In the Journals

Colon cancer screening, treatment limited in low-income patients by 4 key barriers

Limited access to health care, misunderstanding of symptoms and certain beliefs about illness are among the key barriers to early diagnosis and treatment of colorectal cancer in patients with lower socioeconomic status, especially those in minority groups, according to new research published in Diseases of the Colon & Rectum.

Isabel M. Leal, PhD, of the department of general surgery at The University of Texas Health Science Center, and colleagues wrote that despite improved screening for colorectal cancer (CRC), inequalities remain among patients of lower socioeconomic status, particularly among Hispanic people.

The researchers interviewed 30 lower-income patients with stage 2 and 3 CRC at Lyndon B. Johnson General Hospital, a safety-net hospital in Houston. A majority of the study cohort was Hispanic (n = 17; 57%). Researchers asked patients questions about their beliefs and experience of illness, barriers they faced in seeking treatment and care, and perceptions of how their illness impacted daily living.

“Four themes describe factors on the structural, health care system, provider and patients level, that interact to make engaging in prevention foreign to this population, thus limiting early detection and treatment of [CRC],” Leal said in a press release.

The four themes included limited resources for accessing care, misunderstanding and misdiagnosis of symptoms, beliefs associated with health and illness, and reactions to screening and illness.

Regarding the first theme, researchers said many patients reported challenges in seeking a diagnosis and treatment because of their limited access to health care resources, including economic constraints, lack of medical insurance, low health literacy and lack of language-specific information.

Next, some patients reported that they did not consider the sudden onset of symptoms — like stomachaches, diarrhea or constipation — to be abnormal, and the symptoms persisted for about 2 weeks before they sought medical help at the hospital. Some patients also received a misdiagnosis and did not receive a referral for CRC screening, according to the study.

Third, patients in all ethnic groups involved in the study only sought medical care once a serious problem started to occur. The researchers said getting regular screenings or check-ups when they did not have symptoms was “foreign to them,” and that “the social norm shared within participants’ communities was reliance on healing through faith, self-care, and folk or natural remedies, such as changing the diet, rather than professional medical care.”

Finally, Leal and colleagues noted that the patients reported several psychosocial reactions to screening procedures and symptoms that kept them from seeking care, including maintaining masculinity, distressing or confusing interactions with physicians, fear and embarrassment, and not valuing themselves.

The researchers said their findings can be used to develop culturally tailored interventions and community resources to address disparities in CRC screening and care.

In an accompanying editorial, Timothy M. Geiger, MD, of Vanderbilt University Medical Center, said the study identified factors influencing the patient’s decision to be screened that physicians do not typically address in their short office visits with patients.

“We have direct control only of the provider factors, including knowledge of the risks and the expertise to make sound recommendations to improve quality and quantity of life,” he wrote. “A comprehensive approach that incorporates all four gaps in screening for [CRC] identified by this study will decrease barriers to screening and save lives. The ultimate goal is to decrease both cancer diagnosis and death. To achieve this, we need to better understand our patients and to help patients merge our recommendations into their frame of reference.” – by Alex Young

Disclosures: The study authors and Geiger report no relevant financial disclosures.

Limited access to health care, misunderstanding of symptoms and certain beliefs about illness are among the key barriers to early diagnosis and treatment of colorectal cancer in patients with lower socioeconomic status, especially those in minority groups, according to new research published in Diseases of the Colon & Rectum.

Isabel M. Leal, PhD, of the department of general surgery at The University of Texas Health Science Center, and colleagues wrote that despite improved screening for colorectal cancer (CRC), inequalities remain among patients of lower socioeconomic status, particularly among Hispanic people.

The researchers interviewed 30 lower-income patients with stage 2 and 3 CRC at Lyndon B. Johnson General Hospital, a safety-net hospital in Houston. A majority of the study cohort was Hispanic (n = 17; 57%). Researchers asked patients questions about their beliefs and experience of illness, barriers they faced in seeking treatment and care, and perceptions of how their illness impacted daily living.

“Four themes describe factors on the structural, health care system, provider and patients level, that interact to make engaging in prevention foreign to this population, thus limiting early detection and treatment of [CRC],” Leal said in a press release.

The four themes included limited resources for accessing care, misunderstanding and misdiagnosis of symptoms, beliefs associated with health and illness, and reactions to screening and illness.

Regarding the first theme, researchers said many patients reported challenges in seeking a diagnosis and treatment because of their limited access to health care resources, including economic constraints, lack of medical insurance, low health literacy and lack of language-specific information.

Next, some patients reported that they did not consider the sudden onset of symptoms — like stomachaches, diarrhea or constipation — to be abnormal, and the symptoms persisted for about 2 weeks before they sought medical help at the hospital. Some patients also received a misdiagnosis and did not receive a referral for CRC screening, according to the study.

Third, patients in all ethnic groups involved in the study only sought medical care once a serious problem started to occur. The researchers said getting regular screenings or check-ups when they did not have symptoms was “foreign to them,” and that “the social norm shared within participants’ communities was reliance on healing through faith, self-care, and folk or natural remedies, such as changing the diet, rather than professional medical care.”

Finally, Leal and colleagues noted that the patients reported several psychosocial reactions to screening procedures and symptoms that kept them from seeking care, including maintaining masculinity, distressing or confusing interactions with physicians, fear and embarrassment, and not valuing themselves.

The researchers said their findings can be used to develop culturally tailored interventions and community resources to address disparities in CRC screening and care.

In an accompanying editorial, Timothy M. Geiger, MD, of Vanderbilt University Medical Center, said the study identified factors influencing the patient’s decision to be screened that physicians do not typically address in their short office visits with patients.

“We have direct control only of the provider factors, including knowledge of the risks and the expertise to make sound recommendations to improve quality and quantity of life,” he wrote. “A comprehensive approach that incorporates all four gaps in screening for [CRC] identified by this study will decrease barriers to screening and save lives. The ultimate goal is to decrease both cancer diagnosis and death. To achieve this, we need to better understand our patients and to help patients merge our recommendations into their frame of reference.” – by Alex Young

Disclosures: The study authors and Geiger report no relevant financial disclosures.