(P 154) BARRIERS TO CARE FOR MUSCULOSKELETAL TUMORS

Objective: Disproportionate access to resources and inequal distribution of care creates important delays in the delivery of healthcare. Understanding the delays in care for patients with musculoskeletal tumors is particularly important given the necessity of prompt diagnosis and treatment for oncologic diseases. If barriers to care exist that prevent patients from receiving timely care, malignant disease may progress beyond the limits of treatment. Therefore, we aimed to perform a high-quality systematic review of the literature to determine the most significant barriers to care that exist for patients undergoing diagnosis and treatment of musculoskeletal tumors.

Methods: A systematic review of the literature was conducted in Scopus, Embase, Web of Science, and PubMed-MEDLINE using a combination of terms. Articles that were in English, available as full text, included patients with musculoskeletal tumors and reported barriers to care experienced by patients were eligible. From these articles, the following data were extracted: musculoskeletal tumor diagnosis, type of barrier to care, patient sex, age, treatment course, and clinical outcomes if available. Quality assessments of final studies were also conducted using the Joanna Briggs Institute’s critical appraisal tools.

Results: Searches generated a total of 1504 publications, and 20 articles were eligible for the final analysis. Across the 114,056 patients in the 20 articles, 5 articles (25%) reported on geographic or locational barriers including distance to academic centers, 5 articles (25%) reported on barriers to diagnosis including rural and suburban settings, 5 articles (25%) reported on financial (socioeconomic/insurance) barriers, and 5 articles (25%) reported on barriers related to patient demographics such as marital status, race, and psychologic factors.

Conclusion: Given the community-related barriers that exist for patients with musculoskeletal tumors, key initiatives such as increasing access to referral centers/academic centers within specific patient communities may reduce delays to care for oncologic patients. These pre-hospital barriers to care highlight the importance of public health initiatives focused on improving patient access based on both internal and external patient factors. Further studies are warranted to explore specific interventions that improve patient access and prevent musculoskeletal tumor progression to an untreatable or complex surgical stage.