Making Meaningful Progress Toward Health Equity

Making Meaningful Progress Toward Health Equity

Linda R. Duska, MD, MPH

Jan 15, 2021
ASCO enters this new year with continued determination to make meaningful progress toward health equity in cancer care. In 2020, we learned a lot about health care disparities from the COVID-19 pandemic, and about the ways the health care system fails minority populations. While people of color, specifically Black and Hispanic patients, are more frequently and seriously affected by COVID-19, they are not being appropriately represented in clinical trials of new treatments. This disparity of representation likely leads to a lack of generalizability of results. Sounds familiar, doesn’t it? We see the same patterns in cancer care; for example, women of color are more likely to die from endometrial cancer but are vastly underrepresented in clinical trials of new therapies. This is a critical issue in cancer and in the health care system at large that we need to do a better job of addressing. 
Another facet of this issue that is likely to be critical and urgent in the coming months is non-acceptance of vaccination. Attitudes toward vaccines are complex and frequently rooted in social determinants of health. As COVID-19 vaccines (hopefully) begin to become available this year, we as health care professionals have a key responsibility to educate patients and elevate health literacy about vaccines—their effectiveness, potential side effects, safety profiles, etc. The oncology field already has a precedent for this work: building acceptance of a safe, effective COVID-19 vaccine will be similar in many ways to building acceptance of the HPV vaccine, a vaccine that scientific evidence suggests could potentially completely eradicate cervical cancer if broadly accepted. Even if we are not infectious disease experts, we are experts in interpreting peer-reviewed studies and accurately translating that information for patients and caregivers, without sensationalism, in a manner that honors the trust they have placed in us. 
Access to care, yet another critical aspect of equity, remains a significant problem in cancer care—but access is often more complex than it seems on the surface. We need to understand what might motivate a patient to stay at their local community hospital rather than travel to a tertiary care center where more advanced care or access to clinical trials may be available. Many of these patient concerns are rooted in social determinants of health. If we are to improve clinical trial access and increase diversity of accrual to clinical research, we will need to understand the reasons why patients do not choose these options, and where social determinants of health may create barriers to care that we can help to overcome.
Dr. Jacquelyne Gaddy brings this discussion into sharp focus. She relates a personal experience in which repeated warnings about a patient’s literacy were nearly an impediment to high-quality care. We must understand social determinants of health, and we must understand and mitigate their impact on cancer outcomes, in order to give every patient the best possible care. At the same time, we must remain alert to our own prejudices, and be vigilant about keeping our personal biases out of the charts and out of our discussions with colleagues, patients, and caregivers. 


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