Implications of Physical Access Barriers for Breast Cancer Diagnosis and Treatment in Women with Mobility Disability

Evaluating differences in receipt of survivorship care plan among cancer survivors with and without disabilities

INTRODUCTION

Despite the role of the Survivorship Care Plan (SCP) in facilitating treatment adherence, research on SCP receipt among cancer survivors with disabilities remains limited. Thus, our study investigated the association between SCP receipt and disability count among cancer survivors.

METHODS

We analyzed cross-sectional data from the 2021 Behavioral Risk Factor Surveillance System, Cancer Survivorship: Course of Treatment module. The final sample included 2271 respondents with self-reported cancer history. The outcome was self-reported SCP receipt (0 = did not receive SCP, 1 = received written summary or follow-up care instructions, and 2 = received SCP-both). Independent variable was disability counts, comprised of six types: hearing, vision, cognition, mobility, self-care, and independent living difficulties. Disability count was categorized into 0 = none, 1 one disability, 2 = two disabilities, and 3 =  ≥ 3 disabilities. We conducted weighted descriptive statistics and multinomial multivariable logistic regression.

RESULTS

The sample was mostly White (70.62%), female (59.42%), and aged ≥ 65 (54.88%). About 57% reported no disability, 20.89% reported 1-disability, 11.03% 2-disabilities, and 11.47% ≥ 3 disabilities. Mobility issues were the most common disability (26.86%), while self-care difficulties were the least common (6.40%). About 12.12% of cancer survivors did not receive SCP, 35.03% received either treatment summaries or follow-up care instructions, and 52.84% received SCP. Compared to those without disability, survivors with ≥ 3 disabilities had lower odds of receiving SCP (AOR 0.44, 95% CI 0.22-0.88, p = 0.022).

CONCLUSIONS

This study suggests disparities in SCP receipt by disability count. Addressing such disparities can promote treatment adherence and reduction of missed follow-up.

Equitable Care for Patients With Disabilities: Considerations for the Gynecologic Health Care Professional

All patients deserve high-quality health care. Patients with disabilities have historically experienced discrimination in health care and subsequently detrimental health outcomes. Health care professionals often lack confidence and preparedness in treating patients with disabilities effectively. Barriers such as communication difficulties, biased assumptions, and inadequate equipment hinder comprehensive care. These barriers to care lead to health inequalities and a diminished overall quality of life for individuals with disabilities. Existing clinical guidelines for care of this underserved population are lacking. This article establishes a comprehensive educational framework and accessible reference tools for gynecologic health care professionals to enhance their ability to offer inclusive and effective care to patients with disabilities. Insights in this article stem from expert consensus among clinicians experienced in this field and ongoing dialog with community-based disability care partners. We present actionable steps to cultivate an open, adaptable, and patient-centric method to actively engage patients and to provide suitable accommodations when needed.

Change Is Slow: Acquisition of Disability-Accessible Medical Diagnostic Equipment in Primary Care Offices over Time

Introduction

The lack of disability-accessible medical diagnostic equipment (MDE) in primary care impedes the receipt of quality medical care by people with mobility impairments. Cross-sectional surveys and observational studies have found <40% of medical offices have disability-accessible examination tables or weight scales. Although government agencies and advocates recommend primary care acquisition of the accessible MDE, the rate of acquisition is unknown.

Methods

Using panel data, the research examined if primary care offices audited for disability accessibility increased accessible examination table and scale presence between the first and second audit. Data for 2006-2009 (Time 1 [T1]) and 2013-2016 (Time 2 [T2]) came from 1293 primary care practices associated with Medicaid managed care organizations. Permutations of presence or absence of a height-adjustable examination table and accessible weight scale were analyzed to assess rate of change across time periods.

Results

More practices had disability-accessible examination tables or weight scales at the second observation, although total presence was low (12.9%, 7.9%). Practices added equipment between time periods; however, ∼60% of practices with accessible MDE at T1 no longer had it available at T2.

Discussion

The acquisition rate of accessible MDE was low, despite prior auditing. Studying change in accessible MDE presence in primary care offices requires attention to equipment acquisition and its retention.

Health Equity Implications

Stronger federal enforcement of Medicaid and Americans with Disabilities Act (ADA) access requirements, with regular standardized auditing of medical office accessibility, may be required to produce a more equitable health care experience for disabled people.

American Cancer Society's report on the status of cancer disparities in the United States, 2023

In 2021, the American Cancer Society published its first biennial report on the status of cancer disparities in the United States. In this second report, the authors provide updated data on racial, ethnic, socioeconomic (educational attainment as a marker), and geographic (metropolitan status) disparities in cancer occurrence and outcomes and contributing factors to these disparities in the country. The authors also review programs that have reduced cancer disparities and provide policy recommendations to further mitigate these inequalities. There are substantial variations in risk factors, stage at diagnosis, receipt of care, survival, and mortality for many cancers by race/ethnicity, educational attainment, and metropolitan status. During 2016 through 2020, Black and American Indian/Alaska Native people continued to bear a disproportionately higher burden of cancer deaths, both overall and from major cancers. By educational attainment, overall cancer mortality rates were about 1.6-2.8 times higher in individuals with ≤12 years of education than in those with ≥16 years of education among Black and White men and women. These disparities by educational attainment within each race were considerably larger than the Black-White disparities in overall cancer mortality within each educational attainment, ranging from 1.03 to 1.5 times higher among Black people, suggesting a major role for socioeconomic status disparities in racial disparities in cancer mortality given the disproportionally larger representation of Black people in lower socioeconomic status groups. Of note, the largest Black-White disparities in overall cancer mortality were among those who had ≥16 years of education. By area of residence, mortality from all cancer and from leading causes of cancer death were substantially higher in nonmetropolitan areas than in large metropolitan areas. For colorectal cancer, for example, mortality rates in nonmetropolitan areas versus large metropolitan areas were 23% higher among males and 21% higher among females. By age group, the racial and geographic disparities in cancer mortality were greater among individuals younger than 65 years than among those aged 65 years and older. Many of the observed racial, socioeconomic, and geographic disparities in cancer mortality align with disparities in exposure to risk factors and access to cancer prevention, early detection, and treatment, which are largely rooted in fundamental inequities in social determinants of health. Equitable policies at all levels of government, broad interdisciplinary engagement to address these inequities, and equitable implementation of evidence-based interventions, such as increasing health insurance coverage, are needed to reduce cancer disparities.