Resource limitations and cancer care access for Native Hawaiian/Pacific Islander veterans in the Pacific region

Native Hawaiian/Pacific Islander (NHPI) populations may experience poorer cancer-related outcomes, shaped by social determinants such as higher poverty rates and underrepresentation in national data. NHPI Veterans face heightened vulnerability due to military-related exposures and the need to navigate distinct Veterans Health Administration (VHA) pathways for care, adding complexity not experienced by civilians. Limited oncology services across Hawai‘i and the U.S.-Affiliated Pacific Islands (USAPI), compounded by geographic isolation and workforce shortages, increase risk for delayed diagnosis and treatment. This qualitative analysis from the PaCiPIC Veterans Study examines key challenges and opportunities to improve access to cancer care among NHPI Veterans residing in the USAPI. Semi-structured interviews were conducted with NHPI Veterans residing within the VA Sierra Pacific Network 21 (n = 8 to date, target = 15-20). Interviews were recorded, transcribed, de-identified, and analyzed thematically in ATLAS.ti. Codes were iteratively developed through team consensus by a multidisciplinary team with clinical, psychological, and qualitative research expertise, guided by Fortney's Access to Care Framework. Veterans described challenges with community care referrals, including delays and uncertainty over follow-up. Many felt resources on the islands remain limited, noting few, if any, noticeable improvements in services or access over time despite advocacy. Long-distance travel for diagnostics and treatment created financial and logistical strain from airfare, lodging, and caregiver support unless Veterans met specified service-related criteria. Teleoncology was viewed as a potential acceptable alternative to reduce travel burden for follow-up care, though Veterans emphasized core aspects-laboratory testing, imaging, and procedures-required in-person encounters. Family and community networks emerged as essential support systems, providing transportation, coordination, and emotional care bridging gaps. Preliminary findings highlight resource limitations as key insular barriers to cancer care for NHPI Veterans in the Pacific, consistent with clinician perspectives from our previously published works. Building on these insights, we will identify feasible strategies to address system-level constraints and inform implementation of services in the region.