Please mind the gap—about equity and access to care in oncology

Abstract

Health care disparities have been described as differences in the quality of care received by those people who have equal access to care and no difference in preferences or needs for treatment,1Torain M.J. Maragh-Bass A.C. Dankwa-Mullen I. et al.Surgical disparities: a comprehensive review and new conceptual framework.J Am Coll Surg. 2016; 223: 408-418Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar representing a serious public health concern.2Hisam B. Zogg C.K. Chaudhary M.A. et al.From understanding to action: interventions for surgical disparities.J Surg Res. 2016; 200: 560-578Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar While most literature has shown how ethnic minorities do experience health care disparities and poorer clinical outcomes,2Hisam B. Zogg C.K. Chaudhary M.A. et al.From understanding to action: interventions for surgical disparities.J Surg Res. 2016; 200: 560-578Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar, 3Haider A.H. Scott V.K. Rehman K.A. et al.Racial disparities in surgical care and outcomes in the United States: a comprehensive review of patient, provider, and systemic factors.J Am Coll Surg. 2013; 216: 482-492.e12Abstract Full Text Full Text PDF PubMed Scopus (216) Google Scholar, 4Elk R. Felder T.M. Cayir E. Samuel C.A. Social inequalities in palliative care for cancer patients in the United States: a structured review.Semin Oncol Nurs. 2018; 34: 303-315Crossref PubMed Scopus (12) Google Scholar inequalities are also encountered according to gender, age, socioeconomic status, sexual orientation, patients in rural areas, or the presence of disabilities.1Torain M.J. Maragh-Bass A.C. Dankwa-Mullen I. et al.Surgical disparities: a comprehensive review and new conceptual framework.J Am Coll Surg. 2016; 223: 408-418Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar While good health and well-being for all at all ages stand as one of the 17 Sustainable Development Goals promoted by the United Nations,5UN. Goal 3Ensure healthy lives and promote well-being for all at all ages. SDGs.2021https://sdgs.un.org/goals/goal3Google Scholar the abovementioned barriers are commonly fostered by geographic isolation and destitution. Such gaps represent a severe challenge in oncology, considering that cancer might be not only a cause but also a consequence of poverty. Indeed, low- and middle-income countries generally experience a high level of health care disparities with scant access to cancer screening and prevention services, vaccinations, as well as state-of-the-art oncological treatments. Particularly, a greater discrepancy is flagrant in the location of radiotherapy (RT) facilities and technologies considering that up to 70% of all the RT hubs are in high-income countries, with 30 countries, in the world, without RT.6Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries. Closing the Cancer Divide: A Blueprint to Expand Access in Low and Middle Income Countries.https://ncdalliance.org/resources/closing-the-cancer-divide-a-blueprint-to-expand-access-in-low-and-middle-income-countries-by-the-global-task-force-on-expanded-access-to-cancer-careGoogle Scholar Moreover, the chronic impairments due to cancer as well as the oncological treatment costs cast people into poverty. The recent coronavirus disease-19 (COVID-19) pandemic has sadly confirmed the trend, with the literature recording higher death rates among minority communities in wealthier countries.7Bonner S.N. Wakam G.K. Kwayke G. Scott J.W. COVID-19 and racial disparities.Ann Surg. 2020; 272: e224-e225Crossref PubMed Scopus (8) Google Scholar Moreover, of the 3.3 billion COVID-19 vaccines administered globally, thus far, only 1% of people in the low-income countries have received at least the first dose, and, dramatically, in Africa, they remain out of reach.8KFF Tracking Global COVID-19 Vaccine Equity.https://www.kff.org/global-health-policy/issue-brief/tracking-global-covid-19-vaccine-equity/Google Scholar The literature of several medical specialities reported some themes around health care disparities. For example, in surgery,1Torain M.J. Maragh-Bass A.C. Dankwa-Mullen I. et al.Surgical disparities: a comprehensive review and new conceptual framework.J Am Coll Surg. 2016; 223: 