Patients' barriers to receipt of cancer care, and factors associated with needing more assistance from a patient navigator

J Natl Med Assoc. 2011 Aug;103(8):701-10. doi: 10.1016/s0027-9684(15)30409-0.


Background: Racial minorities have poorer cancer survival in the United States compared to whites. The purpose of this study was to better understand patients' barriers to cancer care and to determine which patients have a greater need for assistance from a patient navigator.

Methods: Community health workers assisted newly-diagnosed breast and colorectal cancer patients during a randomized trial of patient navigation and collected information about patients' barriers. Barriers to care were characterized and compared between non-Hispanic white and minority patients. A multivariate model was constructed of factors associated with increased log navigation time, a measure of patients' need for assistance.

Results: Patients' (n = 103) most commonly identified barriers to care included a lack of social support, insurance/financial concerns, and problems communicating with health care providers. Barriers differed between nonminority and minority patients, and minority patients faced a greater number of barriers (p = .0001). In univariate analysis, log navigation time was associated with race/ethnicity, education, income, employment, insurance type, health literacy, marital status, language, and comorbidity. A multivariate model (R2 = 0.43) for log navigation time was created using stepwise selection, and included the following factors: minority race/ethnicity (p = .032), non-full-time employment (p = .0004), unmarried status (p = .085), university center (p = .0005), and months in study (p <.0001).

Conclusions: Newly diagnosed cancer patients' most common barriers to care include lack of social support, insurance/financial concerns, and problems with health care communications. In this sample of patients, a greater need for assistance was independently associated with minority race/ethnicity and unemployment. These data may help in the design and targeting of interventions to reduce cancer health disparities.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Health Services Accessibility* / organization & administration
  • Health Services Research
  • Healthcare Disparities / organization & administration*
  • Healthcare Disparities / statistics & numerical data
  • Humans
  • Insurance, Health
  • Minority Groups / statistics & numerical data*
  • Neoplasms / therapy*
  • Patient Advocacy*
  • Social Support
  • Socioeconomic Factors
  • Unemployment