ASO Author Reflections: A Path Forward: Improving Access to Guideline-Concordant Treatment for Foregut Cancers

PASTForegut cancers account for over 20% of new cancer deaths in the United States each year.These cancers have poor overall survival rates due to inherent biological aggressiveness, relative chemoresistance, and significant challenges in the delivery of cancer care.Despite evidence that guideline-concordant treatment (GCT), i.e., stage-specific, standard-of-care treatment, improves patient outcomes in foregut cancers, a large proportion of patients with foregut cancers do not receive GCT. 1 Numerous institutional and administrative database studies have shown that sociodemographic variables such as race, socioeconomic status, and rurality are predictive of GCT, however these studies lack detailed insights into individual barriers preventing access to GCT.Non-receipt of GCT is likely multifactorial, and a result of multiple, unmeasured barriers along the cancer care continuum, several of which may be potentially modifiable.Our study aimed to identify specific barriers to the receipt of GCT among patients with foregut cancers treated at an academic center in the Deep South through a detailed review of electronic health record (EHR) data.Using a root cause analysis approach, we sought to explore the underlying issues contributing to non-receipt of GCT in order to provide a comprehensive understanding that could inform subsequent targeted interventions to improve cancer care equity.