Action is Key to Continue to Break Down Barriers for Equitable Cancer Care

Catherine Zhang, MD, MPH

Experts from the University of Wisconsin (UW) School of Medicine and Public Health, including Catherine Zhang, MD, MPH, an assistant professor of gynecologic oncology in the Department of Obstetrics and Gynecology; Monica Patel, MD, an assistant professor of hematology, medical oncology, and palliative care in the Department of Hematology/Oncology; Janelle N. Sobecki, MD, an assistant professor (CHS) of gynecologic oncology in the Department of Obstetrics and Gynecology; and Loyda Braithwaite, NP, an oncology nurse practitioner, participated in an interview with OncLive® on disparities in cancer care.

In the interview, these experts addressed significant barriers to equitable cancer treatment and highlighted challenges for rural communities to access specialized oncologic care. Furthermore, they emphasized financial limitations affecting treatment access, specifically for marginalized groups, and the need to push for health policy changes.

In a previous article, Zhang, Patel, Sobecki, and Braithwaite provided further insights into the need for mitigating disparities in cancer care.

OncLive: What are some of the most significant barriers preventing marginalized communities from accessing timely and equitable cancer treatment?

Zhang: Geographic isolation [is one barrier]. Especially in the state of Wisconsin, there are rural communities that where it is difficult to access good oncologic care. For example, we know that patients who aren't able to see subspecialists—such as gynecologic oncologists—have worse outcomes in terms of survival. Another barrier is distrust of our medical system, either due to historical trauma or health literacy.

Braithwaite: [A barrier] that I have experienced more often is financial limitation, including all the toxicity that people experience due to the costs of treatment or insurance coverage, or lack thereof. It's a barrier that we have experienced for many years within our health systems, and we continue to see it. Our treatments are continuing to get more advanced. [Options] continue to expand, offering more opportunities for patients through approved treatments or through clinical trials.

However, we know that there are barriers for many patients to access even standard therapies. Recently, I was reviewing studies about how standard therapies are not necessarily accessible for patients from marginalized backgrounds or minority populations. We are looking at these treatments that we have available, but even for some standard treatments, patients may not be able to receive [them]. That limitation, in terms of the financial aspect, is a big barrier.

We are taking some steps trying to improve [financial barriers], but we still have a lot of ground to cover. The more science that we put behind it, the more we can implement changes in health policy. The advances that we're making in science and health care [must translate] to making those findings and those resources available to our patients; this goes side by side with health policy changes. This is one of the ways we can make cancer care more equitable [for all patients].

Sobecki: In addition to access, once patients arrive at the clinic, some of the ways that we approach our diagnostics can have big implications, as well. In the field of gynecologic oncology, [specifically] in uterine cancer, which has had well-documented racial inequity, sometimes the way that we approach diagnoses can create delays in that process. [Providing] access for patients to arrive within the health care setting [is one challenge]; how we're managing early signs and symptoms once they arrive in our system can also have an impact.

Looking critically and reevaluating some of the algorithms and ways that we approach diagnosis is incredibly important. Within our field and in the space of uterine cancer, there has been some recent data showing that there are some ways that we can do better [diagnose uterine cancer]. That may move the needle for some of the racial inequities that we experience in that area.

How do these various barriers affect patient outcomes? What strategies do you currently implement to mitigate these challenges at UW Health?

Patel: Equity in cancer treatment includes clinical trials. We try to ensure that we, as providers and staff, are educated about this topic, [allowing us] to offer [enrollment to] studies to all potentially eligible patients. We [try to eliminate] implicit bias, making sure that providers are aware and offering studies to all potentially eligible patients, regardless of background or sex.

We're also trying to expand the eligibility and exclusion criteria of clinical trials so that these studies can be more inclusive of all patients to represent the greater [real-world] population. We are also trying to expand nurse and patient navigation in our cancer center to help patients along their cancer treatment continuum. [This could help them overcome] potential barriers, including things like transportation and other obstacles that come up along a patient's treatment course.

Braithwaite: At UW, we are fortunate that we are a large research institution, and we have access to tools such as next-generation sequencing [NGS] for our patients; however, there are other areas, even within our own state, where centers perhaps don't have access. [Accessing these tools could create] additional costs to cancer care if [NGS] testing could potentially open doors for additional treatment tailored to exactly what a patient needs.

What role do medical professionals play in raising awareness about disparities and promoting health equity on a broader scale?

Braithwaite: As health care professionals, we have been talking about inequities and disparities for quite some time. At this point in time, we are more than ready to start moving the needle toward action. We recognize that there are needs, and we recognize disparities are there in many areas, not only when it comes to race.

How do we plan right? How do we get ourselves involved? One of the ways we can increase that awareness is by raising that voice—not necessarily being louder, but being smarter about how we work, who we connect with, and how we make those changes in health policy at different levels. This means at our local institutional levels, but how do we get professionals and organizations to be involved in being part of that voice and being out there? [We cannot be] afraid to engage with policymakers.

We are the ones who care for these patients, we are the ones who need to inform [policy makers]; they are there to create and establish the policies, but we are the voice behind [policy changes]. I'm a big advocate, and being involved and having professional knowledge behind us is a great tool that we can utilize to continue to move forward in cancer care with a more equitable and accessible lens.

Patel: We need to think about community engagement and have discussions with our community advocacy boards to get their input. [It is important] to make sure [these conversations and initiatives] are a two-way street.

How can the drive to eliminate disparities be continued by the next generation of doctors and nurses?

Braithwaite: I am incredibly grateful to have had great mentors. I was recently at the National Palliative Nursing Conference in Washington, DC, and I cannot express how grateful and refreshed I feel after getting together with researchers in cancer nursing.

[I am grateful] to have been in their path as a learner and as a colleague, and it is incredible how empowering it can be to meet that one person in your professional career who opens the doors for you in the future. Let's be those people who can inspire the ones that are coming into this field.

Zhang: Mentorship is so important. We've started this [conversation] talking about how we need to increase representation [of women] at the leadership level, but it's important, even as a reminder for myself, that representation is just the beginning.

Ultimately, we're hoping for increased representation to instill a sense of belonging. For people who are underrepresented within medicine, whether you're a woman or a person of different color, we all feel like we can advocate for each other and support one another.