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. 2025 Jun;32(6):3900-3912.
doi: 10.1245/s10434-025-17113-2. Epub 2025 Mar 4.

Patient-Reported Barriers to Foregut Cancer Care in the Deep South

Ioannis Liapis #  1 , Alfonsus Adrian H Harsono #  1 , Jaspinder Sanghera  1 , Katie West  2 , Rida Ahmad  3 , Michelle Holland  1 , Larry Hearld  4 , Smita Bhatia  5 , Krista Mehari  6 , Martin J Heslin  1 , Daniel I Chu  1 , Annabelle L Fonseca  7
Affiliations

Patient-Reported Barriers to Foregut Cancer Care in the Deep South

Ioannis Liapis et al. Ann Surg Oncol. 2025 Jun.

Abstract

Background: Many patients with foregut cancer do not receive guideline-concordant treatment (GCT). Although social determinants of health (SDOH) have been associated with differences in receipt of GCT, the underlying mechanisms that perpetuate these disparities remain unknown. This mixed-methods study explored barriers to receipt of care among patients with foregut cancer.

Methods: Patients with foregut cancers treated at a safety-net hospital in the Deep South were purposively selected. The patients completed semi-structured interviews, which were recorded, transcribed, and analyzed. Grounded theory methodology was used to generate themes through open coding, develop a thematic coding structure, and create a codebook. Intercoder agreement was above 90%. Patient sociodemographic and treatment-related variables were abstracted from the patients' medical records to produce simple descriptive statistics.

Results: The majority of the 30 participating patients were male (n = 23, 77%), black (n = 18, 60%), and with a median age of 63 years (interquartile range, 55-67 years). Using the socioecologic model, barriers were categorized into individual, interpersonal, organizational, and policy levels. Within the individual level, the barriers were access to primary care providers, personal barriers, competing responsibilities, multifaceted financial barriers, and transportation barriers. The interpersonal barriers involved communication challenges, physician mistrust, and absence of social support. The organizational level barriers were health system mistrust, inadequate health care infrastructure, and lack of insurance coverage consequences. The policy level barriers were health care access policies and insurance policies.

Conclusions: The patients reported multiple barriers related to accessing and adhering to their treatments. Understanding these barriers is critical to forming the basis for developing and implementing programs to increase the delivery of GCT.

Keywords: Foregut cancer; Guideline concordant treatment; Mixed methods; Social determinants of health; South.

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Conflict of interest statement

Disclosure: Annabelle L. Fonseca has received funding from the National Institutes of Health National Institute of Minority Health and Health Disparities and the Department of Defense. Krista Mehari has received funding from the National Institutes of Health National Institute of Minority Health and Health Disparities (NIMHD) and the Office of Disease Prevention (ODP; R01MD017477), the National Institute of Mental Health (R01MH137695), and the National Bureau of Economic Research. She has served as a consultant on a grant from the Centers for Disease Control and Prevention (U01CE003384), and she has received honoraria from The John Templeton Foundation, the University of Washington, the American Public Health Association, Great KIDS, and Virginia Commonwealth University. She is a member of the Board of Directors of the Society for Prevention Research. Martin J. Heslin has received payments for electronic consultation for Teladoc, Inc. The remaining authors have no conflicts of interest.

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