More Cancer Research Needs to Evaluate Health Disparities in Patients Aged 65 and Older
“The current body of research inadequately addresses the intersection of aging, health disparities, and cancer outcomes among older adults, highlighting the imperative for heightened attention, enhanced infrastructure, and collaborative efforts to fill this critical gap,” a team of expert investigators from across the United States reported in a scoping review (https://doi.org/10.1111/jgs.18881) published in the Journal of the American Geriatrics Society.
The investigators reviewed original research articles published from January 2016–September 2023 that evaluated racial, ethnic, social, socioeconomic, geographic, sexual, gender, and disability disparities in cancer treatment, survivorship, and mortality among patients aged 65 and older. Among the 59 studies included in their final review, they found that (https://doi.org/10.1111/jgs.18881):
- 44 studies looked at racial and ethnic disparities.
- 25 explored economic inequities.
- 10 reported geographic disparities.
- None investigated disabilities or sexual and gender disparities.
Additionally, only 16 of the studies looked at survivorship issues, and most of the research was descriptive, without any analysis of the potential underlying factors contributing to the disparities.
Across all of the categories, the researchers identified individual patient-level factors as the primary contributors to disparities. Although limited, some of the findings included (https://doi.org/10.1111/jgs.18881):
- Racial and ethnic disparities were influenced by biologic implications, health behaviors and coping strategies, insurance status, and treatment preferences.
- Socioeconomic disparities were influenced by financial distress, household income, poverty status, area-level poverty, education level, and marital status. “The results of these studies indicated that patients with higher socioeconomic status were associated with better survival among adult patients with cancer,” the researchers wrote.
- For geographic disparities, patients living in rural areas were less likely to receive guideline-appropriate care and had higher mortality rates. Several of the studies associated increased morality with reduced access to specialty providers.
The investigators paid particular attention to whether studies addressed structural and interpersonal biases, such as ageism and racism, that have downstream effects on health and cancer care, including cancer development, optimal treatment planning, access to quality cancer care, and survivorship outcomes. They reported that (https://doi.org/10.1111/jgs.18881) none of the studies included measures about the role of biases in cancer outcomes for patients aged 65 and older or interventions to reduce structural or individual biases that lead to disparities in cancer outcomes.
“Overall, this study indicates an urgent need to develop new approaches and infrastructure to support investigation into and develop strategies to remediate cancer disparities,” the researchers concluded (https://doi.org/10.1111/jgs.18881).
According to one of the evergreen statements in ONS’s 2024 research agenda (https://www.onfgivesback.org/funding-for-nurses/research/research-grant#:~:text=Chemotherapy%20Adherence%20%E2%80%93%20%24100%2C000-,2024%20updated%20ons%20research%20agenda,-*2024%20Updated%20ONS), “oncology nursing scientists are committed to equity, diversity, and inclusion in all oncology nursing research. All individuals across the cancer continuum, regardless of race, ethnicity, gender, or geography (rural/urban), must be considered in the design and conduct of oncology nursing research.”
From early-career to established, the Oncology Nursing Foundation supports oncology nurse scientists (https://www.onfgivesback.org/funding-nurses#:~:text=Flaherty%20Memorial%20Lectureship-,research,-We%20support%20research) at every level of their research career. Learn more about funding opportunities (https://www.onfgivesback.org/funding-for-nurses/research/research-grant) and the Oncology Nurse Scientist Research Intensive (https://www.onfgivesback.org/funding-for-nurses/research/oncology-nurse-scientist-intensive) Mentorship opportunity for newer nurse researchers.