Abstract B68: Advocating for affordable colorectal cancer screening and diagnostic services within a patient navigator research program

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 its mission is the availability of resources and services that are affordable and accessible within communities in need. Specifically, for colon cancer services, the cost and availability of screening and treatment colonoscopies represents a considerable barrier. Community partnerships and advocacy are needed to address these barriers.

Objective: The aims of this study were to 1) assess the affordability of colonoscopies, 2) explore policies of charitable and discounted care, and 3) partner with community groups to identify resources and facilitate linkages and accessibility to colonoscopy screenings.

Methods: 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, and study participants to compare availability and affordability of services with patients' preferences for services.

Results: 88 colorectal cancer patients' medical records from seven participating clinics were reviewed. The patients were predominately Hispanic, within the recommended age for colon cancer screening, uninsured, and receiving health care in medically underserved counties of central Florida. Each patient was recommended for a colonoscopy and approximately one-third received the exam via charity care. 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 methods of identifying community resources as well as insights into participants' preferences for service.

Conclusions: PNRP, community partnerships, and advocacy are instrumental in assisting the medically underserved in affording and utilizing healthcare services. Considerable barriers exist in accessing colorectal cancer screening and treatment services. Healthcare systems' policies for charity care substantially facilitate the receipt of screening and treatment that prevents the unnecessary burden of cancer health disparities.