Closing the Cancer Equity Gap: Cancer Services in Rural and Medically Underserved Communities

A special issue of Current Oncology (ISSN 1718-7729). This special issue belongs to the section "Palliative and Supportive Care".

Deadline for manuscript submissions: 30 November 2024 | Viewed by 6780

Special Issue Editors


E-Mail Website
Guest Editor
Cumming School of Medicine, Calgary, AB, Canada
Interests: health services research; quality improvement; palliative care

E-Mail Website
Guest Editor
Tom Baker Cancer Center, Calgary, AB, Canada
Interests: drug access; cost of care; economic evaluation; equity

E-Mail Website
Guest Editor
Cumming School of Medicine, Calgary, AB, Canada
Interests: palliative care; advance care planning; implementation science; qualitative research

Special Issue Information

Dear Colleagues,

Despite advances in cancer prevention, diagnosis, treatment, and survival, disparities in cancer outcomes continue to persist in underserved and rural communities. Low-income, rural, and minority populations experience higher incidence, morbidity and mortality rates from cancer than other populations. In addition, these populations suffer higher rates of psychological and physical distress, financial burden, health service use, and in-hospital death. 

Data show that inequities in health care exist across the entire cancer care continuum and are disproportionately affecting medically underserved and rural populations who may encounter cultural, linguistic, economic, and other barriers to care. Etiologies for disparities are multifactorial and include structural factors, such as structural racism and its associated impact on social and economic factors, and health-system-level etiologies, such as inequitable evidence-based cancer care delivery.

For this Special Issue of Current Oncology, we invite submissions that advance the understanding of the disparities in cancer care amongst medically underserved and rural populations as well as those that describe strategies, approaches, and policies along the cancer care continuum that will effectively deliver optimal care for these populations. Underserved communities can include: racial/ethnic minorities, rural populations, First Nations, Inuit, Metis, urban indigenous, aged, adolescent/young adult, LGBTQ, people with disabilities, immigrants and refugees, and under- and uninsured communities. 

Dr. Safiya Karim
Dr. Doreen Ezeife
Dr. Jessica E. Simon
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Current Oncology is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • cancer screening
  • access gaps
  • equity
  • culturally sensitive care

Published Papers (4 papers)

Order results
Result details
Select all
Export citation of selected articles as:

Research

Jump to: Other

13 pages, 410 KiB  
Article
Sex-Based Analysis of Quality Indicators of End-of-Life Care in Gastrointestinal Malignancies
by Caitlin S. Lees, Hsien Seow, Kelvin K. W. Chan, Anastasia Gayowsky, Shaila J. Merchant and Aynharan Sinnarajah
Curr. Oncol. 2024, 31(3), 1170-1182; https://doi.org/10.3390/curroncol31030087 - 22 Feb 2024
Viewed by 556
Abstract
Indices of aggressive or supportive end-of-life (EOL) care are used to evaluate health services quality. Disparities according to sex were previously described, with studies showing that male sex is associated with aggressive EOL care. This is a secondary analysis of 69,983 patients who [...] Read more.
Indices of aggressive or supportive end-of-life (EOL) care are used to evaluate health services quality. Disparities according to sex were previously described, with studies showing that male sex is associated with aggressive EOL care. This is a secondary analysis of 69,983 patients who died of a GI malignancy in Ontario between 2006 and 2018. Quality indices from the last 14–30 days of life and aggregate measures for aggressive and supportive EOL care were derived from administrative data. Hospitalizations, emergency department use, intensive care unit admissions, and receipt of chemotherapy were considered indices of aggressive care, while physician house call and palliative home care were considered indices of supportive care. Overall, a smaller proportion of females experienced aggressive care at EOL (14.3% vs. 19.0%, standardized difference = 0.13, where ≥0.1 is a meaningful difference). Over time, rates of aggressive care were stable, while rates of supportive care increased for both sexes. Logistic regression showed that younger females (ages 18–39) had increased odds of experiencing aggressive EOL care (OR 1.71, 95% CI 1.30–2.25), but there was no such association for males. Quality of EOL care varies according to sex, with a smaller proportion of females experiencing aggressive EOL care. Full article
Show Figures

