ASCO Plan to Reduce US Cancer Disparities
Elderly and minorities will be most affected by cancer in the future
Initiatives are clearly needed to address the needs of these rapidly growing populations of patients.—Benjamin Smith, MD
During the next 20 years, the number of cancer cases in older and minority Americans is expected to increase at a much higher rate than in other populations —a 67% and 100% increase, respectively, compared with a 31% increase for whites, according to a study published in the Journal of Clinical Oncology.1 In hard numbers, of a total 2.3 million diagnosed cancer cases in 2030, 1.6 million will be adults older than age 65 years—or 70% of the 2.3 million total—and 660,000 will be nonwhite individuals —28% of the 2.3 million total.
“Initiatives are clearly needed to address the needs of these rapidly growing populations of patients,” says the study's senior author Benjamin Smith, MD, adjunct assistant professor of radiation oncology at the University of Texas M.D. Anderson Cancer Center in Houston.
The American Society of Clinical Oncology (ASCO) recently proposed a set of recommendations to help reduce these disparities. According to ASCO President Richard Schilsky, MD, “We need to practice more efficiently, collaborate better with primary care physicians, think about diversity diversity in the oncology workforce, and provide incentives for physicians to work in oncology.”
ASCO is linking with several other professional organizations to put some of their plans into action, says Derek Raghavan, MD, PhD, co-chair of ASCO's Health Disparities Advisory Group and director of the Cleveland Clinic Taussig Cancer Center in Cleveland, Ohio. “We've made so much progress in the field with the advent of the molecular revolution, but the underserved are not benefitting,” Dr. Raghavan says.
Lack of health insurance and access to medical care continue to be among the biggest contributors to the problem, with more than 1 of every 5 African Americans and more than 1 of every 3 Latinos uninsured, according to ASCO. Programs that improve access to care can significantly reduce disparities, notes Otis Brawley, MD, chief medical officer of the American Cancer Society and co-chair of ASCO's Health Disparities Advisory Group. He cites a study conducted among female breast-cancer patients who were treated at military hospitals.2 In the study, African American women treated in military healthcare facilities had a lower mortality rate (24.77%) than that of African American women represented in the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute (34.2%). In the study, the mortality rates for white women were 18.08% for those treated in military facilities and 18.4% for white women in SEER. The researchers concluded that although ready access to medical facilities and a full complement of treatment options improve survival rates for African American women, a significant, unexplained, survival difference still exists compared with white women.
Dr. Brawley points to another study that found that in urban Atlanta today, 7.5%of African American women and 1.5% of white women had not undergone surgery to remove their tumor within 1 year after they received a breast cancer diagnosis —a surgery the medical community has used for more than 100 years.“People are disenfranchised, scared, and having difficulty accessing care,” he says. In response to these issues, ASCO's “road map” for helping to reduce disparities includes the following recommendations:
Increase prioritization of public and private research on cancer-care disparities. Even when underserved populations are insured, gaps still exist in the quality of care received by minorities. ASCO is supporting research in this area through the establishment of a Young Investigator Award in health disparities research. The society also plans to continue integrating health-disparities research into its annual meeting's scientific sessions.
Diversify clinical trials. Researchers and physicians who treat racially and ethnically diverse populations must participate in clinical-trial recruitment. Improving access means educating physicians and patients about these trials, developing eligibility criteria that ensure participation by minorities, and addressing logistical issues such as transportation and child care. Medically underserved groups' participation in clinical trials will expand these individuals' available treatment options and also increase the likelihood that research results will apply to all cancer patients.
Diversify and train the oncology workforce by increasing the recruitment of minorities in the healthcare field. Currently, only 12% of US medical students are African American, Latino, or Native American, even though these groups compose 25% of the US population. Experts add that minority physicians are more likely to practice in underserved, urban communities. Few clinical oncology programs target minority students, and improved recruitment efforts could increase the number of oncologists who provide care tomedically underserved populations. In partnership with the Susan G. Komen for the Cure Foundation, ASCO has launched the Diversity in Oncology Initiative, which is designed to recruit and retain diverse clinical oncologists. They recently announced the first awards, which provide $50, 000 each to 3 young oncologists. The awards cover research, travel, and a loan-repayment program for minority medical students and residents who agree to practice in a medically underserved region.
Enhance patient involvement in their own care. ASCO is attempting to define patient-centered care that is culturally and linguistically appropriate by developing templates for treatment plans, summaries, and follow-up survivorship plans. These plans will help physicians improve documentation and communication while enabling patients to manage their care.
ASCO leaders are confident that these initiatives will begin to address disparities in cancer diagnosis and treatment. Says Dr. Raghavan, “This is a national emergency…. If we can catch cancer early enough, we can treat it.”
The number of minority and older cancer patients will increase dramatically during the next 20 years.
Even when insurance and access to medical care are comparable, minorities still have higher mortality rates than whites.
ASCO, in partnership with other organizations, recently announced specific initiatives to help address these disparities, including increasing disparities research, diversifying patients in clinical trials, diversifying and increasing recruitment into the oncology workforce, and enhancing patients' involvement in their own care.
1. Smith BD, Smith GL, Hurria A, Hortobagyi GN, Buchholz TA. Future of cancer incidence in the United States: burdens upon an aging, changing nation. J Clin Oncol. 2009;27:2758–2765.
2. Wojcik BE, Spinks MK, Optenberg SA. Breast carcinoma survival analysis for African American and white women in an equal-access health care system. Cancer. 1998;82:1310–1318.
3. Lund MJ, Brawley OP, Ward KC, Young JL, Gabram SS, Eley JW. Parity and disparity in first course treatment of invasive breast cancer. Breast Cancer Res Treat. 2008;109:545–557.