Access, Outcomes, and Costs Associated with Surgery for Malignancy Among People Experiencing Homelessness

Area of Science:

• Oncology
• Health Services Research
• Socioeconomic Determinants of Health

Background:

• Limited understanding of surgical oncology outcomes for people experiencing homelessness (PEH).
• Potential for delayed diagnosis and unplanned surgeries due to healthcare access barriers.
• Need to characterize care access, outcomes, and costs for PEH undergoing cancer surgery.

Purpose of the Study:

• To characterize healthcare access among PEH undergoing cancer surgery.
• To evaluate postoperative outcomes in PEH compared to housed patients.
• To assess the economic impact of cancer surgery on PEH.

Main Methods:

• Retrospective cohort study using the Healthcare Cost and Utilization Project (HCUP) database (2016-2017).
• Inclusion of patients undergoing gastrointestinal or lung cancer surgery in Florida, New York, or Massachusetts.
• Identification of PEH using the HCUP 'Homeless' variable and ICD-10 code Z59; multivariable regression analysis.

Main Results:

• PEH (0.2% of cohort) more frequently had unplanned surgeries (65.3% vs 23.7%) and were less often treated at cancer centers.
• Similar postoperative morbidity rates between PEH and housed patients (20.4% vs 14.5%).
• PEH showed higher odds of facility discharge, readmission, longer adjusted length of stay (LOS) (+67.7%), and increased adjusted costs (+32.7%).

Conclusions:

• People experiencing homelessness undergoing cancer surgery face higher rates of unplanned procedures.
• PEH experience significantly longer hospital stays and increased healthcare costs post-surgery.
• Enhanced access to oncologic care is essential for improving outcomes for PEH.