New HHS Secretary Becerra Says Increased Access and Reduced Disparities Are Agency Priorities
On March 22, 2021, Xavier Becerra, BA, JD, became the first Latino appointed as secretary of the U.S. Department of Health and Human Services (HHS), and announced the agency’s focus on ensuring affordable and accessible health care for every American.
CDC Builds a Powerful Plan to Confront Racism and Health
In the early 2000s, healthcare professionals began creating theoretical frameworks to better understand racial gaps in care. Two decades later, racial disparities remain across all aspects of cancer care, from clinical trials and screening to mortality rates and survivorship. Rochelle P. Walensky, MD, MPH, director of the Centers for Disease Control and Prevention (CDC), declared racism a serious public health threat. To put those words to action, the agency also unveiled Racism and Health, an online hub for CDC’s efforts and a catalyst for education and dialogue around the critical issue.
The Time Is Now to Address Racial Disparities in Oncology Symptom Science
Although cancer mortality in the United States has decreased in most populations, non-Whites still have a disproportionately higher risk, and recent events have raised awareness of racial healthcare disparities. During a session on April 29, 2021, for the ONS 46th Annual Congress™, Margaret Quinn Rosenzweig, PhD, FNP-BC, AOCNP®, FAAN, of the University of Pittsburgh School of Nursing, Susan G. Dorsey, PhD, RN, FAAN, of the University of Maryland School of Nursing, and Angela Starkweather, PhD, ACNP-BC, FAAN, FAANP, of the University of Connecticut School of Nursing and School of Medicine, explored the application of the symptom science model to address the needs of underrepresented patients.
How to Overcome Underrepresentation in Oncology Clinical Trials and Research Studies
For the findings to be usable, healthcare research clinical trials must accrue participants that accurately represent the general population to which the study applies. But that’s easier said than done. During a session on April 27, 2021, for the 46th Annual ONS Congress™, two oncology nurse scientists shared strategies that other researchers can use to overcome disparities in clinical trial study populations.
WHO Campaigns for Global COVID-19 Vaccine Equity
More than 800 million COVID-19 coronavirus vaccine doses have been administered worldwide. However, 54% of those have been in high-income countries, which contain only 19% of the world’s population, whereas lower-middle income countries have only 33% of the vaccines for their 81% of the population. Those disparities have serious implications and limit equal access to health care, including vaccinations. The World Health Organization (WHO) is campaigning to address vaccine inequity on a global scale.
Social and Economic Factors Have a Bigger Influence on Health Outcomes Than Clinical Care
Between 10%–20% of health outcomes are a direct result of clinical care, whereas 40% are attributed to social and economic factors such as education, employment, income, family and social support, and community safety, speakers said during a session for the 46th Annual ONS Congress™ on April 20, 2021. The remaining 40%–50% correlate with health behaviors, physical environment, and genes and biology, they said.
Research Validates Tools to Increase Screening in Communities of Color
Reduced adherence to recommended screening and prevention relates to a lack of knowledge and barriers like inadequate insurance, low engagement with primary care, time constraints, and misconceptions about risks of screening or their individual risk of developing cancer. We must do a better job of educating people about cancer screening and linking them to affordable or free services.
Biden’s American Rescue Plan Targets Social Determinants of Health and Other Disparities
The Biden administration’s American Rescue Plan (APR) is the largest, single piece of legislation focused on economics since Franklin D. Roosevelt proposed in his New Deal programs to pull the United States out of the Great Depression. Sweeping in scope, two of APR’s goals are to make health care accessible for all and to create formal plans for addressing racial disparities.
U.S. Rep. Underwood, RN, Introduces Climate and Health Protection Act
Climate change was a core issue throughout the Biden-Harris campaign trail, and many advocacy groups are clamoring for the new administration to keep its promises. Recognizing the link between environmental concerns and health care, U.S. Representative Lauren Underwood (D-IL) introduced a bill that addresses both topics.
HHS Releases National Strategic Plan to End HIV Epidemic
The two most recent administrations prioritized ending the HIV epidemic, which has claimed the lives of more than 700,000 Americans since the virus was first identified in the 1980s. To follow those initial efforts, the U.S. Department of Health and Human Services (HHS) released a strategic roadmap to end the HIV epidemic and reduce new HIV infections by 90% by 2030.
Lung Cancer Screening Guidelines to Reduce Disparities May Increase Them Instead—But Risk Model Can Help
The draft 2020 U.S. Preventive Services Task Force (USPSTF) lung cancer screening recommendations were intended to increase the number of high-risk minorities eligible for lifesaving tests. And they do, but not as much as USPSTF anticipated, still leaving gaps and disparities, researchers reported in the Journal of the National Cancer Institute. They created a risk model to augment the guidelines that eliminated the disparities for most racial groups.
