Nearly everyone has been touched by cancer. For some of us it may be a family member, friend, or coworker. Others have experienced a heartbreaking diagnosis themselves. During the last few years, I helped my friend and hair stylist navigate the healthcare system after she found a lump in her breast.
The good news is that thanks to better screening and advancements in treatment, cancer deaths have decreased more than 30% over the past few decades. Diagnostic tools like mammograms and colonoscopies, as well as routine use of chemotherapy and radiation, have made a huge impact on recovery. In addition, over the years, the scientific community has developed a more in-depth understanding of many types of cancers, resulting in targeted treatments through personalized medicine.
However, these improvements are not universally experienced or evenly distributed. Stark racial disparities in cancer outcomes persist. Black Americans are 20% more likely to get colorectal cancer and 40% more likely to die from the disease. Data on prostate cancer shows the widest racial disparities, with Black men 2 times more likely to die from prostate cancer compared to White men. Breast cancer data is equally alarming: Black women have a lower incidence of breast cancer, but when they get it, their mortality rate is 41% higher than white women.
In communities like South LA, the disparities in cancer deaths are significant. For example, 60% of lung cancers are among Black residents, while they represent only 35% of the population.
Better access to cancer screening, diagnosis, and treatment is needed to help turn these disparities around.
Cancer screening saves lives. For some forms of breast cancer, a few weeks can mean the difference between an early or late-stage diagnosis.
Accurate diagnosis and up-to-date treatment for cancer require access to specialized providers, often involving multiple visits to treatment centers for daily radiation or weekly chemotherapy infusions.
South LA has 1,500 fewer doctors than more affluent communities our size, making it hard to get appointments for screening and treatment, particularly for a specialty like oncology. The providers are simply not there in the local community. The lack of providers and treatment centers near where people live means patients need to travel, which is a huge burden when they don’t feel well—and because of the distance, they often spend the entire day doing it.
We saw this with our patient James*, who received a prostate cancer diagnosis last year. He lives close to our hospital and has a urologist in our health system he’s grown to trust. His doctor recommended he start Lupron, a life-saving medication. However, James’s health plan sent him to a cancer treatment center located nine miles away. For our cancer patient, who has no car, nine miles might as well be 100. After extensive counsel from our urologist, James finally got treatment, but our doctor spent hours helping him navigate the healthcare system as he faced this diagnosis.
We frequently care for patients in our hospital who need urgent specialized cancer treatment. Still, we struggle to get them transferred to tertiary hospitals with specialized cancer treatment because they have the “wrong” insurance – they’re on Medi-Cal or uninsured.
There are several solutions needed to improve cancer screening and treatment in communities that too often go without.
First, raising Medi-Cal reimbursement rates would go a long way toward closing the large deficit of cancer providers and improving access to care in South LA. Right now, providers aren’t paid enough to establish practices here. But it shouldn’t matter where you live; your zip code should not determine your life expectancy. Everyone should have access to timely cancer diagnosis and quality treatment regardless of race, income, and geography.
Second, community hospitals like ours need partnerships with specialty cancer centers. These partnerships would allow us to transfer critically ill patients, helping them access the care they need before their conditions deteriorate and cause lasting harm. Cancer centers often decline transfers when they know a patient’s insurance is Medi-Cal; raising Medi-Cal rates would help fix this problem, too.
Ultimately, we would love to partner with a specialty cancer provider to offer outpatient cancer treatment for patients like James in our local community. This could be a win-win for cancer providers who need to enroll diverse patients in clinical trials of the latest treatments and for patients who would access cutting-edge treatments.
To begin to close the cancer care access gap for our patients, we’ve established a partnership with City of Hope. We’ve created a new role at MLK Community Healthcare to facilitate this partnership: a cancer care nurse manager. Cecilia brings expertise and compassion to this new role.
Cecilia’s job is to help our patients with cancer access treatment at a nearby City of Hope facility. She helps patients understand their treatment plans, coordinate with other providers, arrange transportation, support family members, and more. She helps patients manage the logistical challenges so they can focus on healing. This won’t close all of the gaps in access, but it is a step in the right direction.
Now, through advocacy for improvements in Medi-Cal, let’s help our communities gain better access to the cancer screening, diagnoses and treatments they need and deserve.
*Names changed for patient privacy.
