by Andrew A. Parsons, PhD, biopharma/life science neuroscientist, EMCC accredited coach/mentor and certified professional medical coach
The Union for International Cancer Control developed the concept of World Cancer Day, celebrated on February 4 annually, in 2000 [1]. The organization aspires to make life-saving cancer diagnoses, treatment and care equitable for all regardless of geography, income, ethnicity or gender. It has set a challenge for governments and health policy leaders to reduce the global burden of cancer by 2025. These include better education for health care professionals and developing health systems, developing equitable prevention and detection programs and the development of universal pain and distress management services.
Their theme for the next three years is focused on the #CloseTheCareGap. This refers to an uneven distribution of resources and avoidable differences in care and outcomes. For example, in the U.S. the five-year survival rate for white women with cervical cancer is 71%, but for black women it is 58%. In New Zealand, Maori are twice as likely to die from cancer than non-Maori individuals in the population. Unfortunately, 10 million people die from cancer each year with 70% of these cases occurring in low to middle income countries [2].
New medicines are also bringing hope for cancer patients. In 2020, the FDA approved 30 new drugs and over 30 new indications for existing medicines [3]. In 2021, the FDA had 19 accelerated approvals to broaden the usage of these medicines [4]. As a global society, if we are unable to #CloseTheGap, many people will be left behind.
There is also perhaps an immediate need in creating equity for different patient groups in bringing these investigational drugs (pre-approval) to clinical practice. A recent publication in Frontiers of Oncology highlighted the under representation of minorities and non-white racial and ethnic groups in cancer clinical trials [5]. There are many areas to consider in closing the gap on this problem. However, it has been well recognized by research institutions [6,7] with discussion regarding progress occurring in respected scientific journals [8].
With better detection, diagnosis and treatment, more people are living beyond cancer treatment. In 2016, it was estimated that more than 16 million people are living beyond a cancer diagnosis in the U.S. [9]. Studies indicate that half of cancer patients re-enter the workplace following diagnosis and treatment [10,11], and face many physical and psycho-social problems [12]. As cancer is a protected status, this becomes an important demographic for the workplace to ensure people feel included and working at their best.
Although inequities in these areas appear well known, World Cancer Day provides an opportunity to further raise awareness and provide a platform for stakeholders from a variety of perspectives. Encouragingly, a range of different stakeholders are already involved.
World Cancer Day Provides an Opportunity to Enhance and Utilize our Multi-cultural Competency.
Cancer impacts people’s lives and that continues after treatment. Individuals may undergo challenges and change across many parts of their lives, including their physical abilities, psychological and cognitive perspectives as well as in social and occupational relationships [13]. As wellness professionals, we need to be aware of this social demographic in our practices. A social demographic variable is a characteristic that informs choices, attitudes and worldview.
World Cancer Day provides us with resources to develop our awareness and understanding of the impact of cancer on individuals and their relationships. A central theme for the initiative is “one size does not fit all” [2] and there will be many events about the impact of cancer on their website or using #WorldCancerDay. Developing our multicultural competency is a dynamic and life-long process and making the most of these resources will enable us to better understand the perspectives of those impacted by cancer.
One simple approach for wellness practitioners to better understand the impact of inequities in cancer care would be to sign up for one of the 21-day challenges [14]. These are daily activities which aspire to bring greater learning and understanding of the issues. The first is designed to help build better awareness of the barriers and inequities around cancer care. The second focuses on moving more, eating well and living thoughtfully. The final area aligns with the declaration set in 2013 with the development of vaccination programs for cancer causing infections such as HPV. The focus in the third area is on raising awareness about the commitment to eliminating cervical cancer as a public health problem.
Multicultural approaches are already providing benefit. The CDC highlights a multi-cultural approach involving the social determinants of health. Progress is being made with increased treatment of non-Hispanic black women and Hispanic women in breast and cervical cancer services [15].
With the impact of cancer being so widespread in society, the use of the Multicultural Wellness Wheel provides practitioners with an opportunity to reflect and initiate discussions regarding this topic. The three domains of the MCC Wheel include the person and family, the worksite and finally the community perspective.
The person and family domain allows us to holistically assess wellness and bring an integrative approach. Awareness and understanding of the impact of cancer may help us challenge any assumptions we make. The worksite domain enables us to think about an inclusive workplace for those impacted by cancer and how to support the development of the appropriate work life balance. The up-, mid- and down-stream community perspective enables us to focus on the effective policies, incentives and the resources that can be used effectively by individuals.
My commitment on World Cancer Day is to further highlight the impact of cancer on people and communities. What would you consider to commit to individually or professionally?
[1] https://www.worldcancerday.org/our-story
[2] https://www.worldcancerday.org/sites/default/files/2021-11/WCD2022-Action-Toolkit-English.pdf
[3] Amiri-Kordestani, L. & Pazdur, R. (2021). Oncology approvals in 2020: a year
of firsts in the midst of a pandemic. Nature Reviews Clinical Oncology 18,129-130
[4] https://www.fda.gov/drugs/resources-information-approved-drugs/ongoing-cancer-accelerated-approvals
[5] El-Deiry, WS & Giaccone, G (2021). Challenges in Diversity Equity and Inclusion in Research and clinical oncology. Front Oncol.11:642112. Doi: 10.3389/fonc2021.642112.
[7] https://www.cancer.gov/research/areas/disparities
[8] Carpten, JD et al., (2021) Making cancer research more inclusive. Nature Reviews Cancer 21, 613-616
[9] Miller KD et al., (2016). Cancer treatment and survivorship ststistics. CA Can J. Clin 66(4) 271-289.
[10] Spelten ER et al., (2002). Factors reported influence the return to work of canner survivors: a literature review. Psycho-oncology 11(2), 124 -131
[11] Arndt, V et al., (2019) Return to work after cancer: A multi-regional population-based sftudy from Germany. Acta Oncologica 58(5), 811-818
[12] Duijts SF et al., (2014). Physical and psychosocial problems in cancer survivors beyond return to work: a systematic review. Psycho-oncology 23, 481-492.
[13] Stanton, AL et al., (2015). Life after diagnosis and treatment of cancer in adulthood: Contributions from psychosocial oncology research. American Psychologist 70(2), 159-174
[14] https://www.worldcancerday.org/21DayChallenge
[15] https://www.cdc.gov/chronicdisease/programs-impact/sdoh.htm
