Missed Care, Missed Opportunities: Health and Economic Impact of Delayed or Forgone Care Among Adults With a History of Gastrointestinal Cancer

BACKGROUND: Timely medical intervention is critical to achieve optimal outcomes in gastrointestinal (GI) cancers, yet numerous patients experience delayed or forgone (D/F) medical care. This study aimed to evaluate the national impact of D/F care on emergency surgical interventions and associated healthcare expenditures among patients with GI cancers. METHODS: Adults with a self-reported history of GI cancer were identified from the Medical Expenditure Panel Survey, 2007-2017. Multivariable regression analyzes was performed to assess associations between D/F medical care, ED-associated GI surgery, inpatient utilization, and related healthcare expenditures after adjusting for demographic and socioeconomic variables. RESULTS: Among a weighted sample of 6 517 883 patients with GI cancers, 8.5% (n = 552 751) reported D/F medical care. Patients with D/F care were older (76 years [IQR: 69-82] vs. 68 years [IQR: 58-76]), more frequently male (57.3% vs. 50.6%) and frequently had family income below the poverty line (40.2% vs. 11.3%) (all p < 0.001). Furthermore, individuals reporting D/F care were more likely to have emergency department visits (44.2% vs. 27.4%), hospitalizations (64.6% vs. 34.5%) (both p < 0.05), or undergo ED-associated GI surgery (41.0% vs. 19.1%; p < 0.001). In multivariable analysis, after adjusting for relevant factors, D/F care was associated with markedly greater odds of ED-associated GI surgery (OR 2.70, 95%CI 1.47-4.95) and higher annual inpatient healthcare costs (β +$31,410, 95% CI $23,592-$39,227) compared with individuals who did not report D/F care. CONCLUSION: Self-reported D/F medical care was associated with greater acute healthcare utilization, higher odds of ED-associated GI surgery, and greater healthcare expenditures. These findings highlight the importance of understanding barriers to healthcare access among adults with a history of GI cancer.