Reducing inequities in cancer care

Despite advances in cancer care, recommended medical treatments and psychosocial interventions 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. 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. For example, socioeconomic status may influence noncompliance with treatment because of patients being unable to afford prescriptions. Lack of health insurance is associated with reduced participation in cancer screening and limited uptake of some cancer treatments. Age also impacts care; older colorectal cancer patients are less likely to receive adjuvant therapy after surgery for colorectal cancer, and elderly cancer patients with greater cognitive impairment receive poorer treatment for breast and colon cancers compared with those with less cognitive impairment. 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. Indigenous Australians are more likely to be diagnosed with advanced stage cancer than nonindigenous Australians. 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. 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