Biden Addresses Health Care and Racial Disparities in Series of Executive Orders
Since taking office, President Joe Biden has made good on his campaign promises to change federal tone and action in response to Americans’ concerns about health care and racial equity. On January 28, 2021, Biden signed an executive order (EO) extending the timeline for more Americans to apply for and receive access to the Affordable Care Act, reiterating his commitment to the law known as Obamacare. Biden also signed an EO supporting women’s health by reinstating Title X protections.
U.S. Sees Another Record-Breaking Decrease in Cancer Deaths, but Disparities Remain
Cancer-related mortality fell by 2.4% from 2017–2018, the largest-ever one-year drop in cancer deaths and a continuation of the downward trend the United States has seen since 1991, the American Cancer Society (ACS) reported in Cancer Facts and Figures, 2021.
Mortality Rates After Cancer Surgery Decrease, but Racial Disparities Remain
During the past 10 years, mortality rates after cancer surgery have improved by 0.12%–0.14%, depending on race, researchers reported in study findings published in JAMA Network Open. However, the gap between outcomes for Black and White patients remains, they found.
How COVID-19 May Increase Access to and Reduce Disparities in Cancer Clinical Trials
To improve clinical trial availability, effectiveness, and diversity in the era of the COVID-19 coronavirus, National Cancer Institute (NCI)-funded clinical trials should adjust their design to increase use of telemedicine and remote informed consent, among other strategies, several NCI department leaders wrote in a commentary in the Journal of the National Cancer Institute.
Telegenetic Counseling Bridges Geographic Barriers and Minimizes Distress
Our 2009–2014 study, Bridging Geographic Barriers: Remote Cancer Genetics Counseling for Rural Women, also known as the REACH Project (Risk Education and Assessment for Cancer Heredity), was the first randomized, noninferiority trial of telephone-based BRCA1 and BRCA2 counseling and testing that used a population-based traceback approach to identify and counsel both rural and urban women who were at increased risk for hereditary breast and ovarian cancer but had not received genetic counseling or testing.
FDA Offers Guidance to Enhance Diversity in Clinical Trials
The COVID-19 coronavirus continues to smother the United States, and nationwide efforts to flatten the curve aren’t lowering cases or preventing deaths. U.S. Food and Drug Administration (FDA) Commissioner Stephen M. Hahn, MD, an oncologist by training and profession, addressed the actions needed to combat COVID-19. One in particular is ensuring that clinical trials accurately reflect diverse populations.
Winning Team Reduces Disparities to Biomarker Testing in First-Ever ONS Hackathon
The Oncology Nursing Society (ONS) launched its inaugural ONS Hackathon™ on November 9, 2020, a competition designed to identify innovative ways to address challenging issues in the delivery of quality cancer care. Meghan O. Coleman, DNP, CRNP, and Alison McDaniel, BSN, RN, OCN®’s winning project, Evidence-Based Quality Understanding in Pathology, provided ways to solve the problem of unequal access to biomarker and other genetic and genomic testing.
Research Shows That Telehealth Has the Power to Meet the Needs of Vulnerable Communities
Telehealth resources have been present in the United States for several decades. Traditionally, clinicians used telehealth to help rural populations with limited access to care. However, telehealth innovations expand beyond home care coordination. We can use technology to reach even the most remote and vulnerable patients.
New NINR Director Celebrates Health Equity and Diverse Nursing Roles
Patients throughout the United States still face persistent inequities across the healthcare continuum because of social determinants of health and inequity in research, Shannon N. Zenk, PhD, MPH, RN, FAAN, director of the National Institute of Nursing Research (NINR) recognized.
Achieving Diversity and Inclusion in Nursing Requires a Closer Look at the Profession’s Structure
Does lack of inclusion in areas that are important to us affect how we see ourselves overall? Can someone amplify their voice without being represented in an authority position? Should leadership reflect the population that it’s leading? More and more medical organizations are publishing formal and informal position statements on diversity and inclusion, which is a great start, but the next logical step is bringing those beliefs and concepts to our institutions and communities. Here are some of the issues and the ways that any nurse can take action.
Nurses Have a Critical Role in Responding to COVID-19, NAM Says
Nursing’s role in health equity, public health emergencies, and COVID-19 is a critical issue for updates to its Future of Nursing 2020–2030 report study, the National Academy of Medicine (NAM) said during a webinar on August 20, 2020, that sought public input on nurses’ roles in responding to the COVID-19 coronavirus pandemic.
