Cancer Disparities for People With Disabilities: Bridging the Gap
Authors: Dikaios Sakellariou, Elena S. Rotarou
Journal: Journal of the National Comprehensive Cancer Network (2020)

T here are approximately one billion people with disabilities globally.Despite the fact that disability affects roughly 15% of the global population, it is often overlooked both in health policy and in research on health access. 1 Therefore, not only do people with disabilities experience disparities in health access and outcomes, but their needs and experiences also remain invisible. 2In this issue of JNCCN, Iezzoni et al 3 draw attention to this population, exploring the association between disability and cancer in the United States.This is one of the few studies that focus specifically on examining incidence of cancer among people with disabilities, a particularly important yet underexplored issue.Although there is a growing body of evidence on disparities in cancer service utilization for people with disabilities, predominantly screening and diagnostic services, limited information is available on cancer incidence.People with disabilities are among the most disadvantaged population groups; they often experience structural disadvantage in the form of increased poverty levels, lower literacy levels, and higher rates of unemployment or informal employment compared with the general population. 4Such structural disadvantage intersects with "ableism," which is discrimination against people with disabilities and the expectation that all bodies can or ought to conform to an idealised nondisabled norm.This intersection leads to compromised access to healthcare services and to living conditions linked to poorer health.Direct and indirect discrimination against people with disabilities can lead to increased barriers to accessing healthcare and reduced use of cancer services.An increasing body of evidence indicates lower participation in cancer screening for people with disabilities, due to a number of physical, institutional, financial, and attitudinal barriers.Such barriers include inaccessible healthcare facilities and/or equipment, lack of social support, financial constraints, past negative experiences with healthcare professionals, discomfort, inadequate information, lack of or inappropriate transport, and inadequate training of healthcare professionals, among other factors. 5,6Similar sets of barriers and patterns of disparities are observed globally across different healthcare systems; evidence suggests that people with disabilities experience worse access to cancer screening not only in the United States 7 but also across the world, including even in countries with universal health coverage and public healthcare that is free at the point of delivery, such as the United Kingdom. 8arious studies also underline the existence of disparities in cancer treatment and substandard experiences of service provision. 9,10Behind the statistics of cancer screening underuse are human stories: men and women with disabilities who-worried about new, unfamiliar symptoms-try to get screened but whom doctors are reluctant to refer, possibly due to diagnostic overshadowing; wheelchair users being asked to stand up; and healthcare professionals not exploring ways to adapt processes to make them disability-inclusive, exemplifying a general lack of disability inclusiveness in the provision of healthcare services. 10,11