Practical Steps Toward Reducing Disparities in Cancer Care

Cancer affects all groups in the United States and while progress has been made in terms of lower incidence and mortality, certain groups bear a heavier burden of cancer. Disparities in cancer is defined as differences in measures such as incidence, prevalence, mortality, survival, financial burden, screening rates, and stage at diagnosis. Disparities in cancer exist when overall outcomes (lower incidence or mortality) are improving in some groups but not in all groups.

Some examples of cancer disparities are: Blacks/African Americans have higher death rates versus all other ethnic groups; the incidence of colorectal, lung and cervical cancers are much higher in rural Appalachia than in urban areas; people with more education are less likely to die before the age of 65 from colorectal cancer regardless of race or ethnicity; Hispanic/Latino and Black/African American women have higher rates of cervical cancer and Black/African American women have the highest rates of death from it; and American Indians/Natives of Alaska have higher rates of mortality from kidney cancer.

Cancer disparities are not rooted in one cause but are multi-factorial. Low incomes, low health literacy, long travel distances to screening sites, and access to health insurance are all barriers that lead to disparities. However, even those who are of a higher socioeconomic status with access to quality health insurance may also experience disparities due to institutional racism, as well as conscious or unconscious bias. Cancer disparities may also arise due to lack of diversity in clinical research recruitment or participation.

But we can help combat cancer disparities by taking a multi-pronged approach that prioritizes diversity in the cancer care workforce, access to early detection, and finally, increasing diversity of clinical trials.

Developing a diverse cancer research and care workforce will be critical in better quality of care for underserved groups. Research has shown that Black and Hispanic women working with patient navigators who spoke the same language and were from similar backgrounds received cancer diagnoses sooner1-4—thereby potentially improving outcomes for those patients. Funding and recruitment for these types of positions is an important goal for private and public sectors.

Instituting policies that increase access to early detection of cancer can also help reduce disparities by preventing cancer. These efforts can range from better access to health insurance, screening centers that are nearer to areas of need, access to healthy food, clean air and water. This will require the coordination of governmental bodies and national health institutions.

Diversity in clinical trials is also important in combating cancer disparities. Ethnic and racial populations are consistently underrepresented in clinical trials.5 The result being that the approved therapies do not accurately represent a diverse set of patients. Additionally, though 58.4% of Black patients with cancer and 55.15% of White patients with cancer would join a clinical trial if they had the chance to do so, many patients are not asked to do so by their health care providers.6 Additionally, the lack of clinical trial sites in some communities, financial burden of participating in the clinical trial, lack of paid sick leave and other factors pose significant challenges to clinical trial participation for certain groups.

Though progress still needs to be made to reduce disparities in cancer, the identification of the multitude of factors is the first step in easing the barriers. A combined and coordinated effort between public and private sectors will be needed to truly remove the barriers that keep cancer patients in some ethnic, geographic, and racial groups from achieving the same results as other groups.

At BGB Group, disparities in cancer care are an area of passion for us. Partnering closely with our clients and thought leaders, we have recommended and developed programs that bring to light disparities in cancer care. We have worked closely with our clients to identify and work with thought leaders from underrepresented groups and proactively prepared content that focuses not just on the disparities but how to close the gap. We continue to create meaningful programs and materials that speak to underrepresented groups with a call to action for HCPs. With our scientific prowess and specialization in oncology, BGB is in a unique position to help reduce disparities whether it’s recognizing these inequities exist to shining a light on how our programs in partnership with the pharmaceutical industry can help, BGB Group remains committed to closing the gap and ensuring equal access in the fight against all types of cancer.

References:

1. Hoffman HJ, LaVerda NL, Young HA, et al. Patient navigation significantly reduces delays in breast cancer diagnosis in the District of Columbia. Cancer Epidemiol Biomarkers Prev. 2012;21(10):1655-1663. doi:10.1158/1055-9965.EPI-12-0479
2. Markossian TW, Darnell JS, Calhoun EA. Follow-up and timeliness after an abnormal cancer screening among underserved, urban women in a patient navigation program. Cancer Epidemiol Biomarkers & Prev. 2012;21(10):1691-1700. doi:10.1158/1055-9965.EPI-12-0535
3. Paskett ED, Katz ML, Post DM, et al. The Ohio Patient Navigation Research Program: does the American Cancer Society patient navigation model improve time to resolution in patients with abnormal screening tests? Cancer Epidemiol Biomarkers Prev. 2012;21(10):1620-1628. doi:10.1158/1055-9965.EPI-12-0523
4. Raich PC, Whitley EM, Thorland W, et al. Patient navigation improves cancer diagnostic resolution: an individually randomized clinical trial in an underserved population. Cancer Epidemiol Biomarkers Prev. 2012;21(10):1629-1638. doi:10.1158/1055-9965.EPI-12-0513
5. Murthy VH, Krumholz HM, Gross CP. Participation in cancer clinical trials: race-, sex-, and age-based disparities. JAMA. 2004;291(22):2720-2726. doi:10.1001/jama.291.22.2720
6. Unger JM, Hershman DL, Till C, et al. “When Offered to Participate”: A systematic review and meta-analysis of patient agreement to participate in cancer clinical trials. J Natl Cancer Inst. 2020;113(3):244-257. doi:10.1093/jnci/djaa155