Racial and Ethnic Disparities in Cancer Treatment

A 2002 report released by the Institute of Medicine concluded that there is “overwhelming evidence” that disparities in cancer treatment exist in the United States. According to the U.S. Department of Health and Human Services, health disparities can be defined as “differences in the occurrence, frequency, death and burden of diseases and other unfavorable health conditions that exist among specific population groups.”

These population groups include racial and ethnic minorities. Factors that likely contribute to significant differences in cancer health care received by minorities include:

  • Poor access to health care
  • Lack of health insurance
  • Barriers caused by language and literacy
  • Low expectations of results

These factors cumulatively combine to result in poorer overall health for minorities in comparison to other population groups. Additionally minorities are believed to have greater difficulty seeking care and acquiring health insurance than other U.S. citizens.

According to the most recent National Healthcare Disparities Report, created by the U.S. Department of Health and Human Services Agency for Healthcare Research and Quality (AHRQ), minorities are less likely to partake in cancer prevention screening tests. For example, the AHRQ cites that 23 percent of Hispanic women report never undergoing a Pap test. This is in comparison to 17 percent of non-Hispanics.

Further exacerbating health care disparities is a lack of access to health care insurance. While less than 16 percent of white Americans do not have a steady source of health care, African-American and Hispanic figures are cited at 30 percent and 20 percent, respectively.

Treatment is another area where minorities may face unfavorable conditions. In general, underprivileged areas have less access to top-quality care. The AHRQ references the fact that African American patients are more likely to visit a doctor that is not board certified.

Other important facts and statistics gleaned from the AHRQ report include:

  • African-Americans are less likely to survive five years after being diagnosed with cancer than white people
  • African-American women are more likely to die of breast cancer than white women, and are diagnosed less frequently with the disease
  • African-American men are at a higher risk for developing prostate cancer than any other minority
  • African-Americans are 17 percent more likely to die from colorectal cancer than white people
  • Cancer accounts for 20 percent of all deaths for Hispanics living in America
  • Hispanics are twice as likely to be diagnosed with liver cancer than white people

Resource:

http://www.cancer.net/patient/All+About+Cancer/Risk+Factors+and+Prevention/Health+Disparities+and+Cancer/Overview+of+Health+Disparities+and+Cancer

Virginia Time Capsule Epitomizes Asbestos Concerns

In Roanoke, Virginia, a time capsule buried beneath the floor at the Roanoke City Health Department office has officials stymied.

The time capsule was originally scheduled to be exposed Thursday, January 7. That was until Virginia Department of Health officials discovered that the capsule was concealed beneath post-1950s flooring that likely contains asbestos.

The asbestos in the flooring isn’t that surprising, however, since many construction products made during the last century contained asbestos. This includes not only floor tiles and sheet flooring, but acoustical ceiling tiles and sprays, boiler pipe and wall insulation, glues and mastics and joint compounds, and even some decorative plaster compounds.

The use of asbestos in domestic products began to decline in the late 1970s, as manufacturers became increasingly aware of its dangers, and virtually ended in 1989, when the U.S. Environmental Protection Agency, or EPA, limited asbestos use to one percent or less (by weight or volume) to American-made products.

This intervention was fortuitous, since asbestos in its natural form is a mineral comprised of minute fibers which, once inhaled or ingested, remain inside the body for life, causing irritation and, eventually, lethal tumors called mesotheliomas in a small but significant number of exposures.

Mesothelioma is, simply put, cancer. But its high rate of deaths is attributed to the fact that it lies dormant for decades – commonly 40 years but sometimes up to 50 years or more – producing few symptoms but invading a large area of vital tissue and organs.

By the time mesothelioma is diagnosed, most patients are given about a year to live. These prognoses are mitigated, but only slightly, by aggressive regimens of surgery, radiation and chemotherapy, which can add about four months to patients’ survival times.

In fact, the only real hope for mesothelioma sufferers to date is a new diagnostic technique which samples pleural fluid to determine the presence of peritoneal mesothelioma. This method, which can establish mesothelioma within the first few years (possibly even at inception), is being viewed by medical professionals as the first true opportunity to curb mesothelioma before it ravages internal organs.

