The American Society of Clinical Oncology has released recommendations for eliminating disparities in cancer care in the US. Published in conjunction with that policy statement was a study estimating the impact of disparities over the next 20 years, predicting that the annual incidence of cancer in minorities will double between 2010 and 2030, from 330,000 to 660,000.
This includes a 142% increase in cancer diagnoses for Hispanics, 132% for Asian Pacific Islanders, and 64% for black Americans. These are in contrast to a 31% increase for non-Hispanic whites.
And the total number of cancers diagnosed annually in older adults will increase by about 67% in that period, from 1.0 million to 1.6 million, according to the study, published in the Journal of Clinical Oncology, now available online, published ahead of print, and titled Future of Cancer Incidence in the United States: Burdens upon an Aging, Changing Nation.
Clearly these are rather eye-popping statistics, ASCO President Richard Schilsky, MD, said in a media telebriefing. The statistics underscore the urgency of expanding access to health insurance and improving cancer care for minority patients.
Insurance status is a major factor in disparity in cancer outcomes, he said, and studies have shown that uninsured Americans receive too little medical care too late, are sicker, and die sooner than Americans who have insurance.
One in five African Americans and Asians is uninsured, Dr. Schilsky said. And among Latinos, American Indians, and Alaskan natives, more than one in three is uninsured.
Other speakers in the news briefing also outlined ASCO's roadmap for addressing disparities, and highlighted the work ASCO is doing with organizations such as Susan G. Komen for the Cure in removing disparities in cancer care.
Derek Raghavan, MD, Co-chair of ASCO's Health Disparities Advisory Group and Director of the Cleveland Clinic Taussig Cancer Institute, reviewed the new ASCO Health Disparities Policy Statement, which he and Dr. Schilsky called a roadmap to reduce the disparities in cancer care.
Major Points
Some major points in the Policy Statement call for:
* Increasing research on the differences and quality of care provided to minority populations compared with white populations and the factors contributing to the poorer quality care they sustain.
* Developing initiatives to increase funding for researchers in health disparities.
* Increasing minority participation in clinical trials, with eligibility criteria established to ensure that.
* Developing policies that guarantee access to care, with special emphasis on eliminating barriers to screening services.
* Increasing the diversity of the oncology workforce to provide more culturally appropriate care to minority patients, and increasing the number of oncologists who practice in underserved areas.
* Increasing awareness on health disparities in cancer care among health care providers, the public and policy makers.
* Recommending that medical schools and medical societies collaborate to improve education on health disparities and provide continuing educations.
The ASCO Health Disparities Policy Statement is not a detailed prescription for overhauling our health care systems, but rather a guide for work over the coming months with the administration, Congress, and our 27,000 members, Dr. Raghavan said. Only through a combination of efforts addressing financing and delivery of care and enhancing the supply and training of oncologists caring for diverse populations…can we deliver the significant achievements that are critical to improving care for all.
Projections for 2030
The principal investigator of the study estimating cancer increases over the next 20 years, Benjamin Smith, MD, Chief of Radiation Oncology at Wilford Hall Medical Center in San Antonio, TX, and Associate Adjunct Assistant Professor at the University of Texas M. D. Anderson Cancer Center Department of Radiation Oncology, reviewed the findings of the JCO article during the teleconference.
The study was conducted by researchers at Lackland Air Force Base in San Antonio; M. D. Anderson, and City of Hope Cancer Center.
Dr. Smith and colleagues used population projections from the US Census Bureau and current cancer incidence rates derived from the NCI SEER program, to estimate the total number of cancers diagnosed in the U.S. from 2010 through 2030.
There will be a 45% increase, he said, from 1.6 million cancers diagnosed in 2010 to 2.3 million diagnosed in 2030. This compares with the projected US growth in population of only 19% in that same period.
Stomach, liver, pancreatic, and lung cancers are expected to be among the fastest growing cancer sites as the US population changes, Dr. Smith said.
Our results highlight the importance-indeed, the urgency-of addressing shortcomings in the cancer care received by older adults and minorities.
Perspective-and a Patient's Story
Dr. Raghavan offered his perspective on interpreting the study data: What we need to focus on are not the absolute numbers, which are projections. What is absolutely clear is that these trends are very strong and very inescapable.
And, like global warming, this is not something we are going to be worrying about in 50 years time, he said. It's here, it's happening now, and if we neglect it we will have catastrophe in the future.
Dr. Raghavan said patients have to live with these problems every day. He described health care disparity as it pertains to one of his patients, a 50-year-old African American who travels about 300 miles to get to the clinic.
The patient started to feel unwell about six months ago and was laid off from his job as part of the economy, and had to drop most of his insurance. And he started to develop symptoms that ultimately showed he had metastatic prostate cancer.