FCC and USDA Partner for Rural Telehealth Initiative
Rural Americans are more likely to have a fatal cancer diagnosis and face additional concerns like fewer hospitals and physicians in a “one-size-fits-all” healthcare system. To address the disparities, the Federal Communications Commission (FCC) partnered with the U.S. Department of Agriculture (USDA) to form the Rural Telehealth Initiative.
We Must Work to Achieve Health Equity in Cancer Research
The National Institutes of Health Revitalization Act of 1993 mandated appropriate inclusion of minorities in all NIH-funded research. Yet more than 20 years later, vast disparities still exist in cancer research, researchers reported in a session for the inaugural ONS Bridge™ virtual conference.
Nurses Present Patient-Centered Research on Survivorship and Health Disparities
Distress, uncertainty, and barriers to care are common experiences for patients with cancer and survivors. Yingzi Zhang, PhD, RN, of the School of Nursing at the University of Rochester in New York, and Jin Young Seo, PhD, WHNP-BC, RN, of Hunter College in New York, NY, reported on their research on quality of life and access to care in vulnerable patient populations.
Address Social Determinants by Meeting Patients Where They’re At
A hallmark principle of social work is meeting clients where they’re at. This means taking time to understand where they come from, what might be influencing how they are navigating the healthcare system, and how their cancer diagnosis personally affects them.
ACA Led to Higher Rates of Early Breast Cancer Diagnoses
Thanks to expanded Medicaid coverage from the Affordable Care Act (ACA), women diagnosed with breast cancer—and in particular, African American women who are more likely to experience breast cancer disparities—are getting their cancers found at earlier stages, according to researchers. The study findings were reported in JAMA Surgery.
Acknowledge and End Unequal Representation in Cancer Research and Improve Access to Care
Research influences care along every inch of the cancer continuum, from prevention to survivorship, enabling healthcare professionals and patients to share decisions that result in the most current and tailored care strategies. It’s a powerful tool that sets the groundwork for providing optimal health outcomes. However, we must work to eliminate unequal representation.
Insulin Resistance May Explain Racial Disparity in Breast Cancer
Black women with breast cancer typically have a worse prognosis than white women, and the results of a new study suggest that insulin resistance may be a factor in the disparity. Findings from the study were reported in Breast Cancer Research.
Prostate Cancer Clinical Trials Don’t Reflect Racial Diversity—And It’s Getting Worse Over Time
More than 96% of participants in prostate cancer clinical trials are non-Hispanic white men even though non-Hispanic black men represent 22% of prostate cancer diagnoses, researchers reported in Cancer Epidemiology, Biomarkers, and Prevention. Even more critical, enrollment rates of black or African American men have been declining since 1995.
NINR Addresses Racism and Reinforces Mission on Positive Health Outcomes
More research funding is needed to learn about and address health disparities in African Americans in the United States, Tara Schwetz, PhD, National Institute of Nursing Research (NINR) acting director, said in an open letter to the research community. In the bold announcement, NINR recognized the unequal treatment of minorities and the need for enhanced dedication to promote equality in nursing research.
Racism and COVID-19; Nurses in Politics; Combat Social Determinants
A multitude of factors influenced by institutional inequality, such as underlying health conditions and employment opportunities, are to blame for the COVID-19 coronavirus’s disproportional effects on African Americans, Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, said. His remarks were part of a June 23, 2020, testimony before the House Energy and Commerce Committee.
LGBTQ Patients With Cancer
Recognized by the National Academies of Medicine as a population vulnerable to health disparities, people who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ) experience specific health disparities, including limited access to health care, increased risk for certain disease types, and an inherent bias in the health system.
Nurses Address Barriers to Care Through CoC’s Revised Standards
Many factors can affect the way patients access their care. But one thing is certain: if patients don’t get the care they need, their chances for success decline. To address barriers to cancer care, the American College of Surgeons’ Commission on Cancer (CoC) outlined specific, measurable actions that institutions must take.
PPE Protests; COVID-19 Health Disparities; Nursing Home Fears
On April 21, 2020, a handful of nurses protested outside the White House to urge the president to respond to the critical shortage of personal protective equipment (PPE)—and other nurses around the country have been speaking out as well.
Geographic Disparities Affect Clinical Trials Participation for Minorities
Clinical trials are a vital part of moving cancer care into the future. Enrollment and participation provide patients with cutting-edge treatments and build the knowledge base for clinicians to offer the best possible care available. Patients who enroll in clinical trials receive a high quality of care, increased surveillance, and a greater adherence to treatment protocols because of the nature of scientific study. However, Latino and African American participation in clinical trials is low compared to their representation in the U.S. population.
