The Invisible People With Cancer Are Least Likely to Get Quality Care

Group Issues Agenda-Setting Report to Identify, Help Americans Who Are

Falling Through the Cracks

Apr 03, 2008, 01:00 ET from Intercultural Cancer Council

    WASHINGTON, April 3, 2008 /PRNewswire-USNewswire/ -- With mounting
 evidence that many Americans remain the invisible people with cancer who
 don't get regular screening examinations, smoke at higher rates, are
 frequently diagnosed after their cancer has spread and, therefore, die more
 frequently and more quickly from this disease, the Intercultural Cancer
 Council Caucus (ICCC) today issued a 12-step action plan outlining how the
 Administration and the U.S. Congress can begin to help those cancer
 patients who are falling through the cracks of the healthcare system.
     In conjunction with ICC's 11th Biennial Symposium on Minorities, the
 Medically Underserved, & Cancer held in Washington, DC, the ICC Caucus
 released a new report -- From Awareness to Action: A Renewed Call to
 Eliminate the Unequal Burden of Cancer -- that provides realistic goals for
 helping racial and ethnic minorities, those living in rural areas, the
 elderly and the poor who remain at greatest risk for developing and dying
 from cancer. Issued as a nationwide call to action, the report states that
 unless more is done to address the unequal burden of cancer faced by ethnic
 minorities, the elderly and the poor, "disparities in cancer care will only
 increase over the next half-century."
     The new report, designed to provide the most up-to-date information
 about disparities in cancer rates and death among the nation's medically
 underserved, finds that certain Americans remain largely invisible to the
 healthcare system and are the least likely to have access to quality cancer
 care at all points in the process -- from screenings and diagnosis to
 access to state-of-the-art cancer therapies and end-of-life palliative
 care. Specifically, the report reveals a widening gap in cancer care among
 American Indians and Alaskan Natives and those living in the out islands of
 Hawaii, Guam, Samoa and other Pacific Islands, who now have cancer
 incidence and death rates similar to third world countries. The report also
 finds that many poor whites have cancer diagnosis rates as high as or
 higher than those for ethnic minority groups most affected by the disease.
     "As the nation considers reforms to the health care system, no workable
 agenda can ignore the pressing issue of combating disparities in cancer
 care," said Lovell A. Jones, Ph.D., co-founder of the ICC. "An intensified
 focus on providing quality cancer care for all Americans is essential to
 winning the war against cancer."
     Looking specifically at those populations that are the least likely to
 benefit from the nation's overall decrease in cancer deaths, the report
 finds the unequal burden is highest among African Americans, where cancer
 deaths are 35 percent higher in black men and 18 percent higher in African
 American women than in the general population. However, Native Hawaiians
 now have the second highest overall rate of cancer in the U.S., the highest
 death rates for stomach cancer, and the highest incidence and death rates
 for endometrial cancers. Moreover, American Samoans have a higher relative
 risk for cancers of the nasopharynx (especially men), stomach, liver, lung
 (especially men), uterus, thyroid and blood while all the Pacific
 jurisdictions (Republic of Palau, Guam, American Samoa, Republic of the
 Marshall Islands and the Commonwealth of the Northern Marianas) except the
 Federated States of Micronesia list cancer as one of the top three causes
 of death.
     Among the 4.3 million American Indians and Alaska Natives now living in
 over 560 federally recognized tribes and over 100 state-recognized tribes,
 the report finds that cancer rates, which were previously reported to be
 lower in these individuals, have been increasing in the past 20 years. As a
 result, cancer is now the second leading cause of death in American Indians
 and Alaska Natives and incidence and death rates from kidney cancer in
 these populations is higher than for any other racial or ethnic population.
 Further, lung cancer is now the most common type of cancer death in eight
 of the nine Indian Health Service (IHS) Areas.
     Also classified as the invisible people with cancer are the rural, poor
 whites living in regions like the Appalachian Mountains where the economic
 status of 78 counties have been designated as "distressed" and another 78
 counties are considered "at risk." Here, the report finds cancer incidence
 rates are higher in Appalachia than the rest of the U.S. and the rates for
 lung, colorectal, and other tobacco-related cancers are particularly high.
 Further, cervical cancer death rates for the Appalachian regions of three
 states (Kentucky, Ohio, and West Virginia) are much greater than the
 overall U.S. cervical cancer death rate.
     According to the ICCC's assessment, poverty is the major factor
 contributing to higher cancer incidence and mortality rates among the
 medically underserved. The report finds that smoking is especially
