Cancer Center Administrators ForumCancer Health DisparitiesMarch 2-4, 2008Santa Fe, New Mexico Elena Martínez, M.P.H., Ph.D. Richard H. Hollen Professor of Cancer Prevention Arizona Cancer Center University of Arizona
Policies and Guidelines Relating to the Cancer Center Support Grant • “…and reach out to under-served populations.” • “…will develop effective research dissemination strategies to eliminate the disproportionate burden of cancer in minority and other underserved populations.” • “… and service delivery partnerships for under-served populations”
NCI Definition of Cancer Health Disparities • “Adverse differences in cancer incidence (new cases), cancer prevalence (existing cases), cancer death (mortality), cancer survivorship, and burden of cancer or related health conditions that exist among specific population groups in the U.S.” • Populations may be characterized by age, disability, education, ethnicity, gender, geographic location, income, or race. Source: Center to Reduce Cancer Health Disparities
Understanding Cancer Health DisparitiesSociodemographic and Cultural Factors • Poverty/low SES • No insurance or under-insured • Not having a primary care physician/health care provider • Non-English speaking • Geographic isolation (i.e., rural populations) • Lack of transportation • Cultural or traditional factors • Distrust of the scientific community • Low perceived risk of cancer
Health Disparities in Rural Populations • Around 60 million (~1 in 5) Americans live rural areas and the number continues to grow. • Compared with their urban counterparts, rural Americans are more likely to: • Be older, to describe their health as poor or fair, and to lack private health insurance. • Have higher smoking and obesity rates. • Not receive preventive services (i.e., cancer screening) • Face longer distances to reach hospital or other health care services, especially medical specialty care (i.e., cancer treatment). AHRQ, 2002 NRSA, 2002
Intercultural Cancer CouncilRural Poor/Medically Underserved Americans & Cancer • Represented by the Appalachian Region • Almost entirely white, largely rural (65%), poor, population. • Some examples of disparities: • Lower cancer screening rates. • Higher prevalence of cigarette smoking (~60% of 2nd and 3rd grade students chew tobacco daily in one West Florida County). • Higher cancer mortality rates. www.iccnetwork.org
Longer Distance and Stage of Melanoma Diagnosis • Longer travel distance to a specialty provider who can diagnose melanoma means a later diagnosis: • For each 10-mile increase in distance, there is a 6% increase in Breslow thickness. • Patients who traveled more than 15 miles had 20% thicker tumors than patients who traveled 15 miles or less. Stitzenberg et al., 2007
Access to Care is Even Worse for Minorities Living in Rural Areas • Mexican-Americans living in non-metropolitan areas are 45% less likely than their White counterparts to have access to primary medical care. • Mexican-Americans living in non-metropolitan areas were 49% less likely than Mexican-Americans living in metropolitan areas to have access to primary medical care. Berdahl et al., Medical Care, 2007
Rural Populations and Cancer: The Appalachia Experience (Wingo et al., Cancer, 2007) • Largely white, rural, poor communities. • Experience higher overall cancer rates than the rest of the U.S. • Experience higher rates of specific cancers: • Lung • Colorectal • Cervix • Variations within Appalachia region reflect differences in SES conditions.
Insurance and Cancer OutcomesWard et al., 2008 • Patients who were uninsured or on Medicaid were more likely to: • Be diagnosed with late stage cancer and larger tumors • Die of their disease. • “There is substantial evidence that lack of adequate health insurance coverage is associated with less access to care and poorer outcomes for cancer patients.” • Barriers to receiving optimal cancer care are complex: Patients on Medicare did as bad as the uninsured-it has more to do than just having a card.
Poverty and Cancer • Cancer + poverty=lethal combination. • “People shouldn’t die because they are poor or because they are uninsured.” (H. Freeman) • The U.S. has the best technology and treatment for cancer….for those who can afford it. Discovery Development Delivery H. Freeman, 2008