(106) Barriers to Head and Neck Cancer Care Among Survivors in Kentucky

Introduction: Head and neck cancer care is complex and can be difficult to navigate. Kentucky harbors a disproportionately high incidence of head and neck cancer, especially in rural communities, and challenges with health access are well-described in this region. We aimed to characterize the prevalence of these challenges.

Methods: The Kentucky Cancer Registry (KCR) and Markey Cancer Center Head and Neck clinic schedules were used to identify adult head and neck cancer survivors. A total of 62 participants completed a survey. The survey was derived from validated measures and included roughly 90 items assessing the patients' barriers to care along six domains including affordability, availability, accessibility, accommodation, acceptability, and awareness as originally described by Penchansky and Thomas’s Theory of Access.

Results: Of the patients that completed the survey, 67% were male, 47% lived in an Appalachian designated county, and the average age at time of completion was 64. Early-stage cancers accounted for 35% of the participants while late-stage accounted for 49%, with an average age at diagnosis of 61. The primary sites of cancer consisted of 45% oral cavity, 31% larynx, 16% oropharynx, and 8% other. On average, participants drove 47 miles in 59 minutes to reach their treatment center. The participants averaged 1.67 barriers, with 25% endorsing challenges in one domain, 28% in two, and 25% in three or more. The most frequently reported barrier was accessibility (48%) followed by affordability (45%), availability (31%), awareness (25%), accommodation (12%), and acceptance (6%). Appalachian participants reported a higher number of barriers than those who were not (p < 0.001).

Conclusions: Nearly three out of four head and neck cancer survivors endorse challenges accessing cancer care, with Appalachian survivors reporting a greater breadth of access issues. The results of this study will be further explored in a subsequent qualitative analysis to support the development of interventions that improve head and neck cancer care delivery.