Patel Manali I, Snyder Richard, Brawley Otis
Stanford University School of Medicine, Stanford, CA.
VA Palo Alto Health Care System, Palo Alto, CA.
Am Soc Clin Oncol Educ Book. 2020 Mar;40:1-9. doi: 10.1200/EDBK_279959.
Disparities in cancer have been documented for decades and continue to persist despite clinical advancements in cancer prevention, detection, and treatment. Disparate cancer outcomes continue to affect many populations in the United States and globally, including racial and ethnic minorities, populations with low income and education, and residents of rural areas or low socioeconomic neighborhoods, among others. Addressing cancer disparities requires approaches that are multilevel. Addressing social determinants of health, such as removing obstacles to health (e.g., poverty, discrimination, access to housing and education, jobs with fair pay, and health care) can reduce cancer disparities. However, to achieve cancer health equity, multilevel approaches are required to ensure that access to high-quality cancer care and equitable receipt of evidence-based services can reduce cancer disparities. Policy, health system interventions, and innovative delivery and health care coverage approaches by private and public payers, employer-based payers, and labor union organizations can assist in ensuring access to and receipt of high-quality cancer care while addressing the high costs of care delivery. Partnerships among patients, caregivers, employers, health care providers, and health care payers can make impactful changes in the way in which cancer care is delivered and, in turn, can assist in reducing cancer disparities.
几十年来，癌症方面的差异一直有记录，尽管在癌症预防、检测和治疗方面取得了临床进展，但这种差异仍持续存在。不同的癌症结局继续影响着美国乃至全球的许多人群，包括少数种族和族裔、低收入和低教育水平人群、农村地区居民或社会经济地位较低社区的居民等等。解决癌症差异问题需要采取多层次的方法。解决健康的社会决定因素，比如消除健康障碍（例如贫困、歧视、住房和教育机会、公平薪酬的工作以及医疗保健），可以减少癌症差异。然而，为了实现癌症健康公平，需要采取多层次方法来确保获得高质量癌症护理以及公平获得循证服务能够减少癌症差异。政策、卫生系统干预措施以及私营和公共支付方、雇主支付方和工会组织采用的创新服务提供与医疗保健覆盖方法，可以在解决护理提供高成本问题的同时，帮助确保获得并接受高质量癌症护理。患者、护理人员、雇主、医疗保健提供者和医疗保健支付方之间的伙伴关系，可以在癌症护理提供方式上做出有影响力的改变，进而有助于减少癌症差异。
