Addressing disparities in cancer care

Race, age, geography, and economic status all factor into the dynamics of cancer care. In 2022, AmerisourceBergen hosted its first Disparities in Cancer Care Summit to address the need for the industry to work together to diminish these evident disparities. Dr. Kashyap Patel, MD, launched a nonprofit foundation in 2021 to do just that. In his presentation, Dr. Patel shared his experience in working to alleviate these challenges within his community and offered key insights from his research.  
 
Cancer care disparities have long been a major concern in the medical field, as individuals from certain racial and socioeconomic groups continue to face significant obstacles in accessing quality care. To address these disparities, medical professionals are taking a closer look at the root causes and developing strategies to improve access to care for all patients. Recently, we had the opportunity to speak with a leading oncologist about this important issue. Below is a shortened version of the full interview. 

To get into talking about disparities in cancer care and the social determinants of health, we first need to do a needs assessment and ask: What is the problem? 

According to the Community Oncology Alliance (COA), “It is estimated that 34 percent of cancer deaths among U.S. adults ages 25 to 74 could be prevented if socioeconomic disparities were eliminated.”¹ So the problem is right in front of our eyes: 34 percent.² Along those lines, it’s important to remember that one in three cancer deaths are preventable if you address disparities in care.³ 

There are some key factors that lead to disparities in oncology care:

• Lack of cancer screening
• Lack of access to clinical trials
• Financial disparities  
• Lack of insurance coverage 

The magnitude of the problem around financial toxicities—that is, if a person does not have financial security, or if they’re underinsured—is significant. Studies show that one hundred million Americans carry medical debt of a significant size.⁴ That’s one in three Americans with medical debts, and coverage issues (mainly on the commercial side) can be a huge problem.

In a paper⁵ that came out last year, the author concluded that patients with the same stage disease, same treatment, with three or four more adverse states have a 20 percent higher risk of mortality. Which means we could be using the best medicine in the world, but if our patient doesn’t have food security, reliable housing, access to transportation, or utility concerns, they could actually end up with a worse outcome.

This highlights the magnitude of problem. For example, 87 percent of eligible Medicare or Medicaid beneficiaries did not receive lung cancer screening,⁶ even though they qualified. And similarly, there has been a decline in women receiving breast cancer screening.⁷ But if you catch these cancers at stage one and look at the economic implications for the patient, the differences are tremendous. If you identify stage one lung cancer, based on the low dose scan, the cost to the patient would be about $25,000⁸ between surgery and post-operative care. If that patient comes back with stage four lung cancer, the annual cost could be about $200,000 a year. And if that patient lives three or four years, which is the expectancy right now, the cost becomes close to a million dollars—but we are going to lose that life. We started looking at the issue of access to care first, and considered: What resources would it take to help these patients? How many patients need help covering out-of-pocket costs? How many patients need cost savings for prescription drugs, and how many patients need insurance help?

We started a not-for-profit called No One Left Alone (NOLA) with the idea that no cancer patient in 21st century, at least in our congressional district, should feel that they’re by themselves in the struggle. In our first year of putting the NOLA program in action, we identified and arranged for exams for more than 600 patients who didn't have cancer screening. We established the pilot on the next generation sequencing (NGS) testing, and we reached a testing rate of about 80 percent. We also raised about $2.3 million in assistance, either by providing drugs at no cost (worth $1.6 million), or about $50,000 in cash assistance for the oral prescriptions and certain other medications.

That’s why it is critical to address social determinants of health. No matter how far we go in developing technology, if we do not take care of social determinants of health, we will never solve for the kind of discrepancy between the life expectancy of one zip code versus another. 
As we continue to explore ways to address and solve for disparities in cancer care, we want to look into expanding this program across the country. We’re building up the phase one clinical trial in improving population health to address cancer and disparities, and we are looking at expanding with other partners.

We also want to continue to publish so that we have the data that helps us determine what works, and what doesn’t. We started not knowing what's going to work. This is like a phase one—studying population health—and we'll continue to trace and track improvements. We'll create a standard for the best practices. We'll do health economic outcomes research. In doing so, the theme we are trying to learn, share, and create best practices around is how to break the silos and make a cohesive collaborative approach that brings a working ecosystem to patients' lives.