In Virginia, officials – who know what health professionals did not know in the 1950s (namely, the inherent lethality of asbestos) – have postponed unearthing the time capsule indefinitely; or at least until the content of the suspect floor tiles is determined by testing.

This delay is, in itself, a form of irony, revealing how the nation, and the world, got itself locked into an asbestos legacy that won’t end until sometime after 2030 – that is, 40 years after the use of asbestos in domestic products was suspended.

Of course, asbestos continues to be used elsewhere in the world, in countries like India, China and Russia, where no ban exists, and the occasional importation of products from these countries extends the asbestos legacy, at least among those who buy products made overseas without reading the labels, or fail to ask contractors and repairmen about the contents of products they use.

http://reports.ewg.org/reports/asbestos/facts/fact1.php

Growing Opposition to Asbestos in Canada

Quebec health officials recently sent a letter to Canada’s federal Health Minister, Leona Aglukkaq, calling for an end to the government’s support of asbestos mining in the country.

Within the letter, which was penned and backed by members of Canadian Association of Physicians for the Environment and Rideau Institute, health officials make known their concern of asbestos materials that provide “misleading, inadequate and, at times, false information” of the health risks of asbestos made available on government websites.

The letter is just the latest in a growing groundswell to limit or ban asbestos mining in Canada. Epidemiologists at Quebec’s Institute of Public Health have previously voiced their concern for the unusually high number of malignant mesothelioma and asbestos cancer cases present in the province of Quebec. Similarly, Liberal Party leader Michael Ignatieff has expressed his unhappiness with Canada’s asbestos industry.

Presently, there is only one active asbestos mine in Canada. Located in Thetford Mines, Quebec, the mine currently employs a little more than 300 workers. Though the industry remains small and localized, asbestos lobbyists remain appalled at the apparent skewed and biased portrayal of the industry to the public.

For example, in response to a recent broadcast of the radio program Telejournal that discussed asbestos mining in Canada, Julie Miville-Dechne, Ombudsman of Radio-Canada publicly opines that the report lacked balance and was deliberately skewed in favor of the asbestos industry. During the 5-minute portion of the program, the only experts offering insight into the subject were from pro-asbestos industry stakeholders.

Despite the historically biased public portrayal of asbestos in Canada, the scientific and impartial health community continues to call for the ban of the hazardous material.

Resource:

http://ibasecretariat.org/lka_n_amer_asb_rev.php

http://www.minesandcommunities.org/article.php?a=9715

EPA to Assess Safety of Six Widely Used Chemicals

Big changes may be coming to how chemicals are approved and monitored in the United States. Presently, Lisa Jackson, administrator for the Environmental Protection Agency (EPA), is promoting the formation of a new chemical law that would force additional responsibility onto chemical manufacturers in proving the safety of their components.

The new bill is in intended to alter the present methods, which were established under a 1976 toxics law that Jackson refers to as “inordinately cumbersome and time-consuming.”

As that bill is being pushed towards the Congress floor, Jackson has called for scrutiny of six widely used chemicals that have come under attack for causing potential health concerns. The highest profile chemicals to be targeted include:

  • Bisphenol A (BPA): used in clear polycarbonate bottles
  • Phthalates: chemicals used for cosmetics and vinyl products
  • Brominated flame retardants: used in electronics
  • Perfluorinated compounds: present in numerous products, including food packaging, paraffins, lubricants, benzidine dyes and non-stick coating

Early research into all of these chemicals suggests a possible link to reproductive complications and cancer. Additionally, these chemicals may mimic the effects of naturally occurring hormones and hinder development of fetuses and children.

To further assess the potential dangers of these products, the EPA is assembling data from the chemical industry. Once gathered, the data will be used to determine safety level of the chemicals and institute action plans that will limit exposure.

The six chemicals under review are just the first in a long line of chemicals the EPA intends to review. The Agency stresses the fact that 80,000 chemicals are currently being used in products sold in the United States. Alarmingly, many of these chemicals have incomplete health and safety data. As Jackson suggests, the chemicals with the highest priority will be reviewed first.

The action-oriented process is seen as a dramatic shift since the days of the Bush administration. While EPA officials under Bush’s leadership testified before Congress that the Toxic Substances Control Act of 1976 adequately safeguards U.S. citizens from chemical health concerns, the Obama administration seems less convinced.

