Overcoming Barriers to Care

It's unfortunate but true that minority populations within the cancer community sometimes have trouble accessing appropriate care or experience worse health outcomes after treatment. Some groups experience a higher relative incidence of cancer and a greater chance of disease complications or death. Also, patients who face barriers to health care may miss out on the chance to be screened for cancer so that the disease can be discovered in its earliest and most treatable stages.

So, it’s helpful for members of these underserved groups to be aware of any obstacles and, if faced with them, speak up or seek support.

Geography: It can be difficult to obtain consistent, expert health care for people who live in rural areas, which often face a shortage of oncologists and are far from top cancer hospitals. These patients should know that they may be able to have an oncologist at a large cancer center direct their are largely from afar with the help of telemedicine, so that they can receive most of their treatments at local facilities.

Socioeconomic status: Statistically, patients with lower education and income levels experience worse health outcomes after cancer than do their counterparts who've had more years of schooling, bring in higher salaries and have some form of health insurance. People affected by poverty also may have higher rates of smoking, lower rates of exercise and breastfeeding, more obesity and drinking and a greater risk of exposure to dangerous pollutants in their neighborhoods, all of which are risk factors for cancer.

It’s particularly important for these individuals, if they don’t have a diagnosed cancer, to get annual well visits, report any unusual symptoms and get all the cancer screenings for which they are eligible. Those in this group who do have cancer can ask for help from a patient navigator or social worker at their care facility if they are having trouble making, keeping, affording or getting to appointments or sticking with the treatments prescribed to them. Patient advocacy groups may also be able to offer help; check our list of resources at curetoday.com/journey.

Insurance status: Not surprisingly, health opportunities and outcomes tend to be worse for those who are uninsured or underinsured. People in this group can check the national health care marketplace website, healthcare.gov, to see if they qualify for insurance that is subsidized by the government or free through Medicaid. In addition, some patient advocacy groups may offer financial help or other support programs to individual patients and pharmaceutical companies may offer discounted or free medications.

Ethnic or racial background: Ethnic and racial minorities who have cancer don’t always benefit from full access to care or participate in clinical trials at the same rates White patients do. This can mean that trial results don’t fully represent the usefulness of drugs in those populations. Socioeconomic factors can be one reason for the lack of participation, but another could involve a cultural reluctance to pursue treatment.

For instance, distrust of the health system among Black patients dates, in part, to the 1932-1972 study of untreated syphilis in Black men, conducted by the U.S. Public Health Service and the Tuskegee Institute. Participating men were not given the opportunity to provide informed consent or given adequate treatment to cure their illness, even when penicillin became the standard of care in 1947, according to the U.S. Centers for Disease Control and Prevention (CDC). One resource working to alleviate this concern is BlackDoctor.com, which helps readers find doctors who are likely to be culturally sensitive.

Language and cultural barriers may also stand in the way of care. For instance, Spanish-speaking Hispanics are less likely to be screened for colorectal cancer than Whites or English-speaking Hispanics.

Furthermore, in some instances, members of specific ethnic or racial groups have worse health outcomes because of genetic predispositions for aggressive or hard-to-treat cancers. Triple-negative breast cancer, which disproportionately affects Black women, is an example of this. In addition, some skin cancers that are difficult to treat affect Black patients disproportionately, and Black patients are twice as likely as White patients to get multiple myeloma. American Indians/Alaska Natives, meanwhile, are the most likely to get liver cancer and cervical cancer and to die from kidney cancer.

Patients who are in these groups or have family histories of cancer can speak with their doctors about increased screening or other preventive measures. They can also call their state health departments to ask about any free cancer-screening programs avail- able for underserved populations. The CDC offers one that provides breast cancer screening, which can be found at cdc.gov/cancer/nbccedp/screenings.htm.

Gender or sexual identity: Members of the LGBTQ+ community, which includes people who are lesbian and gay, also face barriers to good, consistent health care. LGBTQ+ people face a higher risk of cancer and a lower likelihood of having health insurance. Furthermore, they may face discrimination and isolation, which could lead to a higher likelihood of smoking and drinking, behaviors that raise the risk of cancer. Finally, discrimination from health care providers, or the fear of it, may lead patients to delay or avoid medical care.

Some patient advocacy groups that may be able to help are the National LGBT Cancer Network (cancer-network.org) and CancerCare (cancercare. org/questions/242), which offers support groups and other resources.

Overall, patients who are aware of these disparities and willing to serve as their own advocates are the most likely to contribute to the protection of their health and obtain appropriate cancer care.