Healthcare, WVU Medicine

New report highlights racial and social barriers to cancer care, offers call to action to address disparities

MORGANTOWN – While significant progress is being made in the prevention and treatment of cancer, socioeconomic and racial/ethnic barriers mean not everyone has adequate access to care.

This is the case made by the American Association for Cancer Research in its new 215-page report: AACR Cancer Disparities Progress Report 2024.

WVU Medicine announced the release of the report and emphasized its importance. Dr. Hannah Hazard-Jenkins, executive chair and director of the WVU Cancer Institute and member of the report’s Steering Committee, commented, “The AACR Cancer Disparities Report highlights the inequities in cancer outcomes of racial and ethnic minorities. In addition, the report sheds light on the challenges rural communities like Appalachia face, as there is often limited access to cancer screening and treatment, leading to higher cancer incidence and poorer cancer outcomes.”

The WVU Cancer Institute continues to champion many of the initiatives highlighted in the report to eradicate those disparities, she said, including the Bonnie’s Bus and LUCAS mobile screening units, investing in a new cancer hospital on the J.W. Ruby Memorial Hospital complex in Morgantown, and pursuing National Cancer Institute designation.

“The WVU Cancer Institute strives to expand clinical access for everyone in our state and region,” Hazard-Jenkins said. “It is imperative that we continue to focus our clinical, translational and foundational research on Appalachians to combat the cancer incidence and outcomes inequities prevent in our communities.”

The report dives into deep detail in its 215 pages. These are a few highlights.

AACR attributes many of the disparities to “a long history of structural inequities and systemic injustices in the United States.”

While prevention and treatment advances, it’s projected there will be just over 2 million new cases diagnosed this year, and 611,720 deaths. “In addition to racial and ethnic minority groups, many segments of the U.S. population shoulder a disproportionate burden of cancer. These groups include rural residents, people living under poverty, and individuals who belong to sexual and gender minority communities.”

Rural communities, AACR says, have seen an overall slower decline in cancer death rates. Counties with persistent poverty have a 7% higher death rate. Social drivers of health play a big role: education level; income; employment; housing; transportation; and access to healthy food, clean air, water and health care services.

For racial and ethnic minorities, biological factors also play a role. Progress here is hindered because most available data is based on studies of people of European ancestry.

Some examples of disparities: Black people have the highest overall cancer death rate. Rural residents are 38% more likely to be diagnosed with and die from lung cancer. Residents of disadvantaged neighborhoods have a 22% higher mortality rate for all cancers combined.

Some risks for developing cancer are behavior-based, AACR says: smoking, diet, physical activity, alcohol consumption, obesity and more. Environmental hazards also play a role, such as air pollution and access to clean water.

But poor neighborhoods are often characterized by low walkability, reduced availability of healthy food options and limited outdoor space for recreation and exercise. Residences may be in less favorable locations such as near highways, busy roads, or industries, which increases their exposure to environmental pollutants to a greater degree, thereby increasing cancer risk.

Lack of access to adequate care for vulnerable and disadvantaged communities crosses the entire spectrum from screening to treatment to follow-up care, AACR says.

And the medical community has inadequate data. “Therefore, it is imperative that participants in clinical trials represent the entire population who may use these treatments if they are approved. Despite this knowledge, participation in cancer clinical trials is low, and there is a serious lack of sociodemographic diversity among those who do participate.”

A note of hope is that certain cancer patients from racial and ethnic minorities may respond better to select treatments compared to white patients and have better outcomes when offered similar access to standard and quality care.

For proper follow-up care for survivors, AACR says, community-based culturally tailored solutions are needed, such as patient advocates and patient navigators, and a more diverse cancer care workforce.

AACR notes that the health system itself can erect barriers: affordability, facility equipment and staff, proximity to patients, preparedness and ability to work with diverse patients.

The report concludes with a call to action spanning several pages of government policy recommendations.

Just a few:

  • Increasing federal funding for research and public health initiatives.
  • Improving data aggregation for all segments of the population.
  • Broadening access to equitable care, through such services as telehealth.
  • $61 billion in congressional appropriations for expanded research on disparities.
  • Full FDA implementation of the Clinical Trial Diversity Reform Act of 2022.
  • FDA finalization of the ban on menthol cigarettes and flavored cigars.
  • Ensure Medicaid coverage of tobacco cessation programs.

AACR concludes, “Fulfilling the aims of this call to action will require not only the commitment from the public sector, but also partnerships with many other stakeholders, including the biopharmaceutical industry, academic and medical institutions, patient-centric organizations, community-based organizations, and professional organizations, to achieve the vision health equity.”