Which patient care access barriers deter cancer screening?

It's well known that the United States has suboptimal cancer screening rates, but which patient care access barriers are behind that trend? According to new data in JAMA Network Open, low screening rates can mostly be attributed to cost concerns, social determinants of health and fear of seeing a doctor.

Cancer screening rates have been on the decline for years, with the most recent data showing that 73% of U.S. adults are behind on their routine screenings. Many factors drive low cancer screening rates, including individual, systemic and societal factors, the JAMA researchers said.

The latest study sought to uncover those barriers further by surveying more than 160,000 adults eligible for breast, cervical, colorectal, lung and prostate cancer screenings. The survey asked whether any of the following 9 barriers contributed to participants delaying or foregoing routine medical care within the past 12 months:

• Lack of transportation.
• Living in a rural area where the travel distance was too far.
• Nervousness associated with seeing a healthcare provider.
• Inability to take time off work.
• Lack of childcare.
• Caregiving responsibilities for an adult they could not leave.
• Can't afford the copay.
• A deductible that was too high or unaffordable.
• Having to pay out of pocket for some or all of the procedure.

It wasn't uncommon for respondents to report one of these care access barriers, with as many as 50% of those overdue for cervical cancer screening reporting a barrier and as few as 28% of those overdue for prostate or colorectal cancer screening reporting an issue.

Some barriers were more common than others, with cost-related issues being the most frequently cited among study participants. Anywhere from 13% of those overdue for colorectal cancer screening to 21% of those overdue for cervical cancer screening cited this barrier.

Notably, most public and private payers are required to cover USPSTF-recommended cancer screenings with no cost-sharing, the researchers pointed out. Therefore, cost-related care access barriers might be about perceived costs rather than actual costs, they said.

"Limited awareness of insurance coverage, requirements for preauthorization and concerns about unexpected costs may contribute to cost-related screening delays, even when the screening test itself is covered," the researchers explained.

Other common barriers include logistical issues and social determinants of health.

Rural residents facing long travel distances and those lacking transportation said it was difficult for them to access preventive cancer screenings, the report showed. The researchers recommended better research into at-home screening, which is common for colorectal and cervical cancer screening.

Finally, respondents indicated that nervousness about seeing a healthcare provider got in the way of their preventive cancer screening.

"These findings are consistent with previous studies, which have shown that individuals avoid screening due to fear, not only of the procedure itself but also of receiving a potential cancer diagnosis," the researchers explained. "Additionally, cultural beliefs that frame cancer as a fatalistic disease can further discourage individuals from seeking screening."

These barriers warrant further exploration, the researchers said.

Future research should also focus on the impact different barriers have on various types of cancer screening. For example, this current study found that cost concerns and logistical barriers were linked to lower odds of breast cancer, cervical cancer and colorectal cancer screening, in particular.

By understanding the forces behind those trends, health systems, providers, payers and policymakers can work to design better interventions to ultimately boost cancer screening rates.

Sara Heath has reported news related to patient engagement and health equity since 2015.