- Better care coordination and patient access to preventive care will help drive cancer care equity, according to a report from the American Cancer Society (ACS) and the Council of Accountable Physician Practices (CAPP).
The 2017 State of Cancer Care in America report showed that cancer treatments themselves are improving. Mortality rates have dropped 13 percentage points since 2004, the ACS and CAPP reported, citing CDC figures. Additionally, the Cancer Moonshot Initiative is making great strides toward determining better, more individualized treatments for cancer patients.
Despite these medical advances, the report showed that there are still substantial care disparities. Patients of certain backgrounds see disproportionate rates of cancer prevention, early diagnosis, and mortality.
“There are stunning socioeconomic and demographic disparities in survival, treatment, prevention and diagnosis,” said CAPP Executive Director Laura Fegraus in a public statement.
The report authors found a slew of health disparities after combing through CDC data. African American women are 20 percent more likely to die of cancer than white women, for example, and individuals living in Western Mississippi are five times more likely to die of breast cancer than the national average.
Ethnic minority patients are also receiving preventive screenings at alarmingly lower rates than their white counterparts, the report said. Latinos are less likely than white patients to receive mammograms, colonoscopies, and other screenings.
The social determinants of health are likely driving these care disparities, the report said. Twenty-one percent of cancer diagnoses are the result of obesity, limited physical activity, and poor diet, the authors explained. Patients living in communities with poor education about diet and limited access to nutritious food might be more likely to develop cancer.
Communities and the healthcare organizations in them must work to address the social determinants of health as a part of cancer prevention efforts. Communities can develop strategies to drive community fitness, work to make healthy food more affordable, and offer nutrition education within the community and in schools.
Healthcare costs and socioeconomic disparities also drive health inequity, the report said. Out-of-pocket costs for cancer patients have reached about $4 billion annually, which puts socioeconomically disadvantaged patients in a terrible bind when accessing cancer treatment, report authors explained.
“Those huge costs also appear to have a disproportionate impact on people of color,” the report pointed out. “According to the CDC, even after the Affordable Care Act has helped millions of uninsured to gain coverage, African-Americans were nearly 60 percent more likely than whites to put off healthcare services due to their costs, suggesting that preventive and follow-up care are being sacrificed.”
The report authors also noted general cancer prevention recommendations that will improve the experience for all patients. Improving care coordination and equal access to preventive services will be critical in reducing cancer mortality.
“Care coordination should also begin with prevention,” ACS Chief Cancer Control Officer Dr. Richard C. Wender said in a statement. “Systems should help patients access the preventive services that are right for them. If a patient receives an abnormal screening, coordinated care should continue through the diagnostic process to resolution and, when needed, to ensure timely initiation of treatment.”
Driving high levels of care coordination will require healthcare professionals to reframe how they pay for medication services. This overhaul should prioritize patient outreach and preventive care engagement.
“If we’re going to create a system that works for patients and ensures no one has to worry about slipping through the cracks, we must embrace the movement toward accountable care-type organizations, patient-centered medical homes, and other value-based payment and care delivery models where prevention and care coordination can result in lower healthcare expenditures and better health outcomes,” Wender said.
Healthcare payers must also use payment models that incentivize accessible preventive services for all patients, the report noted. Payers must cover both the cost of cancer care as well as cancer prevention and detection. Most patients cannot access preventive services if they are not included in patient healthcare coverage.
Improving patient access to preventive care and care coordination will ultimately drive positive outcomes in all aspects of cancer care, report authors asserted.
“Transforming healthcare delivery—and cancer care—in this fashion will result in better clinical decisions and proactive treatment, reduce medical errors, and improve the patient experience,” the report authors concluded. “Following these recommendations can also provide the connections that will significantly improve prevention and reduce disparities. Integrated, comprehensive and coordinated systems of care are the key to closing the gaps in cancer care that exist today.”