University of Miami Miller School of Medicine & Sylvester Comprehensive Cancer Center, Miami, Florida, USA.
Georgetown University Lombardi Comprehensive Cancer Center, Washington, District of Columbia, USA.
Oncologist. 2021 Jun;26(6):443-452. doi: 10.1002/onco.13729. Epub 2021 Mar 10.
Hispanic and Latino (HL) cancer survivors are at a critical disadvantage compared with non-Hispanic White (NHW) patients regarding sociodemographic adversities and access to equitable treatment options. By 2030, there will be about four million HL cancer survivors in the U.S., representing nearly 20% of survivors in this country. Hispanics and Latinos are subjected to significant challenges in accessing and receiving equitable care relative to NHWs. Hispanics and Latinos also experience lower rates of health insurance and financial resources, limiting health care options. These disparities often originate from disparate social determinants of health, including lower funding for education and school programs, greater neighborhood stressors and violence, lower access to healthy and affordable food, and greater barriers to community health and exercise opportunities. Even among HL cancer survivors with proper access to health care, they experience disparate treatment options, including low inclusion in clinical trials and/or access to experimental therapies. A solution to these barriers necessitates complex and systemic changes that involve, for example, investing in public health programs, increasing the diversity and cultural awareness of the medical workforce, and promoting research opportunities such as clinical trials that are inclusive of HLs. Only through meaningful reform will equitable cancer care be available for all in the U.S. regardless of racial and/or ethnic background. This article reviews some of the critical social determinants of health and biases relevant to HL cancer survivors and provides recommendations for achieving cancer health equity. IMPLICATIONS FOR PRACTICE: Hispanics and Latinos experience a significant and often disproportionate cancer-related burden compared with non-Hispanic and Latino White individuals and other racial and ethnic groups. Meaningful reform to achieve health equity in oncology should focus on approaches to gaining trust among diverse patients, cultural and community sensitivity and engagement in oncology care and research, diversifying the workforce, and improving inclusion in clinical trial participation. Taken together, these recommendations can lead to exemplary and equitable care for all patients.
与非西班牙裔白人（NHW）患者相比，西班牙裔和拉丁裔（HL）癌症幸存者在社会人口逆境和获得公平治疗选择方面处于严重劣势。到 2030 年，美国将有大约 400 万 HL 癌症幸存者，占该国幸存者的近 20%。与 NHW 相比，西班牙裔和拉丁裔在获得和接受公平护理方面面临重大挑战。西班牙裔和拉丁裔的医疗保险和财政资源也较少，限制了他们的医疗保健选择。这些差异通常源于不同的健康社会决定因素，包括教育和学校计划资金不足、社区压力和暴力更大、获得健康和负担得起的食物的机会较少，以及社区健康和锻炼机会的障碍更大。即使是在能够获得适当医疗保健的 HL 癌症幸存者中，他们也面临着不同的治疗选择，包括临床试验参与率低和/或获得实验疗法的机会有限。解决这些障碍需要进行复杂和系统的变革，例如投资公共卫生计划、增加医疗保健劳动力的多样性和文化意识，以及促进包括 HL 在内的临床试验等研究机会。只有通过有意义的改革，才能为美国所有人群提供公平的癌症护理，无论其种族和/或族裔背景如何。本文回顾了与 HL 癌症幸存者相关的一些关键健康社会决定因素和偏见，并为实现癌症健康公平提供了建议。对实践的意义：与非西班牙裔和拉丁裔白人个体以及其他种族和族裔群体相比，西班牙裔和拉丁裔经历着显著且往往不成比例的癌症相关负担。为了在肿瘤学领域实现健康公平，有意义的改革应侧重于获得不同患者信任的方法、在肿瘤学护理和研究中注重文化和社区敏感性和参与、使劳动力多样化以及提高临床试验参与度。这些建议加在一起，可以为所有患者提供卓越和公平的护理。
