ArticleSupportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer2026
Coordinated psycho-oncology in young adults with breast cancer: equity gradients, timely access, and out-of-pocket spending in China.
Article in Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveYoung women undergoing radical mastectomy in China have substantial psychosocial needs, yet equity of access to coordinated psycho-oncology care remains uncertain.
methodsIn a cross-sectional study in Zhanjiang, Guangdong, patients aged 18-45 years with stage I-IV breast cancer completed surveys, and clinical data were abstracted. The primary endpoint was receipt of coordinated psycho-oncology care within 3 months, defined by documented interdisciplinary planning plus patient confirmation. Exposures were monthly household income (five bands) and insurance type (UEBMI, URRBMI, commercial/private, other public, none). Multivariable logistic regression estimated adjusted odds ratios (aORs).
resultsAmong 2831 participants (mean age 36.0 years; 98.9% female), 47.5% received coordinated psycho-oncology care within 3 months. Coordination rates varied by insurance: 51.4% with UEBMI versus 39.2% uninsured. Monthly income showed a graded association: each band increase yielded aOR 1.18 (95% CI 1.09-1.28). URRBMI enrollees had lower odds than UEBMI (aOR 0.78, 95% CI 0.66-0.93); uninsured were most disadvantaged (aOR 0.58, 95% CI 0.35-0.97). Higher distress increased coordination (Distress Thermometer 7-10 vs 0-3: aOR 2.23, 95% CI 1.65-3.02); limited digital access reduced it (aOR 0.73, 95% CI 0.55-0.97). Referral showed a strong gateway effect (aOR 4.72, 95% CI 4.35-5.09). Process barriers reduced coordination: appointment delays > 14 days (aOR 0.47, 95% CI 0.39-0.57), travel > 120 min (aOR 0.38, 95% CI 0.26-0.55), cost-related avoidance (aOR 0.58, 95% CI 0.46-0.73). Predicted coordination ranged from 35% (uninsured, lowest income) to 63% (highest income, commercial coverage). Coordinated care was associated with higher satisfaction, lower out-of-pocket spending (-133 RMB), and reduced catastrophic expenditure among those with longer waits (-12.3%).
conclusionSocioeconomic position, insurance generosity, and modifiable process barriers are associated with access to coordinated psycho-oncology. Interventions targeting rapid referral, appointment capacity, travel assistance, and digital navigation warrant evaluation to improve equity and reduce financial toxicity.
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