The ASCO Post asked AACR President Frank McCormick, PhD, Director, UCSF Helen Diller Family Comprehensive Cancer Center, about the ongoing problem of health-care disparities among minorities and other subpopulations.
First, can the Patient Protection and Affordable Care Act lessen these disparities? He noted that the most immediate effect of the legislation is expanded coverage for the un- and underinsured. Minorities are disproportionately represented in these ranks, especially those with preexisting conditions. For cancer specifically, lack of health insurance lowers screening rates.
In addition, Dr. McCormick pointed out:
The Affordable Care Act will expand community health centers, which tend to be located in underserved areas and which specialize in marginalized populations. “However, when certain groups are more susceptible to cancer or respond differently to treatment, there needs to be a greater focus on the underlying science.”
The law also created the Patient-Centered Outcomes Research Institute to identify priorities and provide funding for research on outcome differences in subpopulations such as racial and ethnic minorities.
The Affordable Care Act requires plans to ensure that all patients have access to clinical trials, which is of critical import in oncology. The provision aims to remove the economic barriers to trial enrollment. In addition, AACR advocates for a provision in the law that prohibits health insurers from denying coverage of routine costs associated with trial participation and from discriminating against patients in trials.
The Affordable Care Act established the Prevention and Public Health Fund, which addresses problems such as poor nutrition, smoking, and the environment.
Reducing Disparities
The ASCO Post also asked Dr. McCormick about strategies that AACR envisions to lessen the disparities. He said that the basic approach is through research to understand the biologic underpinnings that cause disparities. For instance, the organization’s annual Conference on the Science of Cancer Health Disparities stimulates development of new research that results in science-based policy changes.
“In fact, AACR will host a congressional briefing during the lame duck session to summarize conference results in order to focus greater attention on ways to address disparities,” he noted.
AACR has submitted comments to the Centers for Medicare & Medicaid Services on the kinds of information that should be collected for electronic health records, including demographic data and family history. These data enable retrospective study of the differential rates of cancer incidence, mortality, and treatment response in subpopulations. “The more such data we have, the better researchers can elucidate causal or confounding factors and tailor interventions accordingly,” said Dr. McCormick. ■
Disclosure: Dr. McCormick reported no potential conflicts of interest.
