Cancer inequity: what can be done?

Written by: Rosie Lobley

In the latest instalment of our series on the cancer care gap, we look at how inequalities of access to care can be ameliorated.

Funding and infrastructure

It has been widely established that economic inequality is a significant determinant of cancer outcomes, both directly and as a result of factors tied to poverty such as education, housing and difficulty accessing medical care.1 Funding is therefore a key issue in addressing the care gap, both in terms of targeted financial support for issues affecting access to care, such as transport, financial aid and childcare, and increased research funding for underserved patient groups. However, there is evidence that the effects of increasing the funds available to disadvantaged patients are greatly heightened when implemented within a robust and accessible healthcare infrastructure, where measures are in place to help patients to access care and staff receive regular, up-to-date training on patient engagement and health equity.2

Holistic service plans are not just beneficial in high-income countries – while funding is certainly a significant factor in addressing the inequalities present in low- and middle-income countries, collaboration between services and in-country ownership of health strategies are equally crucial for shoring up long-term cancer care infrastructure.3

cancer funding policy innovation

Policy and education

Targeted, patient-led taskforces and working groups can drive efforts to enshrine equity within health policy.4 The European Commission has established a European Cancer Inequalities Registry, aimed at identifying and addressing inequalities through the EU, as part of its ongoing Beating Cancer Plan.5

Representation of marginalised groups across the care and treatment space is similarly important, and improving race and sex diversity in oncology teams can help to address both discrimination at the treatment level and disparities in research.6 Members of some underserved communities can be reluctant to access cancer diagnosis and treatment even where they are available, often out of a combination of fear and mistrust: here, community-based programmes with a strong focus on patient outreach and education have shown significant positive results.7

Innovation and development

Technological innovation has the potential to alleviate social inequality in cancer care,8 as long as it is appropriately and affordably implemented: NHS England’s Innovative Medicines Fund, for example, grants patients early access to the most promising emerging treatments while real-world evidence is being collected.9

The growing complexity of emerging cancer treatments may make them more expensive, thereby further widening the disparity between low- and high-income patients.10 However, the development of biosimilar medicines can drive competition between producers, leading to lowered prices and wider ranges of choice for patients and healthcare providers.11 In these cases, the cost savings from biosimilars and other affordable value-based medicines can then be reinvested in further improving treatment.12

Conclusion

We know the cancer care gap can be exacerbated by a range of factors pertaining to money, from economic issues affecting individual patients to the differences in care available in higher- and lower-income countries. Widespread increases in funding for cancer research, treatment and healthcare infrastructure would doubtless significantly aid in alleviating inequality in cancer care and access to treatment. For funding to achieve its full effect, it should be complemented by a focus on innovation in accessible treatment, as well as initiatives and programmes which have been shown to improve equitable treatment of both patients and staff.

References
    1. Cancer Research UK. Cancer in the UK 2020: socio-economic deprivation. 2020. Available at: https://bit.ly/3B5CPxq [Accessed July 2022].
    2. Racial disparities in cancer care: can we close the gap? The Lancet Oncol 2021;22:1643. https://doi.org/10.1016/S1470-2045(21)00669-0
    3. Morgan GW, Foster K, Healy B, Opie C, Huynh V. Improving health and cancer services in low-resource countries to attain the Sustainable Development Goals target 3.4 for noncommunicable diseases. J Global Oncol 2018;4:1-11. https://doi.org/10.1200/JGO.18.00185
    4. European Cancer Organisation. Inequalities Network. 2022. Available at: https://bit.ly/3ohUsTh [Accessed July 2022].
    5. European Commission. European Cancer Inequalities Registry: policy context. 2021. Available at: https://bit.ly/3omj7WM [Accessed July 2022].
    6. Patel MI, Lopez AM, Blackstock W, Reeder-Hayes K, Moushey EA, Phillips J, Tap W. Cancer disparities and health equity: a policy statement from the American Society of Clinical Oncology. J Clinical Oncol 2020;38(29):3439-3448. https://doi.org/10.1200/JCO.20.00642
    7. Sprague Martinez L, Freeman ER, Winkfield KM. Perceptions of cancer care and clinical trials in the black community: implications for care coordination between oncology and primary care teams. Oncologist 2017;22(9):1094-1101. https://doi.org/10.1634/theoncologist.2017-0122
    8. Sullivan R, Aggarwal A. Technology and cancer systems: creating better policy to enhance equality. In: Vaccarella S, Lortet-Tieulent J, Saracci R et al (eds). Reducing social inequalities in cancer: evidence and priorities for research. 2019. Available at: https://bit.ly/3onq6OZ [Accessed July 2022].
    9. Department of Health and Social Care, Javid S. Patients to have earlier access to cutting-edge treatments on NHS. 2022. Available at: https://bit.ly/3onRg8A [Accessed July 2022].
    10. Simoens S, Harten W, Lopes G, Vulto A, Meier K, Wilking N. What happens when the cost of cancer care becomes unsustainable? Touch Oncol & Haematol 2017;217:epub. https://doi.org/10.17925/EOH.2017.13.02.108
    11. Peeters M, Planchard D, Pegram M, Gonçalves J, Bocquet F, Jang H. Biosimilars in an era of rising oncology treatment options. Future Oncol 2021;17(29):3881-3892. https://doi.org/10.2217/fon-2021-0546
    12. Lopes G, Vulto A, Wilking N, Harten W, Meier K, Simoens S. Potential solutions for sustaining the costs of cancer drugs. European Oncol & Haematol 2017;13:102. https://doi.org/10.17925/EOH.2017.13.02.102