Αρχική World News Cancer Does Not Affect All People Equally: An Expert Q&A on Cancer...

Cancer Does Not Affect All People Equally: An Expert Q&A on Cancer Disparities and Health Equity

Karen Winkfield, MD, PhD, is an associate professor of radiation oncology at Wake Forest Baptist Health in Winston-Salem, North Carolina, and the former Chair of ASCO’s Health Equity Committee. She is the Cancer.Net Associate Editor for Radiation Oncology and Health Equity.

Cancer does not affect all people equally. The phrase “cancer disparities” refers to the differences in the number of new cancer cases, as well as differences in cancer outcomes, that exist among different populations. Disparities more often negatively affect racial and ethnic minorities, poor people, sexual and gender minorities (LGBT+), adolescent and young adult populations, and older adults.

Identifying cancer health disparities helps us work together with the communities at highest risk to find out the best ways to reduce cancer risk and improve access to preventive care and treatment. 

Q: What are health disparities?

Here in the United States, health disparities are commonly used to describe differences in illnesses among racial and ethnic minorities. However, it is important to note that health disparities impact many different groups based on factors like age, gender, education level, income, disabilities, and sexual orientation.

Health disparities based on race seem to persist even after taking into account a person’s socioeconomic status, which is typically measured as a combination of income, occupation, and education. For example, Black men and women bear the greatest burden for many conditions, including cancer, heart disease, HIV-AIDS, asthma, and childhood death. These disparities often exist regardless of a Black person’s socioeconomic status. The burden of disease among certain populations represents a form of social injustice based in structural racism. These facts have been highlighted by the recent COVID-19 pandemic.

Q: Who is most affected?

Black, American Indian, and Alaskan Native communities experience the worst cancer health disparities among racial/ethnic groups in the United States. These populations continue to suffer the greatest rates of cancer and the poorest outcomes for each of the most common types of cancer, despite incredible progress in reducing overall deaths from cancer.

The statistics for Black men and Black women are alarming. Black men are diagnosed with prostate cancer at almost twice the rate of any other racial or ethnic group. Black men die from prostate cancer twice as often as white men. Black women have a 13% higher relative risk of dying from cancer, according to a 2019 report from the American Cancer Society. Black women are 40% more likely to die from breast cancer, even though white women are more frequently diagnosed.

Q: Why do certain racial and ethnic minorities experience health disparities?

Health disparities experienced by racial and ethnic populations is linked to a history of discrimination and systematic exclusion that has prevented communities of color from achieving social and economic well-being. The resulting poverty, lack of education, and unstable job opportunities, worsen issues that are specific to health security, such as lack of health insurance and a mistrust of doctors. Black people in the United States have been associated with “unhealth” for centuries, with the beginning of health inequities rooted in the trauma of slavery.

Q: How do health disparities affect people with cancer?

The bottom line is: Cancer outcomes are worse in people who experience health disparities.

Why? Because other diseases affect our ability to treat cancer well.

Heart disease, obesity, diabetes, and infections (including the novel coronavirus that leads to COVID-19) all disproportionately impact Black communities. These health disparities can make cancer treatments, including surgery, chemotherapy and other systemic treatments, and radiation therapy much harder to give, or treatments may cause more severe side effects. Factors that lead to health disparities—including poverty, socioeconomic factors, lack of trust in doctors and medicine, low literacy, and inadequate health insurance—create barriers to good care along the entire cancer continuum, from prevention and screening through treatment and end-of-life care.

Socioeconomic factors such as job security play a major role in treatment decisions and, ultimately, cancer outcomes. I’ve seen this firsthand in my community outreach in many cities, including my work in Boston and Winston-Salem. For instance, I have talked with women around the country who felt forced to choose a mastectomy (surgery to remove the breast) instead of more time-consuming, daily radiation treatments that may preserve the breast because they worried about being able to take time off from work or the potential loss of pay.

Poor people are less likely to enroll in clinical trials for cancer treatments, according to a 2016 study in the Journal of the American Medical Association Oncology. Clinical trials offer new treatments that might improve cancer outcomes. However, people with low income or insufficient health insurance may not have access to specialist doctors or the genetic tests needed to enroll in clinical trials. My fear is that the divide will widen between groups if we don’t create policies to provide equal access to genetic testing and clinical trials.

Q: What research is being done to reduce health disparities?

We’ve known for centuries that health disparities exist. Research continues to show (over and over) that racial and ethnic minorities face poorer cancer outcomes. More reporting on the problem is not needed. Let’s move beyond simplistic reporting of disparities and actually change the lives of people with cancer.

Improving cancer screening is one goal—and the U.S. government has funded several programs for people with low income or without health insurance. Improving how patients navigate the health care system, such as how appointments are made or how clinicians follow up with patients after treatments, is another goal. It can reduce costs and improve cancer screening, according to a 2018 study on colorectal cancer. And a recent workshop explored the topic of patient navigation programs in depth.

Examining the cost of enrolling in clinical trials is another research topic. A recent ASCO policy statement outlines these challenges, but few recommendations for overcoming financial barriers are available.

For me, the most exciting research pinpoints the social issues that underlie health disparities. Semi-structured interviews with people and focus group data bring a wealth of information, and I hope journals and academic institutions continue to support this type of research. They tell us how people’s perceptions, behaviors, and cultural circumstances affect the health of communities and help us develop specific programs to improve health equity.

