On November 9, 2021, in partnership with the Alliance for Health Policy, several investigators associated with the Alliance to Advance Patient-Centered Cancer Care joined a diverse panel of presenters to discuss challenges and opportunities to improve the oncology patient experience and promote health equity. For more details on each panel and to view the recorded presentations, please view the event’s webpage here.
The Alliance to Advance Patient-Centered Cancer Care (Alliance), an initiative funded by the Merck Foundation, comprises six program partners working to advance health equity. Their interventions have demonstrated that multiple components are required to address disparities in cancer care. Interventions implemented by Alliance program partners included technology solutions to identify underserved and at-risk patients, specially trained personnel working with patients to reduce barriers to care, and community partners to support health promotion activities.
Comprehensive, multifaceted programs like these can improve access to high-quality cancer care. State and federal policy strategies are essential to improve cancer care delivery and to support the work of addressing disparities for vulnerable and historically underserved populations.
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Family caregivers, or cancer co-survivors, are unpaid volunteers who spend time and energy caring for and fearing for a loved one undergoing cancer treatment (a cancer survivor). There are approximately 2.8 million people providing this type of informal care in the United States. A caregiver may work closely with cancer care clinical teams, administer drugs, report any concerns on behalf of the patient, manage health insurance claims, and keep other family members informed of the patient’s condition. Many who have taken up this role have reported lacking resources or support. Reports show that rates of depression for cancer patients and their loved ones is approximately twice as high as for people who live in the same communities. Caregiving is often characterized as a public health crisis.
Interviews were conducted with key stakeholders from across the six Alliance to Advance Patient-Centered Cancer Care grantee sites to better understand their perspectives on their most important accomplishments, challenges faced, and lessons learned in their work to improve care coordination and access to care.
Some of the questions touched on health disparities, with grantees sharing their experiences and those of their patients. They described a wide variety of factors that influence a person’s ability to access high-quality, equitable cancer care. We collected some of their most common responses here.
The world has changed significantly over the past year, but the needs of vulnerable and underserved patients remain as urgent as ever. Supportive care interventions aim to prevent and treat physical, psychological, social, and spiritual problems related to cancer. Alliance program partners are improving the quality of life of vulnerable and underserved persons with cancer through supportive care programs that aim to address their psychosocial concerns and reduce barriers to care. As many clinical centers around the country have had to increase their reliance on telehealth to deliver safe cancer care, the Alliance sites, too, have been working to adapt to the new world order.
In the era of precision medicine and molecular oncology, persons with cancer are gaining access to increasingly advanced forms of treatment. However, while some may be able to benefit from this cutting-edge clinical innovation, many underserved patients are still struggling to receive care. A new law in Massachusetts is set to eliminate a major financial barrier to accessing clinical trials. Lawmakers, health care practitioners, and other stakeholders behind the measure hope that the provision contained in the health care bill “promoting a resilient health care system that puts patients first” will increase access to care for all, regardless of their sex, age, race, ethnicity, or socioeconomic status.
Patient navigation has always been an essential intervention to improve access to care for vulnerable and underserved patient populations. New data from the Massachusetts General Hospital Cancer Center shows that navigation is also a promising approach to ensure continuity of care during the COVID-19 pandemic.
Patient navigators have been assisting persons with cancer for approximately twenty years. However, there is little consensus on how the role should be defined, or how to best evaluate a navigator’s impact on patient care. Demonstrating the value of navigation is an essential step in determining the sustainability of these programs, making the business case for a patient-centered approach to cancer care.
Implicit bias is a manifestation of prejudice deriving from thoughts and feelings generated outside of an individual’s conscious awareness. These automatic judgments can be especially dangerous in a clinical setting, where they may be contributing to the health care disparities often experienced by vulnerable and underserved patient populations. A new publication from the University of Arizona presents a promising approach to reducing implicit bias in medical trainees. Alliance to Advance Patient-Centered Cancer Care Investigator Dr. Jeff Stone and his colleagues developed and tested an intervention aimed at reducing the stereotyping of Hispanic patients as medically non-compliant. The term refers to a patient’s unwillingness to follow treatment recommendations or take medications as prescribed. Studies show that physician implicit bias may influence treatment recommendations: one study found that African American patients were significantly less likely to receive a recommendation for thrombolytic drugs to treat myocardial infarctions compared to their white counterparts.
Our society can place white culture, ideas, thoughts, beliefs, and actions above others. A series of tragic events have brought this critical issue back into the public consciousness. Health care professionals, like many others, are striving to bring about lasting change. Naturally focused on helping others, clinical care teams all over the country have been explicitly working on becoming better allies to their vulnerable and underserved patients. Despite their best efforts, many are still manifesting what the experts refer to as implicit bias, or prejudicial and racist thoughts embedded into an individual’s mind on a subconscious, perhaps hidden level. These automatic judgments can significantly affect the way minority patients experience the health care system, from spending less time with physicians than their white counterparts to feeling less involved in decision-making regarding treatment.