The man was initially managed in his home town, perhaps not optimally, the biggest problem being very significant pain from his bone deposits, Dr. Raghavan said.
When the man found his way to the Cleveland Clinic, it took several hours for social workers to get permission from what little insurance the man had left to prescribe medications to relieve pain. He was also put into an NCI-supported clinical trial.
He's now on track but the reality is, this was a man whose care was held up for weeks and weeks simply because of lack of access to support he needed to get his care, Dr. Raghavan said.
ASCO Diversity Initiative
The ASCO Diversity in Oncology Initiative, funded by Susan G. Komen for the Cure, is intended to help recruit and retain individuals from populations underrepresented in medicine to cancer careers, with particular attention to the development of clinical practitioners and investigators.
Currently, 2% of US oncologists are African American and 3% are Latino, compared with 12% and 15% of the US population, respectively, according to data from ASCO.
3 Programs
Beginning this year, three programs will be offered for individuals interested or currently practicing in oncology:
* Loan Repayment Program Award-three grants of up to $50,000 each for young oncologists who have committed to providing cancer care in a medically underserved region of the US for at least two years.
* Medical Student Rotation Award-four grants of $8,500 each for medical students from populations under-represented in medicine who enter oncology, allowing medical students to participate in eight- to 10-week rotations in oncology. Students are matched with a mentor oncologist, who will provide ongoing academic and career guidance through the rotation and beyond.
* Resident Travel Award-13 grants of $1,500 each for medical residents from populations under-represented in medicine to attend the ASCO Annual Meeting and be paired with a mentor onsite.
Winners of First Oncology Loan Repayment Awards
ASCO announced the first Oncology Loan Repayment Award Winners, describing their backgrounds in a news release.
* Derrick S. Haslem, MD, who moved to Southern Utah as a teenager, comes from a family of farmers, ranchers, and blue collar workers, and he said it was their example of hard work and dedication that inspired him to pursue a career in medicine. Before attending college at Southern Utah University, he spent two years in the Dominican Republic, where he became fluent in Spanish. At the University of Utah School of Medicine, he volunteered at a community health center as translator for Spanish-speaking patients and traveled to high schools as part of the Utah Rural Outreach Program.Upon completing his fellowship at the Huntsman Cancer Institute this month, Dr. Haslem will work at the nonprofit Intermountain Medical Group in southern Utah, providing cancer services to patients regardless of their insurance status. I consider myself lucky to have the opportunity to come back to my roots and treat cancer patients in an area that is sorely in need, Dr. Haslem said.
* Boone Wilder Goodgame, MD, grew up in Uganda, where his father taught at the nation's only medical school. He moved to Texas at age 14, where he completed high school, earned his undergraduate degree from the University of Texas, and completed medical school at Baylor College of Medicine. He returned to East Africa with his wife and daughter during his final year of medical school, where they worked at a hospital in rural Kenya.The medical plight of the American inner-city minimum-wage earner, rural mechanic, or immigrant is not much better than that of the Masai woman with advanced esophageal cancer, whose face is imprinted on my memory, he said.Dr. Goodgame completed his residency and fellowship at Barnes Jewish Hospital and Washington University School of Medicine in St. Louis; and in his current position as Assistant Professor in the School's Division of Oncology, he divides his time equally between research and patient care. His research focuses on clinical trials and biologic predictors of outcome in lung cancer. At the primary safety-net hospital in the region, he will be treating the largest uninsured and underinsured populations in the state, spending one day a week at an outreach clinic in rural Missouri.
* Brooke Gillett, DO, first became interested in medicine as a high school student in Las Vegas, where her mother was a speech pathologist. She then started volunteering at a local hospitals through a Medical Explorer program.While completing her undergraduate degree at Southern Utah University, she trained as an emergency medical technician. She learned how the medical system works in a rural and underserved area, seeing first-hand how physicians coming into an underserved area could make a big difference, she said.Before going to medical school at Midwestern University Arizona College of Osteopathic Medicine, she traveled on a volunteer mission to Guatemala, helping to organize a small health clinic. The mobile clinic treated patients of Mayan decent living in remote villages without running water or electricity. While in medical school, she also helped facilitate a student-run health clinic for homeless people in the Phoenix area. She then went to the University of Utah for her residency and her fellowship.Once her fellowship is complete this month, Dr. Gillett will move to Springfield, Missouri, to join Oncology Hematology Associates, a practice that serves southwestern Missouri and northern Arkansas, locations with a significant shortage of both primary care physicians and oncologists. When searching for a practice, I thought back to those experiences that made me aware of the needs of people in underserved communities, Dr. Gillett said.
© 2009 Lippincott Williams & Wilkins, Inc.