To Cancer : Complementary and Integrative Therapies of Cancer.

The Panel reviewed current cancer rates and trends for the most prevalent cancers in various population subgroups. For the first time since cancer statistics have been collected, mortality from all cancers declined, albeit only 2.6 percent . These declines accrued principally to those under age 65, and to men more than to women. It is expected that more than 1.2 million new cases of cancer will be diagnosed, and cancer will claim more than a half million lives. Thus, although the downturn in cancer mortality statistics, reflecting population lifestyle changes (e.g., fewer lung cancer deaths among white men due to decreasing smoking rates), earlier detection, and better treatment is highly encouraging, these benefits did not accrue equally to all parts of the population. The continuing, heavy burden of cancer in the United States leaves no room for complacency.

As many of the speakers emphasized, social disparities are linked to differences in health care access that often result in disparities in health outcomes. Cancer statistics provide an essential tool for understanding what these disparate outcomes reflect about relative quality of care and for setting research and health care priorities. The statistics show clearly that vulnerable populations-the poor, elderly, less educated, medically underserved, the uninsured, and some minorities, however defined-bear a disproportionate share of the cancer burden, though there are important variations both across populations and specific cancers. Speakers pointed out that race is frequently a proxy measure of socioeconomic status (SES), which in turn is often a proxy measure of both health care access and the quality of available care. Income and education, important indicators of SES, are also correlated with variations in cancer risk and disease variables, e.g., people with lower income and/or education have a greater risk of dying from cancer. Though extremely difficult to measure, wealth-including assets, savings, and access to family support-may be a better measure of SES than current income. This distinction is important relative to cancer care, since an individual with assets could choose to use them to pay out-of-pocket for care, an option that would be unavailable to another person having equal income but lacking assets.

Speakers also pointed out that patterns of disease and related mortality typical of the home countries of rapidly growing immigrant populations are starting to be observed in the United States. Most of the study of cancer patterns has focused on tracking rising cancer rates in acculturating immigrant populations with historically low rates of certain cancers (e.g., increased breast cancer rates of Japanese and Chinese women with increasing length of residence in the U.S.). The impact of these and other cancer patterns (e.g., high cervical cancer rates among Vietnamese and Hispanic women; high nasopharyngeal cancer rates among some Asian populations) on U.S. cancer statistics and trends must be understood and addressed in the provision of cancer care at all levels, since these patterns are influenced by differences in culture and lifestyle as well as geography. Language barriers and cultural differences in perceptions about the importance of personal health, disease risk, and the meaning of disease all influence the perception and provision of “quality” cancer care.

Continuing high rates for certain cancers, most notably the tobacco-related neoplasms and those linked to obesity (e.g., endometrial and postmenopausal breast cancers), highlight the need for more effective cancer prevention and control interventions, and their wider application in all populations. Improvements have been made, however, particularly in effecting certain population lifestyle changes (e.g., smoking cessation) and in the technologic quality of and access to cancer screening and detection services. These improvements are reflected in the recent declines in cancer incidence and mortality rates, and the diagnosis of certain cancers at earlier, more treatable stages.

At the same time, speakers noted that data (particularly on subpopulations and at the local level) on the use of state-of-the-art treatment and on outcomes are sparse; these data would provide important measures of the quality of cancer care and better monitoring of the cancer burden in these populations. It was recognized that population mobility complicates efforts to monitor cancer in specific populations and the quality of care they receive. It was also underscored that improving care in Native American and other racial/ethnic communities requires consistent, continued effort and community involvement to overcome mistrust. Unfortunately, most health care outreach efforts, regardless of target population, have been initiated as pilot efforts by research funding bodies. Because outreach services have not generally been reimbursable, they have not been integrated into the continuum of care and sustained.

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