Commentary
Reducing Inequities in Cancer Care The Role of Cancer Registries Rob Sanson-Fisher, PhD1; Mariko Carey, DPsych2; Lisa Mackenzie, BPsych3; David Hill, PhD4; Sharon Campbell, PhD5; and Donna Turner, PhD6,7
Despite advances in cancer care, recommended medical treatments1 and psychosocial interventions2 are not provided to all patients who are likely to benefit. The gap between best-evidence practice and existing care means cancer patients continue to receive different levels of care, resulting in differences in important outcomes.3 This article proposes that central (population-based) cancer registries could play a role in enhancing the delivery of equitable cancer control services to the populations they serve. This could include assessment of quality and variations in care, identification of cancer patients to support the delivery of cancer control services to improve postdisease surveillance, screening of at-risk relatives of cancer patients, and identification of candidates for services designed to improve psychosocial well-being. Research has identified factors that are consistently associated with inequitable access to cancer services. Patient factors such as age, socioeconomic status, health insurance status, race, language and culture, attitudes, and family composition may all influence access to care.1 For example, socioeconomic status may influence noncompliance with treatment because of patients being unable to afford prescriptions.4 Lack of health insurance is associated with reduced participation in cancer screening and limited uptake of some cancer treatments.5 Age also impacts care; older colorectal cancer patients are less likely to receive adjuvant therapy after surgery for colorectal cancer,5 and elderly cancer patients with greater cognitive impairment receive poorer treatment for breast and colon cancers compared with those with less cognitive impairment.6 Racial and cultural disparities are also demonstrated worldwide. In Canada, screening rates for both breast and cervical cancer among First Nations women are relatively low.7 Indigenous Australians are more likely to be diagnosed with advanced stage cancer than nonindigenous Australians.8 Compared with white Americans, African Americans are less likely to receive radiotherapy after breast-conserving surgery, are less frequently treated for cervical cancer, and receive less aggressive treatment of colorectal cancer.3 Geographic location may also influence access to best practice cancer care. Reduced access to healthcare because of limited transport and shortage of healthcare providers may contribute to poorer health in isolated
Corresponding author: Rob Sanson-Fisher, PhD, University of Newcastle, School of Medicine and Public Health, Room 267 David Maddison Building, Cnr King and Watt Streets, Newcastle, NSW 2300, Australia; Fax: (011) 61 2 4913 8779;
[email protected] 1 Priority Research Centre for Health Behaviour, Faculty of Health, School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia; 2Centre for Behavioural Research in Cancer, The Cancer Council Victoria, Carlton, Victoria, Australia; 3Priority Research Centre for Health Behaviour, University of Newcastle, Newcastle, New South Wales, Australia; 4Cancer Council Victoria, Carlton, Victoria, Australia; 5Evaluation Studies, Centre for Behavioural Research and Program Evaluation, University of Waterloo, Waterloo, Ontario, Canada; 6Population Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada; 7Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
Received: August 25, 2008; Revised: December 11, 2008; Accepted: December 17, 2008 C 2009 American Cancer Society Published online: May 28, 2009 V
DOI: 10.1002/cncr.24415, www.interscience.wiley.com
Cancer
August 15, 2009
3597
Commentary
communities.9 There are disparities in cancer treatment in rural, regional, and remote Australia, compared with metropolitan regions.8 Increasing remoteness has been associated with worse cancer survival in Australia,9 the United States,10 and the United Kingdom.11 In Canada, palliative patients who live 200 km away from a treatment center are less likely to have a radiation oncology consultation than those who live