 prevalent among those who are poor (34.7 percent) and nearly poor (34.2
 percent). Further, the report finds that although smoking rates between
 African Americans (25.9 percent) and whites (25.9 percent) are not
 significantly different, black Americans are more likely to suffer
 smoking-related mortality, due in part to the increased smoking of menthol
 cigarettes, which are more addictive.
     What is equally disturbing, according to the new report, is that
 minorities and the poor are less likely to be screened for cancer and,
 therefore, are more likely to have late-stage cancer when the disease is
 diagnosed. Here, the review finds that only 66 percent of American
 Indian/Alaska Native women 60 years or older have ever had a breast exam
 and only 36.5 percent of Hispanic women aged 50 plus have regular screening
 mammograms. At the same time, the report reveals that Asian American,
 Hispanic, low income and less educated women are less likely than the
 general population to get Pap smears, greatly increasing their risk of
 being diagnosed with invasive cervical cancer.
     According to the report, a major factor behind these disparities is the
 prevailing societal and institutional racism. While overt racism is seldom
 practiced or observed in today's medical setting, the report finds that a
 "deep-rooted institutional memory of racism" permeates the nation's health
 policies and practices, as well as in the personal attitudes and
 perceptions of health care providers and researchers.
     Also addressed in the report is access to pain management and
 palliative care at the end of life, two areas where disparities in cancer
 care are significant. Specifically, the ICCC review finds that metastatic
 cancer patients at centers that treat predominantly minorities are three
 times more likely than those treated elsewhere to have inadequate pain
 management. The report further shows that research in cultural
 quality-of-life issues, including pain symptom management, has been
 neglected. Most pain literature acknowledges that culture influences cancer
 pain management, yet little empirical work has been conducted in this area.
     To begin to change these statistics, the ICC Caucus has created a
 12-point action plan to provide vulnerable populations with greater access
 to programs that will prevent, detect and treat cancer at its earliest
 stages while supporting these individuals through and beyond treatment.
 Specifically, the organization is calling on the Administration and the
 U.S. Congress to take immediate action in these areas:
     1. Fully implement and fund the recommendations of the Trans-DHHS
 Cancer Health Disparities Progress Review Group, Making Cancer Health
 Disparities History. This report contains 14 recommendations that will
 mobilize the government's available resources to eliminate cancer
     2. Fully fund the Patient Navigator, Outreach and Chronic Disease
 Prevention Act of 2005, which was signed into law with strong bipartisan
 support from Congress, but has yet to be funded and has a sunset looming
 over its ability to be implemented.
     3. Enhance the collection of data that will better describe racial,
 ethnic and socioeconomic diversity in cancer care in the U.S.
     4. Increase federal funding for government programs that provide
 greater access to cancer screening programs.
     5. Acknowledge and then move quickly to fully address and monitor
 institutionalized racism as a major factor in the excess burden of cancer
 borne by our nation's minority and medically underserved communities.
     6. Make tobacco control a priority concern, backed by new federal and
 state initiatives that are specifically targeted to minorities and the
 medically underserved.
     7. Eliminate the barriers to more effective pain management and
 palliative care for minorities and the medically underserved.
     8. Increase the level of knowledge about cancer survivorship among the
 medically underserved.
     9. Restore Medicare reimbursement for cancer treatment and cancer care
 in all settings this year.
     10. Immediately implement and increase the funding for the Medicare
 demonstration project providing access to oral chemotherapy drugs.
     11. Enact the Patients' Bill of Rights to provide strong comprehensive
 protection to all cancer patients in managed care plans.
     12. Achieve universal health insurance and establish a schedule to
 reach this goal by 2010.
     "Creating a public policy agenda that focuses on eliminating the
 disparities in cancer care must occur immediately if we are going to
 eliminate the unequal burden of cancer experienced by minorities and the
 poor," concluded Jennie R. Cook, President of the ICC Caucus. "The action
 plan advocated by the ICC Caucus will make the difference in the lives of
 many Americans."
     The Intercultural Cancer Council Caucus is an advocacy organization
 whose mission is to advance policies, programs, partnerships and research
 to eliminate the unequal burden of cancer among racial and ethnic
 minorities and medically underserved populations.

SOURCE Intercultural Cancer Council