Examining health system stakeholder-reported barriers and solutions to foregut cancer care

Many patients with foregut cancers fail to receive guideline-concordant treatment. The perspectives of health system stakeholders who care for these patients, and their insights into feasible solutions, remain underexplored.

Using grounded theory methodology, 12 semi-structured interviews were conducted to identify multilevel barriers, and health system stakeholders proposed solutions to overcome these barriers.

Participants described barriers across four levels. Individual-level barriers included financial toxicity, transportation challenges, and psychosocial distress. Provider-level barriers included inadequate physician-patient communication and insufficient inter-provider communication. Institutional barriers included delays in accessing specialty care, scheduling inefficiencies, and institutional resource limitations. Policy-level barriers included care fragmentation, inadequate sub-specialty care in rural areas, and inadequate reimbursement. Proposed solutions included strengthening institutional psychiatric support programs, increasing inter-provider engagement, streamlining referral pathways, targeted rural physician recruitment, and reimbursement reform.

Health system stakeholders proposed interventions emphasizing communication, navigation, and system-level integration that may improve the delivery of foregut cancer care in resource-constrained environments.