GIVING EMOTIONAL SUPPORT–Mother with cancer and daughter sit together at home. Getty Images stock photo.
According to the American Cancer Society, Black Americans undergo more illness, worse outcomes, and premature death than Whites. For cancer prevention, detection, treatment, and survival, Black Americans suffer significantly more than White individuals.
Black Americans experience the highest death rate and shortest survival for most cancers.
Black men have the highest cancer death rate of any racial/ethnic group – 24% higher than White men.
Black women have higher death rates from cancer — 42% higher than White women.
These statistics are grim for many reasons that range from deep, historical, and well-founded mistrust in the medical community and problems with access to care.
For example, early cancer screenings are important for finding breast, colorectal, and prostate cancers. If these cancers are treated early, Black people have a better survival rate.
But screening centers aren’t located in or near Black neighborhoods, and they’re not open after normal business hours. Visiting them can be a hassle.
For instance, to get a mammogram, a Black woman must miss work, take a bus, and maybe find someone to care for her kids or an aging family member while she’s gone.
Hardest of all for low-income Black people is lack of insurance. According to the National Cancer Institute, less than 40% of uninsured women aged 50-74 had a mammogram in the past two years compared with 75% of insured women.
Where Black Americans live is a factor, too. In low-income neighborhoods, people are more likely to be exposed to asbestos, lead paint, and air pollution, which may increase the risk of cancer.
Black people also have fewer resources that support a healthy lifestyle. That includes, community centers for exercising, safe places to walk, or nearby grocery stores or farmers’ markets to purchase affordable fresh food.
Then there are research inequities. Black people are underrepresented in clinical trials compared to other racial/ethnic groups. According to the Annals of Internal Medicine, less than 8% of participants in cancer treatment clinical trials are Black.
That means that doctors may not have as deep an understanding of how cancer cells behave in Black women versus other groups of women, for example. Findings from mostly white cancer patients are applied to every woman, regardless of race/ethnic group.
Systemic racism and abuse by medical people have created distrust in the Black community. In a recent poll by the Kaiser Family Foundation, 70% of Black Americans say they’re treated unfairly by the health care system and 55% percent say they distrust it.
Together with that distrust is the lack of doctor diversity. A National Bureau of Economic Research study found that Black men treated by Black doctors agreed to more, and more invasive, preventive services than Black men seen by nonblack doctors. Why? If the doctor looks like you, there’s a greater chance for deeper connection.
That connection is important to Black people’s health.
DR. HAILEY BULLS
“Communication and trust in your doctor can be critical to successful cancer treatment,” says Dr. Hailey Bulls, Assistant Professor of Medicine in Pitt’s Palliative Research Center.
“The goal is to create a cancer care plan that’s specific to the person being treated,” she explains. “The plan must value the individual’s experience and include teamwork between the doctor and the patient. When this happens, the patient gets the best type of treatment.”
Dr. Bulls studies disparities in cancer pain management. Her work seeks to understand how racial biases and negative stereotypes result in less access to pain medicine. Stigma around prescription opioids, or “opioid stigma” includes addiction fears, difficulty filling and paying for prescriptions, and the uncomfortable feeling people have discussing pain with a doctor. “We think these challenges are even more common in underserved communities, where we know there are stark racial disparities in successful pain management,” she says. “We are working on ways to help narrow that gap.”
Dr. Bulls continues, “Maybe you feel the doctor won’t take your pain seriously because you’re a Black woman. Or (s)he won’t consider prescribing opioids because you’re a young, Black man. When you feel you’re being judged, you don’t ask about options, and you don’t get relief from your pain.”
There are many layers to opioid stigma, and Dr. Bulls’ team is currently working on ways to help clinicians and patients address stigmatizing experiences in the clinic. One step that can help is to make yourself heard and understood. “As a patient with cancer, you may not be able to choose your cancer doctor because of your insurance or where you live,” Dr. Bulls says. “However, you DO have a choice about how you communicate with that person and your entire medical care team.”
It’s crucial that Black patients feel confident and free to share what they know about their own health. “Think of your oncologist as the cancer expert and YOU as the expert on you,” Dr. Bulls explains. “The doctor knows how to treat cancer, but YOU know your pain level and what you need in terms of well-being and support. Bringing those two areas of expertise together can help make sure you’re on the same page with your care team.”
Dr. Bulls recommends that patients freely offer information about their experiences, ask questions, and have conversations about ALL that’s happening. “What are you feeling physically, emotionally, spiritually? What’s working for you with your treatment? What’s not working? What do you need at every stage of your healthcare journey?”
“I strongly believe the majority of doctors and nurses want to help people,” Dr. Bulls states. “Make sure you vocalize what YOU need. Consider writing down your questions and concerns between appointments and bring that list in during your appointments to help you remember what you want to cover. If that’s not something you’re comfortable doing, take along a trusted friend or family member who DOES feel comfortable advocating on your behalf.”
When it comes to cancer care, receiving the best possible treatment that’s specific to you is your right as a patient – no matter what your race/ethnicity.
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