Medically underserved communities experience significant health care inequities, including preventive screening for colorectal cancer (CRC) and CRC-related morbidity and mortality. Multilevel barriers to CRC screening and subsequent follow-up create disparities and inequities in individual outcomes. Pandemic-related pre-procedure COVID-19 testing has been shown to cause higher rates of endoscopy cancellations among patients from marginalized populations. This, in addition to financial concerns, patient mistrust, lack of access to specialists and colonoscopy services are just some of the barriers to completion of CRC screening and follow-up procedures. 

CRC Screening Disparities: What’s the Solution?

The fecal immunochemical test (FIT) is one of the most widely used CRC screening methods globally and is an affordable screening tool for studying large populations. FIT detects hidden blood in stool, which can potentially be an early sign of cancer, and is an affordable home-health test with an overall 95% diagnostic accuracy for CRC. However, to be an effective screening tool, each step of the multi-step screening process must be completed: a diagnostic colonoscopy must follow a positive FIT test. Failure to complete the screening process is associated with higher rates of CRC mortality. 

While patient navigation helps with follow-up after a positive FIT test, only one-third of patients complete colonoscopy. Proactive, organized CRC screening involving centralized tracking, reminders, alerts for providers, and culturally competent and tailored messaging for patients are more effective for improving screening rates for White and African American patients. Such tactics have also reduced the differences in screening rates and cancer-specific mortality between White and African American patients. 

The COVID-19 pandemic has disproportionately impacted medically-underserved communities. African American, American Indian/Alaska Natives, and Hispanic populations have been particularly hard hit. COVID-19 testing requirements prior to endoscopy have disproportionately affected medically-underserved communities. 

While COVID-19 testing was a requirement earlier in the pandemic, the American Gastroenterological Association updated its guidelines as our understanding of viral transmission improved, vaccines became available, and viral transmission during endoscopy was found to be minimal. However, multiple institutions have continued to require pre-procedure COVID-19 testing prior to medical procedure—including endoscopy—which has led to high rates of endoscopy cancellations among individuals from marginalized populations. Pre-procedure testing may have introduced an additional barrier to care and increased existing disparities in health care and health outcomes. 

Recommendations for Eliminating Screening Barriers

Researchers have recommended the following strategies to reduce the impact of disparities due to COVID-19 testing:

  • Mailing SARS-CoV2 testing kits to endoscopy patients several weeks pre-procedure
  • Offering rapid testing to patients on the day of the procedure
  • Offering an opt-out option for testing due to hardships, such as the inability to schedule testing due to work schedules, difficulties finding transportation, or the need for childcare

Multilevel barriers to CRC screening and appropriate follow-up after screening create disparities and inequities in health care outcomes. Healthcare systems must collaborate with healthcare providers, community leaders, and social service representatives to improve access to care and guarantee equitable health care for all.  

 

Sahar Alam is a Colon Cancer Prevention Intern with the Colon Cancer Foundation.

Jamie Crespo lives in Seattle, Washington and is a Colon Cancer Foundation (CCF) Champion. She was introduced to CCF through the New York City marathon when she registered to run for our charity in 2020. When looking through charities, she found that CCF’s mission and cause was relevant to her personal experience with her family. Due to the COVID-19 pandemic, she ran the marathon in 2021.

In 2017, Jamie’s parents who were both in their 60s had never undergone a screening colonoscopy. In the absence of a family history of colon cancer, they did not even consider scheduling one. However, her father started losing a significant amount of weight and seemed very pale. When Jamie persuaded him to see a doctor, they discovered he had internal bleeding. After running some tests, the doctors found a mass in his colon. Following a colectomy, he was diagnosed with stage 3B colon cancer. Jamie’s father started chemotherapy in the fall of 2017 and is, fortunately, in remission!

In the beginning of the same year, Jamie’s mother was to receive a check-up but it was delayed to the fall due to her father’s diagnosis and subsequent treatment. Unfortunately, when her mother went through a screening colonoscopy, she was diagnosed with stage 1 colon cancer. Thankfully, she was able to undergo a laparoscopic colectomy, in time, and remains in remission.

With no known history of colon cancer in her family, Jamie emphasizes that everyone should initiate their screening at the recommended age of 45 years. She promotes preventative care knowing that typically, individuals who present with symptoms may be diagnosed at a more advanced stage when the disease is less treatable. Ever since her parents’ diagnoses, Jamie posts regularly on social media and raises money for the CCF. She is a member of the Club Seattle Runners Division and posted photos of her run to promote colorectal cancer awareness as well as relay her personal story of colorectal cancer. 

