Relationship between intersectionality and cancer inequalities: a scoping review protocol

Abstract

IntroductionPersistent inequalities in cancer care and cancer outcomes exist within and between countries. However, the evidence pertaining to the root causes driving cancer inequalities is mixed. This may be explained by the inadequate attention paid to experiences of patients with cancer living at the intersection of multiple social categories (eg, social class, ethnicity). This is supported by the intersectionality framework. This framework offers an alternative lens through which to analyse and understand how these interlocking systems of oppression uniquely shape the experiences of patients with cancer and drive inequalities. In this protocol, we outline a scoping review that will systematically map what is known about the relationship between intersectionality and inequalities in care experience and cancer outcomes of patients with cancer; and to determine how the intersectionality framework has been applied in studies across the cancer care pathway and across countries.Methods and analysisThis study will be guided by Arksey and O’Malley’s, and Levacet al’s frameworks for scoping reviews. We will identify and map the evidence on cancer inequalities and intersectionality from 1989 to present date. Electronic databases (EMBASE, PsychINFO, CINAHL, Medline, Web of Science, ProQuest) and a systematic search strategy using a combination of keywords and Boolean operators AND/OR will be used to identify relevant studies. Screening of eligible papers and data extraction will be conducted by two independent reviewers, and disagreements resolved by discussion with the research team. We will use an iterative process to data charting using a piloted form. Findings will be collated into a narrative report.Ethics and disseminationEthical approval is not required since data used are from publicly available secondary sources. Findings will be disseminated through peer-reviewed journals, conferences and stakeholder meetings. Further, findings will inform the next phases of a multistage research project aimed at understanding inequalities among patients with breast cancer.

Adapting an Adolescent and Young Adult Program Housed in a Quaternary Cancer Centre to a Regional Cancer Centre: Creating Equitable Access to Developmentally Tailored Support

“…Social location refers to a person’s position in society based on socially constructed factors such as gender, class, education, employment, socioeconomic status, identity, geographic location, mental health, and disability [ 23 ]. Access to quality cancer care can be further impacted by individuals’ SDH [ 13 ], specifically, individuals’ social location may lead to inequities [ 24 ]. Both concepts can negatively impact patients’ health outcomes across the cancer continuum from routine screening to survivorship [ 25 , 26 ].…”

“…Additionally, consideration of historically oppressed members of the LGBTQ+, Indigenous, and Black communities, highlights the interconnectedness of social and personal identities with the behaviors and perceptions of patients [ 12 ]. Drawing on an intersectionality framework allows clinicians to remain cognizant of the compounding impact of an individual’s unique identity in their cancer care [ 13 , 14 ].…”

An Intervention-Based Approach to Achieve Racial Equity in Gynecologic Oncology

“…Recognizing the intersectionality of these identities is critical not only to understanding disparate outcomes but to creating solutions that center the margins. 17 , 18 We organize evidenced-based strategies within the socioecologic framework. This framework describes the way in which multiple levels of influence—societal, community, organizational, interpersonal, and individual—all affect health outcomes.…”