Identifying and Addressing Barriers to Timely Access to New Cancer Therapies

Dr. Nicole Rochester:

From your perspective, in your research examining disparities in breast cancer outcomes, you’ve shown how social and structural factors can influence both diagnosis and treatment options. What key factors continue to limit timely access to new therapies? And how can providers begin to close these gaps in care delivery? 

Dr. Demetria Smith-Graziani:

Well, it’s a really good question, and so much of it is due to the effects of structural racism. And that really affects patients before they even get to see me, the oncologist, right? There are people who, because of where they live, because of their income, because of lack of insurance, may not have timely access to even get their screening mammogram in the first place and so when you think about the time it takes just to get the mammogram, if that mammogram is abnormal, they then need to come back for a biopsy. So there’s another opportunity for delay, and then if that biopsy does show that the patient has breast cancer, then they need to get to that appointment to see an oncologist.

And so there are a lot of different steps along the way before they even arrive at an oncologist’s clinic, where they can have delays in their care. And so much of that access can be related to just proximity to a hospital or a clinic, which is a result of the effects of redlining. Access to public transportation and then the affordability of all of that, once we actually get that diagnosis, their ability to miss work, to take that time off of work to get childcare. All of that is going to affect someone’s ability to receive timely, guideline-directed care. 

Dr. Nicole Rochester:

Thank you so much for pointing that out. I think it’s important to make sure that the audience understands what redlining is, so would you mind just giving us a brief explanation of redlining so that they can appreciate how that disproportionately influences or impacts Black Americans?

Dr. Demetria Smith-Graziani:

Definitely. So, redlining is the historical practice in the United States, where, the government was, segregating, racially segregating, neighborhoods, and that happened in practice by, not approving mortgages for Black families, for Black homeowners in certain neighborhoods, and it was a very purposeful process and this created very segregated neighborhoods and in those neighborhoods that were more likely to be Black, there then were less resources available. We see that today in what we call food deserts, in that people have less access to grocery stores, to fresh foods, and you can think about all the other resources that might exist in a neighborhood that was redlined versus one that was not. We can sometimes measure that in what we call neighborhood deprivation, and the income, the average income of that neighborhood, and their access to various resources. 

Dr. Nicole Rochester:

Thank you, thank you so much for sharing that. Dr. May, we’re going to turn to you. Much of your work focuses on improving access to cancer prevention, and early detection in diverse populations. What patterns do you see when it comes to barriers in screening and treatment adoption for patients facing a colorectal cancer diagnosis, whether they be logistical, financial, communication-related, or all of the above?

Dr. Folasade  May:

Thank you for that question, and it’s really interesting to hear Dr. Smith-Graziani, because you realize that regardless of the cancer type you’re talking about, there are common themes when we talk about inequities, access to care, disparities, and we certainly see them in colorectal cancer. I like to point out that colorectal cancer is a unique disease, and the reality that we actually can prevent most people from developing it. It’s a disease that starts in the form of a polyp, that over time develops into a cancer. So we have years to intervene before that transition occurs. Unfortunately, we aren’t able to do that in many patients, and that’s why it remains the number two cancer killer in the United States, and unfortunately, it’s one of the fastest-growing cancers in young people, people under age 50. I still believe in the power of screening. We can screen and prevent most people from getting this disease, as I mentioned, but that does require people to have knowledge that screening is available. that we can prevent it, that we can early detect it, and that that saves lives. And a lot of patients don’t even have that information. They’ve heard about breast cancer, or even the NFL celebrates breast cancer by having people wear pink in the month of October and they’ve heard about prostate cancer, particularly males have a fear about that diagnosis. Women have been empowered to learn about pap smears and cervical cancer, but we don’t do it as well of a job in educating about colorectal cancer risk. People certainly don’t know that it’s the second most common cancer killer.

So, we have to improve knowledge about this disease among our patients. We also have to make sure that patients have access to screening. We’re very lucky in that there are several screening modalities for colorectal cancer, so we can screen with colonoscopy, but we even have screening tests that you can do in the comfort of your own home. These are stool-based tests. And we need to just make sure that patients know that they have an opportunity to pick between a colonoscopy, which is more invasive and which may have some stigma attached. Versus doing an at-home stool test, which I think a lot of patients find more convenient. So, empowering your patients with knowledge about the importance of screening, and also screening options, and making sure that all patients, regardless of background, regardless of those social determinants that we just heard about, have access to a doctor who can order these tests and provide follow-up care.

Dr. Nicole Rochester:

Wonderful. Thank you, Dr. May. There definitely are similarities, as you stated, really, between all types of cancer.