insurance status, and transportation barriers. While these factors are well recognized, their underlying impact on access to care remains underexplored; this qualitative study aims to investigate how these SDOH facilitate or hinder HNC care through insights from patients and healthcare workers (HCWs) in the United States, to identify targets for intervention.

METHODS

Semi-structured interviews were conducted with patients with newly diagnosed HNC, and HCWs caring for these patients, between June 2022 and July 2023. Audio-recorded interviews were transcribed. Iterative deductive and inductive analysis was performed using NVivo 1.7.1 with two coders to identify mechanisms by which SDOH shaped HNC care processes.

RESULTS

A total of 72 participants were interviewed, including 42 patients with HNC (mean age 57 years, range 19-81; 64 % female; 81 % white) and 30 HCWs (mean age 42 years, range 20-68; 77 % female; 83 % white). In analysis, three mechanisms were identified: (1) socioeconomic instability forces patients to make critical choices, (2) the added burden of addressing health insurance gaps falls on patients, and (3) transportation-related financial and logistical barriers disrupt care processes.

CONCLUSION

Financial instability, insurance gaps, and transportation challenges create barriers to HNC care for disadvantaged patients. Understanding these SDOH can improve care timeliness and patient experiences.