408-418Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar the dominant themes have been recognized as patient-related factors, provider-related factors, system and access issues, clinical care and quality, and post-operatory care and rehabilitation.9Haider A.H. Dankwa-Mullan I. Maragh-Bass A.C. et al.Setting a national agenda for surgical disparities research recommendations from the National Institutes of Health and American College of Surgeons Summit.JAMA Surg. 2016; 151: 554-563Crossref PubMed Scopus (70) Google Scholar While many research works have tried to address several problems and efforts around each of the main topics,9Haider A.H. Dankwa-Mullan I. Maragh-Bass A.C. et al.Setting a national agenda for surgical disparities research recommendations from the National Institutes of Health and American College of Surgeons Summit.JAMA Surg. 2016; 151: 554-563Crossref PubMed Scopus (70) Google Scholar the COVID-19 crisis,7Bonner S.N. Wakam G.K. Kwayke G. Scott J.W. COVID-19 and racial disparities.Ann Surg. 2020; 272: e224-e225Crossref PubMed Scopus (8) Google Scholar with its related disruptions,10Cobianchi L. Pugliese L. Peloso A. Dal Mas F. Angelos P. To a new normal: surgery and COVID-19 during the transition ohase.Ann Surg. 2020; 272: e49-e51Crossref PubMed Scopus (33) Google Scholar,11Tseng J. Roggin K.K. Angelos P. Should this operation proceed? When residents and faculty disagree during the COVID-19 pandemic and recovery.Ann Surg. 2020; 272: e157-e158Crossref PubMed Scopus (5) Google Scholar delays in cancer diagnosis and treatment,12Bardet A. Fraslin A.M. Marghadi J. et al.Impact of COVID-19 on healthcare organisation and cancer outcomes.Eur J Cancer. 2021; 153: 123-132Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar,13Hartman H.E. Sun Y. Devasia T.P. et al.Integrated survival estimates for cancer treatment delay among adults with cancer during the COVID-19 pandemic.JAMA Oncol. 2020; 6: 1881-1889Crossref PubMed Scopus (28) Google Scholar and higher mortality rate for certain communities,7Bonner S.N. Wakam G.K. Kwayke G. Scott J.W. COVID-19 and racial disparities.Ann Surg. 2020; 272: e224-e225Crossref PubMed Scopus (8) Google Scholar has proved that there is still much work to be done to limit the phenomenon of health care disparities. Several types of vulnerable patients are constantly at risk, despite the theoretical opportunity to get the same overall outcomes of those who experience more favourable conditions. The situation looks extremely complex. While we still believe that one size cannot fit all,14Cobianchi L. Dal Mas F. Angelos P. One size does not fit all—translating knowledge to bridge the gaps to diversity and inclusion of surgical teams.Ann Surg. 2021; 273: e34-e36Crossref PubMed Scopus (9) Google Scholar a call for investments, practical tools, tailored solutions, and best practices emerges.6Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries. Closing the Cancer Divide: A Blueprint to Expand Access in Low and Middle Income Countries.https://ncdalliance.org/resources/closing-the-cancer-divide-a-blueprint-to-expand-access-in-low-and-middle-income-countries-by-the-global-task-force-on-expanded-access-to-cancer-careGoogle Scholar,9Haider A.H. Dankwa-Mullan I. Maragh-Bass A.C. et al.Setting a national agenda for surgical disparities research recommendations from the National Institutes of Health and American College of Surgeons Summit.JAMA Surg. 2016; 151: 554-563Crossref PubMed Scopus (70) Google Scholar Starting from the results from the previous literature, the present work identifies some major topics with the aim to include the whole spectrum of themes that might lead to disparities in cancer care, highlighting the tentative strategies to facilitate equity and access to care for oncological patients. Under the umbrella of system-related factors, several elements have been discussed by the literature, including sociodemographic factors (like gender, culture, ethnicity), economic situation, geographic locations (low-/middle-income versus high-income countries, rural areas versus city), behaviours (lifestyle, self-monitoring abilities), and care processes (including testing, screening, and counselling services).1Torain M.J. Maragh-Bass A.C. Dankwa-Mullen I. et al.Surgical disparities: a comprehensive review and new conceptual framework.J Am Coll Surg. 2016; 223: 408-418Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar In such a scenario, social determinants of health (SDOH) play an essential role. They represent “the conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks”.15Doll K.M. Investigating Black-White disparities in gynecologic oncology: theories, conceptual models, and applications.Gynecol Oncol. 