EPD202 - Relationship between County-Level Financial Assistance Programs and Guideline Concordant Treatment for Uninsured Patients with Colon Cancer. A Population Based Study.

Purpose/Background: Texas has the largest share of the 27 million uninsured individuals in the United States. To address this lack of financial access, many counties in Texas offer financial assistance to uninsured patients. The relationship of these financial assistance programs (FAP) with cancer care and outcomes has not been studied. Significant disparities in access to care and survival for patients with colon cancer have been reported. The objective of this study was to determine if county financial assistance programs are associated with improved access to guideline concordant care and decrease in all-cause mortality for uninsured patients with colon cancer.

Methods/Interventions: We used the population-based, Texas Cancer Registry to identify uninsured patients aged 18 to 64 years and diagnosed with invasive colon cancer from 2017 to 2022. Guideline concordant care (GCC) was defined as surgical resection (excluding diversion only operations) for localized cancer, surgical resection and chemotherapy for regional cancer, and chemotherapy for metastatic cancer. Official county and county safety net hospitals were searched to identify the counties that offer FAP. Multivariable binary logistic regression models were used for receipt of guideline concordant care. Cox Proportional Hazards model was used for all-cause mortality. Patient demographic characteristics, cancer stage at diagnosis, rural-urban continuum codes and census tract level poverty indicators were used as covariates in multivariable models. An interaction variable that combined GCC and county FAP status was used in the survival analysis.

Results/Outcomes: Overall, 3,134 uninsured patients were included. Of these, 58.6% of patients received GCC. Patients with localized cancer were most likely to receive GCC (80.1%) while patients with regional cancers were least likely to receive GCC (48%). A significantly greater proportion of those who lived in FAP counties (vs those who did not) received GCC (FAP vs non-FAP: 61.9% vs 53.9% p< 0.001). From multivariable logistic regression analysis, estimated odds ratio (95% Confidence Interval) for residence in counties that offered FAP was 1.38 (1.13 - 1.69) when compared to residence in non-FAP counties. From multivariable Cox analysis, compared to patients who did not receive GCC and did not live in counties that offered FAP, the estimated hazard ratios of all-cause mortality (95% Confidence Interval) were as follows: received GCC and lived in FAP counties 0.63 (0.52 - 0.76), received GCC but did not live in FAP counties 0.65 (0.54 - 0.78).

Conclusion/Discussion: For uninsured patients with colon cancer, residing in counties that offered financial assistance was associated with significantly higher odds of receiving GCC. Additionally, receipt of GCC was found to be most significantly associated with lower hazards of death. These findings provide evidence for county level policy interventions that may improve access to colon cancer care and outcomes.

Forest Plot: Adjusted Odds Ratios of Receipt of Guideline Concordant Care for Residential County Financial Assistance Program Status
Forest Plot: Adjusted Hazard Ratios for All Cause Mortality for Guideline Concordant Care and Status of County Financial Assistance Combined.