Researchers Urge Efforts to Improve Diagnosis and Care of Patients with Disabilities that Affect Mobility

Key Takeaways:

  • Diagnosing and treating patients with mobility issues can be complex, and patients may experience substandard care because of disability-related problems.
  • As the population ages, more people may be affected by mobility issues.
  • Authors of a recent study urge providers to take steps to improve the timeliness, diagnosis, and quality of care for these patients.

People with disabilities that affect their mobility often face special challenges when diagnosed with cancer. Beyond logistical matters such as getting to and from medical appointments, they may be diagnosed with more advanced, harder-to-treat cancer than non-disabled individuals, making them more likely to die of their disease, research suggests.

While most previous studies of these issues have been based on the results of patient surveys and interviews, Harvard Medical School-affiliated researchers recently examined medical records for clues to how oncologists and other cancer clinicians view patients with pre-existing mobility issues and how those views may affect diagnosis and treatment. A paper on their findings identified four major concerns:

  • Some clinicians expressed concern that cancer screening and diagnostic procedures could adversely affect patients’ disabilities or other health conditions;
  • Some of the signs and symptoms of cancer were mistakenly attributed to patients’ disabilities, delaying accurate diagnosis and timely treatment;
  • Physical disabilities can complicate decisions about treating cancer; and
  • Lack of accommodations for people with disabilities — including equipment that is inaccessible to such individuals — can impede cancer diagnosis.

The researchers conclude that even though clinicians recognize that diagnosing and treating patients with mobility issues may be complex, these patients may still experience substandard care because of disability-related problems. As the population ages and more people experience mobility difficulties, the study authors urge care providers to take steps to improve the timeliness of diagnosis and the quality of care for these patients.

Addressing gaps in cancer care

“It is essential that we measure cancer care quality for vulnerable patient populations to address gaps in cancer care that will improve clinical outcomes,” says Dana-Farber’s Charlotta Lindvall, MD, PhD, a co-author of the study. The study was led by researchers at Harvard-affiliated Brigham and Women’s Hospital and Massachusetts General Hospital.

Dana-Farber’s Charlotta Lindvall, MD, PhD, a co-author of a study on how oncologists and other cancer clinicians view patients with pre-existing mobility issues and how those views may affect diagnosis and treatment.
Dana-Farber’s Charlotta Lindvall, MD, PhD, a co-author of a study on how oncologists and other cancer clinicians view patients with pre-existing mobility issues and how those views may affect diagnosis and treatment.

Overall, approximately 13% of U.S. adults are estimated to have a mobility disability, with the percentage increasing as age rises. Cancer, too, is more prevalent in older individuals. For these reasons and others, cancer rates in people with mobility issues are equal to or higher than those in the general population.

Despite this unequal burden, there’s substantial evidence that people with pre-existing mobility problems experience disparities in health care, including lower cancer screening rates than non-disabled people.

For the new study, researchers conducted in-depth reviews of electronic medical records of 27 patients with pre-existing mobility disabilities diagnosed with one of three common cancers — non-Hodgkin lymphoma, colorectal cancer, or prostate cancer — at the Partners Healthcare network (now Mass General Brigham). All of the patients had used wheelchairs for at least a year before their cancer diagnosis.

Delayed diagnosis        

Clinicians’ notations within the electronic medical records illustrate the four areas of concern that researchers identified.

Concerns about the impact of diagnostic tests on people with physical disabilities, for example, are reflected in a comment by a physician that patient in his 60s had been “unable to get [a] colonoscopy [because] of polio.” The patient was later diagnosed with stage III colorectal cancer. Concerns that cancer symptoms may be incorrectly attributed to a patient’s disability are reflected in the case a patient in her early 60s with multiple sclerosis (MS) who had constipation and rectal bleeding. Her gastroenterologist wrote that “most of her issues with stool retention are due to a defecatory disorder…likely related to her MS.” This patient, too, was later diagnosed with stage IIII colorectal cancer.

“The consequences of delayed diagnosis include emergency presentation with escalating symptoms, advanced stage at diagnosis, and limited treatment options,” the study authors write. “Given the growing population of people with mobility disability, further efforts to improve care quality and timeliness of diagnosis are warranted.”