Geographic Disparities in Cancer Care
As part of a larger understanding of the social determinants of health, geography—whether it’s rural or metropolitan, urban or suburban—plays a huge part in how patients understand, receive, and access care. Regardless of zip code, community, or travel distance, patients have a right to receive the best possible care for their cancer diagnosis. As staunch patient advocates, oncology nurses are primed to help patients navigate geographic disparities and overcome challenges they face in treatment.
Latinas’ Breast Cancer Genetic Disparities Require More Focused Counseling and Testing
Breast cancer is the most commonly diagnosed cancer and the leading cause of cancer death in Latina women. Compared to all patients with breast cancer, Latinas are the second most common ethnic group to carry BRCA1 deleterious mutations, after Ashkenazi Jewish women. However, Latinas are less likely to receive genetic counseling education, referrals, and testing services and have the least awareness of genetic testing compared to non-Hispanic whites and other minority populations. Research indicates that despite their low awareness, Latinas have high interest in participating in genetic counseling and testing.
Prostate Cancer Disparities Disappear With Equal Access to Care
Typically, African American men have worse outcomes from prostate cancer than their white counterparts. But according to the results of a new study in patients in the U.S. Department of Veterans Affairs (VA) health system where all patients have equal access to care, no disparities exist between the two groups—in fact, the African American men in the VA system had better outcomes than non-Hispanic whites. The findings were reported in Cancer.
Nurses Are Critical to Reducing Global Geographic Cancer Disparities
Cancer is a global health problem. According to the American Cancer Society, cancer incidence is expected to continue to grow to nearly 27 million new cases around the world by 2040. In 134 of 183 countries, cancer is the first or second leading cause of premature death for people aged 30–69 years, and it ranks third or fourth in an additional 45 countries. Although cancer is a major health issue across the world, outcomes differ depending on a patient’s country of origin.
Healthcare Coverage Linked to Racial and Ethnic Cancer Disparities
Uninsured women or women on Medicaid are at a greater risk to develop advanced stage III breast cancer compared to women with health insurance, according to the results of a National Institutes of Health (NIH)-funded study reported in JAMA Oncology. Naomi Ko, MD, and Gregory Calip, PhD, noted that up to 47% of racial and ethnic disparities in advanced stage breast cancer could be mitigated by health insurance coverage.
Women With Diabetes Are Less Likely to Get Cancer Screenings
Modest differences may exist among women with diabetes compared to healthy controls when it comes to adhering to screening recommendations for breast, cervical, and colorectal cancers, according to results of a study published in Diabetologia.
Trump's Pre-Existing Condition Record; Geography Affects Insurance Status; State Vaping Regulations
The pre-existing condition coverageAffordable Care Act is a bipartisan plank that connects every policy conversation about health care. Public opinion overwhelmingly supports maintaining clauses to protect coverage for those with pre-existing conditions—like cancer—through treatment and survivorship, particularly as people change jobs and insurance companies.
Breast Cancer Is More Fatal in Men Than Women
Men have higher death rates than women across all stages of breast cancer, study findings reported in JAMA Oncology show. In the study, five-year overall survival after a breast cancer diagnosis was 77.6% for men and 86.4% for women.
Nurses Must Understand Health Disparities to Provide Effective Patient Education
Issues pertaining to geography, socioeconomic status, or racial or ethnic background can prohibit patients from accessing the treatment and care they need to successfully navigate their cancer diagnosis. Connecting patients to healthcare professionals and tailored interventions that educate, motivate, and reduce barriers can be a tremendous boon for their care and ultimately their outcomes.
Getting the Right Treatment at the Right Time Reduces Inequities in Breast Cancer Survival
Although death rates from breast cancer have been falling, the trend has not been equal among all women. Looking at breast cancer survival on a population level can tell us how effective our public health and healthcare systems are at early diagnosis, delivery of evidence-based treatment, and management of follow-up care.
Isolation Hinders Care in Rural Appalachia
Found along the expansive Appalachian mountain range in the Eastern United States, Appalachia is legally recognized as an economically disadvantaged area that’s home to a unique population of patients requiring special considerations.
Social Disparities in Radiation Therapy
Global radiation oncology research has seen an increased commitment to addressing disparities in the world and at home. The more radiation oncology proves and improves itself as a therapeutic modality, the more we are faced with the reality that the odds for survival are related to geography, poverty, education, and race.
Geriatric Oncology Ambulatory Care Clinics Address Older Patients’ Needs
Traditionally defined as patients aged 65 and older, older adults make up the majority of patients with cancer. Ambulatory care clinics with a specialized focus on older patients with cancer can provide age-specific care and an interprofessional team of providers well versed in cancer, aging, and geriatric assessment. Through geriatric oncology ambulatory care clinics, providers can work together to identify and coordinate plans to individualize treatment and supportive care for older patients.