2018; 149: 78-83Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar According to the literature, most SDOH can be included in five categories, namely economic stability, education, social and community context, health and health care, neighbourhood, and built environment. A worrying gap emerges when considering the situation of developing countries. As highlighted by the Global Task Force on Expanded Access to Cancer Care and Control, five crucial points magnify the disparities in oncology between high- and low-/middle-income countries.6Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries. Closing the Cancer Divide: A Blueprint to Expand Access in Low and Middle Income Countries.https://ncdalliance.org/resources/closing-the-cancer-divide-a-blueprint-to-expand-access-in-low-and-middle-income-countries-by-the-global-task-force-on-expanded-access-to-cancer-careGoogle Scholar The first difference is represented by risk-factor prevention, which stands as one of the winning strategies for fostering lifestyles and behaviours that can prevent the onset of the disease (like avoiding smoking or unhealthy food or stimulating regular fitness activity).15Doll K.M. Investigating Black-White disparities in gynecologic oncology: theories, conceptual models, and applications.Gynecol Oncol. 2018; 149: 78-83Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar The second difference concerns preventing infection related to cancers for which there are no available treatments (human immunodeficiency virus) or for which there are currently vaccines (human papillomavirus, hepatitis B virus). The third factor is the availability of screening programs for early diagnosis (for instance, promoting tests or checks regularly, or self-assessment—like palpation for breast cancer, Pap test screenings). The fourth factor relates to the physical and psychological consequences and social matters of survivorship, which can lead to impoverishment, prejudice, and discrimination. Last but not least, low-income countries often lack the availability of treatment to face cancer-related symptoms and pain (i.e. palliative care, pain control) as well as end-of-life care.6Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries. Closing the Cancer Divide: A Blueprint to Expand Access in Low and Middle Income Countries.https://ncdalliance.org/resources/closing-the-cancer-divide-a-blueprint-to-expand-access-in-low-and-middle-income-countries-by-the-global-task-force-on-expanded-access-to-cancer-careGoogle Scholar Closing the gap in outcomes for preventable and treatable cancers requires a global effort. While low-/middle-income countries need investments in terms of adequate willingness for health care resources, knowledge, and tools to increase the number of available treatments, a general call for prevention programs emerges worldwide. Free access to counselling services, community engagement,16Kronenfeld J.P. Graves K.D. Penedo F.J. Yanez B. Overcoming disparities in cancer: a need for meaningful reform for Hispanic and Latino cancer survivors.Oncologist. 2021; 26: 443-452Crossref PubMed Scopus (5) Google Scholar,17Presch G. Dal Mas F. Piccolo D. Sinik M. Cobianchi L. The World Health Innovation Summit (WHIS) platform for sustainable development. From the digital economy to knowledge in the healthcare sector.in: Ordonez de Pablos P. Edvinsson L. Intellectual Capital in the Digital Economy. Routledge, Routledge, London2020: 19-28Crossref Google Scholar and sensitivity as well as social campaigns might be organized and tailored according to the target population, employing adequate knowledge translation tools18Dal Mas F. Biancuzzi H. Massaro M. Miceli L. Adopting a knowledge translation approach in healthcare co-production. A case study.Manag Decis. 2020; 58: 1841-1862Crossref Scopus (23) Google Scholar to ensure that citizens can understand the importance of prevention,15Doll K.M. Investigating Black-White disparities in gynecologic oncology: theories, conceptual models, and applications.Gynecol Oncol. 