Equity Report Card: Advocacy Organizations Offer Recommendations to Combat Racial Disparities in Cancer Care

A recent poll found that 63% of Black and 67% of Latinx patients, survivors and caregivers reported having a negative experience with their oncology team.

The poll, fielded by Public Opinion Strategies on behalf of the National Comprehensive Cancer Network® (NCCN®), American Cancer Society Cancer Action Network (ACS CAN) and the National Minority Quality Forum (NMQF), showed that negative experiences for these patients included oncology teams having assumptions made about them or their financial situation, or trouble getting questions answered. Moreover, these rates were compared with just 43% of White patients, survivors and caregivers who reported negative experiences. Similarly, of the oncologists polled, two-thirds reported that non-White patients experience worse outcomes from cancer care.

“The research shows disparities in outcomes that aren’t based on biology; they result from systemic inequality and bias in access and care delivery,” Dr. Robert W. Carlson, chief executive officer at NCCN, said in a press release. “Racism exists in the United States and impacts everyone, including the medical community.”

As a result of the poll, NCCN, ACS CAN and NMQF presented new ideas and recommendations – developed by a group of 17 national experts comprised of patients and advocates, caregivers, health care providers, researchers and industry – for overcoming inequality in oncology by creating the Elevating Cancer Equity Working Group. The group was co-chaired by Shonta Chambers, Health Equity Initiatives and Community Engagement at Patient Advocate Foundation, and Dr. Robert Winn, director of the VCU Massey Cancer Center.

The Elevating Cancer Equity joint initiative, which “aims to go beyond discussion toward actionable solutions,” includes an Equity Report Card, designed to help health care providers, payers and accreditation entities to advance equity in cancer care. The report card included 17 measurable practice changes in community engagement, accessibility of care and social determinants of health, addressing bias in care delivery, and quality and comprehensiveness of care.

“One proven method for improving equity is using guideline-concordant care. We’re grateful to be able to learn from experts about what we can do right now to make sure everyone is getting the best evidence-based care possible; the process has been both humbling and inspiring. Now we’re committed to working together to make these recommendations a reality,” Carlson said.

In the report care, the three organizations set three clinical practice guidelines recommendations:

• Clinical practice guidelines should be reviewed for disparity issues within guidelines that could eliminate or reduce disparity. Additionally, clinical practice guidelines should incorporate language recognizing the existence of bias in care.
• Clinical practice guidelines should incorporate a framework to account for health disparities into the panel processes. Panels should also consider adding a health equity expert representative.
• Clinical Practice Guidelines should consider incorporating age adjustments on screening recommendations for specific populations that may have earlier manifestations.

“Communities of color and other medically underserved groups continue to have higher cancer rates and are less likely to be diagnosed early or receive optimal treatment compared to other groups,” Lisa Lacasse, president of ACS CAN, said in the release. “Ensuring quality clinical practices are in place and applied equitably to all patients regardless of race, ethnicity, socioeconomic status or geographic location is essential to reducing those disparities. We cannot achieve our mission of a world without cancer until we lessen the burden of this disease across all communities; these recommendations provide important means to achieve that goal.”

NCCN, ACS CAN and NMQF also created a series of policy change recommendations for the United States Congress, CMS and commercial payers, federal agencies, and state and local policymakers.

“We can improve cancer outcomes for communities of color and rural areas by closing gaps in screening, diagnosis, treatment and survivorship, both in clinical practice and in policy," Gary A. Puckrein, NMQF president and CEO, said in the release. "NMQF is pleased to collaborate with NCCN and ACS CAN to develop evidence-based recommendations using real-world data that allow us to design a system that delivers high-quality cancer care to all of America’s diverse populations.”

The NCCN noted that these recommendations will be explained further during a keynote address at the NCCN Virtual 2021 Annual Conference on March 19.

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