Socioeconomic Factors Predictive of Access Delays in Oncology

Abstract Purpose: To identify demographic and socioeconomic factors predictive of access delays in patients referred for radiation oncology services. Methods and Materials: A prospective data registry of consecutive patients referred for initial consultation from October 2018 to April 2022 was reviewed. To evaluate access, the number of business days from referral to consultation was calculated. Demographic characteristics recorded included age, gender, race, language preference, and insurance status. Zip code data linked to a patient’s residential address was used to classify socioeconomic status (SES) based on publicly available data on median household income. Descriptive statistics were presented to identify factors predictive of delays in the time from referral to consultation. Results: A total of 9,241 consecutive patients were referred and logged into the database during the 4-year period, of which 5,321 were scheduled, registered, and seen in the outpatient setting. Delays in access were associated with low SES and Black race (p<0.05, for both). Three hundred and seventeen of the 1,203 patients (26%) in the lowest SES quartile had their appointments scheduled greater than 21 days from the time of referral compared to 482 of the 4,118 patients (12%) in the non-lowest quartile SES group (p<0.001). Black patients were significantly less likely to have their appointments within 5 days compared to non-Black patients (17% versus 24%, p=0.01). On multivariate analysis, the only variable independently associated with higher odds of appointment delays was SES (low-SES quartile versus non-low-SES quartile (OR= 3.98, 95% CI [2.01-7.92], p<0.001). Conclusions: SES factors related to geographical zip code predict for access delays in radiation oncology care. Targeted interventions are urgently warranted for low SES groups residing in underserved communities.