Access to Oncology Care: Addressing Disparities

J Clin Pathways. 2025;11(1)49-50.

Cancer remains one of the leading health challenges in the US, disproportionately affecting specific populations due to structural, social, and economic inequalities. Despite advances in treatment and prevention, disparities in cancer outcomes persist, particularly among racial and ethnic minority groups. These disparities are evident throughout the cancer care continuum, from prevention and early detection to treatment and survivorship. In this article, I will detail organizations that continue to help address the disparities across the patient access care journey.

Initiatives led by organizations such as the American Society of Clinical Oncology (ASCO) outline comprehensive approaches to promoting health equity. By focusing on equitable access to high-quality care, inclusive research opportunities, structural reform, and increased awareness, ASCO aims to reduce disparities and improve patient outcomes.

The ASCO recommendations to promote health equity are based on four focus areas:

1. Ensuring equitable access to high-quality care;
2. Ensuring equitable access to research;
3. Addressing structural barriers; and,
4. Increasing awareness and action.

These recommendations provide a framework to achieve health equity in the near term and long term for patients with cancer. ASCO’s premise is that high-quality cancer care across the care continuum—from prevention, early detection, diagnosis, and treatment to survivorship and end-of-life care—can reduce and sometimes eliminate cancer disparities.¹

According to an article published in the Journal of the National Medical Association, in 2021, approximately 1.9 million Americans were diagnosed with cancer. Researchers expect racial/ ethnic minority individuals to account for a disproportionate number of these cancer cases. Racial cancer disparities represent a substantial proportion of the overall mortality disparity between patients who are non-Hispanic, Black, and White and are a major consideration in the provision of clinical care and public health practice and policy. The authors note that racial disparities at each point in the cancer care continuum may contribute to the greater cancer burden experienced by minority populations.²

In early 2021, a collaboration between the National Comprehensive Cancer Network (NCCN), American Cancer Society Cancer Action Network (ACS CAN), and the National Minority Quality Forum (NMQF) conducted a survey of 600 patients/family caregivers and 208 oncologists to investigate perceptions, experiences, and practices regarding racial bias in cancer care. The results of the survey indicated that most oncologists (62%) believed that racial and ethnic minority groups experienced worse outcomes from cancer care, but only 36% felt those patient populations were receiving worse care or poorer communication during treatment and follow-up care. Among patients, survivors, and caregivers, 63% of Black respondents and 67% of Latinx respondents said they had a negative experience with their oncology care team vs only 43% of White patients reported such experiences.²

The collaboration between the NCCN, ASC CAN, and NMQF states that the causes of disparities in cancer care are complex, reflect social and economic inequalities, and can be linked back to social determinants of health that are well documented in the literature. As such, disparities in cancer care can be characterized into the following areas:

1. Exposure to risk factors and structural racism, of which the critical driver is socioeconomic status;
2. Prevention, which racial differences between practice settings may indirectly impact as a contributing factor to preventive screening and health care access;
3. Early Detection, of which a key contributor to this disparity is the receipt of commonly performed/ recommended procedures during primary care office visits; and,
4. Access to Treatment, in which the authors cite racial disparities in outcomes for several types of cancer that could be eliminated if all patients have equal access to standard treatments.

The authors conclude that a greater understanding of the underlying factors of racial disparities in cancer care will provide the foundation for comprehensive, sustainable interventions that can potentially narrow the treatment differences among different populations and improve outcomes for all patients.²

Study results presented at the 2023 ASCO Quality Care Symposium reported patients with cancer undergoing care face administrative, logistical, navigational, and legal barriers, as well as certain groups facing specific barriers more than others, confirming the findings and conclusions of the 2021 collaboration survey.³

The study was a retrospective analysis using deidentified data from 2613 patients who called in to the Triage Cancer Legal and Financial Navigation Program.³ This is a national nonprofit organization that provides education on practical and legal issues for patients with cancer, their caregivers, and health care providers. The presenters cited examples of barriers related to health insurance, including choosing an insurance provider, navigating a health insurance plan, or appealing insurance denials. Other issues include navigating disability. Barriers related to employment included the inability to take time off, needing to stay working during cancer treatments, being laid off or searching for new employment, or filing for unemployment benefits. Black patients and patients with gastrointestinal and lung cancers were more likely to face disability-related concerns relative to health insurance issues. Black and Hispanic individuals were more likely to call for employment issues relative to health insurance issues.³

This study highlights the importance of patient navigation programs. The unmet need is for more accessible solutions to help support patients with cancer. These solutions can be administered at the provider level or through a hospital-based navigation program. Institutional or state-level solutions could include research around the potential impact of reimbursing providers and hospitals for providing care coordination. In addition, these solutions should ideally cover the entire spectrum of cancer care, from surveillance to treatment.

With preventive care and follow-up incorporated as a focus for the ASCO policy statement and frequently cited as a disparity in cancer care, one solution is the Adventist Health’s Early All-Around Detection (AHEAD) program, which is based in St Helena, California. This program was developed in 2017 with the goal of detecting cancer early through personalized and comprehensive cancer risk assessments.4 The early version of the AHEAD (AHEAD 1.0) program used evidence-based criteria to identify and test patients with a risk for hereditary cancer syndromes. Patients identified with genetic mutations were provided access to genetic counselors and additional necessary screening when appropriate. However, it was quickly realized that hereditary cancers only account for 10% of cancers. To make the AHEAD program more comprehensive and personalized, the AHEAD 2.0 program was launched, incorporating a multicancer early detection (MCED) test.⁴

Thus, the AHEAD 2.0 program starts with family history, and where indicated, includes genetic testing. For certain groups of patients who are high-risk, the AHEAD program includes the MCED test. Patients who are high-risk include first responders, especially firefighters and farm workers, who are exposed to chemicals and pesticides. To ensure that all patients at risk have access to the MCED test, AHEAD has engaged in philanthropic fundraising through the support of the St Helena Hospital Foundation to fully cover the costs of these tests in the Northern California region.

By creating frameworks and pathways (eg, AHEAD’s Circles of Care, which also drives downstream revenue for health systems), it is possible to keep patients within the health system, route them to the right specialist, and provide follow-up services and treatments that they need.⁴

Addressing disparities in cancer care requires a multifaceted approach that acknowledges and confronts the structural, social, and economic barriers impacting vulnerable populations. The initiatives discussed in this article demonstrate the potential to advance health equity through prevention, early detection, comprehensive care coordination, and community-focused solutions. By prioritizing equitable access to resources, fostering awareness, and implementing sustainable interventions, the health care system can move closer to ensuring that all patients—regardless of race, ethnicity, or socioeconomic status—receive the high-quality cancer care they deserve.