Insights and Innovative Approaches to Addressing Disparities in Cancer Care
In Partnership With
Cancer care disparities exist for underrepresented groups due to limited access to healthcare, clinical trials, and cultural barriers, but solutions like telemedicine and improved communication are emerging.
3D rendering of DNA: © catalin - stock.adobe.com
Scrutiny of studies from the past decade has revealed several striking disparities in cancer outcomes for people in the US from groups that have been traditionally underrepresented in health research. Data shows that people of color, people with low socioeconomic status, or from rural populations, etc., have less accessibility to clinical trials,1 are often diagnosed at later stages,2 and show worse outcomes3,4 compared with White people, people in cities, or people with higher socioeconomic status.2,5 Much of this is due to lower accessibility to medical care in general.2
Factors That Most Affect the Ability of Underrepresented Groups to Access the Best Cancer Care
The issue of oncology care is multifaceted and complex, but 1 thing that has become clear is that if you look at the cancer care journey like a pipeline, there are many junctures—many steps in the process—where patients can encounter barriers to their care and effectively “leak” out of that pipeline. Healthcare accessibility in general is very limited for some groups of people, whether it is based on their income and ability to pay for services, their geography and proximity to clinics, their ability to put aside time for visits to the clinic based on their employment or family obligations, or even cultural barriers that affect their willingness to enter the clinic in the first place. All of these factors play a prominent role in healthcare accessibility and, ultimately, outcomes in cancer care.
Additionally, enrollment in clinical trials, which give people with cancer access to emerging potential treatments and care, factors in. People from traditionally underrepresented groups face multiple barriers to inclusion in those trials because they often lack the financial or social support to invest the time necessary to participate. In this regard, we recognize that clinical trial design and the very infrastructure of the healthcare system play a prominent role in affecting cancer care outcomes.
Innovative Approaches to Increasing the Accessibility of Clinical Trials in Underrepresented Communities
One of the biggest cultural changes in healthcare over the past few years has been the introduction and normalization of telemedicine, which enables consultations between medical professionals and patients from the comfort of their own homes. A prospective clinical trial participant who comes from a traditionally underrepresented group, such as a racial or ethnic minority or rural community, may have a harder time participating in a trial that requires lengthy or frequent visits to the clinic. Telemedicine reduces travel for people who do not live near a health facility or people with lower incomes who must rely on public transportation.6 When designing these trials, it is helpful to identify any consultations that can be conducted remotely to make those visits more feasible for participants.
Global insights and bidirectional communication have greatly expanded our knowledge base and understanding of the barriers cancer patients face when seeking care, as well as how we can address those issues. Sharing information between healthcare entities from various global communities has helped us identify common challenges with oncology care accessibility. For example, the geographic and infrastructure-based barriers faced by potential clinical trial participants in a rural part of Asia may not be so different from people in rural parts of the US. Finding solutions for one of these groups can potentially lead to solutions for others.
Improving Accessibility to Clinical Trials
One of the most important steps we have taken is to improve communication and understanding of clinical trials in general. Some patients with cancer—particularly from traditionally underrepresented groups—may have misperceptions about the safety or benefits of clinical trials that limit their desire to participate in those studies. By increasing understanding and awareness of clinical trials, we can empower patients to start the conversation with their healthcare providers and identify the best course for their unique cancer journey.
In addition, the healthcare infrastructure and study design are key operational components that affect clinical trial enrollment in a major way. For example, when it comes to participation in clinical trials, some cancer patients might be discouraged by the distance needed to travel to the clinic or imaging facility or lengthy or frequent blood draws. At Sarah Cannon Research Institute, we continue to see progress and discovery by helping patients participate in cutting-edge clinical trials closer to home. To alleviate these burdens, patients in more rural areas may find a community oncology center that participates in clinical research, or a study may include in-home lab visits. The practices of thousands of independent, community-based providers are supported through the work of The US Oncology Network and McKesson Provider Solutions to advance specialty care and high-quality cancer care in the communities where these patients live.
In the end, we should focus on how to reduce the burden on the participants and their caregivers while maximizing the potential findings from more diverse clinical trials. By analyzing which assessments are strictly necessary and then offering additional measures as optional portions of the study, we can gain insights from the additional data, when possible, but avoid excluding prospective participants just based on the study design.
How to Best Facilitate Communications About Clinical Trials
The key factor here is bidirectional communication. It is not enough to analyze results and use them to try and improve future study design or communications—we must listen to the people most affected by these studies. What barriers are they facing or what is holding them back? By dialoguing with patients, caregivers, advocacy groups, and regulatory partners, we can gain insights into the factors that most affect clinical trial participation and how to address them. Understanding the problems from the perspective of the people facing them is the most important part of identifying tangible and long-lasting solutions and reducing disparities in oncology care.
