Nurse prepares a cancer patient for her chemotherapy in the hospital. There is inequality in cancer care … [+]
In recent years, researchers in the United States and abroad have discovered striking differences between income groups in the level of cancer care they receive. The poorer the patient, the less care he received.
The American Society of Clinical Oncology has issued a policy rack earlier this year, he stated that despite decades of significant investments in expanding health care coverage and improving its delivery, health care disparities in the U.S. persist based on race, ethnicity, gender identity , disability, geography and various other factors that underlie the social, economic and environmental conditions that individuals and their communities face.”
This is reflected in what the National Cancer Institute said when it confirmed that certain groups in the US are affected differences in cancer outcomes because they more often encounter obstacles in obtaining healthcare.
Among non-small cell lung cancer patients, authors of a Nature article wrote Last year, more than 100,000 non-small cell lung cancer patients included in the National Cancer Database who were in the lowest income groups were found to be “29% less likely to receive immunotherapy.”
Reinforcing these findings – and expanding beyond NSCLC to include renal cell carcinoma and melanoma – low income was one of the most important factors associated with less use of immunotherapy, according to a study. paper published in 2022 in the Journal of the American Medical Association. More than 400,000 patients were examined in the large-scale cohort study. Researchers found significantly less frequent use of immunotherapy among individuals with lower household incomes, before and after new immunotherapy drugs called checkpoint inhibitors were approved by the Food and Drug Administration.
The factors mentioned in the JAMA publications are not only income related. They also include race, ethnicity and issues such as disability health literacy or long distances to travel (without adequate transportation) for screening or treatment appointments.
In addition, some patients in the US face a problem that most people in other countries do not face: they may not have (sufficient) health insurance that would otherwise pay for all recommended cancer tests or treatments, in accordance with established clinical practice guidelines. In the JAMA study, uninsured cancer patients and patients on Medicaid received less care.
Patients without reliable access to health care are more likely to be diagnosed with late-stage cancer, which may have been treated more effectively had it been detected at an earlier stage.
Not receiving the necessary care has negative consequences for patients with diabetes low incomesincluding a higher death rate from cancer, as the National Cancer Institute points out.
Particularly in healthcare systems abroad, where universal access to healthcare exists, income-related disparities in cancer care persist.
The Integrated Cancer Organization of the Netherlands has released a second one study in late June, as part of a three-part series on socioeconomic status and cancer care. The latest research shows that patients from lower income groups undergo tumor-targeted treatment less often than patients with higher incomes. Researchers examined treatment differences between patients in the national database of five common tumor types: breast, non-small cell lung, colon, prostate and skin cancer.
When patients do receive treatment, lower-income people are more likely to receive less invasive treatments. For example, 67% of patients from higher income groups were prescribed immunotherapy for metastatic melanoma, compared to 47% in lower income groups.
Similar major differences were found regarding the treatment of metastatic colorectal cancer. To slow down the disease, patients can receive chemotherapy, possibly in combination with a targeted drug. In the higher income group, 54% received this double treatment, while in the lower income group this was only 39%.
Patients with higher incomes are also more likely to be tested to detect specific biomarker mutations in their tumors. Identifying these mutations is essential to determine which targeted drug to use.
Interestingly, patients with advanced cancer from lower income groups are more likely to visit a healthcare provider in the last six months before their death than patients from higher income groups.
Dutch researchers have suggested several possible explanations for the observed disparities, including that lower-income patients tend to have more comorbidities and a higher body mass index, in addition to the fact that this group has a higher percentage of smokers. In addition, poorer people are more likely to have limited health literacy, which can make shared decision-making between doctors and patients more difficult.
Inequities in cancer care appear to be related to a number of factors, most notably the socio-economic status of patients. The lower the income level, the less care cancer patients receive.