Recently released dissemination papers led by researchers at the American Cancer Society (ACS), Baylor College of Medicine, and the Hollings Cancer Center at the Medical University of South Carolina, show how differences in social determinants of health—the conditions in the places where people live, learn, work, and play—are associated with profound inequities in cancer incidence, care delivery, and patient outcomes, including stark disparities in survival. The three papers identified housing, transportation, and food insecurity among patients with cancer, outlining a call to action to address and improve health disparities from a series of webinars sponsored by the National Cancer Policy Forum of the National Academies of Sciences, Engineering, and Medicine. The papers and an accompanying editorial were published September 21 in the Journal of the National Cancer Institute (JNCI).
“Reducing long-standing disparities in cancer care and patient outcomes in the United States will require addressing social risks in cancer care, including but not limited to food, housing, and transportation insecurity,” said Dr. Robin Yabroff, scientific vice president, health services research at the American Cancer Society and senior author of the paper addressing transportation insecurity among patients with cancer and a co-author of the paper addressing housing insecurity. “It’s critical we ensure that the remarkable progress in cancer care is equitably accessible for all patients.”
Researchers authoring the papers summarized existing evidence related to disparities in cancer care and patient outcomes, as well as identifying promising interventions and research opportunities to inform policy and improve health equity. According to the authors, more than one in five patients with cancer in the United States struggles to meet at least one of these basic needs, and estimates are much higher for patients from historically marginalized populations including those of Black race, Hispanic ethnicity, or living in poverty. Material hardships are associated with delays in cancer diagnosis and initiation of cancer-directed therapy, greater distress and financial toxicity, and a higher risk of relapse and death.
“Many people struggle with food insecurity during cancer treatment and survivorship, which can lead to worse outcomes and further widen disparities,” said Dr. Margaret Raber, assistant professor of Pediatrics-Nutrition, Baylor College of Medicine, and lead author of the paper on food insecurity among patients with cancer. “Ensuring access to nutritious food should be an integral part of cancer care delivery and will require coordinated and sustained efforts between clinicians, community-based organizations, cancer centers, and policy-makers.”
“Addressing health-related social risks such as transportation insecurity is critical to ensure optimal and equitable outcomes for patients with cancer. As we see in our clinical practice and research, lack of transportation can prevent patients with cancer from getting high-quality care and worsen outcomes, and also negatively impact caregivers, clinicians, health systems, and our society as a whole,” said Dr. Evan Graboyes, associate professor, department of Otolaryngology-Head & Neck Surgery, member of the Hollings Cancer Center Cancer Control Program at the Medical University of South Carolina, and lead author of the paper addressing transportation insecurity among patients with cancer. “Our work highlights efforts to identify at-risk patients and address transportation insecurity through changes at the policy and health system levels while partnering with stakeholders from industry and the not-for-profit sectors.”
“Accumulating evidence shows that housing insecurity, including lack of safe, affordable, and stable housing, can influence—and be influenced by—cancer care,” said Dr. Qinjin Fan, senior scientist, health services research at the American Cancer Society and lead author of the paper addressing housing insecurity among patients with cancer. “Systematically identifying and addressing housing insecurity to reduce health disparities will require greater investment at the practice, systems, and broader policy levels.”
ACS programs, including Hope Lodge and Road to Recovery, can help to address some of these challenges, especially those related to transportation and housing near treatment:
Individual papers, including an editorial, can be found here:
This article was originally published September 21, 2022, by the American Cancer Society. It is republished with permission.