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World Cancer Day 2022: how do we close the care gap?
1 February 2022
Advances in oncology have drastically improved diagnosis, treatment options and health outcomes, but there is still a long way to go to achieve equitable access to care.
It is not an exaggeration to say that gaps exist in every type of cancer and almost all aspects of cancer care, including prevention, diagnosis, treatment and ongoing psychosocial support. Because of this, the theme of the 2022 World Cancer Day is ‘close the care gap’. It marks the beginning of a three-year campaign to raise awareness and help ensure all people around the world can access high-quality cancer care.
What is a care gap?
The care gap is defined as a ‘discrepancy between recommended best practices and the care that is actually provided’. This provides a helpful overview, but ultimately leaves me wanting more. I found the World Cancer Day campaign’s much more nuanced definition helpful: a difference in access, needs and services owing to ‘income, education, geographical location and discrimination based on ethnicity, race, gender, sexual orientation, age, disability and lifestyle’. It is well evidenced that different people can have vastly different experiences of cancer diagnosis, treatment and survival. But what drives these gaps and how do we begin to fix them?
It is well evidenced that different people can have vastly different experiences of cancer diagnosis, treatment and survival.
What drives care gaps?
Care gaps are extremely complex. There are, of course, issues in access to and affordability of care and treatment, but health outcomes are only partly related to health services. Wider system-related factors, including the social determinants of health (such as economic stability, education level, sociodemographic and environmental factors), can lead to markedly different outcomes. Clinicians may have different levels and types of training, workload and unconscious bias, leading to care gaps. At the institutional level, differences in person-centred approaches, supportive technology and infrastructure may mean that different hospitals or regions within a country provide inconsistent standards of care.
How do we fix care gaps?
As there is no ‘one-size-fits-all’ approach to treating cancer, there is no single solution to fixing gaps in care. Practical, adaptable tools and approaches are required, supported by consensus-driven, person-centred best practice. We need realistic analysis of the needs of people with cancer, and we need to involve them and those working in cancer care to co-develop solutions for both the long and the short term. People experiencing gaps in care must be brought into every piece of research and every decision made – especially people from marginalised communities, who feel the impact of gaps particularly acutely. Some gaps may be more straightforward to close, but most will require system-level changes and significant political motivation and advocacy. As Bob Hudson, David Hunter and Stephen Peckham aptly put it:
‘Policies do not succeed or fail on their own merits; rather their progress is dependent upon the process of implementation.’
The pandemic has created new gaps in cancer care and widened pre-existing ones – and both are likely to grow as we emerge from it. Yet I firmly believe that post-COVID-19 recovery also presents a unique opportunity for change. This year’s World Cancer Day comes with a new and powerful message for equity and positive change; I hope that we can listen to this message and drive important improvements for all people with cancer.