Figure 1

19 pages, 300 KiB  
Article
Implementation of a Cervical Cancer Screening Intervention for Under- or Never-Screened Women in Ontario, Canada: Understanding the Acceptability of HPV Self-Sampling
by Kimberly Devotta, Mandana Vahabi, Vijayshree Prakash and Aisha K. Lofters
Curr. Oncol. 2023, 30(7), 6786-6804; https://doi.org/10.3390/curroncol30070497 - 18 Jul 2023
Viewed by 1623
Abstract
With appropriate screening, cervical cancer can be prevented. In Ontario, Canada, some groups of women have low screening rates. South Asian, Middle Eastern and North African women are particularly at risk of under-screening. Currently, cytology-based screening is used in Ontario, although the growing [...] Read more.
With appropriate screening, cervical cancer can be prevented. In Ontario, Canada, some groups of women have low screening rates. South Asian, Middle Eastern and North African women are particularly at risk of under-screening. Currently, cytology-based screening is used in Ontario, although the growing evidence and adoption of HPV testing for cervical screening has encouraged many jurisdictions around the world to move towards HPV testing, with the option of self-sampling. We conducted an intervention beginning in June 2018, where we recruited over 100 under- or never-screened (UNS) women who identify as South or West Asian, Middle Eastern or North African from the Greater Toronto Area, to understand the uptake and acceptability of HPV self-sampling as an alternative to a Pap test. Participants self-selected if they tried the kit or not and completed both quantitative and qualitative research activities. This paper focuses on the qualitative arm of the study, where follow-ups and five focus groups were conducted with those who tried the kit (three groups) and those who did not (two groups), as well as eight key informant interviews with community champions and others who were involved in our recruitment. We used the Consolidated Framework for Implementation Research (CFIR) to guide our data collection and analysis. Major themes around convenience, privacy and comfort came from the data as important drivers of the uptake of the intervention. The role of community champions and peers in engaging and educating UNS women, as well as having self-confidence to collect the sample, also came out as factors impacting uptake and plans for continued use. Overall, the intervention showed that HPV self-sampling is an acceptable alternative to a Pap test for some but not all UNS women in Ontario. Full article
9 pages, 731 KiB  
Article
Disparities in All-Cause Mortality in Older Patients with Colorectal Cancer According to Disability Status: A Nationwide Analysis
by Woo-Ri Lee, Kyu-Tae Han, Mingee Choi and Woorim Kim
Curr. Oncol. 2022, 29(10), 7430-7438; https://doi.org/10.3390/curroncol29100584 - 05 Oct 2022
Viewed by 1132
Abstract
Background: Although investigating patterns of cancer mortality is important in understanding the effect of cancer on population health, knowledge regarding mortality in cancer patients with disability is scarce. This study examined the association between disability status and all-cause mortality in older patients with [...] Read more.
Background: Although investigating patterns of cancer mortality is important in understanding the effect of cancer on population health, knowledge regarding mortality in cancer patients with disability is scarce. This study examined the association between disability status and all-cause mortality in older patients with colorectal cancer. Methods: Data were obtained from the 2008–2019 National Health Insurance Service claims data. The study population included patients with colorectal cancer aged 60 years or above. The outcome measure was all-cause 5-year and overall mortality. A survival analysis was performed using the Cox proportional hazards model to analyze the association between all-cause mortality and disability status. Subgroup analysis was conducted based on disability severity. Results: The study population consisted of 6340 patients, and disability was reported in 15.8% of the included individuals. Participants with disability had a higher risk of both all-cause 5-year (hazard ratio (HR) 1.21, 95% confidence interval (95% CI) 1.07–1.37) and overall mortality (HR 1.15, 95% CI 1.03–1.28). These findings were particularly significant in individuals with severe rather than mild disability. Conclusion: Older colorectal cancer patients with disabilities showed a higher risk of overall and 5-year all-cause mortality, which was evident in individuals with severe disabilities. The findings indicated disparities in mortality according to disability status. Further, we suggest that policies that can mediate such disparities must be strengthened. Full article
Show Figures

Figure 1

Other

Jump to: Research

6 pages, 211 KiB  
Commentary
From Cultural Safety to Anti-Racism: Reflections on Addressing Inequities in Palliative Care
by Seana Bulle, Amit Arya and Naheed Dosani
Curr. Oncol. 2023, 30(9), 7920-7925; https://doi.org/10.3390/curroncol30090575 - 28 Aug 2023
Cited by 2 | Viewed by 2693
Abstract
The purpose of palliative care is to ease the suffering of individuals with a serious and often life-limiting illness throughout the course of their disease by providing holistic care that considers the physical, spiritual, and psychosocial dimensions of health and well-being. Research shows [...] Read more.
The purpose of palliative care is to ease the suffering of individuals with a serious and often life-limiting illness throughout the course of their disease by providing holistic care that considers the physical, spiritual, and psychosocial dimensions of health and well-being. Research shows that a palliative approach to care is cost-effective for the healthcare system and results in improved quality of life for patients and their loved ones. However, it is well-documented in the literature that structurally vulnerable populations have greater difficulty accessing equitable and culturally safe palliative care. Several domains are identified as contributing factors to the disparities seen in the literature, including systemic racism, cultural differences around death and suffering, and language barriers. Although Canada has had a national palliative care framework since 2018, ongoing issues of access and equity continue to disproportionately impact certain groups, including racially marginalized, immigrant, and low-income communities. In this commentary, successes and ongoing gaps in providing culturally safe and anti-racist palliative care are explored. In these proposed interventions, we advocate for a palliative approach to care that is grounded in equity, justice, and human rights. Full article
Back to TopTop