Integrated health systems and evidence-based care: standardizing treatment to eliminate cancer disparities.

Abstract

10.2217/FON.15.90 © 2015 Future Medicine Ltd Historical explanations for disparities: are we running in place or falling behind? Disparities in cancer incidence and survival have persisted for more than two decades. Historically, the literature has focused on the patient as the agent of poor outcomes. Early reports explained that breast cancer disparities in African–American women were due to a lack of self care. They were more often obese [1], had poorly controlled comorbid disease [2] and delays in seeking medical care resulted in more advanced and more aggressive tumors at the time of presentation [3]. Subsequent studies shifted focus, but continued to point to patient level social factors such as lack of insurance and overall decreased access to care [4]. Because of these explanations, interventions to address disparities have largely focused on changing individual behavior. Programs to raise awareness, promote cancer screening and early detection dominate the approaches deployed by the National Cancer Institute, the American Cancer Society and local agencies to address disparities. While patient activation may improve select health outcomes [5], disparities in many prevalent cancers (colorectal, head and neck, uterine [6] persist; and in some cases, the gaps have widened over time [6]).