Tackling Healthcare Disparities for Urothelial Cancer

Healthy People 2030 defines health disparities as “a particular type of health difference that is closely linked with social, economic and/or environmental disadvantage.” Reducing disparities has come into particular focus because of the COVID-19 pandemic and its disproportionate effects.

Shaakir Hasan, DO, and his colleagues recently conducted a study that evaluated social disparities in the diagnosis and management of bladder cancer using the National Cancer Database to stratify cases of urothelial carcinoma by the National Comprehensive Cancer Network guidelines. They presented their results as the American Society of Clinical Oncology’s 2021 Genitourinary Cancers Symposium. There were 331,714 (76.3%) early, 72,154 (16.6%) muscle invasive, 15,579 (3.6%) locally advanced, and 15,161 (3.5%) metastatic cases identified. The study revealed that the two strongest predictors of diagnosis made at later stages were being Black and of the female gender

Additionally, Black patients and individuals of the female gender also had reduced survival rates. Other factors that predicted later diagnosis included older age, Medicaid insurance and residing in lower-income/less educated/ more rural areas. It is critical to take an interdisciplinary team approach to managing patients with urothelial cancer that includes physicians, nurses, pharmacists, and social workers. This approach should be integrated with a patient-centered model of care that involves shared decision-making to ensure that individuals are empowered to be involved in their disease management.

The Institute of Medicine (IOM) evaluated the differences in the types and quality of healthcare received by U.S. racial and ethnic minorities and nonminorities. The IOM report revealed that there are racial and ethnic disparities in healthcare, and they are associated with worse health outcomes. It is important to eliminate these disparities through an interdisciplinary approach that involves increasing awareness among the public, healthcare providers and other key stakeholders.

Other recommendations include promoting consistent and equitable care using evidence-based clinical practice guidelines, structure payment systems to ensure there is an adequate supply of services to minority patients, support the use of interpretation services, and implement patient education programs to enhance knowledge of how to access care and participate in treatment decisions.