Availability and affordability of colorectal cancer screening and diagnostic services within a patient navigator research program

A61

Background: The NCI Patient Navigator Research Program (PNRP) is designed to assist racial/ethnic minorities, individuals with low socioeconomic status, and residents of rural areas, disproportionately affected by cancers, to obtain health care services in an affordable and timely manner. One significant challenge to fulfilling the overall mission of the PNRP is the availability of resources and services that are affordable and accessible within communities in need. Specifically, of the services available for medically underserved patients at risk for colon cancer, the cost and availability of screening and treatment services represents considerable barriers. Objective: The aim of this study was to assess the availability and affordability of colorectal cancer screening services and to explore local policies of charitable and discounted care. Method: An assessment of patients’ demographic information, reported symptoms, income level and insurance status was completed using data extracted from patient medical records. Additionally, reports of available services from local health systems’ providers were reviewed and summarized as a resource guide detailing guidelines and policies of local charity care. Finally, informal interviews were conducted with health institutions, navigators, study participants, and research assistants to compare availability and usability of services as well as to document patients’ preferences for receipt of service. Results: Patientmedical records from 32 navigated colorectal cancer patients receiving care at five participating clinics were reviewed. The findings reveal that the study participants were predominately Hispanic, within the recommended age for colon cancer screening, uninsured, and receiving health care in rural, medically underserved counties of central Florida. Each navigated patient was recommended for a colonoscopy and approximately one-third received the screening exam via charity care offered by one local medical system. The policies and guidelines for charity care within the local healthcare systems were often not readily accessible and of those reported, many were limited in scope or non-existent. Of the systems providing colonoscopies, the cost of the exam ranged from $0 to $2200 (as a discounted rate). This study provided additional valuable information including the participants’ preference for services and the additional cost incurred from lost wages and transportation expenses. Conclusions: The PNRP is instrumental in assisting the medically underserved in locating and utilizing healthcare services that will improve their health. Considerable barriers exist in accessing and affording cancer screening and treatment services, particularly for colorectal cancer. Healthcare systems’ involvement in providing, documenting and distributing their policies and guidelines, for charity care would substantially facilitate the receipt of screening and treatment services that would prevent the unnecessary burden of cancer health disparities.