Understanding the complexities of health disparities within cancer care requires an exploration beyond immediate clinical factors. According to Elisa Rodriguez, PhD, MS, of Roswell Park Comprehensive Cancer Center, Buffalo, New York, geography plays a critical role in defining health outcomes in cancer care.
Elisa Rodriguez, PhD, MS
During the NCCN Oncology Policy Summit: Cancer Across Geography,1 Dr. Rodriguez argued persuasively for the necessity of addressing disparities through effective strategies and solutions. They should consider not only socioeconomic status, race, and ethnicity, but also the geographic location of patients, she noted.
Unmasking Geographic Disparities in Cancer Care
According to Dr. Rodriguez, disparities in cancer care are not only a national issue but also have severe implications within urban and nonmetropolitan areas. Roswell Park, where Dr. Rodriguez is Vice-President and Associate Director of Diversity, Equity, and Inclusion for the Cancer Center Support Grant, and Director of Community Engagement Resource, collectively serves a diverse population across geographies. They include urban suburbs, remote rural areas, and parts of Appalachia, which pose unique challenges in terms of resource allocation and health-care provision. In her catchment area alone, shortages of health-care professionals vary between 20% and 80%, with significant increases seen in rural counties.
“We have to examine county-level characteristics, especially how those factors impede or facilitate health-care utilization,” said Dr. Rodriguez. “Factors such as distance to health-care facilities, lack of sufficient health-care providers, and unique neighborhood stressors significantly affect health-care outcomes.”
The role of education, too, cannot be overlooked. As Dr. -Rodriguez explained, adults aged 25 and older in rural areas more commonly hold a high school degree as their highest level of educational attainment, which inherently complicates their capacity for health-care decision-making. “We know that education is a critical determinant of health-care decision-making. When we look at social environment, it plays a role in income, it plays a role in employment, it plays a role in a lot of other resources that impact an individual,” said Dr. Rodriguez.
Building Trust and Engaging the Community
The crucial question then becomes, what is the best way to overcome these disparities? Although it is easy to view rural communities as disadvantaged, said Dr. Rodriguez, they are also home to extremely resourceful people who are already engaged in building relationships and managing infrastructure. Drawing upon these assets is a crucial element of any strategy to overcome health-care disparities.
Dr. Rodriguez cited examples from her own work, highlighting the different issues influencing trust in the urban and rural communities of Western New York. Despite geographic accessibility, she said, urban residents faced more challenges with medical mistrust, creating an “invisible barrier” when seeking cancer treatment. In rural communities, on the other hand, the primary concerns were “privacy, respect for privacy, and the need for information to make informed decisions.”
“It takes a lot of time to develop relationships and trust [from patients] in a meaningful way,” Dr. Rodriguez continued. “Health-care industry stakeholders must understand the need for investment in time to cultivate these relationships, thereby facilitating better community engagement.”
KEY POINTS
- Geographic disparities in cancer care are significant, particularly in rural areas. These disparities may be associated with distance to health-care providers, lack of sufficient providers, and local neighborhood stressors, which can hinder the use of health care.
- Community engagement is an essential strategy to address these disparities. It helps build trust and improves the perspective and involvement of the local community in addressing these health-care challenges.
Dr. Rodriguez underscored the significance of community outreach and engagement in monitoring cancer rates, facilitating strategic research, and speeding up implementation in the community. Roswell Park Comprehensive Cancer Center, for example, has leveraged the power of the community by creating an advisory board composed of a diverse group of individuals with varied experience and background to guide strategic priorities at the Center.
“If our community outreach and engagement is not really leading that charge and helping to facilitate this, it’s really tough to do that from a health-care perspective,” said Dr. Rodriguez.
Creation of the Research Oncology Community Knowledge Stars program also exemplifies the Center’s effort to foster reciprocal relationships with local communities, according to Dr. Rodriguez. The program pairs cancer advocates with researchers, allowing the community to impact research and care in real terms.
“The work we’re seeing from the research perspective is being informed by patients,” Dr. Rodriguez explained. “Investigators are using that, whether it’s implementation or behavioral scientists. Without the infrastructure to do research that is meaningful and helpful to these communities, it’s hard to be successful,” she added.
Innovating Toward Health Equity
In a bid to reduce health-care disparities, Roswell CARES, a social responsibility program, was launched around a year and a half ago. Dr. Rodriguez emphasized the role of medical institutions as neighbors in the community, underscoring their duty to offer aid and support. So far, the program has contributed around $1.1 million through construction aid, other resources, and small grants, all aimed at enhancing community resources.
Furthermore, Dr. Rodriguez highlighted the creation of a new lung cancer screening program called Eddy, which stands for Early Detection Driven to You. In collaboration with community partners, the program is focused on enhancing lung cancer screening, “a process faced with significant challenges.” Eddy offers mobile lung cancer screening services to address access disparities across different areas and already conducted more than 700 screenings since November 2022.
In addition, Dr. Rodriguez noted the importance of small federal grants, referred to as P30 supplements. “These grants have been a really, really important strategy in that work,” she said. “They are used to help build infrastructure and promote progress.”
Finally, recognizing the critical role of health equity in improving outcomes, Roswell Park has created a position dedicated to addressing equity across its network of practices. Set to launch by early fall 2023, this role involves the use of community-engaged best practices and epidemiologic data to study trends in medical care and services.
“By engaging with epidemiologic data to identify trends, we hope to implement innovative roles and positions to make a real, meaningful impact,” Dr. Rodriguez concluded. “I encourage you all to consider opportunities to adopt similar strategies in your own work to address health-care disparities.”
DISCLOSURE: Dr. Rodriguez reported no conflicts of interest.
REFERENCE
1. Rodriguez E: Addressing cancer disparities across geography. NCCN Oncology Policy Summit: Cancer Across Geography. Presented June 15, 2023.
