Significant Roadblocks to Oncology Appointments at NCI Cancer Centers

Phoenix, AZ—Newly diagnosed cancer patients face fear and uncertainty regarding their prognosis. Many seek evaluation and treatment from top-tier, comprehensive cancer centers, but recent literature has revealed barriers to access for these patients and their family members.

Geoffrey Hamlyn and colleagues from Duke University and the Duke Cancer Institute in Durham, NC, conducted a study to evaluate this availability and accessibility gap in National Cancer Institute (NCI)-designated cancer centers and presented their results at the 2016 ASCO Quality Care Symposium.

In order to evaluate the obstacles faced by patients and caregivers in attempting to access services at major cancer centers, the investigators used a "mystery shopper" format to contact 40 NCI-designated, comprehensive cancer centers.

Five Duke graduate research assistants simulated calls by a patient's family member to make an initial consultation appointment, using a standardized script informed by real patient calls to Duke and reflecting a "typical" caller's knowledge and concern. Each center received 4 calls each on separate dates (160 total), and call order and patient names were randomized. Two calls to each center presented a patient with private insurance, and 2 presented a patient with Medicaid.

Of 160 calls, 117 (73%) were first answered by electronic prompts or voicemail, rather than a live person. "The question is whether that customer engagement strategy is really ideal for something as intimate and sensitive as oncology," said Mr Hamlyn.

Mean call duration was 9.4 minutes, and, on average, callers spent 7.1 minutes speaking to an attendant and 2.4 minutes on hold or being transferred.

Only 19.3% of callers were able to obtain an actual date for a first-available appointment without first registering into the cancer center's database. Half (51.3%) of the callers were given an estimated date for a next-available appointment, and nearly a third (29.4%) were told that a date for an appointment could not be estimated unless the patient was registered in the cancer center's database.

Nearly three-quarters of appointment dates (estimated or actual) were more than 1 week away. Specifically, only 1.3% of next-available appointments were within 1 to 2 days, 25.7% were within 3 to 7 days, 57.5% were within 7 to 14 days, and 15% were not available until 2 weeks or later.

"These are really big hurdles," said Mr Hamlyn. "If we're calling on behalf of the patient and may not be armed with certain information, this accessibility/availability gap is certainly something that we need to be aware of. It's a business concern and a quality concern, and it may inform some potential reevaluation."

The investigators observed no statistically significant variation in appointment availability according to payer, with 7 to 14 days to next-available appointment the most common time span for both Medicaid and private insurance, but they did notice some qualitative differences, in particular, a "variation in tone."

"In many cases, an attendant would be dismissive in some tone or perhaps particularly interested if we indicated that we had privately insured patients, so this is a significant finding in many ways," said Mr Hamlyn. "I think this is something that could be a real barrier to entry for some people who are calling for patients who are publicly insured."

"These findings were striking," said Sandra L. Wong, MD, MS, Professor and Chair in the Department of Surgery at Dartmouth-Hitchcock Medical Center and the Geisel School of Medicine at Dartmouth. "What this means is that there are real barriers to getting into what is perceived as high-quality cancer care."

"The qualitative feel that callers were treated differently once the payer type was known is concerning," she added. "These findings scream at a need to reevaluate our intake processes and address barriers to care."

Reference

Hamlyn G, Hutchins K, Johnston A, et al. Accessibility and barriers to oncology appointments at 40 NCI-designated cancer centers. Presented at: ASCO Quality Care Symposium; February 26-27, 2016; Phoenix, AZ. Abstract 55.