In an effort to spur change and guide an effective bill formation in Congress, the EPA has released a set of principles that would improve information released about a chemical’s heath and safety concerns.

Representatives of numerous environmental groups have praised the pro-active initiatives proposed by the EPA.

Resource:

http://www.scientificamerican.com/article.cfm?id=epa-lisa-jackson-industrial-toxic-compounds-bpa

Morphine May Promote Growth of Cancer

Morphine is a common pain reliever that has been prescribed along with chemotherapy and other cancer treatments for decades. Now, new lab tests suggest that morphine, along with other opiate-based painkillers, may actually encourage the spread of cancer.

A team of researchers at the University of Chicago Medical Center recently reported the findings of two studies related to the cancer drug. Based on these studies, the team believes that opiates enhance the growth of new blood vessels in the body. Angiogenesis is a key element in the spread of cancer, as tumors require increased oxygen flow to grow.

Lead author of the studies, Dr. Patrick Singleton, also relays evidence that shows morphine also made it easier for cancer cells to spread to other areas of the body.

These latest studies are just the newest in the growing belief that opiates may be counterproductive in cancer treatment. The idea was first expressed in 2002, and retrospective studies of cancer survival rates comparing the administration of general vs. regional anesthesia have previously suggested morphine’s connection to tumor growth.

Resources:

http://news.bbc.co.uk/2/hi/health/8367301.stm

http://www.medicalnewstoday.com/articles/171900.php

http://www.dnaindia.com/scitech/report_common-pain-relief-drugs-promote-cancer-growth_1315282

Chemotherapy for Mesothelioma

In chemotherapy, drugs that destroy malignant cells are used to treat cancer. These drugs may be used to reduce the size of the tumor before surgery (neo-adjuvant therapy), help destroy malignant cells that may remain untreated after surgery (adjuvant chemotherapy), improve the effectiveness of immunotherapy and radiation therapy, or destroy cancer that has reappeared or spread out to other parts from the original site. They can also be used on a standalone basis if the patient does not qualify for surgery.

Significant research work is underway in the field of chemotherapy treatment for mesothelioma patients. Progress has been achieved over the past five years in the systemic treatment of this disease. Anti-angiogenesis agents including endostatin and bevacizumab along with standby drugs such as gemcitabine, cisplatin, and alimta are being actively pursued by researchers. Other drugs with potential include Ranpirnase (onconase) and coramsine.

Chemotherapy drugs can either by given on a standalone basis or in combination with two or more drugs simultaneously. This is referred to as “combination therapy”. For instance, Alimta, an investigational drug, (currently prescribed to mesothelioma patients through an expanded access program), is used in combination with other standard drugs such as gemcitabine and cisplatin. Petr F. Hausner has mentioned other effective combinations of chemotherapy drugs such as raltitrexed (Tomudex) used with oxaliplatin (Fizazi, Doubre et al. 2003).

Prior to initiating a chemotherapy procedure, your physician should discuss the proposed treatment and inform you about any potential side effects related to the drugs you may be administered.

Questions related to side effects that you can ask include:

  • What are the side effects of the drug/drugs?
  • Which of the side effects are most likely to manifest?
  • What can be done to alleviate side-effects?
  • Do I have to report certain side effects immediately?
  • How do I contact a doctor after office hours?

Normal cells usually recover after the completion of chemotherapy treatment, which implies that side effects will wane gradually after the treatment ends. The time it takes for side effects to disappear may vary, depending on factors such as the type of treatment administered and your overall health.

Better results are being achieved for mesothelioma patients through the use of new chemotherapy agents and drug combinations. Researchers have shown great interest in combination therapies and targeted therapies involving agents such as angiogenesis inhibitors and kinase inhibitors.

Cancer Advocacy for a Brighter Future

Cancer advocacy describes actions by a group or an individual that enhances the worldwide effort to manage and eventually defeat cancer. When an individual dies of cancer, you often hear a loved one’s call for donations to the local cancer society, with contributions to be made in the deceased’s name. This survivor’s plea for donations is a laudable act of cancer advocacy that is repeated countless times in towns all across America and around the world—the cumulative effect of these calls for donations results in millions of dollars being directed towards cancer treatment and education, as well as research initiatives that seek a cure for the disease.

