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Making Progress on Disparities in Cancer Care 

Today is World Cancer Day, a global day of reflection and advocacy led by the Union for International Cancer Control, and this year in particular there is a lot to be excited about. At the State of the Union Address, President Obama tasked Vice President Joe Biden with heading a “moon shot” initiative to find a cure for cancer, that while perhaps overly ambitious in its title, promises to unlock greater governmental support for cancer research and to foster greater collaboration among researchers. Non-communicable diseases (NCDs), including cancer, were formally included as part of the UN’s Sustainable Development Goals’ (SDGs) health targets, which will have a tremendous ripple effect on countries’ health priorities and aid and development spending over the next 15 years. At the same time, the pace of scientific progress in cancer research continues to accelerate as advances such as immunotherapy, genetics, and “big data” analysis yield disruptive new therapies and insights.

Despite this pace of progress, tremendous challenges persist, namely the huge disparities that exist in the timing of when cancer patients are diagnosed, the types of treatment made available to them, and their ultimate outcomes. I am currently working on 2 cases that bring these disparities into sharp relief. In one, FSG is supporting the corporate foundation of a major pharmaceutical company in its grant-making and advocacy to address inequities in specialty care, including cancer. In the other, we are working with a world-renowned cancer research center to help create a long term strategy for its new research facility in sub-Saharan Africa.

These inspiring clients are both working to address pronounced disparity in cancer care, one focusing on disparities within the United States, and one focusing on disparities between the developed and developing world. This opportunity to work with clients addressing an issue at multiple levels is one of the things I most value about my work at FSG. In particular, FSG’s work in healthcare has significant US and global reach, allowing us to work with clients on pressing issues, such as HIV, maternal and child health, or NCDs, across a range of settings, informing a broad perspective of issues that we bring to each project. In this instance, the opportunity to simultaneously support organizations working to address cancer disparities within the US and between the US and sub-Saharan Africa reveals the depth of need for greater advocacy and resourcing to stem the cancer epidemic, at all levels.

In the US, disparities in cancer primarily fall along socio-economic and racial lines and persist across all the steps in a patient’s experience with the disease, from diagnosis to remission. A range of factors drive these challenges, including patients’ social and community context, limited availability of oncologists, and linguistic and cultural barriers between patients and providers. All of these factors culminate in sharp disparities in incidence and mortality rates among underserved patient groups, for example, African Americans experience a lung cancer incidence rate 20% higher than the general population, and a mortality rate that is ~25% higher. Opportunities to address these challenges are increasing as payment models in the US slowly shift to value-based models, more closely aligning provider incentives with better meeting the needs of underserved populations. However, there is still a long road to go in addressing the pronounced disparities in cancer care in the US, requiring greater advocacy and awareness of these issues among healthcare leaders, policymakers, and the general public alike.

Driven by weak health systems, limited cancer awareness, shortages of drugs, nurses, and oncologists alike, the disparity between the standard of cancer care in sub-Saharan Africa and that of the US is drastic. All too often, countries with limited healthcare budgets are forced to choose between investment in cancer, which is expensive to treat and in many cases difficult to cure, or more affordable and treatable infectious diseases. At the same time, foreign aid spending has historically been largely focused on addressing infectious disease epidemics. However with the growing burden of cancer in Africa and greater prioritization of NCDs on the UN agenda, there is greater need and opportunity than ever before to mobilize more resources for treating, and building capacity for treating, cancer in sub-Saharan Africa.

This World Cancer Day, while we can, and should, celebrate the remarkable progress made in addressing and prioritizing the disease, we should also reflect on the many people left out by these advances. Each step forward that the field takes is another step closer to a cure, but is also a step away from patients suffering from inadequate systems of care. 

Chris Carlson