50 Years Since the National Cancer Act: Equitable Access is the Next Frontier
In the early 1970s, only fifty percent of people diagnosed with cancer would live at least another five years. Patients did not have access to targeted therapies or immunotherapies and certainly nothing as innovative as the cell and gene therapies that are being developed today. Despite previous, intermittent breakthroughs, the national effort addressing rising cases lacked coordination, funding, and an infrastructure to support world-class research across the U.S.
Which is why, on December 23, 1971—a little over 50 years ago—Congress passed the National Cancer Act. The National Cancer Act sprang into action a country-wide commitment to address increasing cancer diagnoses. It established the National Cancer Institute’s Cancer Centers Program and expanded the National Clinical Trials Network.
Now, mortality rates for all cancers combined have dropped 27%. There’s more than 1,300 oncology medicines and vaccines in development—some of which even use a patient’s own cells—and treatments are more effective and present fewer side effects than ever. Yet, the proverbial “war on cancer” does not, should not, and cannot end here.
In the next era of cancer care, leaders across healthcare are laser-focused on advancing equitable access to care and reducing disparities for historically marginalized communities.
While cancer impacts individuals of every background in the U.S., some groups—due to social, environmental, economic, and geographic disadvantages—experience a disproportionate number of new cases and differences in treatment outcomes. This is often due to the increased likelihood of encountering a barrier that hinders or prevents access to the care they need.
For instance, individuals with lower health literacy levels, insufficient insurance, transportation needs are less likely to receive recommended screenings than those who don’t encounter these barriers. There’s also a greater chance that if diagnosed with cancer, it will be at a later stage than if it had been detected earlier. In addition, the impact of institutional racism on accessing care—such as biases (implicit or conscious) and mistrust in the healthcare system—also contributes to the disparities experienced by Black, Latinx, Indigenous, Asian and other marginalized communities. Moreover, a lack of racial diversity in oncology clinical trials also exacerbate disparities.
Not to mention, the COVID-19 pandemic has resulted in nearly 10 million missed cancer screenings in the U.S., deepening health disparities especially for Black, Latinx, and rural communities. To continue the progress of the last 50 years and address the deep disparities that exist within cancer care, institutions across healthcare must come together to collaborate with providers to help drive access to optimal cancer care.
One step is to expand and diversify clinical trial access and create research networks that bring together local, community oncology practices and streamline the patient recruitment process. Supporting practices and providing research opportunities they might not otherwise have will benefit under-resourced and underrepresented communities, who often don’t have a large academic research institution in their proximity.
In addition, social determinants of health, which vary from patient to patient, can impact an individual’s treatment plan and health outcome. Digital tools that can capture these data points and produce insights for physicians will pave the way for care plans that meet patients’ clinical, psychosocial, and financial needs. Furthermore, tracking social determinants of health at a practice-wide level gives oncologists a holistic understanding of their patient population and may unearth further insights that have implications for the care they provide.
One thing that patients and caregivers can do is research local, independent oncology practices in their area. Finding the right provider can be daunting, and the potential expense can be overwhelming to say the least. But patients should know that independent oncology practices have teams and resources—from social workers to help patients find treatment funding to offering advanced clinical trial opportunities—in place to help patients navigate this difficult time and deliver the best care possible. Patients are not alone in their communities.
We’ve made great progress on preventing and treating cancer over the past five decades, but what we accomplish in the next 50 years will depend not only on scientific and medical innovation but also intentional inclusion. It will continue to require coordination, collaboration, and a consistent focus on ensuring equitable access to quality care. Are we up to the challenge? We know so.