By Dr. Foster Lasley, DABR, Radiation Oncologist, GenesisCare
As the saying goes: All healthcare is local. And while that holds true — care occurs when physicians and patients are together— the saying, unfortunately, doesn’t ring true in every town or for every person.
Wide disparities exist in care access between class, urban and rural locations, college-educated and not. Race plays a role, as do smoking, obesity, diet, drug and alcohol use, physical activity level, and other factors.
A study of cancer mortality trends over six decades (1950-2014) shows significantly lower cancer survival rates in more deprived neighborhoods and among most ethnic minority groups. “Socioeconomic patterns in all-cancer, lung, and colorectal cancer mortality has changed dramatically over time. Individuals in more deprived areas or lower education, low- income groups had higher mortality and incidence rates than their affluent counterparts, with excess risk for lung, colorectal, cervical, stomach, and liver cancer,” states the study’s executive summary.
While overall cancer mortality rates are declining, the rates were slower among those in lower socioeconomic classes, widening the overall gap. Recorded mortality was higher among Blacks and lower among Asian/Pacific Islanders and Hispanics than whites.
I practice in Rogers, Arkansas, (population 66,000) one of the fastest-growing metro areas in the country. I also practice about 100 miles away in Muskogee, Oklahoma, population 37,000. The two areas are polar opposites in terms of opportunity and access to care.
In Muskogee, I see a lot of patients who delayed care and now have giant tumors or cancers that have progressed far beyond what would be considered curative intent. Many of them can’t afford to go to the doctor until the pain becomes too much to bear. In multiple cases, they can’t afford to take time off work and can’t afford gas money to make the trip into town. Many of these patients also present with complicated comorbidities such as uncontrolled diabetes, hypertension or heart conditions that haven’t been addressed.
GenesisCare purchased hundreds of practices and could have closed lower-volume clinics such as the Muskogee office. Not only did the company not go that route, Muskogee was among the first clinics to receive enhanced technology that allows me to treat more types of cancers locally. The investment in technology allows us to connect patients with physicians, staff and resources that include a global network of experts in research, evidenced -based approaches, novel therapies not to mention additional opportunities for these teams in smaller communities that would otherwise not have this access.
Previously, I could treat basic cancers, but if a patient needed radiosurgery or special techniques to spare the heart when treating breast cancer, for example, those patients were referred to Tulsa, a 50-mile one-way journey. These technology investments are a huge step toward improving equity in Muskogee.
While there’s not much upside to a global pandemic, the increased use of telehealth facilitated needed care for patients across socioeconomic strata. Between February and April 2020, telehealth usage rose by a factor of 78 as medical offices closed and Medicare, Medicaid, and private insurers loosened telehealth usage and reimbursement rules. As medical offices reopened, telehealth usage declined, but its use in July 2021 was 38 times higher than the pre-COVID-19 baseline. Many specialties, including oncology, can make a compelling argument that payers look at telehealth reimbursement more closely to facilitate better care.
Telehealth also can help underserved communities like Muskogee. We’ve been using it for routine, uncomplicated follow-ups where a physical exam isn’t necessary. For a prostate cancer patient whose PSA is undetectable, it’s great to do a check in and make sure the patient doesn’t have any new side effects or new symptoms. I know patients are really grateful they don’t have to travel several hours to get here.
Opinions may be mixed on the monopolization of healthcare, but it does allow large organizations and hospital chains to open satellite clinics in underserved communities to extend their reach. And as drug costs continue to soar, we are seeing more drug subsidy programs that provide medications for low-income patients at a huge discount or for free. The necessity of these programs underscore the need for federal drug reform, which I believe is a bipartisan issue. Drugs in subsidy programs can often only be accessed by the very rich, who can afford them, and the very poor, who are only able to obtain the drugs with the subsidy program. Lost in the programs are the middle class, for whom the drugs remain too expensive and for whom the subsidy programs do not apply.
People in underserved areas also need access to free or low-cost screenings to catch cancers and other diseases at their earliest stages when interventions reap the greatest benefits.
The path to better care for everyone starts with the recognition that all care is local, backed up by efforts to make that dream a reality.
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