Not all cancer patients die of cancer. Many die as a result of structural and socioeconomic inequities, a suite of circumstances that cut off access to care and/or insurance and lead to delays in diagnosis and treatment. These delays can lead to unnecessary deaths, especially in non-English speakers or people who are Black, Indigenous, Hispanic/Latino, or LGBTQ+.
One leading cancer research institute is working to fix this — through data. Ending health disparities and easing the burden of cancer are top research priorities at the Fred Hutchinson Cancer Research Center in Seattle. Both its Office of Community Outreach and Engagement (OCOE) and the Hutchinson Institute for Cancer Outcomes Research (HICOR) have amassed a wealth of data on U.S. cancer disparities.
- African Americans have the highest overall cancer death rate of any racial or ethnic group in the United States and have for 40 years.
- Black women have an almost 40 percent higher risk of dying from breast cancer than white women.
- Hispanic people with stomach cancer die at twice the rate of non-Hispanic people with this cancer.
- American Indian/Alaska Native people are more likely to get liver, stomach, kidney, lung, colorectal, and breast cancer than white people.
- People without insurance are 45 percent more likely to be diagnosed later and to die from their cancer than those with insurance. They’re also less likely to receive standard of care.
In a recent Congressional briefing, Dr. Christopher Li, epidemiologist and director of the Office of Diversity, Equity & Inclusion Faculty at Fred Hutch, said, “These disparities date to the very founding of our nation and persist to this day, and they are present along the full cancer continuum — in education about prevention, access to screening and delivery of lifesaving treatments.”
Measures of success — or not
His colleague, HICOR Director Dr. Scott Ramsey, knows that you can’t manage what you can’t measure.
Ramsey and his team track the challenges and barriers to quality care as a way to improve healthcare practice and patient outcomes. Thanks to this research, patient navigators now help those in treatment deal with language, transportation, childcare, and financial challenges.
But it will take policy change, HICOR’s primary goal, to make a true difference. “Social determinants like race, socioeconomic status, and neighborhood have a big impact on cancer patients’ outcomes,” Ramsey said. “Data from our own state show they can impact whether someone is diagnosed at a more advanced stage. And the later the stage, the harder it is to achieve a cure.”
One recent HICOR analysis showed people in the poorest neighborhoods were 60 percent more likely to be diagnosed with metastatic cancer, a stage that’s treatable, but not curable.
Policy change needed
Data drives policy, which is why Hutch researchers continue to drill down into cancer’s disparate numbers, using novel linkages between insurance claims and patient health records to determine where the inequities lie — and how they might be fixed.
They aren’t just looking outward, though. They’re also tracking the gaps and gains in diversity and equity within the center’s own faculty and staff and are actively working to recruit scientists, physicians, cancer care, and administrative help from a broad mix of countries, cultures, and ethnicities.
In July, the Hutch and its partners — UW Medicine, Seattle Cancer Care Alliance, and Seattle Children’s — announced they’re exploring a restructure of their longtime relationship. Improving access to pioneering research is just part of why they’re pursuing this change.
Health inequities won’t fix themselves. That’s why our scientists continue to shine a light on the country’s disturbing disparities and decry the life-and-death differences — in their clinics, at their lab benches and through the halls of Congress — to ensure changes in policies and practices that make cancer care equitable for all.
To learn more about the research behind ending disparities, visit fredhutch.org.