Colorectal Cancer: In the Pursuit of Health Equity.
Colorectal Cancer: In the Pursuit of Health Equity.
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DOI：
10.1200/edbk_321071
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发表时间：
2021-03-01
期刊：
影响因子：
--
通讯作者：
Mitchell, Edith P
中科院分区：
文献类型：
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作者：
Musselwhite, Laura W;May, Folasade P;Mitchell, Edith P
在采用国家筛查计划后，结直肠癌死亡率大幅下降，然而，在高危亚组中，由于筛查、接受化疗、放射或手术、获得临床试验的机会、参与研究和生存的不同，临床结果仍然存在可测量的差异。这些差距是有目共睹的，而且随着时间的推移，一些差距还在恶化。已查明的差异包括种族和族裔、年龄(特别是年轻人)、社会经济地位、获得保险的机会、地理和环境暴露。在新冠肺炎大流行的背景下，结直肠癌的护理必然发生了巨大的变化，广泛、立即采用远程医疗，在可行的情况下过渡到口服药物，并考虑治疗顺序。然而，它还边缘化了结直肠癌患者，这些患者的癌症特定结果历来不同；其中包括没有保险的、低收入、移民和少数民族患者--他们都更有可能被感染、住院，并死于新冠肺炎或结直肠癌。在这里，我们勾勒出可测量的差距，审查实施的解决方案，并制定战略，以确保所有人都有尽可能公平和公正的健康机会。
Colorectal cancer mortality has decreased considerably following the adoption of national screening programs, yet, within at-risk subgroups, there continue to be measurable differences in clinical outcomes from variations in screening, receipt of chemotherapy, radiation or surgery, access to clinical trials, research participation, and survivorship. These disparities are well-described and some have worsened over time. Disparities identified have included race and ethnicity, age (specifically young adults), socioeconomic status, insurance access, geography, and environmental exposures. In the context of the COVID-19 pandemic, colorectal cancer care has necessarily shifted dramatically, with broad, immediate uptake of telemedicine, transition to oral medications when feasible, and considerations for sequence of treatment. However, it has additionally marginalized patients with colorectal cancer with historically disparate cancer-specific outcomes; among them, uninsured, low-income, immigrant, and ethnic-minority patients-all of whom are more likely to become infected, be hospitalized, and die of either COVID-19 or colorectal cancer. Herein, we outline measurable disparities, review implemented solutions, and define strategies toward ensuring that all have a fair and just opportunity to be as healthy as possible.