One of the nation’s leading cancer organizations today called for new actions to reduce disparities in cancer outcomes affecting racial and ethnic minorities, rural populations, sexual and gender minorities, people without insurance, and other disadvantaged populations. In a policy statement published in the Journal of Clinical Oncology (JCO), the American Society of Clinical Oncology (ASCO) argues that while progress has been made in raising awareness of disparities and driving research, the cancer community needs to take bolder, more aggressive steps to achieve equity for all patients.
The policy statement makes a series of recommendations to ensure equitable access to care and research, to guide both ASCO’s own programs and the work of the broader oncology community. The ASCO board-approved statement was developed by ASCO’s Health Equity Committee, consisting of ASCO members with specific expertise in cancer care disparities.
“To do right by the patients we serve, we have to confront the complex forces and systems that have created disparities in cancer prevention, treatment, and research participation,” said ASCO President Lori J. Pierce, MD, FASTRO, FASCO, and author of an accompanying editorial in JCO. “Our field has taken important steps in recent years. Now it’s time to dig deeper, take new risks, and do everything we can to ensure that every patient benefits from decades of advances in cancer care.”
“Everyone should have equitable access to timely, high-quality cancer care, no matter their race or ethnicity, where they live or were born, or how they identify,” said Manali Patel, MD, MPH, Immediate-Past Chair of ASCO’s Health Equity Committee and lead author of the policy statement. “Like all health care in America, cancer care remains far from that goal. But there is a path to achieving equity, and it’s what we’ve begun to lay out here.”
Emerging challenges reinforce need for action
The statement and editorial briefly examine developments since ASCO issued its last policy statement on cancer disparities in 2009. ASCO and others in the oncology community have worked to expand awareness of disparities across the field, increase diversity in the oncology workforce, and conduct research to identify specific changes in medical practice or policy that can reduce or eliminate disparities.
Yet, while progress in cancer prevention, detection and treatment has reduced overall mortality in the past decade, that progress has not been equitably distributed. For example, Black men and women, people in rural areas, and those with lower income and education status experience worse survival for many cancers, regardless of stage at diagnosis. For some populations, especially sexual and gender minorities, a lack of reliable data make it hard to even measure access to care or outcomes.
In addition, several recent developments could worsen existing disparities if not aggressively addressed. Closures of rural hospitals and oncology practices risk further limiting access to care. Many Americans have lost their health insurance coverage due to the economic impact of the COVID-19 pandemic. Cancer screening and care have also been interrupted by COVID-19, which is disproportionally affecting Black and Hispanic communities across the country.
“Our patients need us, today more than ever, to be champions for equity in cancer care,” said Dr. Pierce. “We have to be willing to take bold steps to overcome the barriers to progress against this disease.”
ASCO Policy Statement Recommendations
ASCO’s recommendations are intended to guide the work of both ASCO and other stakeholders, including medical training programs, health systems, payers, policymakers, and researchers.
The recommendations fall into four main areas:
- Ensuring equitable access to high-quality care — including expansion of Medicaid in all U.S. states; advocacy against policies, such as work requirements and other coverage limits, that threaten access to cancer care; development of alternative payment models for oncology care providers, and financial assistance programs for patients; and new collaborations between providers, payers, employers, and other stakeholders.
- Ensuring equitable access to research — for example, adopting new trial recruitment strategies that consider socioeconomic status, race/ethnicity, or location; requiring collection and public reporting of research data on race/ethnicity, sexual orientation, gender identity, and other variables that are known to influence outcomes; and reducing financial and other barriers to participation.
- Addressing structural barriers to equitable care — for example, through institution-level efforts to examine and rectify implicit biases or discrimination toward patients, families, or healthcare workers; sustained efforts to increase diversity in the oncology workforce; and partnerships with local communities and legislatures to apply research findings known to improve health equity.
- Increasing awareness and action – including public awareness and education campaigns; collaborations among oncologists, patients, and advocacy groups to drive action; and engagement with state, local, and national policymakers to drive acceptance of proven solutions.
ASCO is committed to advancing the recommendations in all areas of its work. To that end, the ASCO Health Equity Committee is developing a concrete action plan that the Society will pursue in the coming years, with particular emphasis on increasing workforce diversity, building partnerships with communities affected by disparities, and addressing institutional discrimination in the oncology field.
Read the full text of “Cancer Disparities and Health Equity: A Policy Statement from the American Society of Clinical Oncology” and accompanying editorial “A Time to Dig Deeper and Take Meaningful Action.”