Overcoming Disparities in Cancer: A Need for Meaningful Reform for Hispanic and Latino Cancer Survivors

Abstract

Hispanic and Latino (HL) cancer survivors are at a critical disadvantage compared to non-Hispanic White (NHWs) patients regarding sociodemographic adversities and access to equitable treatment options. By 2030, there will be about four million HL cancer survivors in the US, representing nearly 20% of survivors in this country. Hispanics and Latinos are subjected to significant challenges in accessing and receiving equitable care relative to NHWs. Hispanics and Latinos also experience lower rates of health insurance and financial resources, limiting healthcare options. These disparities often originate from disparate social determinants of health including lower funding for education and school programs, greater neighborhood stressors and violence, lower access to healthy and affordable food, and greater barriers to community health/ exercise opportunities. Even among HLs with proper access to healthcare, they experience disparate treatment options including low inclusion in clinical trials and/or access to experimental therapies. A solution to these barriers necessitates complex and systemic changes that involve, for example, investing in public health programs, increasing the diversity and cultural awareness of the medical workforce, and promoting research opportunities such as clinical trials that are inclusive of HLs. Only through meaningful reform will equitable cancer care be available for all in the US regardless of racial and/or ethnic background. This manuscript reviews some of the critical social determinants of health and biases relevant to HL cancer survivors and provides recommendations for achieving cancer health equity. The Oncologist 2021;9999:• • Implications for Practice: Hispanics and Latinos experience a significant and often disproportionate cancer-related burden compared to non-Hispanic and Latino Whites and other racial/ethnic groups. Meaningful reform to achieve health equity in oncology should focus on approaches to gaining trust among diverse patients, cultural and community sensitivity and engagement in oncology care and research, diversifying the workforce, and improving inclusion in clinical trial participation. Taken together, these recommendations can lead to exemplary and equitable care for all patients.

American Cancer Society nutrition and physical activity guideline for cancer survivors

“…For instance, cancer survivors from rural areas, particularly Black and American Indian populations, experience greater poverty and racism—both systemic and structural—and often lack access to culturally competent care in accordance with guidelines, including availability, accessibility, and affordability of health care services, which results in lower survival 123 . Hispanic individuals have the lowest health insurance prevalence of any racial and/or ethnic group 124 ; many individuals may be undocumented and have unique challenges when accessing health care, particularly cancer care. Cancer health disparities, defined as measurable differences in cancer outcomes in population groups , continue to be a significant public health concern in the United States 125 .…”

Racial and Ethnic Disparities in Preoperative Surgical Wait Time and Renal Cell Carcinoma Tumor Characteristics

“…HAs are the highest-ranking population for being uninsured [ 32 ]. The lack of health insurance among HAs is an established factor in lower rates of cancer screenings, receiving a diagnosis at a later stage, and treatment [ 33 ]. Additionally, HAs often experience cancer treatment delays across various cancer types [ 34 , 35 ].…”

An Analysis of Individual and Contextual-Level Disparities in Screening, Treatment, and Outcomes for Hepatocellular Carcinoma

“… 72 These disparities are exacerbated by disparate oncology care for malignancies such as HCC. 121 Ensuring adequate access and equitable care for minority patients begins with understanding a patient’s cultural beliefs and practices. 122 For example, some cultures may have different approaches to cancer care with some patients choosing to keep their malignancy hidden from their families.…”