Evidence map›Paper›PMID 40736258›Full record

ArticleCancer medicine2025

Providers' and Survivors' Perspectives on Affordability Challenges for Gastrointestinal Cancer Treatment in Two Low Socioeconomic Status States of the Southern United States.

Maria Pisu, Nataliya V Ivankova, Jessica Morgan, Courtney P Williams, Nathan C English, Burkely P Smith, Bayley A Jones, Wendelyn M Oslock, Yu-Mei Schoenberger, Ivan I Herbey and 1 more

Abstract read
In one paragraph

Article in Cancer medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Beyond the patient: how providers perceive and experience non-medical barriers in gastrointestinal cancer care.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2026
    Article
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Maria PisuDivision of General Internal Medicine and Population Science, University of Alabama at Birmingham, Birmingham, Alabama, USA.ORCID https://orcid.org/0000-0001-9329-3268
Nataliya V IvankovaDepartment of Health Services Administration, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Jessica MorganDepartment of Sociology, University of Arkansas, Fayetteville, Arkansas, USA.
Courtney P WilliamsDivision of General Internal Medicine and Population Science, University of Alabama at Birmingham, Birmingham, Alabama, USA.ORCID https://orcid.org/0000-0001-5328-7517
Nathan C EnglishDepartment of General Surgery, University of Cape Town, Cape Town, South Africa.
Burkely P SmithDepartment of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Bayley A JonesDepartment of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Wendelyn M OslockDepartment of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Yu-Mei SchoenbergerDivision of General Internal Medicine and Population Science, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Ivan I HerbeyDepartment of Health Services Administration, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Daniel I ChuDepartment of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.

Funding

XRAY CRYSTALLOGRAPHYP30CA013148 · NCI · UNIVERSITY OF ALABAMA AT BIRMINGHAM · PI Omer Jamy · 1985 to 2026
$165.9M
Designing a Plan of Action for Better Access and Quality of Surgery for African-Americans with Gastrointestinal Cancers in the Deep SouthR01MD013858 · NIMHD · UNIVERSITY OF ALABAMA AT BIRMINGHAM · PI CHU, DANIEL I, PISU, MARIA · 2020 to 2024
$3.0M
NCI NIH HHS P30 CA013148NCI NIH HHS P30CA013148NIMHD NIH HHS R01 MD013858NIMHD NIH HHS R01MD013858
6 · The paper itself

Abstract

introductionAffordability is an access to care domain contributing to disparities in gastrointestinal (GI) cancer outcomes and care, including surgical care. Affordability challenges for GI cancer care in socioeconomically disadvantaged and diverse states of the southern United States are unknown: this paper addresses this knowledge gap.

methodsWe conducted semi-structured interviews with 32 providers (13 surgeons and 19 other) and 36 survivors (53% colorectal, 19% pancreatic, and 28% esophageal cancer) in Alabama and Mississippi. Questions were about barriers and facilitators to surgical care along five domains, including affordability, that is, the relationship between health care costs, patients' income, health insurance coverage, and the resulting ability to afford care. Verbatim transcripts were analyzed using thematic and content analysis.

resultsThemes were about: (1) affordability-related underlying context, that is, (i) patients' limited means and competing basic needs priorities, (ii) scarcity of quality medical services, and (iii) rural hospitals' limited means; (2) barriers to medical decision-making, that is, (i) guideline-concordant care unfeasible due to poverty and (ii) insurance authorizations and coverage delaying and making care costlier; (3) economic burdens from (i) many types of needed expenses and (ii) billing; and (4) strategies to improve affordability, that is, (i) care adjustments to reduce patients' costs, (ii) community organizations' support, and (iii) burdensome access to resources.

conclusionsUnderlying poverty, scarce quality medical services, and restrictive insurance provisions significantly impact medical decision-making, access to quality and prompt care, and economic and administrative burdens. Future research should quantify the extent of these challenges and identify programs and policies to address them.

Indexed as

Cancer SurvivorsGastrointestinal NeoplasmsHealth Care CostsHealth Services AccessibilityAdultAgedAlabamaFemaleHealthcare DisparitiesHumansInsurance CoverageLow Socioeconomic StatusMaleMiddle AgedPovertySocial Classaccess to careaffordabilitydisparitiesgastrointestinal cancerhealth insurancepoverty

Identifiers

PMID40736258
PMCPMC12308909

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.