Colorectal Cancer: In the Pursuit of Health Equity

Abstract

Colorectal cancer mortality has decreased considerably following the adoption of national screening programs, yet, within at-risk subgroups, there continue to be measurable differences in clinical outcomes from variations in screening, receipt of chemotherapy, radiation or surgery, access to clinical trials, research participation, and survivorship. These disparities are well-described and some have worsened over time. Disparities identified have included race and ethnicity, age (specifically young adults), socioeconomic status, insurance access, geography, and environmental exposures. In the context of the COVID-19 pandemic, colorectal cancer care has necessarily shifted dramatically, with broad, immediate uptake of telemedicine, transition to oral medications when feasible, and considerations for sequence of treatment. However, it has additionally marginalized patients with colorectal cancer with historically disparate cancer-specific outcomes; among them, uninsured, low-income, immigrant, and ethnic-minority patients—all of whom are more likely to become infected, be hospitalized, and die of either COVID-19 or colorectal cancer. Herein, we outline measurable disparities, review implemented solutions, and define strategies toward ensuring that all have a fair and just opportunity to be as healthy as possible.

Socioeconomic differences in help seeking for colorectal cancer symptoms during COVID-19: a UK-wide qualitative interview study

“…The impact of COVID-19 on colorectal cancer care is of particular concern because it risks perpetuating persistent social/health inequalities in outcomes, 8 , 9 including late presentation, 10 less access to treatment, 11 delayed treatment, 12 higher mortality, 13 , 14 and poorer survival for more deprived groups. 11 …”

Spatial analysis of colorectal cancer outcomes and socioeconomic factors in Virginia

“…Lifestyle-based risk factors such as diet and smoking vary greatly, as well as preventive measures such as screening test access and mass education campaigns [ 3 ]. Disparities in CRC refer to population subgroups that experience worse outcomes due to social, economic, other factors that impede their access to preventive services or to practice healthy lifestyles [ 4 ]. Though the characteristics and risk factors of groups experiencing CRC disparities can vary by place, studying and measuring disparities is important for informing efforts to improve health equity.…”

Economic Pressure and Intention to Complete Colorectal Cancer Screening: A Cross-Sectional Analysis Among U.S. Men

“…Our results suggest that both population-based and intervention research studies designed to promote CRC screening should consider participants’ psychological perceptions of their economic circumstances in addition to their income and educational attainment. Given the current economic inflation and the financial and personal losses caused by the COVID-19 pandemic (which has also exacerbated CRC disparities; Musselwhite et al, 2021 ) examining perceptions of economic circumstances is a salient topic for medicine and public health research moving forward.…”