P-53 Cross-border cancer care in the Caribbean: a retrospective analysis of applicants for government medical assistance in Saint Lucia

Methods: We conducted a retrospective analysis of requests for financial assistance submitted between January 1, 2011 and May 31, 2024. Data included demographic, employment, and income information, as well as referral destinations and requested amounts. Crude prevalence ratios (PR) and their 95% confidence intervals were calculated using a Poisson regression to assess associations between patient characteristics and overseas referrals.

Results: Among 71 cancer patients requesting assistance, the median age was 50 years, 75% were women, and 82% reported no income or less than $1000 XCD monthly. Requests increased markedly post-COVID-19 (2020–2024 average: 8 per year vs. 3 pre-pandemic), with a greater proportion of local referrals during this period. Overall, 54% of referrals were local and 45% overseas, primarily to Martinique (37.5%), Guyana (28.1%), and Antigua (15.6%). Overseas referrals were significantly associated with employment (PR=2.05, 95% CI: 1.21–3.47) and higher-cost requests (≥$10,000 USD; PR=2.32, 95% CI: 1.50–3.61). Older age and the post-COVID-19 period were linked to lower likelihood of overseas travel. Higher income was significantly associated with increased overseas referrals (PR=1.84, 95% CI=1.03–3.29).

Conclusion: Medical travel for cancer care in Saint Lucia reflected significant socioeconomic inequities and vulnerability to global shocks. Strengthening local oncology capacity and financial protection is critical to reduce health inequity and dependence on overseas care. Larger population-based studies are warranted to inform interventions.