Thursday, December 9, 2010

Understanding Cancer Care Disparities Today

While the United States offers the most advanced cancer treatment in the world, issues of race, culture, demographics, education, economic status, institutional prejudice and discrimination have lent themselves to the reality that not all Americans are offered the same resources for cancer prevention, diagnosis, treatment or follow-up. But in the past decade, cancer disparities in minority and underserved groups have become the focus of many of us in the cancer community.

Many of us acting as patient advocate pioneers in the nonprofit sector and/or medical field have implemented unique programs to improve cancer prevention through health education initiatives, access to care grants and programs, post treatment follow-up education and outreach in our communities and through social media networks. Many of us are very passionate and motivated by our own personal experiences or the experience of friends, family and loved ones.

While much attention has been focused in recent years to federal and state governments that provide nonprofits, medical clinics, hospitals and teaching institutions with annual grants and funding to create programs that assist the indigent with access to care and address the multicultural and psychosocial issues of general health education and cancer prevention the truth is these initiatives are simply not enough and have fallen short again and again from their stated goal -- they have made tremendous progress in their public relations and media image yet continue to "educate" patients "after the fact" and/or provide inadecuate services to their "target market".

In addition, research funded by the government aims to find underlying causes and solutions to overcome the barriers to equal cancer treatment (access to care) for all Americans. The statistics that prompted this funding initiative have been gathered by various entities for a number of years and will continue to be gathered, at the very least, for the next decade. The National Cancer Institute's Center to Reduce Cancer Health Disparities (, created to "reduce the unequal burden of cancer in our society" has gathered statistics showing that while all deaths from cervical cancer are preventable, 4,000 American women died of the disease as early as 2005.

What's more, researchers even know the predominant demographics of these women: African American women in the South, Hispanic women (specially along the Texas-Mexico border), Vietnamese women and Caucasian women in Appalachia and the rural Northeast. These findings should give us some pause for reflection and the clearly profound message the research has unwittingly revealed to us all. This is the United States of America yet we continue selectively ignore to openly discuss the racial divide that exists even in our most basic of human needs and rights, which is preventive healthcare.

Another study found that African American patients are less likely than whites to receive recommended chemotherapy for stage 3 colon cancer. Indeed, an African American man is more likely to die of cancer than his caucasian counterpart despite an overall decline in the rate of death from cancer. African Americans (regardless of sex) experience higher mortality with cancers of the prostrate, colon, breast, cervix and lung than a white patient with a comparable tumor and medical history !

Native Americans, which include more than 560 federally recognized tribes that speak 217 native languages, have the poorest survival rates from all cancers combined than any other ethnic groups here in the United States of America. Similarly, less educated Americans who live in rural areas are less likely to have a family doctor and follow prevention and screening recommendations for the general population.

Statistics for the Hispanic population are equally disappointing. According to data compiled by the Intercultural Cancer Council ( cervical cancer incidence is two to three times higher in Hispanic women than in white women and only 38 percent of Hispanic women age 40 and older have regular mammograms. While Hispanics represent about 12 percent of the U.S. population, they make up 25% (percent) of the country's uninsured.

According to a report on cancer health disparities commissioned by the Department of Health and Human Services in 2005, minority and underserved populations are more likely to be diagnosed with and die from preventable cancers and be diagnosed with late stage disease for cancers that are detectable through screenings at an early stage !

In addition, these populations receive either no treatment or treatment that does not meet current standard of care practices and die of generally curable cancers because they do not have the benefit of coordinated specialty care early on in their cancer journey. What's more co-existing disorders are often untreated, they don't receive the benefit of adecuate pain management and/or palliative care.

The research in cancer healthcare disparities continues as the healthcare reform debate rages on. It may be many decades years, even decades before we fully understand and address this aspect of our national health crisis but as of today the general consensus is that there are multiple contributors to healthcare disparities ranging from language issues to biases based on cultural or racial differences, the complexity of the current healthcare system combined with the simple economics equated to the number of uninsured in America today versus the cost of effective cancer care.

No matter what you choose to believe as an individual, I, as a cancer survivor, caregiver and patient care advocate - see the issue clearly defined and ever present everydat as one of the simplest things to ignore and "dress-up" behind all the excuses, complicated research and political debate -- it boils down to the almighty dollar and something as basic as free access to community health education programs.

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