You can find Jamie on Instagram: @jamielynette

Kenadi Kaewmanaprasert is a Colon Cancer Prevention Intern with the Colon Cancer Foundation. 

The American Gastroenterological Association (AGA) has developed 8 position statementssolutions to eliminate colorectal cancer (CRC) screening barriers and reduce CRC burden. Evidence supports the existence of disparities in CRC screening: individuals with low income and lack of access to insurance coverage are disproportionately affected. Cost-sharing for preventive screening, in the form of deductibles and copayments, can be a financial barrier for some individuals. CRC screening programs and policies should cover all the steps following screening because each element is essential to the effectiveness of a screening program. Furthermore, these factors should not be subject to cost-sharing. Uniform, equitable delivery of screening programs will not only improve adherence and participation in CRC screening but also eliminate health disparities and reduce the burden of CRC in the United States. 

The following infographic details AGA’s approach:

The position statements have been published in Gastroenterology.

 

Photo credit: Clarissa Watson on Unsplash

Sahar Alam is a Colorectal Cancer Prevention Intern at the Colon Cancer Foundation.

Justin Adler is a Colon Cancer Foundation (CCF) Champion who lives in New York City. He works for a small SaaS (Software as a Service) company leading their strategic finance team. In addition to being involved with CCF, Justin coaches a football team and is a member of the Big Brothers Big Sisters of New York where he mentors a 9-year-old boy. He joined CCF in the beginning of 2022 as he hoped to be involved with something more personal.

CCF Champions started off as a young leadership council of the board—it has now evolved into a team of individuals with a personal or familial impact of colorectal cancer. The team meets on a monthly basis to discuss how best to support CCF’s mission of raising awareness around colorectal cancer from a board perspective, including leading and participating in the Foundation’s events.

One such event was  the annual Colon Cancer Challenge 5K Run/Walk during the Colorectal Cancer Awareness Month in March. Each Champion led their own team and fundraised individually. As a team, they also create social media campaigns. Recently, they partnered with DuClaw Brewing on their “Give A Crap” campaign to fundraise and share each champion’s personal story around colorectal cancer.

Justin was 8 years old when his mother passed away from colon cancer. Seeing at a young age how the disease affected his mom and their family, he is very keen to spread the word on the importance of early detection. Because his mother was not screened prior to her diagnosis, his main goal is to push the message of colorectal cancer screening. Justin notices that individuals without a family history of colorectal cancer are not as motivated to schedule a colonoscopy. They sometimes push it off until they are required to receive one, which could potentially be deadly for some. He emphasizes building a level of comfort around the topic, citing the “Give A Crap” challenge as an example, where they spoke openly about the elephant in the room.

Justin and the rest of the CCF Champions are always on a lookout for opportunities to partner with and help further colorectal cancer research and treatment through fundraisers and also spreading awareness.

 

Kenadi Kaewmanaprasert  is a Colon Cancer Prevention Intern with the Colon Cancer Foundation.

There is little known about the connection between various factors (such as environmental quality index, unmet needs, cancer survivorship, etc.) and the outcomes of patients affected by colorectal cancer (CRC). Studying the trends and associations around the onset and progression of CRC is integral to educating people on risk reduction. Additionally, using a disparity lens can aid decision-making processes and allow providers to target high-risk populations who may be in need of greater assistance and care. 

Several such studies were presented at the 2022 annual meeting of the American Society of Clinical Oncology. For example, Suleyman Yasin Goksu and team studied the association of young-onset CRC with the national level Environmental Quality Index (EQI). Their greatest finding? YOCRC can be linked to lower environmental quality. Additionally, Megan E. Delisle and team identified the association between unmet needs (in the physical, emotional, and practical sense) and survivors’ utilization of emergency services in the first three years following treatment. They found that a greater amount of unmet needs could be linked to higher utilization of emergency services–which is an issue that can be resolved through preventative measures. Both these studies reach important conclusions regarding how we draw patterns from disease. 

