New Framework to Address Cancer Care Disparities in Medically Underserved Populations

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A new article published in JCO Oncology Practice puts forth a framework to guide researchers, health-care leaders, advocates, community- and patient-focused service organizations, and policy leaders in their work to address and promote health equity in cancer care access and treatment outcomes.1

The framework, which was developed by the National Minority Quality Forum’s Diverse Cancer Communities Working Group, aims to answer one central question: What strategies, approaches, and policies along the cancer continuum of care will effectively deliver optimal care for medically underserved populations? The working group defines medically underserved populations as racial/ethnic minority groups, rural populations, aged, adolescent/young adult, LGBTQ, people with disabilities, immigrants and refugees, and under and uninsured communities.

“The complicated and interconnected nature of the [cancer care continuum] means that everyone in the cancer care community is jointly responsible for ensuring access to high-quality care across the entire continuum—not just within their own domain,” the authors write. “If disparities are not addressed, health inequity will be exacerbated, increasing the burdens for underserved and vulnerable populations.”

A Steering Group identified U.S. community leaders and other stakeholders who have implemented successful programs to improve cancer-related health outcomes for the communities they serve and have expertise across all domains, including prevention and risk reduction, screening, diagnosis, treatment, survivorship, and end-of-life care. Through a survey of those experts, they identified three priority focus areas for the framework: coordination of care/patient navigation, community engagement, and health-care system changes. These activities found to be relevant across domains were most commonly identified as having the greatest potential impact on patient outcomes in the target populations.

Patient navigation/coordination of care—The Working Group identified several notable practices to help bridge the gap between domains. They include tracking patients through transitions of care (including second opinions and warm handoffs from one provider or service to the next), use of data and information technology solutions to track metrics and effective navigation throughout the cancer care continuum, and screening for cancer-related distress and social determinants of health with ongoing assessment so providers can adapt to changing patient needs.

Community engagement—In order to leverage community strengths and networks, the Working Group developed high-impact practices to increase community engagement, such as through identifying and collaborating with trusted community organizations to disseminate health information and including community members on hospital boards and patient or family advocacy or advisory committees.

Health-care system changes—The members of the Working Group also identified notable actions for stakeholders to take to address equity challenges within the health-care system. For example, the article recommends developing a realistic assessment of operational capacity or commitment before outreaching to target populations; ensuring workforce diversity and cultural awareness training; identifying and sharing appropriate health-literate, culturally sensitive, and linguistically appropriate resources; developing clear transitions of care processes that include accountability and documentation; and developing health-equity metrics as part of the institutional performance scorecard against which senior leaders are measured.

The article also includes recommendations for national policy changes to support suggested health-care system changes and to ensure long-term sustainability of a more equitable cancer care system.

ASCO is committed to advancing health equity in cancer care and recently issued a policy statement on health equity that set forth specific recommendations—including addressing underlying institutional and structural barriers to equitable care and education and awareness programs for oncology professionals—to ensure equitable access to care and research.2 ASCO is developing a concrete strategic plan, with particular emphasis on increasing workforce diversity, building partnerships with communities affected by disparities, addressing institutional discrimination in the oncology field, and increasing awareness and action on equity issues.

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1. Winkfield KM, Regnante JM, Miller-Sonet E, et al: Development of an actionable framework to address cancer care disparities in medically underserved populations in the United States: Expert roundtable recommendations. JCO Oncol Pract. January 18, 2021 (early release online).

2. Patel MI, Lopez AM, Blackstock W, et al: Cancer disparities and health equity: A policy statement from the American Society of Clinical Oncology. J Clin Oncol 38:3439-3448, 2020.

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