State of cancer survivorship among
medically underserved is poor; Requires
immediate attention to reduce disparities…

New report finds minorities and poor least likely to remain cancer-free

WASHINGTON, April 19 /PRNewswire/ -- On the heels of a landmark report from the Institute of Medicine (IOM) about the continuing medical needs of the nation's 10 million cancer survivors, a new assessment by the Intercultural Cancer Council (ICC) finds those who are poor, lack health insurance or otherwise have inadequate access to high-quality cancer care are the least likely to get comprehensive post-treatment care, increasing their odds for an early death.

In conjunction with ICC's 10th Biennial Symposium on Minorities, the Medically Underserved, and Cancer held in Washington, the organization released a new report -- Cancer Survivorship and the Medically Underserved: Reducing the Disparities in Cancer Care -- examining the prospects for ethnic minorities and the poor to achieve a long-term cancer survival. The assessment finds that because of disparities in care at all points along the cancer continuum -- from screenings and diagnosis through access to cancer therapies and follow-up care -- the medically underserved are the most likely to experience a shortened period of survival with a lesser quality of life.

The new report evaluated the state of cancer survivorship among the nation's minorities and the medically underserved using five criteria considered essential to a national comprehensive control effort -- whether the care is available, accessible, acceptable, affordable, and accountable. Based on this review, the report finds major disparities in the incidence and death rates among minorities and the poor for all cancers compared to the general population. Moreover, the report concludes that lack of health insurance, social inequities, difficulties with language and lack of health literacy will only compound these disparities for those underserved individuals who are cancer survivors.

"All Americans deserve the same opportunity to become cancer survivors and to have assurance that their future health care needs will be properly managed," said Lovell A. Jones, Ph.D., co-founder of the ICC. "Disparities in cancer care are a problem of crisis proportions, but this issue has not achieved the level of public attention or commitment of financial resources that it deserves."

Looking at the universe of cancer survivors, the report finds the medically underserved are significantly underrepresented within this population group. Among African Americans, the death rate from cancer is 40 percent higher for men and 18 percent higher for women than their White counterparts. Further, specific forms of cancer affect ethnic minority communities at rates several times higher than the national average, such as liver cancer, which is nearly twice as high in Asian American and Pacific Islander men as in African American men and nearly three times that of Whites. The incidence rate of cervical cancer is highest in Hispanic/Latina women.

The underlying reason for these higher death rates, according to ICC's review, is poverty. Across all racial and ethnic groups, the 5-year survival rate is more than 10 percent higher for persons who live in affluent areas. Compared with 8 percent of Whites, 24 percent of African Americans and 22 percent of Hispanics/Latinos live below the poverty line, which influences the prevalence of underlying risk factors for cancer, as well as access to screening services and comprehensive cancer care.

As a consequence of poverty, the report finds that lack of health insurance influences both the amount and quality of the health care received. Specifically, the report finds that uninsured adults face a 25 percent greater mortality risk than adults with health care coverage and that for uninsured women with breast cancer, the risk of dying increases by 30 to 50 percent over insured women.

The report further reveals that minorities are the least likely to have health insurance, which impacts their chances for long-term survival. Although the U.S. Census Bureau estimates that 15.5 percent of the population -- 46 million Americans including more than 8 million children -- lacks health insurance, most of these individuals are from ethnic and racial minorities. 2004 data from the Census Bureau finds that 32.7 percent of Hispanic/Latinos were uninsured, followed by 19.7 percent of African Americans, and 16.8 percent for Asian Americans. Further, the two-year (2003-2004) average uninsured rate for American Indians and Native Americans was 29.1 percent, followed by Native Hawaiians and other Pacific Islanders at 21.3 percent.

Looking specifically the existing pool of cancer survivors, the report finds that more than a half million Americans -- 570,000 people or an estimated 11 percent of all cancer survivors -- are uninsured, especially younger survivors ages 25 to 44 (19 percent) and Hispanic/Latino survivors (26 percent). These uninsured survivors are less likely than insured survivors to receive follow-up monitoring and have higher out-of-pocket spending burdens. In one study of non-elderly cancer patients without insurance, expenditures were nearly half (57 percent) that of privately insured patients over a 6- month period.

However, the report also cites prevailing societal and institutional racism as another factor contributing to the gap in cancer survivorship among the medically underserved. Besides cultural factors, such as language, values, traditions and trust in health providers, multiple studies have shown the adverse impact of health care providers' personal attitudes and perceptions towards patients due to race and socioeconomic status. Although exhibited as the subconscious level, these attitudes lead to lingering racial and ethnic disparities in cancer care across the health care continuum.

According to the report, these factors are especially troubling for the early detection and treatment of the late-effects of cancer, which may occur immediately or several years after treatment ends and include a recurrence of the cancer, a secondary cancer, and the increased risk for cardiovascular disease, osteoporosis, and other chronic conditions. Among women with breast cancer, who now represent 22 percent of the survivorship population, a recurrence can occur more than 20 years after primary therapy. However, existing studies find major differences in outcomes among African American and White breast cancer survivors due to socioeconomic and life-burden factors. Lack of health coverage and less access to follow-up care also significantly affects the outcomes of colorectal cancer and prostate cancer survivors, who also represent a large number of today's cancer survivors.

Access to cancer clinical trials and treatment with newer, more targeted cancer therapies remains a serious problem for the medically underserved, according to the ICC report. Today, only 2 to 3 percent of adult cancer patients participate in cancer clinical trials, with the elderly, racial and ethnic minorities and the medically underserved even less likely to participate. Further, the report reveals that minorities who are significantly less likely than White patients to receive prescriptions for analgesic agents are at risk for inadequate pain control, and that unrelieved pain among minority groups is highly prevalent. According to one major pain study, only 28 percent of Hispanic/ Latinos and 31 percent of African Americans with metastatic or recurrent cancer received analgesics of insufficient strength to manage their pain.

"Elevating the needs of the medically underserved must be a priority for policy makers as they address the future of quality cancer survivorship care," said Pamela Brown, Chair of the 10th Biennial Symposium and Chair Elect of the ICC. "Ending the unequal burden of cancer requires providing minorities and the poor with greater access to services and programs at every stage of the cancer continuum, from early detection and treatment of their disease to comprehensive post-treatment care."

The Intercultural Cancer Council is an advocacy organization whose mission is to advance policies, programs, partnerships and research to eliminate the unequal burden of cancer among racial and ethnic minorities and medically underserved populations. For more information, visit http://iccnetwork.org/.

Source: Intercultural Cancer Council