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For some marginalized populations in the U.S., barriers preventing access to radiation therapy and other lifesaving cancer care are as insurmountable as those in the poorest nations, according to Shearwood McClelland III, M.D., a clinical research assistant in radiation medicine in the OHSU School of Medicine.

The journal Advances in Radiation Oncology recently commissioned McClelland and co-authors to produce a series of papers on the “pervasive crisis” of unequal access to radiation therapy for vulnerable populations in America. Their review of the literature put a spotlight on some astounding disparities in cancer care for African Americans:

• In a population of 55,000 early-stage, operable breast cancer patients, black women were less likely to receive chemotherapy and radiation therapy and were significantly more likely to die than white women, even after adjusting for socioeconomic status.
• Black men with prostate cancer were 42 percent less likely to receive prostatectomy or radiation therapy than white men and, across age groups, blacks had higher mortality than whites in a population of 54,400 prostate cancer patients.
• Among 11,200 stage IV colorectal cancer patients, being black meant you were significantly less likely to receive treatment (30 percent less likely to receive radiation therapy) and 15 percent more likely to die. After adjusting for differences in treatment, the race-based increased risk of death disappeared.

“Despite the many advances stemming from the 20th-century Civil Rights movement, disparities in [radiation therapy] access for African Americans remain prevalent and persist in the treatment of cancer across a large number of organ systems,” McClelland and colleagues concluded. “The diminished [radiation therapy] access in many instances is independent of, yet often in concert with, low socioeconomic status. These findings underscore the importance of finding systemic and systematic solutions to address these inequalities to reduce the barriers that patient race provides in receipt of optimal cancer care.”

Read more about McClelland’s work at OHSU News. His series includes papers on cancer care access for Native Americans and Hispanic Americans. A forthcoming paper will focus on residents of Appalachia.

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Further reading:

The pervasive crisis of diminishing radiation therapy access for vulnerable populations in the United States, part 1: African-American patients by Shearwood McClelland III, Brandi R. Page, Jerry J. Jaboin, Christina H. Chapman, Curtiland Deville, and Charles R. Thomas Jr. Advances in Radiation Oncology (October–December 2017)

The pervasive crisis of diminishing radiation therapy access for vulnerable populations in the United States, part 2: American Indian patients by Shearwood McClelland III, Jennifer Leberknight, Ashleigh Guadagnolo, C. Norman Coleman, and Daniel G. Petereit. Advances in Radiation Oncology (January–March, 2018)

The pervasive crisis of diminishing radiation therapy access for vulnerable populations in the United States—part 3: Hispanic-American patients by Shearwood McClelland III and Carmen A. Perez. Advances in Radiation Oncology (April–June, 2018)