2018; 149: 78-83Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar regardless of gender, age, economic status, and race16Kronenfeld J.P. Graves K.D. Penedo F.J. Yanez B. Overcoming disparities in cancer: a need for meaningful reform for Hispanic and Latino cancer survivors.Oncologist. 2021; 26: 443-452Crossref PubMed Scopus (5) Google Scholar,19Gibbon S. Family medicine, ‘La and breast understanding the of in PubMed Scopus Google Scholar stimulating also M. P. P. et of healthcare 2016; PubMed Scopus Google Scholar, P. P. S. B. the of as described by patients surgery J. Scopus (2) Google Scholar, Mas F. Biancuzzi H. Massaro M. A. Cobianchi L. Miceli L. translation in a case J 2020; Scopus Google Scholar in a Mas F. Biancuzzi H. Massaro M. Miceli L. Adopting a knowledge translation approach in healthcare co-production. A case study.Manag Decis. 2020; 58: 1841-1862Crossref Scopus (23) Google L. Dal Mas F. Massaro M. et in a approach for of surgical J Surg. 2021; Full Text Full Text PDF PubMed Scopus (5) Google Scholar that more when the health care are treatment quality of by patients to have and has been the of care in countries such as and and clinical by screening tools be in countries with B. S. I. to of treatment needs by clinical and 2018; PubMed Scopus Google Scholar factors to or of and and of health M.J. Maragh-Bass A.C. Dankwa-Mullen I. et al.Surgical disparities: a comprehensive review and new conceptual framework.J Am Coll Surg. 2016; 223: 408-418Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar when considering this worrying differences when areas of the et B. R. A. et oncology in one several Oncol Coll 2020; Full Text Full Text PDF PubMed Scopus Google Scholar reported disparities in clinical around with a higher of medical in countries in countries by a higher number of in versus in in versus in and the new in versus in In a comprehensive on countries, the of medical A. Global of clinical oncology Oncol. 2018; Scholar in countries, an care for patients with cancer, and in countries which in and in a clinical care for new of A. Global of clinical oncology Oncol. 2018; Scholar In there are for a of and, in for Task Force on Expanded Access to Cancer Care and Control in Developing Countries. Closing the Cancer Divide: A Blueprint to Expand Access in Low and Middle Income Countries.https://ncdalliance.org/resources/closing-the-cancer-divide-a-blueprint-to-expand-access-in-low-and-middle-income-countries-by-the-global-task-force-on-expanded-access-to-cancer-careGoogle Scholar In to the of in the high-income countries, an in countries and in countries A. Global of clinical oncology Oncol. 2018; Scholar treatment can increase the of treatment high psychological patients to treatment higher in oncological health care low-income countries in screening tools, and general oncological F. R. a global cancer Oncol. Full Text Full Text PDF PubMed Scopus Google Scholar The of in high- versus countries the availability of While developing still with the of hubs and and countries are an technologies A.C. J. et in Surg Res. 2020; Full Text Full Text PDF PubMed Scopus Google Scholar and and Mas F. Piccolo D. Edvinsson L. M. S. and the of The case of by F. I. Edvinsson L. Massaro M. and Digital for a Sustainable Scopus Google Scholar represent the to and cancer P. A. D. et for surgical of the of in Surg. 2020; PubMed Scopus Google Scholar and surgical A.C. et and surgical Surg. 2020; PubMed Scopus Google Scholar for the best is one of the major to the by the new J. et and for of Scopus Google Scholar including fostering equity and social in the best cancer Indeed, developing countries and Task Force on Expanded Access to Cancer Care and Control in Developing Countries. Closing the Cancer Divide: A Blueprint to Expand Access in Low and Middle Income Countries.https://ncdalliance.org/resources/closing-the-cancer-divide-a-blueprint-to-expand-access-in-low-and-middle-income-countries-by-the-global-task-force-on-expanded-access-to-cancer-careGoogle Scholar and A. Dal Mas F. et surgical in the pandemic is Surg 2020; PubMed Scopus Google Scholar The recent literature has how has proved to be to and between low- and high-income countries as well as