Disparities in Gynecological Cancer Care

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In this video, Marcela del Carmen, MD, a gynecologic oncologist in the Department of Obstetrics and Gynecology at the Massachusetts General Hospital, a clinician in the Center for Gynecologic Oncology in the Mass General Cancer Center, and chief medical officer of Massachusetts General Physicians Organization, discusses her research of the disparities in gynecological cancer care.

Transcript

The focus of my research over the last decade has been primarily around treatment-related outcomes for patients with gynecological cancers, really focusing on the treatment of patients who are underserved—so essentially woman that are of ethnic or racial minorities in this country, or women at the extreme of ages, very young or the elderly. The demographics of this country are changing over time and we are more and more becoming a country of underrepresented minorities and becoming more a majority in the population. And one of the concerns that I have is that as we change, in terms of demographics of this country, we also have a lot of innovation in cancer delivery—especially in the cancer space, there has been a lot of innovation both in surgical treatment and the medical management of patients. And to the degree that we don't understand how we are leaving vulnerable populations behind, the disparity gap actually gets wider.

We put together a protocol to enhance recovery after surgery for our patients, and our previous understanding of where we have gaps in the care that we deliver allowed us to inform those protocols before we actually rolled them out, so that we had in place initiatives that would be able to support vulnerable populations as we were trying to allow these efforts. Understanding that we needed to have, for example, documentation that was accessible to our patients who are not English-primarily speaking, access to initiatives that would allow patients to adhere to the protocols based on what supports they have at home, and taking care of them in the hospital in a way that actually translated what we wanted to do and carry forward in improving their outcomes for surgery with the support that was attentive to their cultural differences. I think that we're already seeing how understanding where we are informs the future of how we roll out these services and these protocols to be more inclusive.

Cervical cancer is the one cancer that I treat that is entirely preventable. We now have vaccines against the human papillomavirus that are primarily preventive of this cancer and we also have screening programs primarily the PAP smear programs that provide secondary preventions.

And what we see is that the patients that are being diagnosed with cervical cancer are women of underrepresented minorities that have not had access to either vaccination programs or to screening. The cost of care is incredibly challenging to the system because instead of preventing cancer, now you're dealing with a cancer that is locally advanced or advanced, and providing care for that patient actually is more cost burdensome to the system.

So ultimately, it matters, because it shouldn't make a difference to us whether you're Caucasian or African American or Hispanic, it shouldn't matter how well you do when you have cancer diagnosed. What we're finding is that location of where you live—so geography—and ethnicity, after you control for everything, will drive how well you do after cancer treatment.

When you find through research that outcomes are less favorable for a certain pocket of the population, I think it is in our mission statement to find ways to remedy that gap and actually provide access that is equitable across the board.

Learn about the Center for Gynecologic Oncology

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