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Addressing the Roots of Disparities in Cancer Care: Inherent Bias, Resources, and Insurance
March 23, 2017

Addressing the Roots of Disparities in Cancer Care: Inherent Bias, Resources, and Insurance

Surabhi Dangi-Garimella, PhD
At the 22nd Annual Conference of the National Comprehensive Cancer Network, held March 23-25, 2017, in Orlando, FL, policy researchers with interest in cancer care disparities discussed the source of existing disparities and how they can be successfully addressed.
At the 22nd Annual Conference of the National Comprehensive Cancer Network: Improving the Quality, Effectiveness, and Efficiency of Cancer Care, held March 23-25, 2017, in Orlando, FL, policy researchers with interest in cancer care disparities discussed the source of existing disparities and how they can be successfully addressed.

Cliff Goodman, PhD, senior vice president, The Lewin Group, led the panelists—Shauntice Allen, PhD, University of Alabama at Birmingham Comprehensive Cancer Center; Moon S. Chen, Jr, PhD, MPH, associate director for cancer control, University of California Davis Comprehensive Cancer Center; Anne Filipic, Enroll America; Edith Mitchell, MD, Sidney Kimmel Cancer Center at Jefferson; and Phyllis Pettit Nassi, MSW, Huntsman Cancer Institute at the University of Utah—through a very interesting discussion that touched on racial, gender, genomic, perspective, economic, and geographic bias.

“Disparities, even if they are not made worse by the replacement healthcare law, are at risk of getting worse,” Goodman said, addressing the panel. “What do these disparities look like? Has [the Affordable Care Act] done anything to reduce them? Financial toxicity: is it harder for certain populations? Can providers introduce bias?”

Allen, who has been diagnosed with cancer herself, said that her motivation to work in the field of cancer disparities is to show that cancer is not a death sentence. “We need to be open to having the conversation and till we are open to doing that, disparities will continue. I think there are differences in how individuals are treated and how the discussions are introduced to people,” she said.

Filipic believes that developing outreach strategies for Americans and figuring out ways to talk about the advantages of enrolling on a healthcare plan to the common man is a viable strategy.

“It is important to ensure that physicians and researchers understand how difficult it is to make it right and how bad it would be if they get it wrong,” Nassi said. “American Indians are dealing with a different health system: the Indian Health Service. This brings geography into play. We have to consider here the fact that this is a medical service that is underfunded—for every dollar they request, they get 13 cents to 24 cents.”

Mitchell explained that African American women have triple the levels of triple negative breast cancer, so although the incidence is not high, death rate due to the genomic nature of their disease augments the death rate. “Understanding disparities in America, working with the population and understanding the genomics that defines the population, is what I do,” she explained.

Another example that Mitchell provided was of colon cancer, which has a 20% higher incidence in African Americans but a 40% higher death rate. Further, incidence is much earlier in this population. “So understanding these individuals, understanding their disease profile and treating them accordingly is important,” she added.

Mitchell emphasized the importance of having an open conversation with patients on clinical trial participation. “Don’t assume, because that can introduce bias. Open a conversation and understand what the individuals want,” she said.



 
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