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Covid-19 has exposed existing disparities among underserved cancer patients, but community difference makers are fighting back

By: Stat News – November 13, 2020

Cancer can affect anyone.
But many patients bear a disproportionate burden.

Underrepresented minority patient groups have historically faced diminished access to health care.

And while recent strides have addressed some inequities, the Covid-19 pandemic has widened these gaps, and risks undoing thirty years of progress in reducing cancer mortality overall.

According to a survey by the American Society of Clinical Oncology, two-thirds of Americans reported their scheduled cancer screenings had been delayed due to Covid-19.Another study showed that new weekly diagnoses had dropped by more than 46% across six major cancer types since the pandemic began.2 Experts worry these trends will contribute to missed diagnoses and worsened outcomes, especially among underserved patients who lack access to cancer screens.

 

Bearing a disproportionate burden for cancer

Cancer can affect anyone. But many patients bear a disproportionate burden.

Members of minority ethnic groups in the US are more likely to be medically underserved, meaning they are less likely to receive recommended cancer screens and targeted therapies.

Black patients suffer the highest mortality and shortest survival of any racial group in the US for most cancers. Black women are nearly twice as likely to be diagnosed with breast cancer than white women, and are much more likely to die from it. And Black men are more than twice as likely as white men to die from prostate cancer, which is often treatable when detected early.3

Hispanics, the largest and youngest minority group in the US, generally have lower cancer rates, but are still more likely than white Americans to die from cancers of the breast, cervix and liver. The same is true of Pacific Islanders and American Indians.4

“Cancer disparities existed long before the pandemic, but have worsened because of it,” said Camille Hertzka, Head of U.S. Oncology Medical Affairs at AstraZeneca. “Disrupted pathways to potentially lifesaving screenings like mammograms and colonoscopies affect minority patients more severely, who regrettably are more likely to be diagnosed with later stage disease, and who often don’t share the same access to the latest targeted therapies and quality care settings.”

 

Making a Difference for Underserved Communities

or the Navajo Nation, one of the largest Native American tribes and home to 250,000 people, half of whom live below the poverty line, cancer disparities have existed for years.

The nearest care center is more than 90 miles away. Rates of certain cancers are also disproportionately high, experts say, because of the more than 550 abandoned uranium mines nearby. Patients are often diagnosed late and seen in the emergency room due to the inability and/or lack of access to care.

Seeing the urgent need for cancer care in the community, in June 2019, the Tuba City Regional Health Care Corporation established the Specialty Cancer Center, the first-ever cancer facility on any American Indian reservation. “There were too many tragic stories,” said Lynette Bonar, CEO of Tuba City Regional Health Care Corporation, who worked for three years on fundraising and advocacy efforts to make the new clinic a reality. Bonar is also the first Navajo woman to helm a Navajo health care system.

Since opening, Bonar’s clinic has seen more than 300 patients and had more than 1,400 visits. “We’ve caught more people with early-stage cancer than we ever would have before through cancer screening programs, and our specialty care center now has a team of nurses and frontline support professionals that immediately get called for care coordination,” she said.

In honor of her work, Bonar received the C2 Catalyst for Change Award last month at the second annual Cancer Community (C2) Awards. Sponsored by AstraZeneca and Scientific American Custom Media, the C2 Awards are part of AstraZeneca’s YOUR Cancer program, which spotlights grassroots-level difference makers to help inspire similar work in other communities.

Finalists in this category also included Greensboro Health Disparities Collaborative (GHDC) in North Carolina, whose mission is to establish structures and processes that respond to, empower and facilitate communities in defining and resolving issues related to disparities in health. And Stephenie Kennedy Rea, EdD, Director of Cancer Prevention and Control at West Virginia University Cancer Institute who established a Lung Cancer Survivorship Program (BRIDGES), partnered with the Patient Advocate Foundation to launch the WV Lung Cancer Project, and is developing a mobile lung cancer screening program to better serve rural residents.

“AstraZeneca’s bold ambition is to redefine cancer care and eventually eliminate cancer as a cause of death,” Hertzka said. “Our Cancer Community Awards recognize those who improve cancer treatments, expand access to care, hasten medical innovations, and anything else we can think of, to create better outcomes for underserved patients across our country.”

In addition to the C2 Awards, New Normal, Same Cancer, a distinct public health initiative from AstraZeneca, amplifies the work organizations are doing to expand access to cancer screens. “The message here is, don’t wait, talk to your healthcare teams and get checked,” Hertzka said.

The program debuted this fall at the Black Health Matters Summit, one of the largest forums dedicated to raising awareness of health issues affecting Black communities. At the virtual summit, Hertzka, alongside E.J. Henry, AstraZeneca’s US Head of Inclusion and Diversity, discussed the need to build stronger screening programs for this underserved community.

“As an organization, we realize the long road ahead, but will always find ways to support those making a difference for patients, especially those without access to quality care,” Hertzka said.

1American Society of Clinical Oncology, National Cancer Opinion Survey, 2020
Kaufman, Changes in the Number of U.S. Patients With Newly Identified Cancer Before and During the Coronavirus Disease (COVID-19) Pandemic, 2020
3American Cancer Society, Facts & Figures for African Americans, 2019
4American Cancer Society, Facts & Figures for Hispanics / Latinos, 2018