In a study reported in a research letter in JAMA Oncology, Patel et al found that delayed or foregone care due to patient-clinician discordance of identity (eg, race, religion, gender) was more common among patients with cancer vs noncancer controls. Approximately one-quarter of younger patients with cancer with a low income and identity discordance had delayed or foregone care.
Study Details
The study involved data from patients in the National Institute of Health’s All of Us Research Program, a prospective cohort study. The current nested case-control study included adults recruited to All of Us between May 2018 and June 2022 who completed a health-care utilization survey. A total of 21,919 cancer survivors were matched 1:5 on age, gender, and race/ethnicity with 109,595 cancer-free participants. The survey queried participants on whether they had ever delayed or foregone care because their clinician was of a different race, religion, native language, or other identity.
Key Findings
Cancer survivors were more likely to report delaying or forgoing care due to patient-clinician discordance vs cancer-free individuals (7.6% vs 5.1%, P < .001).
Among White survivors, those who were younger at diagnosis (18–45 years) and had a low annual income (< $25,000) had the highest prevalence of delayed or foregone care due to patient-clinician discordance (26.5%). Among pooled racial and ethnic minority individuals (eg, Asian, Black, Hispanic), those aged 18 to 45 years at diagnosis with an annual income of < $25,000 had a prevalence of 28%.
On multivariate analysis among cancer survivors, risk of delayed or foregone care due to discordance was significantly elevated for:
- Younger patients (odds ratios [ORs] = 3.10 for 18–44 years, 2.21 for 45–54 years, and 1.76 for 55–64 years vs 65–74 years; all P < .001)
- Asian (OR = 1.81, P = .002), Black (OR = 1.38, P < .001), and Hispanic patients (OR = 1.39, P = .004) vs White patients
- Women vs men (OR = 1.33, P < .001)
- Lesbian, gay, or bisexual patients vs heterosexual patients (OR = 1.31, P = .01)
- Patients with an annual income of < $25,000 (OR = 1.58, P < .001) and $25,000 to $50,000 (OR = 1.36, P < .001) vs $50,000 to $100,000
- Education consisting of high school or less (OR = 1.51, P < .001) and some college (OR = 1.28, P < .001) vs at least a bachelor’s degree
- Primary cancer sites of breast (OR = 1.29, P = .01), gynecologic (OR= 1.3, P = .04), head and neck (OR = 1.27, P = .04), and urologic (OR = 1.26, P = .04) vs gastrointestinal tract.
The investigators stated, “In this study, cancer survivors disproportionately reported delaying or forgoing care because their clinician was of another identity. In groups such as younger adults with low income, approximately a quarter of survivors shared this experience…. [ASCO] recently announced a plan to improve workforce diversity and clinician preparedness over the next 3 to 5 years through the expansion of minority leadership roles, equity and inclusion training, and professional development programs for underrepresented minority individuals in medicine. In the interim, patient-clinician identity discordance remains a barrier to care for many cancer survivors and should be addressed.”
Vishal R. Patel, BS, of Dell Medical School, The University of Texas at Austin, is the corresponding author for the JAMA Oncology article.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
