番茄社区

Despite the many great advances in cancer care over the past several years, healthcare disparities continue to limit optimal cancer-directed treatment. Disparities leading to unequal access can be seen throughout the patient journey, from cancer screening to end-of-life care, as reviewed in an article in the most recent that focused on immune-based cancer therapies.

We have established data on unmodifiable patient characteristics such as demographics and socioeconomic characteristics. The next step, however, is finding solutions to modifiable factors such as provider-, organization-, and societal-level barriers.

The existing disparities in cancer treatment and access have only widened with the availability of new therapies such as immunotherapy. To narrow the gap we must first recognize which problems are actionable.

One potential solution in clinical research is an increased focus on smaller, investigator-initiated trials that can enroll in regional sites, offer more access for more diverse groups of patients, and loosen enrollment criteria. In addition, financial assistance programs can be offered to patients with lower economic profiles, language barriers can be alleviated with telecommunication translational services, and government-led programs such as the Affordable Care Act and the aim to improve inequality via health coverage.

Also directly impacting patients (and hospitals) are the high cost of cancer drugs, such as immunotherapy. Overcoming longstanding lack of trust in the medical system and frank racism will take education and likely several more generations. Although there is some research to suggest that biological difference may be involved in disparities, the data remain mixed and evolving.

The next actionable category against inequalities is at the provider level such as improving awareness of and education about newly approved medications and tackling implicit bias with training programs.

Finally providing more "real-world" trials and financial assistance for transportation can help make an impact on healthcare system inequalities such as overly strict trial criteria and absence of an infrastructure for clinical trial infrastructure and administrative positions.

We now have a better idea of actionable ways to address the monster of disparities and inequalities in healthcare, and local and national programs are underway to help alleviate many of the problems. Ongoing education is crucial.

Arpan A. Patel, MD, is Assistant Professor in the Department of Medicine, Hematology/Oncology at the University of Rochester Wilmot Cancer Center in New York.

Read the study here and an interview about it here.