A problem of social injustice

Research alone will not close the cancer gap

Bill Snyder
Published: February, 2007

Harold Freeman, M.D., and Jane Weeks, M.D., discuss what needs to be done to reduce the disproportionate impact of cancer on racial and ethnic groups, the poor and the elderly.

Freeman is president and founder of the Ralph Lauren Center for Cancer Care and Prevention in New York City, and professor of clinical surgery at Columbia University. A leading authority on the link between race, poverty and cancer, Freeman has served as president of the American Cancer Society, chairman of the President’s Cancer Panel and director of the National Cancer Institute’s Center to Reduce Cancer Health Disparities.

Weeks is professor of Medicine at Harvard Medical School, professor of Health Policy and Management at the Harvard School of Public Health, and chief of the Division of Population Sciences at the Dana-Farber Cancer Institute. She also is co-leader of the Outcomes Research Program at the Dana-Farber/Harvard Cancer Center, which aims to “enhance the outcomes, including efficacy and cost-effectiveness, of interventions to prevent and treat cancer.”

They spoke with Lens editor Bill Snyder via conference call in 2006.

How well are we doing in reducing disparities in cancer incidence and outcomes?

Photo Courtesy of Harold Freeman, M.D.
Freeman: We’re not addressing it very well… Everyone has made progress as measured by diminishing mortality from cancer in general and (in) specific cancers, but the gap between groups has not closed.

Why aren’t we closing the gap?

Weeks: It’s possible that patients may be poorly informed about effective treatments and/or are unequipped to deal with the health care system to make sure that they get effective treatments. They may have preferences for treatments that are associated with poorer outcomes.

Physicians caring for minority patients and elderly patients may be unaware of the current evidence, or they may have biases that cause them to selectively give less effective treatments in those settings.

They may also have inadequate evidence to guide the care that they give. This is particularly a problem with the elderly where there have been so few clinical trials in treatment of elderly cancer patients—and I might point out that cancer is largely a disease of the elderly—that we really don’t know whether the same treatments that are useful in younger patients are also useful in older patients.

Finally there are potential problems in the structure of the health care system itself. So patients may face difficulty accessing the health care system. They may have difficulties with coordination of care that causes key components of their treatment to be left out. And providers may have inadequate reimbursement to deliver high quality care.

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