Unmet needs such as transport and finances forcing cancer patients to miss imaging appointments

Unmet needs such as transportation and finances are forcing cancer patients to miss scheduled imaging appointments, according to new research published Monday. 

Despite the prevalence of this concern, relatively few (about 17%) are screened for these health-related social concerns, experts write in the Journal of the American College of Radiology. They believe their new research highlights the importance of using these assessment tools during patient intake to ensure cancer patients return for regular radiology visits. 

“[Health-related social needs] may impact patients’ ability to access healthcare resources and may result in missed appointments, care delays, and poor health outcomes,” Angelica Gordon, MD, a radiology resident with the University of California, Irvine, and co-authors wrote April 7. “Missed appointments can disrupt clinical workflows and waste resources,” they added later. “This can also impact the healthcare of other patients, who could have been accommodated in place of the missed appointment.”

For the study, Gordon and colleagues analyzed data for adult patients with cancer who completed UCI’s oncology wellness form as part of their care between 2022-2023. The paperwork asks questions about an individual’s quality of life, assessing housing, transportation or financial needs and their willingness to speak with someone about them. Forms also inquired about patients’ pain scores on a 10-point scale. 

During the study period, only about 17% (or 3,495) of patients completed an oncology wellness form during 4% of all encounters (3,964). Of those, about 2,900 had imaging scheduled within the next three months and were included in the study. Patients (about 18%) reported unmet health-related social needs in about 23% of these encounters, the investigation found. This included financial hardship (83%), transportation needs (40%), and housing issues (38%). However, fewer than 7% of this group shared a desire for written information and 4% wanted to speak with someone about their unmet necessities. When adjusting for various sociodemographic factors, patients with unaddressed health-related social needs were more likely to miss imaging appointments (odds ratio of 1.29). 

Gordon and colleagues did not attempt to determine why screening rates were so low, but they have theories. 

“We hypothesize that low response rate has been due to several factors: early phases of [health-related social needs] screening implementation, staff shortages, use of only paper forms and the need for manual entry in EMR, and selective screening only for new cancer diagnoses and only at provider request for other patients,” they wrote. “Additionally, stigma associated with disclosing HRSNs, may deter some patients from participating. However, studies suggest at screening, in general and even at radiology encounters, is acceptable for most patients, if patients’ privacy and confidentiality are insured.” 

To address this, the UCI cancer center recently implemented electronic versions of the wellness form via the online patient portal. They note that similar screening could be administered during radiology check-ins. Fostering partnerships with community organizations can further address these unmet needs, along with prioritizing at-risk patients who are willing to accept help and track whether referrals are completed. 

The study found that patients with higher physical quality-of-life scores were less likely to miss imaging appointments.

“Higher [quality of life] is linked to having access to better support systems and resources (e.g., transportation, financial, familial), and better physical mobility,” the authors concluded. “It is also associated with lower [health-related social needs] and financial hardship, which may explain its impact on missed appointments. However, QOL can also be affected by cancer type, stage and treatment, which were not collected in this study. Future should explore the association of QOL and missed appointments by cancer type or stage.”