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In a narrative review published in Obstetrics & Gynecology, researchers highlight successful, evidence-based interventions to help alleviate disparities in gynecologic oncology.
Study after study shows there are racial differences in outcomes for people with gynecologic cancers. In a narrative review recently published in the journal Obstetrics & Gynecology, my co-authors and I present action steps to reduce racial disparities.
The differences in Black women’s outcomes are real: Black women die of uterine cancer at rates more than twice that of other racial and ethnic groups; they are 30% more likely to develop cervical cancer and 60% more likely to die from it than non-Hispanic white women. While white women have a higher incidence of ovarian cancer, Black women have a 1.3 times higher chance of dying of the disease.
Our research looks at actionable steps that can make a real difference in the lives of Black women with gynecologic cancer as we work to close the equity gap.
We organized these evidence-based strategies to describe how multiple levels of influence affect health outcomes. Each part of this complex web presents opportunities to promote equality in gynecologic oncology:
- Policy
- Community
- Organizational
- Interpersonal
- Individual
Policy-level opportunities.
Research funding
Uterine cancer is among the lowest-funded diseases in the National Cancer Institute (NCI) budget—but throwing money at the problem isn’t enough. Our work identified an opportunity to reduce racial inequalities by increasing federal research funding with intentional efforts to support equity.
For example, a significant increase in federal funding for melanoma (a type of skin cancer) research led to new drugs that achieved a 6% reduction in deaths between 2013 and 2017. However, white patients received these immunotherapy treatments because they enrolled in clinical trials in their early rollout. The result? The gap between white patient’s 5-year survival and Black patients’ widened to 24%, the largest of all cancers in the U.S.
Insurance coverage
The Patient Protection and Affordable Care Act expanded Medicaid to cover more than 20 million additional people, and Medicaid expansion is associated with better treatment and outcomes for patients with gynecologic cancers. Yet the nine states that have chosen not to expand Medicaid have left more than 2.1 million people uninsured, widening disparities for low-income patients. Expanding Medicaid in these states is one effective way to reduce health disparities.
Related reading: Black Women Have Worse Endometrial Cancer Outcomes: What Patients and Providers Should Know.
Community engagement.
Since 2012, all NCI-designated cancer centers must include community outreach in their action plans to address things outside the hospital that can impact health outcomes, such as the quality of the environment, a person’s income, education, food access, and others. These are called social determinants of health.
Colorectal cancer outcomes, for example, improved from a multi-level, multi-year approach. The Delaware Cancer Consortium secured statewide funding for:
- Reimbursement for colonoscopies for uninsured residents with incomes up to 250% of the federal poverty level
- Two years of cancer care for uninsured patients with incomes up to 650% of the federal poverty level
- Implementing aggressive outreach, community partnerships, marketing campaigns, and care navigation for colorectal cancer, focusing on the Black community.
Disparities in screening and frequency of colorectal cancer and rates of death were notably reduced. Similar community-wide strategies can help reduce disparities in gynecologic cancer.
Related reading: Community Participation in Research Advances Health Equity.
Organizational changes.
Patient navigation programs are designed to help patients through the complex health care system and access resources and services. Studies have shown women who use care navigation services miss fewer appointments, and that these programs help eliminate disparities caused by housing types, employment status, and marital status.
Once patients become a part of the healthcare organization, technological and point-of-care changes from the top down can improve outcomes:
- Capture detailed data on social risk factors. Standardizing the data we collect about things like financial strain, stress, depression, social ties, intimate partner violence, and residential neighborhood poverty can help identify opportunities to help.
- Adopt equity-driven tools. Technology combined with electronic medical records can help healthcare providers make patient care and screening decisions with equity in mind. The U.S. Centers for Disease Control and Prevention is developing a digital decision-support tool for screening and managing cervical cancer.
- Include more Black patients in clinical trials. The American Society of Clinical Oncology and the Association of Community Cancer Centers have partnered to create online resources to help researchers use evidence-based strategies to improve clinical trial design and enrollment equity.
- Integrate provider-level interventions. Efforts to incorporate equity checklists and eliminate stigmatizing language can reduce disparities in care. A similar system at Yale revealed that bias, racism, and social determinants of health were behind almost half of preventable patient safety events.
Interpersonal partnerships.
Black women are highly affected by the anxiety, depression, and stress that impact all patients with cancer. Social support and partnerships with patient advocacy groups and faith-based organizations can improve social support and help reduce inequity in gynecologic oncology.
Individual action.
Producing content addressing gynecologic topics such as abnormal uterine bleeding, bloating, family history, and essential management of gynecologic cancers is one way individual health systems can help reduce disparities and close education gaps.
Among both Black and white patients, for example, delayed diagnosis of endometrial cancer is related to lack of knowledge about menopause, negative healthcare experiences, and inadequate physician response. Media campaigns and community education programs can increase awareness.
Move the Message, a social media video campaign by The Society of Gynecologic Oncology and the Foundation for Women’s Cancer increased the percentage of women who correctly identified that human papillomavirus causes vaginal and vulvar cancer and helped more women identify the recommended age for HPV vaccination.
Working for equity requires real action.
We know that race-based disparities in gynecologic care harm patients from historically minoritized groups. There are effective strategies throughout the socioeconomic framework that can help reduce these disparities and improve care for vulnerable patients, so now what?
It’s time to take action.
There’s no substitute for the hard work necessary to set up comprehensive navigator programs, address barriers to social support, build effective partnerships, eliminate bias, and continue research to understand the molecular differences that make Black women’s gynecologic cancers harder to treat.
MedStar Health and MedStar Health Research Institute providers and researchers collaborate with our community partners in our nation’s capital to raise awareness of clinical trials, educate patients, and shine a light on our collective work to eliminate racial disparities in gynecologic cancer care.
