Disparities in Cancer Care Need to Be Reduced, Says ASCO

Roxanne Nelson

August 05, 2011

August 5, 2011 — Racial and ethnic disparities exist in cancer care, even after factors such as insurance and socioeconomic status are controlled for. These disparities are particularly apparent when it comes to cancer-related mortality, because a disproportionate number of these deaths occur in racial/ethnic minorities.

To address the serious racial and economic disparities that currently exist in cancer prevention, diagnosis, and treatment in the United States, the American Society of Clinical Oncology (ASCO) has released a policy statement that outlines the specific provisions of the 2010 Patient Protection and Affordable Care Act (PPACA) that have the potential to affect on these disparities.

"The Affordable Care Act provides a foundation for meaningful progress in eliminating disparities in healthcare," said ASCO president Michael P. Link, MD, in a statement. "However, many of its provisions are vague and open for interpretation. In addition, significant progress requires added measures that are not in the new law."

The ASCO policy statement, published online August 1 in the Journal of Clinical Oncology, makes recommendations to ensure that the provisions in PPACA are effectively carried out. The statement emphasizes the fact that additional strategies are needed so that system issues, including insurance reform, quality of care, prevention, research, and diversity in the healthcare workforce, are effective.

"Our hope is that this statement will catalyze the entire oncology community to actively advocate for implementation of the disparities-related provisions in the PPACA," Beverly Moy, MD, MPH, chair of the ASCO Health Disparities Advisory Group, told Medscape Medical News. "It is also a call to action for policymakers to ... further improve the access to quality cancer care for all patient groups, particularly our most vulnerable."

This new policy statement builds on ASCO's 2009 statement, which highlighted the importance of eliminating disparities in cancer care (J Clin Oncol. 2009;27:2881-2885). However, developing a strategy to improve quality, affordability, and access to care for patients and communities is not without its obstacles. "This will be a challenging task, but the PPACA provides a good foundation upon which we can continue to build," she said.

The main challenge is to improve and ensure access to cancer care, Dr. Moy emphasized. "The Medicaid expansion in the law is a great step forward but, with continued looming cuts to Medicare that will likely trickle down to Medicaid, we will still be left with tremendous challenges with access," she explained. "We, as an oncology community, have a real opportunity to lead the progress in this important cause."

Strategies

The statement identifies some specific strategies to help eliminate cancer care disparities, including the following.

Insurance Reforms

  • Stop making Medicare reimbursement cuts to cancer care and require reimbursement at Medicare rates to providers who care for individuals diagnosed with cancer in the Medicaid program.

  • As an alternative, allow cancer patients enrolled in Medicaid to have immediate, presumptive eligibility under Medicare.

  • Promote and recommend best practices for exchanges that encourage the elimination of disparities in cancer care.

Access to Care

  • Assist underserved individuals in applying for health insurance coverage.

  • Allow for cancer-centered services under the direction of oncology professionals in the community health teams and medical home provisions of the PPACA.

  • Ensure that Medicaid patients are protected by the safeguards for participation in clinical trials that apply to other individuals.

  • Require health plans to demonstrate the steps they take to ensure that members of racial, ethnic, and low-income groups have meaningful access to clinical trials.

Quality of Care

  • Work with existing quality-of-care initiatives.

  • Conduct quality-improvement efforts in such a way that providers caring for underserved patients are not penalized.

  • Ensure that quality-improvement programs are patient-centered and that they address the different modes and locations of care.

Prevention and Wellness

  • Require insurers to cover appropriate follow-up testing, without deductibles or copays, of abnormalities found during covered cancer screening services.

  • Support research to identify optimal screening services to detect cancer in ethnically diverse populations.

Health Disparities Research

  • Adequately fund the National Institute on Minority Health and Health Disparities and the Office of the Assistant Secretary for Minority Health.

  • Prioritize public and private research on cancer-care disparities through collaboration with key stakeholders.

Healthcare Workforce Diversity

  • Maintain a commitment to carry out programs aimed at enhancing the supply of minority physicians and to improve the training of the oncology workforce to meet the needs of ethnically diverse cancer patients.

Caveats

The policy statement also identified several important caveats to their recommendations:

  • Authorized provisions in the law related to disparities in cancer care must be funded.

  • Regulations must be written to reflect the intent of Congress to eliminate disparities in cancer care.

  • Key stakeholders such as ASCO must be consulted as government agencies, state exchanges, and private plans work to apply the new law to cancer patients in a way that eliminates disparities in care.

  • The elimination of disparities should be a primary focus of every advisory board established under the law.

The authors have disclosed no relevant financial relationships.

J Clin Oncol. Published online August 1, 2011. Abstract

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