Here are some other studies from ASCO that dived into disparities and early-age onset CRC (EAO-CRC) outcomes:

  1. Disparity of treatment-related adverse events and outcome in patients with early-onset metastatic colorectal cancer (mCRC). With the marked rise of early-onset metastatic CRC (mCRC), there is a gap in diagnosis and adverse events related to treatment. Patient outcomes have not been conclusively studied, so Lingbin Meng and team reviewed the potential age-related disparity and its causes. Using individual patient data from three clinical trials in Project Data Sphere, patients were categorized into three age groups and sorted by adverse events. Patients younger than 50 had shorter median overall survival, higher incidence of toxicity (abdominal pain, severe anemia, and nausea/vomiting), but lower incidence of severe diarrhea, neutropenia, and fatigue. This group had the earliest onset of these adverse events and was associated with worse overall survival. Some of these disparities may be explained by distinct genetic profiles, but overall, patients with early-onset mCRC had worse outcomes and endured greater overall treatment-related adverse events. This study provides a basis for developing a personalized treatment plan when selecting patients for chemotherapy, providing counseling, and monitoring adverse events.
  2. Modifiable and non-modifiable risk factors associated with early-onset colorectal cancer: Analysis of the National Health Interview Survey. Risk factors for EAO-CRC are largely understudied, while on the other hand, there is a rapid increase in incidence. Hyeun Ah Kang and Yahan Zhang of The University of Texas at Austin studied modifiable and non-modifiable risk factors associated with the rise. Their cross sectional study analyzed data from the 2004-2018 National Health Interview Survey (NHIS). Individuals between the ages of 18 and 49 with a history of CRC diagnosis at the time of the interview were compared with their non-cancer counterparts. Additionally, the researchers also compared their nonage-related characteristics to those with late-onset CRC, meaning after 50. One hundred and fifty six patients with EAO-CRC were identified. Results from the comparisons showed that greater odds of EAO-CRC were associated with older age, living in the Midwest, and history of alcohol consumption. Lower odds were associated with Hispanic or Asian race and a lifestyle of vigorous physical activity. This study points to both modifiable and non-modifiable characteristics of EAO-CRC risk. Further studies can help identify the associated risk in-depth.
  3. Racial disparities in receipt of guideline-concordant care for early-onset colorectal cancer in the U.S. Black patients diagnosed with EAO-CRC have worse survival than their white counterparts, even in lieu of early-stage disease. Leticia M. Nogueira and team studied these racial disparities, with specific focus on guidance-concordant cancer care.The study included newly diagnosed non-Hispanic black and white individuals  between the ages of 20 and 49. Demographics, comorbidities, and insurance coverage were added to multivariable models to predict their contribution in the disparities with quality measures. Out of the 84,728 colon and 62,483 rectal cancer patients, 20.8% and 14.5%, respectively, were black. They were less likely to receive guideline-concordant care than white patients, which was primarily driven by insurance coverage rather than demographics or comorbidities. Overall, black patients received worse and less timely care than their white peers. Health insurance, a modifiable factor, was identified as the largest contributor to this gap. This study suggests that access to care can significantly influence EAO-CRC outcomes.
  4. Racial parity in rectal cancer treatment and outcomes within an integrated healthcare system. Hyunjee V. Kwak and team also looked at the survival outcomes of patients in the context of their race. They conducted a retrospective study of patients at the Kaiser Permanente Northern California health system, who were treated between 2010-2019. The study included over 3,500 patients diagnosed with rectal adenocarcinoma. Using self-reported race information, various analyses evaluated differences in race, age, stage of diagnosis, treatment, and overall survival. There was a greater proportion of Black patients with localized disease, who also had the longest overall survival. Hispanic patients were more likely to be male, younger, and have a shorter overall survival. These results show a gap in survival outcomes for patients treated at a large integrated healthcare system, where access to care is roughly equal. This calls for an improvement in outreach and screening, as well as awareness in these communities.
  5. Trends and disparities in the treatment of older adults with colon cancer. Half of the patients diagnosed with colon cancer are aged above 70, yet there is a huge gap in treatment for this population. Most are undertreated, perhaps due to age-related biases. Philip Q. Ding and team looked at age-related disparities in the realm of CRC care. Their retrospective, population-based study of adults diagnosed with CRC between 2010 and 2018 in Alberta, Canada included more than 10,000 patients, 48% of whom were over 70 years old. Upon further examination, it was found that older age correlated with more comorbidities and less advanced disease. Despite this, there was no statistically significant correlation between age and treatment status. As compared to the younger group, the odds of receiving surgery and systemic therapy were three and five times lower (respectively) among older patients. These two interventions continue to improve the outcomes of colon cancer in old and young patients alike, but the rates of treatment were lower in older patients and with minimal change over time. This study highlights a disparity in CRC care within the geriatric population.

