Cancer survivors may be more likely to delay or forgo care if their treating clinician is of a different race, gender, or other identity, according to study results published in JAMA Oncology.

Young, non-White, and lower-income cancer survivors are among those most likely to delay or forgo care, researchers found.

The researchers surveyed 21,919 cancer survivors and 109,595 matched cancer-free individuals from the National Institute of Health’s All of Us Research Program. 

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The results showed that patient-clinician identity discordance led 7.6% of cancer survivors to delay or forgo care, compared with 5.1% of cancer-free individuals (P <.001).

A multivariable analysis of the cancer survivors showed that age, gender, race/ethnicity, sexual orientation, educational attainment, income, and cancer type were all associated with the likelihood of delaying or forgoing care due to identity discordance.

Cancer survivors were more likely to delay or forgo care if they were Asian (adjusted odds ratio [aOR], 1.81; 95% CI, 1.25-2.63; P =.002), Black (aOR, 1.39; 95% CI, 1.15-1.68; P <.001), or Hispanic (aOR, 1.39; 95% CI, 1.11-1.74; P =.004) rather than White.

Survivors who were lesbian, gay, or bisexual were more likely to delay or forgo care (aOR, 1.31; 95% CI, 1.06-1.63; P =.01), compared with survivors who were heterosexual. 

Cisgender women were more likely than cisgender men to delay or forgo care (aOR, 1.33; 95% CI, 1.15-1.53; P <.001), but there was no significant difference between cisgender men and transgender or nonbinary people.

Delaying or forgoing care was more likely for:

  • Breast cancer survivors (aOR, 1.29; 95% CI, 1.05-1.58; P =.01)
  • Gynecologic cancer survivors (aOR, 1.3; 95% CI, 1.01-1.66; P =.04)
  • Head and neck cancer survivors (aOR, 1.27; 95% CI, 1.02-1.59; P =.04)
  • Urologic cancer survivors (aOR, 1.26; 95% CI, 1.02-1.57; P =.04).

Delaying or forgoing care was also more likely among cancer survivors younger than 65 years of age (P <.001), those with educational attainment below a Bachelor’s degree (P <.001), and those with an annual income below $50,000 (P <.001). 

The researchers noted that efforts are currently underway to improve workforce diversity and clinician preparedness in oncology. In the meantime, patient-clinician identity discordance “remains a barrier to care for many cancer survivors and should be addressed.” 


Patel VR, Gupta A, Blaes AH, Winkfield KM, Haynes AB, Hussaini SMQ. Prevalence of delayed or forgone care due to patient-clinician identity discordance among US cancer survivors. JAMA Oncol. Published online March 30, 2023. doi:10.1001/jamaoncol.2023.0242

This article originally appeared on Cancer Therapy Advisor