the gap in access to care and clinical outcomes in developing I. A. A. et al.Impact of on in a developing the Cancer. PubMed Scopus Google R. I. and for cancer care Oncol. Full Text Full Text PDF PubMed Scopus Google Scholar as reported by the J. G. Cancer diagnosis and a case from Oncol. Full Text PDF PubMed Scopus Google Scholar programs among and health care around the have also proved to be to L. Dal Mas F. Peloso A. et the an on surgery Surg. 2020; 272: PubMed Scopus Google Scholar the health care the literature has how a clinical can facilitate the and the inequalities in L. Dal Mas F. Angelos P. One size does not fit all—translating knowledge to bridge the gaps to diversity and inclusion of surgical teams.Ann Surg. 2021; 273: e34-e36Crossref PubMed Scopus (9) Google and Surg. 2020; PubMed Scopus Google G. in and inclusion in research and clinical Oncol. 2021; Scopus (2) Google Scholar diversity in clinical has proved to higher and clinical A. D. et of and in the of a of the of Surgeons and a call to Surg. 2021; 273: PubMed Scopus (9) Google and inclusion in American Scholar as who are on the gaps with L. Dal Mas F. Angelos P. One size does not fit all—translating knowledge to bridge the gaps to diversity and inclusion of surgical teams.Ann Surg. 2021; 273: e34-e36Crossref PubMed Scopus (9) Google Scholar be more to do also in with patients. diversity can the sensitivity and the of knowledge and gaps of up to the of clinical and The of equal access to cancer and high technologies needs resources, adequate and efforts up to differences in screening, and RT willingness around the Indeed, high costs and scant of cancer treatments are the greater barriers in developing countries. To face this an with a of essential and treatment technologies is to more and sustainable access to oncological the World Health a Global for with the aim to at least of essential and technologies in such as the American of the of and the of Cancer Control, have been in this a of essential for and oncological The to for greater access to fostering in low- and middle-income A. J. G. to the of medical treatment in oncology: the of 2016; Full Text Full Text PDF PubMed Scopus (8) Google Scholar in the the access to Scholar in and low-income countries to high costs for oncological on the of essential R. J. M. A. on the costs and of in countries of Oncol. Full Text Full Text PDF PubMed Scopus Google Scholar To that more available or not available at all in the and low-income countries for and that the R. J. M. A. on the costs and of in countries of Oncol. Full Text Full Text PDF PubMed Scopus Google Scholar need sustainable costs considering that a more number of essential are as well as adequate processes and and in and oncological treatments, RT is in of and is crucial for and as or in many countries. To and RT treatment is to for treatments, and adequate of RT To in only and a for a of around As a the in a around and most RT treatments up as B. et of care of cancers and radiotherapy in Oncol. Google Scholar In the RT be a for and breast cancers the only has for a of A. R. in experience from a 2020; PubMed Scopus Google Scholar Such delays RT the be that such low-income countries on RT such as which increase with RT currently available in of the and care also play a in oncology, but in the low-income countries patients are often when the is In countries most health care are on the National Health the related to access to care be in countries, adequate access to care be by health care and and strategies M.J. Dal Mas F. R. in health knowledge new J 2021; Google Scholar and M.J. Maragh-Bass A.C. Dankwa-Mullen I. et al.Surgical disparities: a comprehensive review and new conceptual framework.J Am Coll Surg. 2016; 223: 408-418Abstract Full Text Full Text PDF PubMed Scopus (49) Google J.P. Graves K.D. Penedo F.J. Yanez B. Overcoming disparities in cancer: a need for meaningful reform for Hispanic and Latino cancer survivors.Oncologist. 2021; 26: 443-452Crossref PubMed Scopus (5) Google Scholar Task Force on Expanded Access to Cancer Care and Control in Developing Countries. Closing the Cancer Divide: A Blueprint to Expand Access in Low and Middle Income Countries.https://ncdalliance.org/resources/closing-the-cancer-divide-a-blueprint-to-expand-access-in-low-and-middle-income-countries-by-the-global-task-force-on-expanded-access-to-cancer-careGoogle J.P. Graves K.D. Penedo F.J. Yanez B. Overcoming disparities in cancer: a need for meaningful reform for Hispanic and Latino cancer survivors.Oncologist. 