Q: What is ASCO doing to reduce disparities in cancer care?

I’m proud to say that ASCO has made addressing cancer disparities a key aspect of its mission and agenda for more than 2 decades. The first Advisory Group on Health Disparities was established in 2003, and today the ASCO Health Equity Committee develops programs and policies to address health disparities in all aspects of cancer care.

Increasing the diversity of nurses and doctors who help patients with cancer is a key goal. ASCO’s Diversity in Oncology Initiative awards program helps recruit and retain underrepresented people in medicine, so they may follow careers in cancer. Efforts are also underway to educate providers and patients about health disparities in cancer care.

Another project helps medical practices that serve underserved populations improve the quality of their cancer care through mentorship and support from ASCO. And ASCO continues to advocate for health equity everywhere.

Q: What is health equity?

The Robert Wood Johnson Foundation describes health equity as when everyone has the opportunity to attain their highest level of health. To improve health equity, greater efforts must be made to address injustices that affect vulnerable populations like Black men and Black women. Only then can we begin to positively change differences in cancer prevalence and outcomes.



Συμπληρώστε το email σας για να λαμβάνετε τις σημαντικότερες ειδήσεις από το ogkologos.com

Βρείτε μας

2,449ΥποστηρικτέςΚάντε Like

Διαβαστε Επίσης


ΕΞΕΛΙΞΕΙΣ ΣΤΗ ΘΕΡΑΠΕΙΑ ΤΟΥ ΜΗ-ΜΙΚΡΟΚΥΤΤΑΡΙΚΟΥ ΚΑΡΚΙΝΟΥ ΤΟΥ ΠΝΕΥΜΟΝΑ (ΜΜΚΠ) Γράφει ο Δρ Παπαδούρης Σάββας, Παθόλογος-Ογκολόγος   Ο ΜΜΚΠ βρίσκεται αναλογικά στο 80% και πλέον του συνολικού...

Διατρέχουν όντως οι καρκινοπαθείς μεγαλύτερο κίνδυνο λόγω κοροναϊού;

Σε πρακτικό επίπεδο, τα δεδομένα των σχετικών μελετών υποδηλώνουν ότι η χημειοθεραπεία ή οι άλλες αντι-νεοπλασματικές θεραπείες δεν αυξάνουν σημαντικά τον κίνδυνο θνησιμότητας από...

FDA: Η ακτινοβολία των smartphones δεν προκαλεί καρκίνο

Σε μια νέα έκθεσή της, η Υπηρεσία Τροφίμων και Φαρμάκων (FDA) των ΗΠΑ αναφέρει ότι επανεξέτασε τις σχετικές επιστημονικές έρευνες που δημοσιεύθηκαν τα τελευταία...

Νέα ανακάλυψη, νέα ελπίδα για τον καρκίνο

Ένα νεοανακαλυφθέν τμήμα του ανοσοποιητικού μας συστήματος θα μπορούσε να αξιοποιηθεί για την αντιμετώπιση όλων των ειδών καρκίνου, σύμφωνα με επιστήμονες του πανεπιστημίου Cardiff...

Καρκίνος: Ευεργετική για τους καρκινοπαθείς η άσκηση

Σημαντικά ωφέλη προσφέρει η άσκηση, ακόμη και σε ασθενείς με καρκίνο. Οι περισσότεροι ασθενείς αγνοούν τα οφέλη που μπορεί να έχει γι’ αυτούς η συχνή...

Prostate Cancer

The article is provided by Scientific Communications Officer of NIPD Genetics, Ms Marina Charitou (MSc) Prostate Cancer Awareness Prostate cancer is the second most common cancer...
- Advertisment -

Ροή Ειδήσεων

News digest – ovarian cancer blood test, statins, spending review and head and neck cancer immunotherapy

Ovarian cancer blood test ‘better than previously thought’   A new investigation into an existing blood test to detect ovarian cancer has uncovered better-than-expected...

Woman with Nonverbal Autism Diagnosed with Breast Cancer After Caregiver Sister Finds Lump

Tabitha Cyrus, whose friends and family affectionately call her Taffy, was three years old when she was diagnosed with autism. Her family had anticipated...

Living With Metastatic Breast Cancer: How I Reinvented Myself

Shonte Drakeford is a 36-year-old Washington, D.C. native, nurse practitioner, United States Army wife, and German Shepherd mama. She was diagnosed with stage IV...

The Mediterranean Diet

The Mediterranean diet is a predominately plant based diet that accents omega 3 rich fish sources and whole foods that are minimally processed. Olives...

Results of Continuous vs Intermittent Dosing Schedules of BRAF/MEK Inhibitor Combination Therapy in the S1320 Study

Opposite to the initial study hypothesis, the results of the S1320 indicate that intermittent dosing of BRAF/MEK inhibitor combination did not improve progression-free survival...

FDA Approves Companion Diagnostic to Identify NTRK Fusions in Solid Tumours for Larotrectinib

On 23 October 2020, the US Food and Drug Administration (FDA) approved the next-generation sequencing (NGS)-based FoundationOne CDx test (Foundation Medicine, Inc.) as a...