Developing robust systems for cancer care delivery is essential to reduce the high cancer mortality in small island developing states (SIDS). Indigenous data are scarce, but community-based cancer research can inform care in SIDS where formal research capacity is lacking, and we describe the experiences of cancer survivors in Saint Lucia in accessing health services. Purposive and snowball sampling was used to constitute a sample of survivors for interviews. Subjects were interviewed with a questionnaire regarding socio-demographics, clinical characteristics, health services accessed (physicians, tests, treatment), and personal appraisal of experience. We recruited 50 survivors (13 men, 37 women). Only 52% of first presentations were with general practitioners. The mean turnaround for biopsy results in Saint Lucia was three times longer than overseas (p = 0.0013). Approximately half of survivors commenced treatment more than one month following diagnosis (median of 32 days, IQR 19–86 days), and 56% of survivors traveled out-of-country for treatment. Most survivors (60%) paid for care with family/friends support, followed by savings and medical insurance (38% each). In conclusion, cancer survivors in Saint Lucia are faced with complex circumstances, including access-to-care and health consequences. This study can guide future research, and possibly guide practice improvements in the near term.

Purpose: Low socioeconomic status could contribute to insufficient access to care and the high cancer mortality in small developing island states (SIDS). However, disparities in care among cancer survivors are rarely studied in SIDS. We investigated for the first time the socioeconomic disparities across the cancer care continuum in Saint Lucia. Methods: We used purposive and snowball sampling to recruit adult cancer survivors residing in Saint Lucia. Trained field investigators interviewed survivors face-to-face with a structured questionnaire ascertaining their care experience and health services accessed. We used univariate logistic regressions to estimate odds-ratios (OR) and their 95% confidence intervals (CI) measuring the association between socioeconomic status and cancer care. Socioeconomic status was modelled as binary outcome variables: educational level, private medical insurance and hot water at home (a proxy for income in Saint Lucia). Results: We included 50 survivors (13 men, 37 women). The majority of survivors were black, and diagnosed with breast and prostate cancer. Survivors who were satisfied with the information provided during their diagnosis announcement were more likely to have hot water (OR=5.0, 95% CI=1.3-19.0). Concerning, sources of funds for treatment, private medical insurance and hot water were associated respectively with less financial contributions from family/friends (OR=0.2, 95% CI=0.1-0.9) and greater use of their own funds (OR=3.3, 95% CI=0.9-15.0). Patients who were provided with doctor’s contact information in case of concerns were more likely to have more than primary education (OR=6.3, 95% CI=1.3-31.1) and private medical insurance (OR=12.3, 95% CI=1.4-111.6). Overseas travel for cancer treatment was significantly associated with having private health insurance (OR=3.4, 95% CI=0.9-12.7) and hot water (OR=4.5, 95% CI=1.2-16.8). Having more than primary school education was associated with better perceived care experience (OR=13.5, 95% CI=2.2-84.0). Having private medical insurance was associated with greater access to supportive care services such as psychologists and physiotherapists (OR=3.6, 95% CI=0.9-14.5). Conclusion: Despite our small sample size and potential confounding, we showed some evidence of socioeconomic disparities across the cancer care continuum in Saint Lucia. Low socioeconomic status should be taken into account when considering interventions to reduce of cancer mortality in SIDS. Citation Format: Aviane Auguste, Dorothy Phillip, Owen Gabriel, James St. Catherine, Carlene Radix. Socioeconomic Disparities Across the Cancer Care Continuum in Saint Lucia: A Community-Based Study [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 72.

Understanding the views of cancer survivors on their experience is important for informing community-based interventions. We studied, for the first time, the views of cancer survivors residing in Saint Lucia on their overall care experience. We used interview data from a cohort of adult cancer survivors from Saint Lucia between 2019 and 2020. We performed a thematic analysis to derive themes from codes. Forty-four survivors provided responses to at least one of the three questions. The majority of survivors were black, female and diagnosed with breast cancer. Survivors were interviewed on average five years after diagnosis. Four common themes emerged; “Availability of support groups”, “Importance of support from family and friends”, “Access to finances” and “Health education and patient navigation”. Travel overseas for health services was common among survivors. Survivors expressed emotional distress during travel due to isolation from family and local providers. This is typical among island populations and is distinct from existing patient frameworks. Survivors also suggested that networking amongst providers and interventions assisted families of cancer survivors. Although tertiary care services are limited, we showed that survivors deeply value and depend on their inter-personal relationships during care. Interventions aimed at strengthening the inter-personal environment of survivors are warranted.