Study reveals 'urgent need' to improve health equity for older adults with cancer
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Research has insufficiently addressed the intersection of aging, health disparities and cancer outcomes among older adults, according to study findings published in Journal of the American Geriatrics Society.
Nikesha Gilmore, PhD — assistant professor in University of Rochester Medical Center’s division of supportive care in cancer and member of Wilmot Cancer Institute’s cancer prevention and control research program — and colleagues reviewed research articles published between January 2016 and September 2023.
Studies included in the analysis evaluated treatment, survivorship and mortality disparities among older cancer survivors who have historically experienced discrimination or exclusion, such as racial/ethnic minoritized individuals; communities with social, economic and/or environmental disadvantages; physical or other disabilities; sexual or gender minorities; and disadvantage due to geographic location (eg, rurality).
Fifty-nine articles met the inclusion criteria. Most focused on racial/ethnic disparities (n = 44) or socioeconomic disparities (n = 25). Ten studies evaluated geographic disparities, and none assessed disparities in outcomes on the basis of disabilities or sexual/gender identity.
“In the future, our hope is that we can develop interventions at all levels — from the policy level down to the individual level — to reduce many of the disparities we’re seeing,” Gilmore told Healio. “We need more research developing and testing equitable interventions so that we can start seeing a reduction in disparities so, ultimately, all older adults with cancer can have equitable outcomes not based on their minoritized status.”
Healio spoke with Gilmore spoke about the findings and the next steps in research.
Healio: What motivated you to conduct this study?
Gilmore: We wanted to systematically search the literature to understand what has been done and where the gaps may be. Journal of the American Geriatrics Society commissioned us to do this work as part of a series aligned with its mission to achieve equity in health care by understanding the intersection of agism with other forms of bias and discrimination, such as ableism, classism, homophobia, racism, sexism or xenophobia.
Healio: How did you conduct the study?
Gilmore: This was a scoping review, and we followed the PRISMA guidelines. We conducted the research by searching a variety of databases — systematically pulling in all the papers that were published using the search criteria. We were looking for any papers that examined disparities among older cancer survivors due to race, ethnicity, socioeconomic status, geographic location, social and gender minority status, and disabilities. We were trying to throw a wide net to capture anything that was known about this topic in older adults with cancer.
The outcome needed to be a cancer treatment-related outcome, and the papers had to address our research question, which was about disparities among older adults. If the papers didn’t include older adults with cancer, we excluded them.
Healio: What did you find?
Gilmore: There hasn’t been a lot of work done as far as disparities among older adults with cancer. Most of the work we found looks at disparities in terms of racial backgrounds, and then there was some looking at geographic work and socioeconomic status.
What we found in the literature, quite profoundly, was that there was no research within the time frame of our study that looked at patients from sexual or gender minority backgrounds.
The majority of the work we did find was looking at larger datasets, specifically the Medicare CMS database, where researchers were looking at these outcomes retrospectively as opposed to prospectively. Additionally, very little of the work looked at interventions to improve equity.
Healio: What are the potential implications of these findings?
Gilmore: This study reveals an urgent need for us to start thinking about how we can move the needle to improve health equity for all adults with cancer. Most of my work is about improving equity for adults with cancer, so I am evaluating and developing interventions to improve outcomes for older individuals with cancer who are from marginalized backgrounds. I hope those results will be coming out in the future. I definitely am committed to looking at ways we can develop and evaluate these interventions to improve the care of all older adults with cancer.
Reference:
For more information:
Nikesha Gilmore, PhD, can be reached at nikesha_gilmore@urmc.edu.
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