Please mind the gap—about equity and access to care in oncology

摘要

Health care disparities have been described as differences in the quality of care received by those people who have equal access to care and no difference in preferences or needs for treatment,1Torain M.J. Maragh-Bass A.C. Dankwa-Mullen I. et al.Surgical disparities: a comprehensive review and new conceptual framework.J Am Coll Surg. 2016; 223: 408-418Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar representing a serious public health concern.2Hisam B. Zogg C.K. Chaudhary M.A. et al.From understanding to action: interventions for surgical disparities.J Surg Res. 2016; 200: 560-578Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar While most literature has shown how ethnic minorities do experience health care disparities and poorer clinical outcomes,2Hisam B. Zogg C.K. Chaudhary M.A. et al.From understanding to action: interventions for surgical disparities.J Surg Res. 2016; 200: 560-578Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar, 3Haider A.H. Scott V.K. Rehman K.A. et al.Racial disparities in surgical care and outcomes in the United States: a comprehensive review of patient, provider, and systemic factors.J Am Coll Surg. 2013; 216: 482-492.e12Abstract Full Text Full Text PDF PubMed Scopus (216) Google Scholar, 4Elk R. Felder T.M. Cayir E. Samuel C.A. Social inequalities in palliative care for cancer patients in the United States: a structured review.Semin Oncol Nurs. 2018; 34: 303-315Crossref PubMed Scopus (12) Google Scholar inequalities are also encountered according to gender, age, socioeconomic status, sexual orientation, patients in rural areas, or the presence of disabilities.1Torain M.J. Maragh-Bass A.C. Dankwa-Mullen I. et al.Surgical disparities: a comprehensive review and new conceptual framework.J Am Coll Surg. 2016; 223: 408-418Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar While good health and well-being for all at all ages stand as one of the 17 Sustainable Development Goals promoted by the United Nations,5UN. Goal 3Ensure healthy lives and promote well-being for all at all ages. SDGs.2021https://sdgs.un.org/goals/goal3Google Scholar the abovementioned barriers are commonly fostered by geographic isolation and destitution. Such gaps represent a severe challenge in oncology, considering that cancer might be not only a cause but also a consequence of poverty. Indeed, low- and middle-income countries generally experience a high level of health care disparities with scant access to cancer screening and prevention services, vaccinations, as well as state-of-the-art oncological treatments. Particularly, a greater discrepancy is flagrant in the location of radiotherapy (RT) facilities and technologies considering that up to 70% of all the RT hubs are in high-income countries, with 30 countries, in the world, without RT.6Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries. Closing the Cancer Divide: A Blueprint to Expand Access in Low and Middle Income Countries.https://ncdalliance.org/resources/closing-the-cancer-divide-a-blueprint-to-expand-access-in-low-and-middle-income-countries-by-the-global-task-force-on-expanded-access-to-cancer-careGoogle Scholar Moreover, the chronic impairments due to cancer as well as the oncological treatment costs cast people into poverty. The recent coronavirus disease-19 (COVID-19) pandemic has sadly confirmed the trend, with the literature recording higher death rates among minority communities in wealthier countries.7Bonner S.N. Wakam G.K. Kwayke G. Scott J.W. COVID-19 and racial disparities.Ann Surg. 2020; 272: e224-e225Crossref PubMed Scopus (8) Google Scholar Moreover, of the 3.3 billion COVID-19 vaccines administered globally, thus far, only 1% of people in the low-income countries have received at least the first dose, and, dramatically, in Africa, they remain out of reach.8KFF Tracking Global COVID-19 Vaccine Equity.https://www.kff.org/global-health-policy/issue-brief