Have you ever volunteered to aid a cancer stricken loved one, relative, friend, or a total stranger who was in need? If you have, then you are a cancer advocate. If you’ve ever volunteered to distribute pamphlets or hand out flyers in an effort to help fight the war against cancer, then you, too, are an advocate. Answering a phone during a cancer telethon funding drive, informing a friend or neighbor about a new advance in the fight against cancer, writing a research or treatment support letter to a health organization or a political leader, speaking out at a rally—all of that and much more constitute cancer advocacy.

Cancer is a Complex Disease

When it comes to cancer, there are no simple answers. The brightest and best minds of times past and present have struggled for over a century to find the silver bullet that will, once and for all, put an end to the countless cancer deaths that occur around the globe every day. Every optimistic voice and every promotional effort brings us one step closer to vanquishing this extraordinarily complex and cure-resistant disease.

Cancer’s complexities aren’t limited to the laboratory or hospital room because, as we all know, the disease complicates lives and injures families in myriad ways large and small. Oftentimes, professional counsel can help, and when a cancer oriented therapist volunteers their time, expertise, and consolation at a cancer patient’s bedside or on talk radio, they are a cancer advocate. A 10 year old student who solicits his or her classmates for nickels, dimes, quarters, and dollar bills for a cancer research funding drive is a cancer advocate. In short, cancer advocacy is all around us. In ways great and small, all of us can help, and for those who wish to contribute to the cause in well informed and broadly effective ways, formal training programs are available to help promote public awareness of and funding for cancer related issues such as those listed below:

• Work directly to solicit funds for cancer research

• Educate others as to the latest in cancer research discoveries

• Support and help facilitate patient participation in cancer research programs

• Become actively involved in improving cancer patient care, both within and outside the medical setting

• Consolidate and coordinate community support resources for those who have been directly or indirectly affected by cancer

• Make your cancer advocacy voice heard in the halls of local, state, and federal government buildings

• Utilize all forms of local and mass media to make your cancer advocacy voice heard

• Coordinate and/or solicit volunteer aid for local cancer society branches or other similar organizations

• Help to educate specific, high risk cancer populations about the disease

• Work to promote early screenings and better detection of cancer

Participate in the Peer Review Process

Before funding is granted to a particular cancer treatment, research or education program, government or other funding officials will typically require an extensive review of the proposed initiative. This review process will generally include the participation of numerous individuals, including scientists, health care professionals, administrators, etc., each of whom will present their findings to the funding authority. This process is known as peer review, and it will oftentimes include the participation of lay persons who have a personal history of cancer; ordinary citizen consumers may be asked to rate various cancer services, programs, specific institutions, etc. Peer review panels that include cancer sufferers and/or survivors provide an excellent opportunity for cancer advocacy through the contributions of those of who have experienced the disease first hand. Listed below are just a few of the organizations that welcome the presence of cancer service consumers on their peer review board:

• The American Cancer Society

The Research Advocacy Network

• Susan G. Komen Breast Cancer Foundation

• The Department of Defense Congressionally Directed Medical Research Program and many more

Help Others by Telling Your Story

One of the more common and useful forms of cancer advocacy is for a survivor of the disease to share their story of hope with others. There are numerous, disease specific (breast, colon, lung, etc.) support groups in communities all across the United States, and anyone who has either survived cancer or who has learned to cope well with ongoing disease can make a valuable contribution to these types of cancer advocacy forums. No one knows the life-altering circumstances of cancer better than someone who has personally lived with the disease, and sharing those experiences with others can be beneficial to all parties involved. One of the greatest challenges faced by health care professionals who work with cancer patients is to maintain the patient’s sense of optimism and hope. Cancer patients who meet face-to-face with others who share their circumstances oftentimes find that these meetings leave them with a greater feeling of peace and an increased determination to fight the disease.

Clearly, cancer advocacy can be accomplished in countless and nearly limitless ways. Whether you’re a physician, a therapist, a carpenter, single mother or a 10 year old volunteer on a fund raising drive, anyone may lend a hand in the ongoing effort to vanquish a disease for which, one day, a cure will undoubtedly be found. In the meantime, cancer advocacy in all its many forms helps to bring us that much closer to the day when cancer deaths become a thing of the past.