Identifying these trends and disparities is just one step towards improved CRC care. It empowers patients to identify their personal risk and also gives their provider another factor to consider for treatment and prognosis. Understanding these correlations may be the next step in eliminating the gap in care for many populations.

 

Juhi Patel is a Colorectal Cancer Prevention Intern at the Colon Cancer Foundation.

Locally advanced rectal cancer may involve multistep neoadjuvant therapy to shrink the tumor before the main treatment, which is often surgery. Although this approach results in a complete pathological response in up to 25% of patients, it involves the risk of complications and toxic effects, including bowel, urinary, and sexual dysfunction; infertility; and altered quality of life in a significant number of patients. A new study, published in the New England Journal of Medicine, has found that patients with mismatch repair-deficient, locally advanced rectal cancer can be effectively treated with neoadjuvant programmed death-1 (PD-1) blockade.  

Approximately 5-10% of rectal adenocarcinomas are attributed to mismatch-repair deficiency, and this subset of tumors respond poorly to standard chemotherapy treatments. Immune checkpoint blockade could be an effective treatment option for this subset of patients. PD-1 elicits an immune checkpoint response of T-cells, allowing tumor cells to bypass the immune system defense, as well as resist the effects of chemotherapy. To test this hypothesis, researchers at Memorial Sloan Kettering Cancer Center and Yale University School of Medicine conducted a phase 2 investigation to analyze the overall response and frequency of sustained clinical complete response to neoadjuvant treatment with a PD-1 inhibitor, dostarlimab. 

PD-1 Blockade Eliminated Rectal Tumors

Of the sixteen patients enrolled in the study, twelve were enrolled for more than six months and completed nine cycles of dostarlimab. The resulting clinical complete response was measured by a combination of rectal MRI, visual endoscopic inspection, and digital rectal examination in twelve patients who had at least six months of follow-up. Endoscopic biopsies were performed at baseline and during visual inspection of tumor response at six weeks, three months, and 6 months, and then every four months thereafter. Serial FDG-PET scans to evaluate tumor eradication presented similar results to that seen with pathological examination and genomic analysis of the evolution of tumor eradication. 

The elimination of tumors after six months of therapy with PD-1 blockade allowed Dr. Cercek and her team to be able to omit both chemoradiotherapy and surgery and to move forward with observation alone. Single-agent dostarlimab was significantly influential in treating mismatch repair-deficient, locally advanced rectal cancer. It provided a clinical complete response in all 12 patients who completed treatment to date. 

Surgery and radiation can permanently impact fertility, sexual health, and bowel and bladder function. With the rise in incidence of rectal cancer among young patients of child-bearing age, anti-PD-1 antibodies can be a good alternative to chemoradiotherapy and surgery and may specifically benefit this cohort of patients. Dostarlimab promotes a refined approach toward treatment that can significantly improve the quality of life of patients, especially younger patients who may not yet have started a family. These findings also encourage the potential for using PD-1 inhibitors in the treatment of other mismatch repair-deficient tumors, such as localized pancreatic, gastric, and prostate cancers.

 

Sahar Alam is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation. 

Colonoscopy is the most effective test for colorectal cancer (CRC) screening and prevention. This procedure minimizes the incidence and mortality of colorectal cancer through early detection. During a colonoscopy, a physician inserts, and threads a flexible tube with a tiny camera called a colonoscope into the rectum and through the entire colon, or large intestine. This helps identify abnormal growths and excise any polyps which can then be sent for diagnosis.

However, research has shown that despite being the gold-standard for CRC screening, 23-30% of adenomas are overlooked and missed during a traditional colonoscopy, the success of which can vary depending on operator skills.

“Colorectal cancer is the second leading cause of cancer-related deaths in the United States and it is one of the few cancers that can be prevented if caught early,” said Aasma Shaukat, MD, MPH at NYU Grossman School of Medicine and the Robert M. and Mary H. Glickman Professor of Medicine and Gastroenterology and Director of Outcomes Research for the Division of Gastroenterology and Hepatology. “Our mission remains to improve and enhance the quality and efficacy of the colonoscopy across the board to provide the best care for patients.”  

