Tackling Health Disparities—and Equity—in Oncology

Health disparities—by race, ethnicity, gender, sexual orientation, and income—are endemic in the United States, and this is true across the care continuum, from prenatal services to infant nutrition to heart health later in life. Seemingly every day new headlines bring further evidence of inequities from across care contexts, and even before care is ever received.  In its inaugural Cancer Disparities Report of 2020, the American Association for Cancer Research (AACR) noted “striking disparities” in the “receipt of standard of care cancer treatment,”  in “exposure to preventable cancer risk factors,” and in “rates of cancer screening for early detection.” Recently, research from the American Cancer Society and Clemson University found notably higher death rates—for all cancer types included in the study—in communities with the most racial and economic segregation.

Evaluating the Health Equity Impacts of Innovative Care Models

The severity and impact of cancer disparities illustrate why Abt prioritizes equity in evaluating federal programs.  As Abt’s Chief Equity Officer Roslyn Brock has stated, “equity is central to everything we do at Abt.”  Equity often takes a clear front-and-center role in our work, such as when we deliver technical assistance (TA) and training to promote practices that alert healthcare providers to unconscious biases so they can deliver equitable care for all patients. Understanding how programs affect historically underserved populations is an important part of the research, monitoring, and evaluation work we do to inform policymakers how their models affect health equity.  For example, in our evaluation of the Oncology Care Model (OCM), we explored and analyzed:

• Changes in the proportion of chemotherapy episodes covering low-income, disabled, Black, or Hispanic beneficiaries, which could signal selection bias against historically underserved populations.
• Model impacts stratified by race and ethnicity.
• Participants’ experiences and culturally sensitive end-of-life care, drawing on 47 case studies. For example, our report noted that “[a]n urban safety net practice serving a largely Black population recognized that many of their patients harbored a deep distrust of medical providers and were loath to discontinue treatment.”

Building on OCM to Improve Equity in Cancer Care

Starting in July 2023, CMS will begin implementing the Enhancing Oncology Model (EOM), which builds upon the agency’s experience with OCM. EOM incorporates several improvements informed by Abt’s evaluation, including a focus on higher-risk cancers that require cytotoxic chemotherapy or other treatments with significant side effects. The model will also focus directly on health equity in several ways, such as encouraging participants to systematically collect data on health-related social needs, sociodemographic data, and health disparities.

As AACR’s 2022 report notes, “Despite … encouraging trends, disparities across the cancer continuum remain a major public health challenge in the United States.” Efforts such as EOM offer increasingly valuable opportunities to not only address health equity but to understand the real impacts of our efforts to do so—and how we can do better.

For a more comprehensive perspective on how Abt thinks about equity and evaluation, see our Embedding an Equity Focus in Evaluation.

For an example where we embed equity in the evaluation of a different model, see Abt’s Evaluation of the Integrated Care for Kids (InCK) model.