Association between disability status, social vulnerability, and healthcare access among patients receiving cancer care in Ontario, Canada.

Abstract

176 Background: Advances in cancer treatment have resulted in increased care complexity and navigational challenges. Recent data suggests that individuals with disabilities face significant disparities when accessing cancer care. We completed a cross-sectional study to better understand barriers that patients with disabilities face when accessing cancer care. Methods: Adult patients attending outpatient oncology clinics at two diverse, urban, public-payor hospitals in Toronto, Canada were invited to complete questionnaires between July - August 2025. The questionnaires collected data on: demographics, transportation stress, financial toxicity (COST-FACIT tool), food and housing insecurity, and other social determinants of health. Consenting participants underwent a retrospective chart review to collect data on cancer diagnosis, treatment, missed appointments, ED visits, and hospitalizations between Jan 1 and Dec 31 2025. Univariate chi-squared and odds ratio analyses were done to explore associations between disability status and social determinants of health. Multivariate analysis is planned. Results: Among 576 participants, 48.6% identified as female. The most common diagnoses were breast cancer (18.8%), and lymphoma (10.8%). Of 539 participants who provided a response regarding disability status, 20% self-reported a disability. Among 426 participants who consented to the chart review, 6% had a disability documented in their medical record, and 21% self-reported a disability on the survey study. Disability status was associated with difficulty paying for basic needs (OR 6.70, 95% CI 3.65-12.30), difficulty obtaining medications and/or medical supplies (OR 4.08, 95% CI 2.20-7.55), food insecurity (OR 3.93, 95% CI 2.24-6.89), missing an appointment due to transportation barriers (OR 3.41, 95% CI 1.28-9.07), financial toxicity (OR 3.13, 95% CI 1.89-5.17), transportation stress (OR 2.41, 95% CI 1.54-3.79) and housing insecurity (OR 3.01, 95% CI 1.79-5.07). Patients self-reporting a disability were less likely to report having someone they could rely on for support (OR 0.24, 95% CI 0.10–0.68). From the chart review, self-reporting a disability was associated with missing at least one appointment (OR 2.25, 95% CI 1.35–3.76), and at least one emergency room visit (OR 2.16, 95% CI 1.34–3.49). Disability status was not associated with age, gender, hospitalization, receiving systemic therapy, or cancer clinic. Conclusions: In two urban public-payor cancer clinics, self-reporting a disability was associated with indicators of social vulnerability and healthcare access challenges. Disability status was under-documented in the medical record, which could limit opportunities to identify and address social needs. Further research is needed to evaluate interventions that improve cancer care access for patients with disabilities.