Multimorbidity and the association with patient reported access to care and physician relationships among racially and ethnically diverse patients with colorectal cancer

Abstract Background: Patient reported access to care and quality of physician relationships are influential determinants of outcomes following cancer diagnosis. Both poorer patient reported healthcare experiences and increased comorbidity loads are more common among racial and ethnic minority patients, contributing to disparities in cancer outcomes. We aimed to determine whether multimorbidity exacerbates racial and ethnic disparities in patient reported healthcare experiences. Methods: We used Surveillance, Epidemiology, and End Results-Consumer Assessment of Healthcare Providers and Systems (SEER-CAHPS) data to identify a cohort of patients diagnosed with non-metastatic colorectal cancer between 1999-2017 who were at least 65 at the time of diagnosis and who completed a CAHPS patient experience survey within two years after diagnosis. Main independent variables included CAHPS self-reported race/ethnicity and number of comorbidities. Patients with multimorbidity included those who reported at least one comorbidity, in addition to their colorectal cancer diagnosis. Dependent variables included validated CAHPS composite scores of getting needed care and physician communication (on a 0-100 scale). Multivariable linear regression was used to determine associations between patient race/ethnicity, multimorbidity status, and self-reported experiences with care controlling for sociodemographic and tumor prognostic factors. Models included a product interaction term between race/ethnicity and multimorbidity status to evaluate effect modification by multimorbidity. Results: We identified 4,201 SEER-CAHPS patients with colorectal cancer, consisting of 78.7% non-Hispanic white (NHW), 7.9% non-Hispanic Black (NHB), 7.6% Hispanic, and 5.9% non-Hispanic Asian (NHA) survivors. In addition, 41.2% self-reported having at least one comorbidity in addition to their diagnosis of colorectal cancer. The mean composite score of getting needed care was 88.2 out of 100 possible points and the mean composite score of physician communication was 89.0 out of 100. In multivariable analyses, NHA patients had a mean composite score of getting needed care that was 7.5 points lower than NHW patients (B=-7.45, 95% CI=-11.54- -3.55). Having multimorbidity (at least one self-reported comorbid condition in addition to colorectal cancer) did not affect mean composite scores of getting needed care or physician communication. However, NHB patients with multimorbidity had a mean composite score of getting needed care that was 7.7 points lower than NHW patients without multimorbidity (B=-7.73, 95% CI=-13.16- -2.30). Conclusions: Multimorbidity may substantially decrease the ability of Black colorectal cancer survivors to get needed care, which is an essential determinant of clinical cancer outcomes. Further research is needed to identify how cancer care can be targeted to racial and ethnic minority populations with multimorbidity to provide equitable cancer care for all patients. Citation Format: Stephanie Navarro, Mariana C. Stern, Afsaneh Barzi, Albert J. Farias. Multimorbidity and the association with patient reported access to care and physician relationships among racially and ethnically diverse patients with colorectal cancer [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A063.