In order to improve the efficiency and efficacy of colonoscopies, Dr. Shaukat and her team have developed an artificial intelligence (AI) platform to assist endoscopists. The findings of their  prospective, randomized, multicenter collaborative study to test the AI platform were recently published in the journal Gastroenterology. Between January and September 2021, twenty-two skilled, board-certified gastroenterologists performed colonoscopies on 1,440 patients. The patients were randomized to receive a traditional colonoscopy or a colonoscopy with computer-aided detection software —the software detects colorectal polyps during high-definition white-light colonoscopy procedures. This device can identify potential polyps and identify areas of concern, refining the results of the procedure in real-time. 

The researchers found that using AI during a screening colonoscopy increased the adenoma per colonoscopy rate by 22%: from 0.82 to 1.05. This evidence indicates that AI can be an effective and efficient tool for gastroenterologists and endoscopists to reduce the number of overlooked polyps left behind in the colon, many of which can be precancerous. 

Dr. Shaukat states, “Our findings add to the growing amount of literature that shows using computer-aided technology during an endoscopy procedure can improve the quality of exams performed and improve outcomes for our patients. Several software technologies are currently available for clinicians and incorporating the use of these resources will only enhance the care we provide our patients and improve the quality of exams we as physicians are able to perform.”

Sahar Alam is a Colorectal Cancer Prevention intern with the Colon Cancer Foundation.

With an observed increase of distant-stage colorectal cancer (CRC) among young patients in recent years, researchers have been searching for the reasons behind rising numbers and ways to counteract them. Carcinoids, a subtype of slow-growing cancer, have been found to contribute to the steadily rising incidence rate of early-onset colorectal cancer, which is diagnosed before the age of 50. This has created a need to assess the shifts toward distant-stage adenocarcinoma and its impact on public health.

Why Are We Seeing This Increase?

A study recently published in Cancer Epidemiology, Biomarkers & Prevention sought to understand how the proportions of distant-stage disease changed over time. Several studies have identified a significant increase (49%) in the average annual percent change for distant stage colorectal cancer in the 20-34 years age group. However, many of these studies do not report histological subtypes of CRC. 

With carcinoids increasing in younger patients, it is important to look at adenocarcinoma (most common cancer of the colon and rectum) staging independently from carcinoids (neuroendocrine tumors). Therefore, these researchers focused specifically on adenocarcinomas. Yearly adenocarcinoma incidence rates from the 2000-2016 Surveillance Epidemiology And End Results (SEER) data were stratified by stage, age, subsite, and race for 103,975 patients. Changes in the three-year annual incidence rate were calculated with the percent contribution of each cancer stage. Lastly, the subgroup with the highest proportion of distant-stage disease was determined.

The greatest percent increases were seen in distant-stage cancer when comparing data from 2000-2002 with 2014-2016. Here are a few significant findings of the study:

  • Colon-only distant adenocarcinoma increased most in 30-39-year-olds (49%)
  • Rectal-only distant-stage adenocarcinoma increased most in 20-29-year-olds (133%)
  • Based on race:
    • Distant stage proportions increased most for both colon- and rectal-only subsites in 20-29-year-old non-Hispanic Blacks (14% and 46%, respectively) 
    • The second most-impacted group was 20-29-year-old Hispanics with a 13% increase in the proportion of those affected by rectal-only, distant stage adenocarcinoma.

From these findings, we can conclude that the greatest burden of disease was on younger patients, highest in the non-Hispanic Black and Hispanic subgroups (despite relatively low absolute case counts). The researchers also uncovered that there is a decrease in early-stage disease in these early-onset groups. As we now know, younger patients are presented with higher risks, but the absolute incidence rates in the youngest subgroups remain relatively low.

These findings are important because they set a new precedent for patients under 50 who may not be aware that preventive screening for those at average risk of CRC starts at 45 years. Studies moving forward should also note that not all adenocarcinomas are categorized as early-onset CRC. Although this study is limited in its observational nature, it raises important questions in analyzing staging results, promoting screening opportunities, and keeping the general public aware of their risks. This study also presents potential solutions, including optimizing earlier screening and the risk-stratification of younger patients by family history and symptoms.

 

Juhi Patel is  Colon Cancer Prevention Intern.

Mom, wife, realtor, runner, cellist, and colon cancer survivor for five and a half years. Suzanne Miller was taken aback when she was diagnosed with Stage I colon cancer at the age of 40. Colorectal cancer screenings start at 45 years for average-risk adults. She was in good health, trained for marathons, and ate well. Luckily, she was able to undergo surgery on November 18, 2016, to remove the cancer. 

