At the start of a new year, experts are encouraged by continuing progress in cancer care, such as immunotherapies and precision treatments.

However, if we’re not careful, disparities in who gets access to high-quality cancer care and treatments could persist and be exacerbated, said panelists at a recent National Academies workshop on promoting health equity in cancer care.

“In cancer care, we’re always thinking about the newest medication, the newest technology, but we’re not always putting the social determinants of health first,” said Lisa C. Richardson, division director for cancer control at the Centers for Disease Control and Prevention. “We’re dealing with people — not just cancer.”

The workshop’s fundamental goal was to examine opportunities to improve health equity across the cancer care continuum. Gwen Darien, executive vice president at the National Patient Advocate Foundation, encouraged attendees to consider how cancer care providers are doing things differently now to advance health equity, and what they need to do in the future.

Equitable cancer care starts with prevention and reaching people before they become patients, said Terence “TC” Muhammad of the Greensboro Health Disparities Collaborative, based in North Carolina.

“Health disparities show up in food deserts and in our judicial system. They show up in landfills, power plants, and pollution in our communities, in over-policing, and underinvestment in education. That all chronically affects our health,” he said.

Once they are diagnosed, people living with cancer require a continuum of care, not just one-time treatments, multiple panelists emphasized. But people who live in marginalized, historically disinvested neighborhoods might be seeing different care providers at different stages of that continuum, or be lost to follow-up care altogether.

“Part of the problem is that we rarely ask people if they’re getting the care they need, and if the things they need exist in their community,” said Richardson. “It’s on us to stop assuming.”

There are also challenges in access to health insurance, especially for those who are unable to maintain employment while undergoing treatment, said Stacie Dusetzina, associate professor of health policy at Vanderbilt University School of Medicine. She discussed several policy opportunities to increase access to care, which include Medicaid expansion, capping out-of-pocket costs for Medicare Part D beneficiaries, and offering supplemental coverage for specialty care under employer-sponsored plans.

Zinzi Bailey, assistant professor at the University of Miami, said at the community level, her vision for equitable cancer care is a world in which “people are not afraid to seek care because they’re not afraid of not being able to pay for it, understanding what’s going on, or connecting with a provider.”

It’s also crucial to expand the definition of who could be part of a patient’s care team, said Jennifer Wenzel, associate professor at Johns Hopkins University School of Nursing. Nurse navigators, social workers, and community health workers can help during transitional phases of care, when patients tend to fall through the cracks. Primary care plays an important role, too, during prevention, screening, and throughout survivorship care, particularly with helping patients manage potential short- and long-term side effects of treatment.

Panelists also spoke about specific actions that comprehensive cancer centers can take toward achieving health equity in cancer care.

At the institutional level, “Many organizations issued statements standing against racism after the highly publicized deaths of Black and brown people at the hands of police. But it became clear many didn’t know what to do after making those statements,” said Reginald Tucker-Seeley, vice president of health equity at Zero - The End of Prostate Cancer. “Similarly, after declaring that cancer inequities are intolerable, what are we going to do? How are we going to focus our resources — fiscal and human?”

These organizations also need commitment from leadership, a data infrastructure to measure disparities in the first place, and alignment on what disparities they’re addressing, he added. Those often go beyond bedside care.

“When I see patients in Danville, Virginia, my phone stops working. Cancer centers should be among the biggest advocates for broadband,” said Robert Winn, director and Lippman Oncology Chair at Virginia Commonwealth University Massey Cancer Center. “While DNA and a love of science are tremendously important, that’s not sufficient in and of itself to eradicate or reduce our cancer burden.”

Achieving equity also requires a fundamental shift in how cancer centers do business and assess impact, Winn added. In the future, he’d like research funding applications to ask how cancer centers have created jobs, reflected their local communities in their work, and improved health and economic opportunity in those communities in tandem.

Cancer centers also need to consider how to embed diversity, equity, and inclusion into everything they do, said Tucker-Seeley.

“We can’t have wins in the cancer center, but the rest of the medical institution is still in an inequitable state. I think of the quote, ‘I can’t be free until all of us are free,’” he concluded.

Related Resources

• Video Playlist