Internal, external and structural barriers in cancer care faced by survivors from the caribcares study

Introduction. Timely diagnosis is a public health priority. However, a great proportion of the population is often diagnosed with advanced disease or as an emergency. The study aimed at examining factors contributing to diagnostic delays and inequalities in cancer care among a subset of cancer survivors in Puerto Rico. Methods. The Caribbean Cancer Research Center on Environmental and Natural Hazards (CARIBCARES) has been recruiting cancer patients who are or have been in active treatment over the past 12 months since August 20, 2025, to assess the impact of extreme weather events on the quality of life of this population. We conducted a cross-sectional study among participants (n=135) from the ongoing research project of CARIBCARES. Trained research assistants interviewed eligible participants who completed the 60-minute survey. A with a $20.00 incentive was provided to each participant. Results. Participants' median age was 60 years, and 41% were living below poverty level. Females were willing to participate than males accounting for 66.4% and 33.6% of the sample, respectively. Over half (53%) of participants had a localized stage at cancer diagnosis, while 35% had regional or distant cancer. Around 49.6% of participants reported delays in their diagnosis. The top reported challenges were problems with their health insurance (24%), financial problems (20%) and Lack of communication with health care providers (14%). Smaller groups of participants were affected due to absence of confirmatory or genetic tests (4.4%), while 3% were unable to attend a medical appointment due to damage to their home or neighborhood caused by an extreme weather event. Discussion. This study highlights critical barriers in the cancer diagnostic and care continuum among survivors participating in the CARIBCARES study, revealing important inequities that disproportionately affect populations in Puerto Rico. These findings underscore systemic weaknesses in healthcare access and navigation that must be addressed to improve early detection and survival outcomes.