The oncology community is focusing more attention on the differences in the occurrence, frequency, and survival of cancer of different populations in the United States. These populations may include members of minority populations, older adults of any race or background, and those who are poor or geographically isolated. Here, Cancer.Net talks with Derek Raghavan, MD, PhD, to learn more about health disparities in cancer.
Q: What are health disparities and the contributing factors?
A: Although there are many relevant definitions, the U.S. Department of Health and Human Services defines health disparities as differences in the occurrence, frequency, death, and burden of diseases and other unfavorable health conditions that exist among specific population groups.
Factors contributing to these differences include poverty; lack of access to health care; lack of health insurance; language and literacy barriers; lack of family support; social habits, such as smoking and lack of exercise; and lack of confidence in cancer treatment, doctors, and/or the health care system.
Q: What are some specific areas of disparity in cancer care?
A: Our current cancer prevention strategies for the various underserved population groups are inadequate. The same factors that may result in general health disparities affect participation in efforts to prevent cancer. For example, some studies show that minority women tend to be more reluctant to have mammograms or testing for genes associated with breast cancer (BRCA1 and BRCA2) when it is needed, which means they are much less likely to benefit from preventive care. Meanwhile, barriers in access to health care can result in delays in diagnosis and treatment.
Q: What are some interesting studies being done about/on cancer disparities?
A: At present, there are two major areas of research: studies focused on improving the scope and quality of cancer care for underserved populations, and research focused on specific population groups, such as African Americans, Hispanics/Latinos, older adults, and impoverished or isolated individuals. There is also emerging evidence that some population groups have genetic differences that influence the effectiveness of specific cancer treatments and the type and severity of side effects people experience.
A small selection of specific studies of interest include:
- The cultural reasons why African American men and women are less likely to undergo cancer screenings
- How chemotherapy affects people over age 70
- Cervical cancer vaccination among Hispanic/Latina women
- How to best manage prostate cancer among African American men
- Differences in genes present in different population groups and the effect on cancer diagnosis and treatment
Q: What is ASCO doing to reduce disparities in cancer care?
A: Some initiatives ASCO is undertaking include the following:
- Educating members about cancer disparities and the biology of cancer in different population groups through ASCO University and at the ASCO Annual Meeting (the premier educational and scientific event where oncology health care professionals gather to discuss the latest in cancer care)
- Facilitating the recruitment and retention of individuals from populations underrepresented in medicine to cancer careers through the ASCO Diversity in Oncology Initiative (DOI), funded by Susan G. Komen for the Cure. Through the Medical Student Rotation and the Resident Travel Award, this initiative offers awards for clinical or clinical research oncology rotations for medical students and travel to the ASCO Annual Meeting for residents who are from populations underrepresented in medicine. The DOI also includes the Loan Repayment Program, which provides repayment of qualifying educational debt for oncologists or oncology fellows who agree to practice oncology in a medically underserved region of the United States.
- Funding grants and awards in health disparities research through the Conquer Cancer Foundation of ASCO
- Advocating for the use of health care reform and policy changes to address cancer health disparities
- Providing practical tools and resources to help oncology providers use strategies in their practices to reduce cancer care disparities
Q: How will those efforts affect people with cancer?
A: The goal is to remove barriers in access to cancer care so that underprivileged groups will have the same access to high-quality care as the rest of the population. This can be achieved by encouraging and training more oncologists from minority groups, providing specific training on culturally sensitive care, and improving education about cancer and prevention. It would also help to develop better treatments that are specific to populations with unique needs, while advancing our understanding of the cancer issues relating to those populations.
Dr. Raghavan is president of the Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; a former chair of the ASCO Health Disparities Advisory Group; and a member of the ASCO Cost of Cancer Care Task Force.
Last Updated: March 16, 2011