Coordinated psycho-oncology in young adults with breast cancer: equity gradients, timely access, and out-of-pocket spending in China.

[OBJECTIVE] Young women undergoing radical mastectomy in China have substantial psychosocial needs, yet equity of access to coordinated psycho-oncology care remains uncertain.

[METHODS] In 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).

[RESULTS] Among 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%).

[CONCLUSION] Socioeconomic 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.