Strategies Can Improve Access to Cancer Care for Black Patients in Canada

Carolyn Crist

October 26, 2022

Black patients in Canada often face barriers to equitable cancer care, including access to novel oncologic advances in screening, molecular testing, targeted therapies, and enrollment in clinical trials, according to a new analysis.

In response, healthcare teams can implement numerous evidence-based strategies to meet the needs of diverse populations and bridge gaps in equity, the authors wrote.

Dr Doreen Ezeife

"Recognizing the different levels of issues can help cancer center leadership, oncologists, clinical trial developers, and patient advocacy groups understand how best to serve our most vulnerable populations," author Doreen Ezeife, MD, a clinical assistant professor of oncology at the University of Calgary, Calgary, Alberta, Canada, and medical oncologist at the Tom Baker Cancer Centre, told Medscape Medical News.

"It’s important to identify barriers that exist for Black cancer patients and all minorities that limit access to breakthrough cancer tests and treatments," she said. "Identifying these barriers is the first step in developing programs aimed at closing these gaps and eliminating disparities in cancer outcomes."

The report was published Oct. 24 in the Canadian Medical Association Journal.

Data Are Missing

Although cancer survival rates are improving in Canada due to early detection and treatment advances, mortality from breast, colorectal, prostate, and pancreatic cancers is higher in Black patients than in White patients, the authors wrote.

At the same time, race and ethnicity data aren’t always collected in Canadian disease registries, which can make it difficult to analyze trends in access to various cancer services. To start, these registries should implement routine collection of racial data to understand system-level and patient-related variables that affect access to cancer clinical trials, hematopoietic stem cell transplantation, and personalized medicine, according to the authors.

Next, healthcare systems need better insight into access gaps for cancer screening programs, the authors wrote. Population-based screening programs have been implemented across Canada for breast, cervical, and colorectal cancers, but Black and immigrant patients are underrepresented in regular screenings. In some parts of Canada, these gaps have been linked to socioeconomic barriers and lack of access to a primary care provider.

Several approaches appear to be effective at increasing screening uptake, the authors wrote, such as providing cultural awareness training for healthcare providers, culturally focused media, multilingual health educators, and lay health educators and patient navigators. These services can improve health literacy, patient understanding, and adherence to cancer treatments.

Importantly, the authors noted, access to cancer care is mediated by patient awareness and views on symptoms, diagnosis, and treatment, which can be influenced by cultural background. Previous studies in other countries have found that using culturally appropriate resources and community engagement can decrease stigma surrounding cancer diagnosis and treatment.

"Black cancer patients who are able to consistently connect with other Black cancer patients or healthcare providers from their cultural community learn about their cancer and cancer treatments more effectively and are more trusting of the health information that they receive," Ezeife said.

A Heterogeneous Population

A major facet of health literacy is cultural literacy, the authors wrote. The Black population in Canada is heterogeneous and includes first-generation Black African patients, as well as second- or third-generation patients of African or Caribbean descent. Healthcare providers must have awareness of the communities they serve to frame health information in the context of the patient’s cultural understanding.

For instance, previous studies in Canada have found that providing individualized, culturally sensitive cancer care is key to improving access. At a Toronto community health center, an Afrocentric education program on cancer screening significantly increased screening rates for breast, colorectal, and cervical cancers.

"This [approach] can empower us to learn ways to increase the cultural sensitivity in the cancer care that we provide to our patients," Ezeife said. "Simple practices such as using multilingual lay translators and tailoring the health information we deliver can really improve the trust our patient has and enhance patient uptake of recommended cancer treatments."

Most of all, patients need to feel seen and understood. Increasing Black representation among healthcare providers can help, the authors wrote, as well incorporating lay and community health educators.

An Afrocentric education program in Toronto, for example, incorporated video testimonials that featured Black women and lay health educators who were trained by Black women. In other studies in Canada, culturally appropriate media also used narratives of Black patients who described their experiences in clinical trials alongside physicians who addressed myths and facts in lay language.

Considering Representation

Commenting on the paper for Medscape, Aisha Lofters, MD, PhD, associate professor of family and community medicine and clinician scientist at the University of Toronto, Toronto, Ontario, Canada, said, "I was particularly excited to see the authors highlight the importance of representation in the healthcare team, recognizing the important role that lay health educators can play."

Dr Aisha Lofters

Lofters, who wasn’t involved with this analysis, has studied breast and cervical cancer screening uptake among Black women in Canada. She and her colleagues tested the feasibility of a lay health educator-led program with an Afrocentric approach among Black women in Toronto. The program increased awareness of cancer risks, screening guidelines, and screening self-efficacy.

"The Black community in Canada has long been marginalized, including in the cancer system, which has had very real effects on people’s lives," she said. "The system will not become more equitable without dedicated time, resources, energy, and attention being put into reducing inequities. It won’t just happen in a passive manner. Inequities are baked into the entire system, and we need evidence-informed approaches to eliminating these inequities. The authors of this piece give us some great steps forward."

The analysis received no funding support. Ezeife reported receiving honoraria and travel support from Pfizer, as well as participation on advisory boards for Pfizer, Bristol Myers Squibb, Novartis, and AstraZeneca. No other competing interests were declared. Lofters reported no relevant disclosures.

CMAJ. Published Oct. 24, 2022. Full text.

Carolyn Crist is a health and medical journalist who reports on the latest studies for Medscape, MDedge, and WebMD.

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