Hospitals serving underserved groups less likely to have cancer-related services
Key takeaways:
- Hospitals serving a high percentage of racial and ethnic minorities are less likely to offer all core services for cancer care.
- Researchers found such gaps in cancer care equity are likely due to less funding.
Hospitals that serve a high volume of Black and Hispanic patients are less likely to offer advanced medical equipment and critical services shown to boost the quality and effectiveness of cancer care, study results showed.
The data published in JAMA Oncology highlight a clear and immediate need to ensure accessibility across diverse health care facilities to secure equitable care for all patients diagnosed with cancer, according to researchers.
“Racial disparities in cancer outcomes are well documented and something we’ve seen play out repeatedly in clinical practice,” Gracie Himmelstein, MD, PhD, a resident physician in the department of medicine at David Geffen School of Medicine at UCLA, told Healio.
“Hospitals serving many Black and Hispanic can’t do their job without adequate financial and physical resources,” she added. “Our fragmented hospital payment system pays lower fees for the care of Medicaid-insured or uninsured patients. This unjustly compromises cancer services, and potentially cancer outcomes for poor and minority patients, and is just one of the myriad ways that structural racism plays out in our health care system.”
Background and methodology
The mechanisms driving racial and ethnic disparities in cancer are not fully understood, according to Himmelstein.
“Cancer care is often resource intensive, and one prerequisite for providing high- quality cancer care is having the resources to do so,” she said. “We were curious about the distribution of cancer care resources and how accessible these resources might be to people of different demographic backgrounds.”
Due to known disparities in cancer care, researchers examined whether hospitals serving disproportionately high numbers of Black and/or Hispanic patients are less likely to offer cancer-related services than other hospitals.
They analyzed the availability of 34 cancer-related services at 432 hospitals serving primarily Black patients, 432 hospitals serving primarily Hispanic patients (62 of which also served Black patients) and 3,509 other hospitals using facility-reported data from the 2020 American Hospital Association Survey.
Results
Hospitals serving primarily racial and ethnic minority groups had significantly lower odds of offering all core services (eg, oncology: OR = 0.51), diagnostic radiology services (eg, PET: OR = 0.73), radiotherapy modalities, various other treatment modalities (eg, interventional radiology: OR = 0.76), and other cancer-related support services (eg, support groups: OR = 0.57).
Despite four of the cancer-related services being more frequently available at hospitals serving racial and ethnic minority groups (eg, bone marrow transplantion), differences did not appear significant.
Next steps
The differences in available resources clearly create a disparity in timely and appropriate screening, treatment planning, cancer care delivery and outcomes, according to researchers, highlighting a need for more work to understand the reasoning behind gaps in equity of cancer care.
“All patients deserve access to high-quality cancer care. Equalization of resources for care, which would likely require an overhaul of the health insurance system that reimburses for care of patients at different rates, would be an important step towards achieving that,” Himmelstein told Healio. “The next step would be to tie these differences in resources to cancer care outcomes by looking at the care received by individual patients. It feels pretty self-evident that not having access to the resources to receive gold-standard cancer care would be bad for outcomes, but it would be interesting to look is this plays out in the data.”
For more information:
Gracie Himmelstein, MD, PhD, can be reached at Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095; email: ghimmelstein@mednet.ucla.edu.
References:
- Himmelstein G, et al. JAMA Oncol. 2023;doi:10.1001/jamaoncol.2023.4952.
- Hospitals serving large Black, Latino populations have fewer resources for cancer care (press release). Available at: https://www.uclahealth.org/news/hospitals-serving-large-black-latino-populations-have-fewer. Published Nov. 16, 2023. Accessed Nov. 21, 2023.
Collapse