Sidney Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia, PA, United States.
Emory University School of Medicine, Winship Cancer Institute, Atlanta, GA, United States.
J Natl Med Assoc. 2022 Jun;114(3):236-250. doi: 10.1016/j.jnma.2022.01.004. Epub 2022 Mar 21.
A need exists to examine racial disparities in the healthcare arena and the impact on patients with cancer. Despite ongoing efforts to increase equity in primary healthcare access, racial and socioeconomic disparities persist, thus contributing to disproportionate treatment outcomes and survivorship among minority and low-income patients. Such disparities have been revealed in treatment cohorts of patients with multiple forms of cancer, including breast, cervical, ovarian, endometrial, prostate, lung, colorectal, gastrointestinal, and hepatocellular, and have been attributed to a range of co-occurring behavioral, social determinants of health, underlying genetic factors, as well as access to educational opportunities that limit the quality of informed healthcare. These various interrelated factors widen cancer healthcare disparities synergistically throughout underserved communities, and their influence has been amplified by the coronavirus disease 2019 (COVID-19) pandemic. Fundamentally, a lack of basic and clinical research exists that fails to adequately reflect diversity and minority involvement in drug development. Although overcoming the obstacles responsible for chronic treatment disparities is a formidable task, promising means of achieving more uniform quality healthcare are becoming more clearly elucidated. To reduce disease progression, increase overall survival, and improve the health of vulnerable populations, it is necessary to identify and fully disclose environmental, biological, and ancestral factors that impact the risk for cancer; heal historical fractures within communities; and increase participation of racial and ethnic minorities in screening efforts and research studies. This requires developing a system of justice and trust based on specific, solution-oriented grassroots community efforts working in tandem with medical and pharmaceutical leaders. By fully exploring and pinpointing the underlying causes of healthcare disparities, it should be possible to define strategies and interventions most likely to transform cancer care. The ultimate goal is understanding individual, cultural, and biological vulnerabilities, including environmental and epigenetic liabilities, to optimize cancer prevention, diagnosis, and treatment.
需要研究医疗保健领域的种族差异及其对癌症患者的影响。尽管在增加初级保健获取方面做出了持续努力，但种族和社会经济差异仍然存在，从而导致少数族裔和低收入患者的治疗结果和生存情况不成比例。这种差异在多种癌症患者的治疗队列中都有体现，包括乳腺癌、宫颈癌、卵巢癌、子宫内膜癌、前列腺癌、肺癌、结直肠癌、胃肠道癌和肝癌，并且归因于一系列同时存在的行为、健康的社会决定因素、潜在的遗传因素，以及获得限制知情保健质量的教育机会。这些相互关联的因素在服务不足的社区中协同扩大癌症保健差距，并且它们的影响因 2019 年冠状病毒病（COVID-19）大流行而加剧。从根本上讲，缺乏基本和临床研究，无法充分反映药物开发中的多样性和少数族裔参与。尽管克服导致慢性治疗差异的障碍是一项艰巨的任务，但实现更统一的优质医疗保健的有希望的方法正在变得更加清晰。为了减缓疾病进展、提高总体生存率并改善弱势群体的健康，有必要识别和充分披露影响癌症风险的环境、生物和祖先因素；弥合社区内的历史裂痕；并增加少数族裔参与筛选工作和研究的人数。这需要建立一个基于具体、以解决方案为导向的基层社区努力与医疗和制药领导者并肩工作的正义和信任体系。通过充分探索和确定医疗保健差异的根本原因，应该有可能定义最有可能改变癌症护理的策略和干预措施。最终目标是了解个人、文化和生物学脆弱性，包括环境和表观遗传缺陷，以优化癌症预防、诊断和治疗。
