Addressing Cancer Treatment Disparities in Underserved Communities

Cancer remains one of the leading causes of death worldwide, but research, scientific advancements, and community support have led to a steady decline in death rates since the early 90s. 

Despite this incredible progress, there is a nagging issue in the fight against cancer: access, particularly for underserved communities. 

Access is far from the only roadblock to curing cancer for good, but it is a major reason why these advancements have made a disproportionately small dent in certain populations. 

Understanding the Disparities

Underserved communities tend to experience higher mortality rates, later detection, and greater barriers to treatment interventions.

Some of these barriers include:

• Income and socioeconomic standing
• Race and ethnicity
• Gender identity and sexuality

This is a multifaceted problem, and no two groups experience the same disparities for the same reasons, but there are a few commonalities between many underserved communities. 

Socioeconomic Factors

A lack of economic access tends to drive similar outcomes in a majority of underserved populations. 

Lower-income individuals are often uninsured or underinsured. From a preventative standpoint, this means they tend to see their doctor less, which leads to higher risk and later detection. When cancer is detected, paying for (often incredibly expensive) treatments and medications becomes another issue entirely. 

Education is another meaningful factor; medical literacy skews lower, which presents problems in understanding and acting upon treatment plans, but also correlates to quality of life factors that can exacerbate occurrence and survival rates. 

Finally, time is an underlooked variable. Appointments, screenings, treatments, and recovery all take time, and economically disadvantaged populations often have fewer options to address things like unpaid time off work or childcare.

Geographic Access

Not everyone lives in cities or suburbs – the 2020 U.S. Census showed that about one in five Americans lives in a rural area. Rural populations have long struggled with access to basic healthcare due to practical issues of scale (fewer facilities, fewer providers, and a much lower density of both). 

Even if they are reasonably close to a hospital or general practitioner, they may not have easy access to specialists or facilities that can perform screenings like mammograms and colonoscopies.

This results in later detection times, making intervention on even the most easily treated cancers less effective. Even when the disease is caught early, rural populations see poorer adherence to treatment, often due to less regular checkups or access to treatment facilities. 

All of these factors present an international problem as well. Entire nations around the globe experience these same roadblocks to treatment, whether or not they live in a city. 

Who Are They? 

While general issues with economic factors or access permeate across every population, certain groups of people have been shown to be at higher risk of cancer, with later detection times and poorer overall outcomes. 

Immigrants, Refugees, and Asylees 

Undocumented immigrants will often avoid any kind of care except in the most dire situations for fear of deportation or prosecution, but issues do not end with legal standing. Immigrants,  refugees, and asylees in a country legally may still struggle to receive care due to paperwork and proof of residency for specialists, insurance, etc. 

Ethnic Minorities

Ethnic minorities as a whole may also face systemic issues with healthcare quality and access, which in turn affects their cancer outcomes. Implicit bias is a long-standing and well-documented phenomenon. 

For example, studies have repeatedly shown that practitioners are less likely to prescribe pain treatment to Black patients due to unsubstantiated claims that their pain tolerance is higher. This, in tandem with an overrepresented white population in the medical field, has lent itself to poorer outcomes in cancer diagnosis and treatment. 

Historical factors, such as experiments that lacked elements of patient consent or were otherwise deceptive, could lead certain members of ethnic minority groups to not trust elements of current scientific research. The scientific community has to earn this trust through genuine outreach, making science, technology, engineering, and mathematics (STEM) careers more attainable, and providing more accessible treatment.

LGBTQ+

Sexual and gender minority (SGM) patients face a variety of unique challenges but often struggle with cancer outcomes due to discrimination, a lack of research, and a lack of specialized care. 

The research component is perhaps the most fundamental. Without a wealth of knowledge to fall back on, there are fewer practitioners who can provide the specialized care that SGM patients often need. 

The small net population makes this tricky, but we also lack the data we need as a whole. For example, cancer registries and clinical trials will not routinely collect data on sexuality and gender identity the way they do with other aspects of a person’s identity, leaving useful historical research reference points difficult to use. 

The Elderly and Disabled

In addition to exacerbated issues of access and socioeconomic factors, more vulnerable populations face outcomes that transcend simple diagnosis and treatment. 

For example, disabled people may face an uphill battle both practically and socially with treatment, with issues like:

• A lack of specialized training, both in accounting for comorbidities appropriately and dealing with the special needs of these patients.
• Exacerbated socioeconomic issues in poor or retired patients.
• Equipment not designed for physical disabilities.
• Discrimination and bias presenting in a variety of ways — for example, studies found that disabled women were more likely to undergo mastectomy than breast-conserving therapies, in line with disregard for quality of life factors in these populations. 

What Do We Do About It? 

There is no cure-all, because there is no one problem to solve. Equally important is to remember that surveys, studies, and research are all based on averages, and the lived experiences of a member of any population may be drastically different. Many people fit within multiple underserved communities, emphasizing the need for a multifaceted approach to addressing disparities.

To that end, an emphasis on individualized, empathetic care is a soft solution that we can foster progress on with awareness and training. From the provider side, an investment in developing cultural competency across underserved populations presents an actionable and immediate opportunity. 

From a policy perspective, it is important to advocate for programs that both improve access and quality of care and also remove inherent barriers to care. While this lies in the hands of our officials, grassroots movements in every community can be the catalyst for change. 

Finally, from an individual standpoint, staying informed and engaged is an easy step we can all take. That means:
 

• Listening to the lived experiences of people in your communities.
• Understanding how we can best support those we know battling cancer.
• Spreading awareness and research. 

At CRI, our mission is to bring more therapies to more people, and transform the lives of cancer patients on a global scale. This includes underserved and disadvantaged communities, and the fight against this disease is not over until we have created a world immune to cancer. 

Take action with us in the search for a cure. There are a variety of ways you can take action to support our cause, including donating directly. Community support enables us to continue leading the charge to advance immunotherapy research.