Addressing Global Cancer Care Disparities: Strategies for Equitable Access and Collaboration

In a Pharmacy Times® interview, Nadine Barrett, PhD, MA, MPH, president of the Association of Cancer Care Centers (ACCC), shares insights from a discussion on factors preventing patient access to cancer care on a global scale and how we can overcome them.

Pharmacy Times: What factors have had the most impact on cancer care access on a global scale?

Nadine Barrett, PhD, MA, MPH: There are multiple factors that impact cancer care and access to cancer care. In particular, globally and locally within the United States, we all know socioeconomic status and poverty plays a huge part across the global scale, no matter where you are or where you live. We also know that access to care is expensive and depending on where we are across the globe and in the US, being able to pay for that, even if someone has insurance, copays, et cetera, can also really build up, and we know that that's a challenge. We also know that where people live also plays a part of that. And so, if people live in areas that are not necessarily close to where cancer care is, that plays a huge part in them being able to have access to care. Whether talking about parts of Africa and Togo, whether we're talking about in countries even such as Afghanistan, Egypt, or even here in the United States, where people live and where services are available, definitely plays a huge part in that as well.

The other piece is huge is people really an understanding or knowing what the cancer risks are, making sure that we know that people can get the information they need for early detection and screenings. And that becomes a challenge across the board, and so the more intentional organizations and countries can be in really recognizing that that prevention and cancer control is so important, and knowing how do we engage our communities in a meaningful way so they can get access to the right information that allows them to be able to act on it, to ensure that they have access so I think that globally, all the challenges are the same. However, how they play out in different countries, based on health systems, insurance, all of that, plays a part in terms of exacerbating it.

I'll also say within that context, based on how various groups are perceived or treated within a particular community, for example, in the United States, minoritized and marginalized populations tend to have the worst health outcomes, and it's not because of who they are, but it's actually because of the systems and structures that are in place that plays out negatively for those who are underserved, marginalized and minoritized. And so, all of these factors play a huge part in that, both locally and globally.

Pharmacy Times: What specific strategies have you found most effective in engaging at-risk communities about cancer prevention and treatment?

Barrett: Engaging communities around what's the best ways in terms of getting access to cancer care and information resources, including screenings. I find some of the best strategies are really around community engagement. The more we engage with our communities, partner with our communities, and also recognize that not only are we talking about needs—because we talk a lot about needs assessments and that always looks at the community from a deficit model, as if the community is lacking and we must go and save them, as opposed to really looking at communities from a strength based perspective. What are the strengths? What are the assets? What is working? And where do we work together with the community, where the community can identify the solutions toward addressing these challenges?

I find those institutions and organizations that focus in on that perspective and look at it and approach it from those frameworks really has the best types of programming. So, when we think about community health workers, when we think about patient navigation, particularly those that are focusing on the social determinants of health, we see that those programs are really incredibly effective in getting the education to the communities, the information the community needs, and being able to ensure that they get access to the appropriate screenings. And, why? Because they're working with the community, not at the community or to the community. When we work with communities, we always do better, and people always get better, better access, regardless of where they are, who they come from, where they who they are, where they come from, where they live, and particularly in the context of marginalized, minoritized populations.

Pharmacy Times: How can international collaboration help to address both the workforce and patient care challenges facing cancer programs today?

Barrett: Global collaborations are a great opportunity for us to continue to do great work together, and for us to grow and learn and identify opportunities for innovation, for novel care and novel ideas that can actually transcend across both the US and other countries. So, the collaboration is important, and being able to identify ways to do that.

When we think about it in the context of workforce development, I think that there's 2 key parts to that. So sometimes when we have workforce development, people from other countries may come to the US or UK or other places like that, and get the education that they need, get access to, becoming medical doctors, nurses, et cetera, in the system. And what happens, however, is that they oftentimes, may not necessarily go back home to be able to make the impact that is needed in their own communities, right? And when I say this, I say this very I'm trying to be very sensitive about this because we certainly have a shortage of diverse providers and doctors in our system right here in the US. We also have a shortage in some other countries in terms of access to the most novel treatments, as well as even the machinery, the tools, the resources that we need to be able to ensure appropriate scanning is available for the number of people in within a given population. So, I think that the collaborations are important, but I think the collaboration should ensure that it is actually mutually beneficial, that those global collaborations are truly building capacity in both countries in the same ways, sometimes different, right? But it's building capacity to ensure that the cancer care and cancer treatment is equitable, and that it's also ensuring that it's meeting the needs of the communities, workforce development programs and opportunities.

I think cross learning and CO learning together is fantastic, creating opportunities for more education and training absolutely critical. But it's also important that we do not move to a space where in both cases, we're training, but not necessarily ensuring that we are building capacity in communities in order to make sure that they also have quality providers and resources and tools to be able to provide the best cancer care possible. That's why we as ACCC are moving into that direction now, creating our global strategy of how we can create bidirectional co learning, co growing together with our other countries, as I mentioned, Sweden, Egypt and Nigeria, our 3 countries that are actually we have delegates here who are sharing about their own experiences and where there's opportunities for that, and that covers both workforce development and cancer care.