Missed Care, Missed Opportunities: Health and Economic Impact of Delayed or Forgone Care Among Adults With a History of Gastrointestinal Cancer.

Authors

Areesh Mevawalla, Meher Angez, Odysseas P Chatzipanagiotou, Azza Sarfraz, Qaidar Alizai, Timothy M Pawlik

Published in

Journal of surgical oncology. Oct 13, 2026. Epub Oct 13, 2026.

Abstract

Timely medical intervention is critical to achieve optimal outcomes in gastrointestinal (GI) cancers, yet numerous patients experience delayed or forgone (D/F) medical care. This study aimed to evaluate the national impact of D/F care on emergency surgical interventions and associated healthcare expenditures among patients with GI cancers.
Adults with a self-reported history of GI cancer were identified from the Medical Expenditure Panel Survey, 2007-2017. Multivariable regression analyzes was performed to assess associations between D/F medical care, ED-associated GI surgery, inpatient utilization, and related healthcare expenditures after adjusting for demographic and socioeconomic variables.
Among a weighted sample of 6 517 883 patients with GI cancers, 8.5% (n = 552 751) reported D/F medical care. Patients with D/F care were older (76 years [IQR: 69-82] vs. 68 years [IQR: 58-76]), more frequently male (57.3% vs. 50.6%) and frequently had family income below the poverty line (40.2% vs. 11.3%) (all p < 0.001). Furthermore, individuals reporting D/F care were more likely to have emergency department visits (44.2% vs. 27.4%), hospitalizations (64.6% vs. 34.5%) (both p < 0.05), or undergo ED-associated GI surgery (41.0% vs. 19.1%; p < 0.001). In multivariable analysis, after adjusting for relevant factors, D/F care was associated with markedly greater odds of ED-associated GI surgery (OR 2.70, 95%CI 1.47-4.95) and higher annual inpatient healthcare costs (β +$31,410, 95% CI $23,592-$39,227) compared with individuals who did not report D/F care.
Self-reported D/F medical care was associated with greater acute healthcare utilization, higher odds of ED-associated GI surgery, and greater healthcare expenditures. These findings highlight the importance of understanding barriers to healthcare access among adults with a history of GI cancer.

PMID:
42870505
Bibliographic data and abstract were imported from PubMed on 14 Oct 2026.

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