The Hidden Costs of Late Presentation of Cancer at Safety Net Hospitals

Safety net hospitals (SNHs), defined as the members of America's essential hospitals, are lifelines for over 28 million uninsured and Medicaid-dependent Americans, yet systemic inequities trap both patients and institutions in a vicious cycle.

A narrative review was performed to examine the impact of late-stage cancer presentations on patient outcomes and cost implications.

Late-stage cancer diagnoses (stages III and IV) are more common at SNHs than other hospitals, likely due to limited access to preventative services. The higher rate of late-stage diagnoses leads to a higher cost of treatment. In fact, patients with stage IV cancer incur 60%-80% higher treatment costs than those with early-stage diagnoses.

SNHs are a vital source of health care for vulnerable populations across the country, with 75% of the SNH patient population being uninsured or underinsured. SNHs more frequently see patients with advanced stage cancers and disproportionately bear the expense of caring for these patients. American College of Surgeons accreditation, which emphasizes screening, quality improvement and strict standards, provides a roadmap to earlier detection and standardized high-quality care. However, only half of SNHs have American College of Surgeons quality accreditations in place, and only 12% of SNHs nationwide have American College of Surgeons cancer-related accreditations in place. Barriers to accreditation include staffing shortages and budget constraints, exacerbated by reductions in disproportionate share hospital funding and anticipated cuts to Medicare and Medicaid funding. Despite these challenges, the long-term benefits of accreditation outweigh the investment. Addressing these barriers is crucial to ensuring that SNHs can provide high-quality care to vulnerable populations.