Faculty Bibliography

BACKGROUND:Patients with breast cancer and limited English proficiency (LEP) experience barriers to care that may result in greater disease burden. We aim to evaluate breast cancer presentation and pathologic characteristics of patients with LEP compared with patients with English proficiency (EP). PATIENTS AND METHODS/METHODS:We performed an institutional review board (IRB)-approved, retrospective review of prospectively collected patient-reported data among a multilingual population evaluated within a New York City safety-net health system between 2018 and 2025. Comparative analysis and logistic regression were used. RESULTS:) compared with EP (31.2% versus 18.5%; p = 0.012) and was significantly associated with completion axillary lymph node dissection compared with EP (12.8% versus 3.6%; p = 0.0041). Patients with LEP had significantly longer time-to-therapy intervals from biopsy to first therapy compared with EP (52 versus 49 days; p = 0.041). On multivariate analysis, both LEP and delays to first therapy were significantly associated with axillary nodal metastasis. CONCLUSIONS:Patients with breast cancer and LEP were significantly more likely to have axillary nodal metastasis compared with patients with EP. Increased axillary nodal metastasis in this population may, in part, be due to lack of screening and delays to breast cancer treatment.

INTRODUCTION/BACKGROUND: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. METHODS:A narrative review was performed to examine the impact of late-stage cancer presentations on patient outcomes and cost implications. RESULTS: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. CONCLUSIONS: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.

OBJECTIVE/UNASSIGNED:The aim is to identify surgical department chairs' perspectives on the role of Vice Chairs for Diversity, Equity, and Inclusion (DEI VCs). BACKGROUND/UNASSIGNED:The role of DEI VCs has become increasingly common in departments of surgery. However, the role remains ill-defined, and most who hold the position are the first to serve their department in this capacity. METHODS/UNASSIGNED:A 27-item online survey was administered in September 2023 to department chairs across US-based academic general surgery departments who reported having a DEI VC instated in the department. The survey assessed (1) the role, purpose, responsibilities, and value of the DEI VC, (2) resources allotted to DEI VCs, (3) demographic characteristics of both surgical chairs and DEI VCs, and (4) recommendations to increase the impact of the position within the department. RESULTS/UNASSIGNED:The survey sample consisted of 22 surgical chairs; White (73%) and men (68%). Twenty (91%) agreed that the DEI VC enhances their ability to fulfill their mission to diversity, equity, and inclusion, but only 12 (57%) said that the DEI VC was given an annual budget. Surgical chairs reported that increasing resources, integrating the position across other departments, and defining measures to evaluate success would increase the impact of DEI VCs. CONCLUSIONS/UNASSIGNED:Surgical chairs with a DEI VC find value in the position and provide a range of resources to support the role. These results should be used as evidence for establishing and funding DEI VCs across US-based academic general surgery departments.

BACKGROUND:Unmet structural and social needs create barriers to breast cancer screening and treatment. The impact of the intersection of these barriers on screening participation and timeliness of breast cancer care remains poorly understood. METHODS:People identifying as women participating in a breast cancer navigation program for screening or treatment were included. Patient navigators administered survey questions that addressed potential barriers to care access using the Health Leads Screening Toolkit. Odds ratios were calculated for unadjusted bivariate associations, and Cox proportional hazards were used to examine the relationship between barriers and time to treatment. RESULTS:A total of 2804 women (mean age, 53 years) enrolled in navigation for screening or cancer treatment participated in the survey about barriers to care. Of those, 435 (16%) reported unstable housing, 610 (23%) reported poor health literacy, and 164 (6%) reported feeling depressed. Limited transportation was significantly associated with unstable housing (odds ratio [OR] = 26.5, 95% confidence interval [CI] 19.9-35.4, p < 0.00001), poor health literacy (OR = 11.5, 95% CI 9.3-14.2, p < 0.0001), and depression (OR = 2.9, 95% CI 2.1-4.0, p < 0.00001). Individual barriers were not associated with a longer time to treatment, but an increasing number of barriers was associated with a longer time to treatment (Coef = 0.9, p < 0.05). CONCLUSIONS:Compounding structural and social barriers limit participation in breast cancer screening, and women with increasing unmet social needs face delays in treatment for breast cancer. Navigation programs may help women overcome barriers to care; however, understanding and targeting the intersectionality of unmet needs is essential for targeted interventions through breast cancer care navigation programs to be effective.

OBJECTIVE/UNASSIGNED:To investigate the number of safety net hospitals (SNHs) that have American College of Surgeons (ACS) accreditation for surgical programs. BACKGROUND/UNASSIGNED:SNHs provide healthcare to a substantial proportion of uninsured and underserved patient populations and rely heavily on public funding to sustain their operations. ACS accreditation emphasizes evidence-based care and standardization to improve patient outcomes. However, SNHs face financial and administrative barriers to ACS accreditation. METHODS/UNASSIGNED:We investigated the number of SNHs with ACS accreditation for specific programs by utilizing the publicly available listing of ACS-accredited programs and the listing of SNHs from the America's Essential Hospitals membership. We then performed a descriptive analysis of the number and geographic distribution of SNHs within the United States and the number of SNHs with ACS-accredited programs. RESULTS/UNASSIGNED:SNHs vary by regional disparities and demographic characteristics of respective states. Almost 20% of states are without access to SNHs. Most SNHs do not pursue ACS accreditation. Of 322 SNHs, 36% were accredited for cancer care (Commission on Cancer), 31% for trauma (Trauma Quality Improvement Program), 21% for bariatrics (Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program), 13% for breast care (National Accreditation Program for Breast Centers), and 5% for rectal cancer (National Accreditation Program for Rectal Cancer). CONCLUSIONS/UNASSIGNED:ACS accreditation can benefit SNHs in improving guideline-concordant care for medically underserved patients and SNHs should be encouraged to attain ACS accreditation to improve access to and quality of care for vulnerable patient populations.