Suzanne realized she aspired to turn this event in her life into something good rather than dwelling on the fact that she had cancer. Since her surgery, on the 18th of each month, she spreads awareness by posting on Instagram and Facebook to remind individuals to “keep their rear in the clear.” Everyone who is over 45, under 45 with symptoms, or has a family history of colon or rectal cancer should get screened for colorectal cancer. Those with a family history of colorectal cancer should start screenings at 40 years or 10 years prior to the earliest diagnosis age in their family.

Survivor and Colon Cancer Awareness Advocate

Suzanne came across the Colon Cancer Foundation (CCF) while she was researching for a marathon to run in New York while raising money for a charity. She reached out to the Foundation and planned to run in the 2020 marathon, but it was canceled due to the COVID-19 pandemic. That didn’t dampen Suzanne’s spirit. She completed the marathon in her hometown and raised the money with support from her friends and family members who participated in the run. She looks forward to running again in the 2023 Colon Cancer Challenge.

This past February, as a CCF Champion, Suzanne and her husband were invited to attend the Cologuard Classic in Tucson, Arizona. She represented CCF and was able to meet 90 other like-minded individuals who shared her passion to make a difference and prevent early onset of colon cancer. Inspired to raise money and awareness in her hometown, Suzanne partnered with her husband’s golf club to hold a fundraising golf tournament on May 16, 2022. She was supported in her efforts by her friend, a 10-year colon cancer survivor who also works to spread colorectal cancer awareness. The event had 10 sponsors, 13 teams, and 20 hole sponsors that covered most of the costs. Half of the profits will go to their local nonprofit, CRC Life, and the other half will go to CCF.

Suzanne emphasizes that people need to be more comfortable discussing colon cancer, as they do other topics. Ever since she began raising awareness on social media, Suzanne has received messages from individuals when they received a colonoscopy, got a polyp removed, or discovered they have a family history of colon cancer. Through her experience as a young, healthy woman diagnosed with colon cancer, she brings attention to the fact that cancer does not discriminate. She always tells individuals to remind their friends and family to get a colonoscopy. “Even having one person find out that they do not have cancer is a win,” she says. Suzanne loves that we live in a world where we can speak our mind, while being kind and courteous, and have people that listen and don’t discount the matter at hand. 

 

Kenadi Kaewmanaprasert is an intern with the Colon Cancer Foundation.

The past few years have seen a concerted effort from stakeholders to raise colorectal cancer awareness; however, those undergoing treatment can face significant financial impact. Financial hardship is one of several factors that has a recognized consequence on treatment outcomes. Many organizations like the National Cancer Institute and American Society for Clinical Oncology are ardent advocates for interventions to diminish the effects of “financial toxicity” that results from medical bills, indirect costs, and non-medical costs faced by patients and their families.

Several retrospective studies have previously found that 25-50% of long-term cancer survivors experience financial hardship. A study recently published in the Journal of the National Cancer Institute is the first prospective cohort study led by the SWOG Cancer Research Network to evaluate financial hardship in metastatic colorectal cancer (mCRC) patients over 12 months. The researchers evaluated the financial impact on newly diagnosed patients who may have an advanced illness. Self-reporting questionnaires were administered over 12 months and considered new debt accumulations in analyses. Of the 380 patients initially enrolled in the study, several became ineligible due to lack of baseline data or death, leaving 302 patients to be evaluated at the end of the one-year follow-up. 

Age, race, income, or marital status did not have a significant impact on major financial hardship. Additionally, unemployed individuals were less likely to face significant financial hardship, which the authors believe may be confounded by age and older individuals having more assets and savings. What the researchers observed was a trend of increased risk of major financial hardship in younger, non-white, lower-income patients (but no statistically significant association). They also found that financial toxicity increases over time, where two-thirds of the study subjects faced hardship during the 12-month study period. 

The bottom line is that patients with limited resources are more likely to be negatively impacted by the financial burden of a cancer diagnosis. Interventions to help ease the effects are only successful when there is a sense of trust between patients and clinicians and a working dialogue about cost and financial concerns surrounding treatment plans. Critical solutions include:

  • Developing policies that facilitate access to affordable healthcare
  • Designing insurance benefits to minimize costs 
  • Connecting patients and caregivers to resources for counseling and assistance

The first step to change is an acknowledgment of the issue and screening patients to identify those most vulnerable to financial hardship.

Image credit: Thomas Breher from Pixabay  

Juhi Patel is a Colon Cancer Prevention Intern with the Colon Cancer Foundation.