We talk a lot about genetics and genomics in oncology—for good reason. But the truth is that, generally speaking, your chances of being diagnosed with and surviving cancer depend more on your ZIP code than your genetic code. That's why we see such striking differences in incidence, staging, and survival based on race, ethnicity, socioeconomic status, and many other non-clinical factors.
While addressing health disparities is one of today's hottest health care topics, it is a layered and complicated problem—especially if our aim is to address the root causes of disparities rather than trying to patch them up with short-term point solutions.
To help organizations drive equitable cancer care, we convened a group of oncology leaders to share strategies and common barriers to meaningfully effecting change. Here are four big takeaways from the conversation.
1. Providing equitable care is central to programs' long term success, but many struggle to craft and sustain an effective strategy.
When asked to share how they define equity in cancer, all attendees' answers were iterations on the same theme: Ensuring all patients receive care that is in line with their unique needs and social situations.
While all attendees agreed that delivering equitable care is important to their future success, most felt that their current strategy will only be somewhat effective in reducing disparities—not surprising, especially given how challenging addressing health equity and social determinants of health is in a resource-constrained, fee-for-service environment.
2. When it comes to data, don't let perfect be the enemy of good.
Ideally, organizations would collect REGAL (race, ethnicity, gender identity and sexual orientation, age, and language preference) data from each patient and use it to identify where health inequities exist. Workshop attendees referenced the many pitfalls in data collection that make it difficult to identify disparities at the population level, specifically when it comes to race and ethnicity. However, imperfect data is still a start.
Attendees agreed that something is better than nothing, and that there is enough evidence both at the organizational and national level to get started. For example, attendees mentioned comparing disparities across demographic groups for these metrics to guide their strategy:
- Time to diagnosis
- Time to first treatment
- Cancer patient demographics compared to overall catchment area
3. Goals should be SMART—but just getting started is progress in and of itself.
Given that most cancer programs are just trying to get a handle on their data, few have articulated specific goals for health equity. Ideally, goals would be SMART—specific, measurable, attainable, relevant, and time-based.
In the meantime, most programs have starting goals of collecting data on disparities, striving to provide high-quality care to all patients, and reframing how they set growth strategy. On this last point, one organization mentioned that their new goal for setting growth strategy involves prioritizing unmet need and deprioritizing payer mix and income.
4. Think creatively about addressing the social determinants of health.
Attendees were split on how much of a role the cancer program should play in addressing social determinants of health in their community. On an individual patient level, cancer programs treat more than "just the disease," often helping patients and families with transportation, financial, and social needs. But on a broader level, the role of the cancer program in addressing inextricable, longstanding issues, such as intergenerational poverty and access to education, becomes much more complex.
To truly deliver on the goal of providing equitable cancer care, I firmly believe that health systems and cancer programs need to help address community-wide social determinants of health and their root causes. That can take many forms, from supporting community partners to advocating for meaningful change to building trust among historically disconnected patients.
An organization won't make real change unless its leaders commit to addressing these structural root causes of health disparities. Only then can we hope to make meaningful progress in eliminating the significant health disparities we see in cancer care.