2021; 26: 443-452Crossref PubMed Scopus (5) Google Scholar can and programs to ensure of cancer A.M. et disparities and health a from the American of Oncol. 2020; PubMed Scopus Google Scholar care and quality factors to is the A review of and PubMed Scopus Google Scholar and quality of to a quality 2013; 26: Scopus (9) Google the presence of (including health quality and (including and quality, and clinical care and quality factors be for a of differences in clinical M.J. Maragh-Bass A.C. Dankwa-Mullen I. et al.Surgical disparities: a comprehensive review and new conceptual framework.J Am Coll Surg. 2016; 223: 408-418Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar In the face of treatment oncological programs might be from the and in to understand the for and practices that in all research be including clinical health and A.M. et disparities and health a from the American of Oncol. 2020; PubMed Scopus Google Scholar The Global Task Force on Expanded Access to Cancer Care and Control how the research in oncology worldwide. While in the wealthier countries, are in new treatment in the low- and middle-income countries, the topics services, and of oncological in Task Force on Expanded Access to Cancer Care and Control in Developing Countries. Closing the Cancer Divide: A Blueprint to Expand Access in Low and Middle Income Countries.https://ncdalliance.org/resources/closing-the-cancer-divide-a-blueprint-to-expand-access-in-low-and-middle-income-countries-by-the-global-task-force-on-expanded-access-to-cancer-careGoogle Scholar more and strategies to adequate of at of or mortality outcomes for the disease or treatment of factors such as socioeconomic status, or and location of not represent barriers in the A.M. et disparities and health a from the American of Oncol. 2020; PubMed Scopus Google Scholar a with research and L. Dal Mas F. Piccolo D. et in The of knowledge in a and clinical Scholar the inequalities in access to A.M. et disparities and health a from the American of Oncol. 2020; PubMed Scopus Google Scholar as well as a clinical clinical in developing countries is for lack of resources, culture, and and and presence of G. J. for clinical in developing J 2018; PubMed Scopus Google Scholar In cancers are a cause of mortality not only in high-income countries but also in the of the world, disease and remain cancer and mortality rates are most Indeed, the in the is with a higher increase in low-income countries as to high-income countries to versus to cancer as the health in developing H. J. et cancer estimates of and mortality for cancers in Cancer J 2021; PubMed Scopus Google Scholar care and oncological to or Health care disparities on outcomes according to care and M.J. Maragh-Bass A.C. Dankwa-Mullen I. et al.Surgical disparities: a comprehensive review and new conceptual framework.J Am Coll Surg. 2016; 223: 408-418Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar The due to cancer as well as treatments often lead to a high psychological and for the patients and patients often need to to as as programs also L. Dal Mas F. Massaro M. et in a approach for of surgical J Surg. 2021; Full Text Full Text PDF PubMed Scopus (5) Google H. Dal Mas F. Miceli L. R. breast cancer a experience for P. R. and Scholar is a of care in R. Biancuzzi H. A. et and physical the in Cancer 2020; PubMed Scopus (5) Google Scholar the equity in the access of be the in the countries related to cancer often cause Task Force on Expanded Access to Cancer Care and Control in Developing Countries. Closing the Cancer Divide: A Blueprint to Expand Access in Low and Middle Income Countries.https://ncdalliance.org/resources/closing-the-cancer-divide-a-blueprint-to-expand-access-in-low-and-middle-income-countries-by-the-global-task-force-on-expanded-access-to-cancer-careGoogle Scholar In can and an to and health care The oncological gap stands as a several of health prevention, survivorship, culture, and Closing this gap is an that size does not fit a of the and needs of each is crucial to of that and be that good health and well-being can be to

Topics & Concepts