In New ASCO Policy Brief, Manali Patel Tackles Cancer Disparities and Health Equity
Back in 2015 when Manali Patel, MD, MPH, MS (assistant professor of oncology), accepted a position on the Cancer Disparities Committee (now the Health Equity Committee) of the American Society of Clinical Oncology (ASCO), she may not have guessed that she’d finish that service six years later with three huge accomplishments.
The first accomplishment was spending three years as a committee rank and file member and three years as chair-elect, chair, and past chair of the committee. The second accomplishment was having two children. And the third was her leadership role in drafting a policy statement on cancer disparities and health equity with a summit of health equity leaders. The statement, which was published in the Journal of Clinical Oncology on August 12, appeared in the midst of the Black Lives Matter movement and a global pandemic, when “equity” and “health” are two words that are top of mind in much of the world.
“I spent over half a decade working with ASCO on different initiatives to try to infuse a health equity lens,” says Patel. “This policy statement arose from our realization that we needed to readdress ASCO’s 2009 recommendations given persistent disparities, despite progress in cancer over the previous ten years. The world has changed since we began crafting this policy statement. We began this effort in January 2019, gathering views from past leaders and members of the Health Equity Committee, drafting the statement and obtaining approval by the ASCO Board. Our recommendations, which were selected for publication prior to COVID-19 and other recent events, hold even more weight now in the context of how the world has dramatically changed.”
The article defines cancer health disparities as “measurable differences in cancer outcomes in various population groups.” Once the U.S. began collecting cancer data in 1973 in the Surveillance, Epidemiology, and End Results (SEER) Program, it became obvious that there were disparities in cancer incidence, prevalence, stage at diagnosis, morbidity, and mortality. Over time more data were collected including differences in screening, survivorship, quality of life, and compounding health conditions. Even later more data were added: race and ethnicity, age, sexual orientation and gender identity, education, socioeconomic status, insurance access and type, environmental exposures. With so much data, it would be hard not to see pervasive gaps.
Bold, collaborative recommendations
Patel’s article proposes several recommendations for promoting health equity, that will guide the work of ASCO and other stakeholders.
Ensuring Equitable Access to High-Quality Care
First is ensuring equitable access to high quality care. Access to care has been improved by the Affordable Care Act (ACA), the expansion of Medicaid, and private or employer-based health insurance. But the ACA is constantly under threat of being eliminated as an option for millions of citizens, many states have not expanded Medicaid, and the cost of premiums and narrowing of networks are challenges to other health insurance. ASCO is committed to eliminating such barriers to access through policy reform and advocacy.
Ensuring Equitable Access to Research
The second recommendation is ensuring equitable access to research so that all populations have an opportunity to participate in research, ensuring robust and generalizable findings. ASCO recommends specific strategies to improve recruitment and retention of diverse participants in research.
Addressing Structural Barriers
The third recommendation is addressing structural barriers, which ASCO believes can be mitigated through “commitment to workforce diversity, development and strengthening of community partnerships, and addressing institutional discrimination.”
Increasing Awareness and Access
The final recommendation is increasing awareness and action so that multiple audiences will become aware of pervasive cancer health inequities and strive to “move oncology care closer to our shared goal of cancer health equity.”
Asked how a group of oncologists might make changes to their practice to reflect their own commitment to health equity, Patel had a ready example: “To improve cancer outcomes, oncologists must collaborate and partner with local communities and community members to understand how to better address inequitable care delivery. Inequities in health are multifactorial but involve certain patient populations not receiving evidence-based cancer care. To address inequities, we have to address these modifiable etiologies. This involves understanding why certain patients may not receive evidence-based care and working with community-based organizations to overcome social determinants of health which impact outcomes such as lack of transportation, job loss, food insecurity, housing, and childcare. We also recommend working closely with state-based societies to advocate for crucial policy changes that directly impact care delivery and outcomes.”
The urgency of the current moment
COVID-19 has worsened problematic issues. Patel explains: “The pandemic has affected our ability to provide basic healthcare for patients who are already comparatively at risk for adverse outcomes, not to mention our ability to provide precision medicine. With the pandemic, for example, the digital divide may further exacerbate disparate cancer outcomes. Many of my patients at the VA, for example, rely on their landline and do not have a mobile device or a computer to receive healthcare through virtual means. In addition, the impact of the pandemic on the fundamental social determinants of health will adversely affect these disparities in a way that is unimaginable.”
She concludes: “My hope is that the recent events in the world, including the pandemic and the Black Lives Matter movement, have shone a spotlight on these longstanding health inequities and social injustices. I am hoping that these events will mobilize us to positively change our society including our healthcare delivery approaches.”