Equity was the focus of this year’s 2021 ASCO Annual Meeting, which took place online from June 4 to 8 and included over 30,000 participants. This theme resonated deeply with ASCO members and attendees after the events of the past year, with over 3.9 million lives lost to the COVID-19 pandemic worldwide, disruptions to all aspects of our daily lives, and the painful recognition of systemic racism in the United States. These dueling pandemics put a sharp focus on ASCO’s efforts to address health inequities in cancer care. As we make significant impacts in our understanding of cancer biology and bring new innovations to people with cancer at a dizzying pace, cancer care providers must commit to ensuring that everyone benefits from these advancements regardless of who they are and where they live.
There are several ways health inequities exist in cancer care. For example, it is well established that Black people with cancer fare much worse for most types of cancer compared with all other racial and ethnic groups. We also know that people with cancer in areas of rural America have difficulty accessing specialty care. So the current challenge in cancer care is that of inequity: treating every person fairly and being aware of the impact of societal circumstances on a person’s health.
To highlight some of the inequities that exist in cancer care, sessions during this year’s Annual Meeting included topics and new research in areas such as, “International Disparities in Gynecologic Malignancies,” “Use of an Antiracism Intervention to Decrease Disparities in Time to Lung Cancer Surgery,” and “Telehealth to Improve Oncology Care for Rural Communities.”
Equity was also the presidential theme for 2020–2021 ASCO President Lori J. Pierce, MD, FASTRO, FASCO. For ASCO, that means that every patient everywhere should receive cancer care that results in the best possible outcome. This is an easy concept to grasp, but addressing inequities in care requires education, deep collaboration, and unwavering intention.
For a person with cancer, this means that their health care team fully acknowledges the conditions in the place where they live, learn, work, and age. In health care, we call these the “social determinants of health.” Understanding an individual’s circumstances helps the health care team recognize potential barriers to care that might exist for them and provides opportunities to overcome those barriers.
Some examples of barriers that lead to inequities in cancer care include:
Transportation. If someone with cancer can’t get to health care facilities, they can’t get the clinical services they need. Transportation barriers include having long distances to travel to medical facilities (which is particularly common in rural areas), limited income, limited support networks, or public transportation that requires multiple transfers or does not drop off near the facility entrance.
Socioeconomic factors. Some people with cancer need care they can’t afford. Others must make choices between paying for insurance premiums and medications or paying for food, housing, and childcare.
Lack of cultural humility. This means that health care systems are sometimes unable or unwilling to acknowledge how someone’s culture or values influences their view of illness and health.
By developing systems and teams that can work to minimize these barriers to care, we can help people with cancer get the care they need. Many centers have incorporated systems to promote equity. For example, we know that having nurse navigators involved can lead to decreases in a person’s time to surgery. We have seen that we can leverage electronic health records to increase cancer screening. It has been proven that having health care providers who reflect the people we treat leads to improved communication and trust.
Equity in cancer care is deeply personal. It’s understanding how to meet a person with cancer where they are and knowing how to get them to the best outcome. By supporting research and innovation areas such as these, ASCO has been true to its mission: “Conquering cancer through research, education and promotion of the highest quality, equitable patient care.”