A Secret-Shopper Study Evaluating Logistic Barriers to Care Among Young Adults with Acute Lymphoblastic Leukemia

Abstract Adolescents and young adults (AYAs) with acute lymphoblastic leukemia (ALL) experience inferior survival relative to children. As access barriers may increase outcome disparities, we conducted a secret-shopper study to identify logistical burdens when initiating care for AYAs. We developed scripts describing hypothetical AYAs with ALL seeking initial oncology appointments and, from February 2024 to March 2025, used data from population-based cancer registries to call facilities treating AYAs with ALL. Outcomes included number of attempts (up to 3) and transfers, call time, and required documentation for scheduling. Data were summarized descriptively. Of 424 facilities, 276 could schedule oncology appointments via phone. Of these, 36.2% required ≥2 attempts. Across attempts, 43.5% required ≥2 transfers. Median call time was 8 minutes, but 19.6% of facilities required ≥15 minutes. Only 20.7% would schedule without a referral or medical records. AYAs with ALL face logistical burdens when scheduling appointments, requiring additional efforts to streamline care.