Guest Blog: Access to services in cancer care

Hi all! My name is Kay. I was born and raised in the Philippines and packed up my entire life to move to London mid-pandemic in 2020. I graduated with a Bachelor of Science in Cancer Biomedicine degree at UCL after three long and fulfilling years.

During my time at UCL, I was lucky enough to be able to learn from pioneering clinicians, oncologists, and consultants. I took modules ranging from innovations in precision cancer medicine to pharmacology and applied human genomics, where I found that despite ever-accelerating breakthroughs in cancer treatment, an expanding portion of the population are faced with individual or systemic barriers in accessing these therapies.

I wanted to further my interest in women’s cancers and identifying barriers to care as the first step in addressing the issues in health equity for women in the UK and Europe. I did this through my bachelor’s dissertation, where I conducted a thorough literature review of over 90,000 patients and aimed to examine demographic disparities that limited access to quality advanced ovarian cancer treatment for patients in the UK and Europe.

Here, non-standard of care indicates treatment that does not fall within published care guidelines. Most standard of care treatments for cancer begin with surgery, then the necessity for a course of chemotherapy or radiotherapy is determined and administered. Care that falls outside of these guidelines can occur in hospitals without adequate surgical technicians or facilities, or for patients for whom it is deemed that a more palliative approach is best. My findings determined that patients who were physically disabled were disproportionately likely to receive non-standard treatment than their non-disabled peers.

I then aimed to extend the concept of health equity to patients with physical disabilities as I determined that standard procedures for cancer diagnosis and treatment only catered to non-disabled patients. As an example, CT/MRI scans, to determine size and extent of disease, are not accessible to wheelchair users, or those who cannot maintain a certain position for extended periods of time. I felt that this research was especially important as cancer is not only predicted to become more commonplace, those who already experience barriers to care access will be furtherly disadvantaged.

My research demonstrated a wealth of empirical evidence that linked patients with physical disabilities with socioeconomic deprivation. Specific barriers that hindered disabled patients included the inaccessibility of medical diagnostic equipment, attitudes of clinical staff about accommodating disabilities, and that clinical presentations of cancer were dismissed or attributed to underlying disabilities, which hampered accurate diagnosis and worsened prognosis for the patient.

These findings are especially important, as they create opportunities for innovations and advancements for research and treatment to widen accessibility of medical diagnostic equipment.

Inaccessibility of medical diagnostic equipment was one of the main barriers established that negatively affected cancer diagnostic procedures. Interview-based research cited inaccurate diagnoses mainly due to patients having mobility impairments that prevented clinicians using ‘standard’ equipment. As examples, patients were not transferred to examination tables or routinely weighed. MRI and CT scanning machines were often elevated at a level that made it difficult for patients who were wheelchair users to access. These design flaws and inabilities to perform full physical examinations often led to misdiagnosis or overlooking of disease.

Another issue identified was the attitudes of clinical staff about accommodating disability, where patients cited staff reluctance to accommodate their disabilities which led to embarrassment for the patient and were less likely to attend the clinic for follow-up appointments. Furthermore, clinical presentations of cancerous symptoms were often dismissed as emotional responses to their chronic health conditions, or were instead attributed to a symptom of their underlying disability. ‌

After establishing commonly experienced barriers to care, pathways to reduce disparities can be established to improve patient experience and prognosis for those with physical disabilities. These include a concerted effort to reduce stigma in allied health education and training, and being able to develop and test culturally aware and community-based and lifestyle change programs that aim to reduce potential cancer risks that disproportionately affect the disabled community, such as smoking, inadequate diet and obesity. Further efforts to develop complaints networks on a hospital or healthcare setting in order to ensure that inadequate care provision is adequately addressed.

To reiterate, this research highlights a need for disability-driven innovation in cancer as well as wider healthcare settings in general in order to ensure that all individuals have equitable access to the best possible care and support throughout their cancer journey.

I have now accepted an offer to pursue a Master of Public Health degree at Imperial College London, where I hope to be able to learn from policymakers and public health officials and complete a thesis looking at women’s health and increasing health equity. From there, I hope to be able to accept a PhD offer and use my collective learnings to enter a rewarding career in public health.

If anyone would like to connect with me online, please get in touch via LinkedIn: https://www.linkedin.com/in/ka...

Studies on the topic that informed the blog:

Hughes, R.B., Robinson-Whelen, S. and Knudson, C. (2022). Cancer Disparities Experienced by People with Disabilities. International Journal of Environmental Research and Public Health, [online] 19(15), pp.9187–9187. doi:https://doi.org/10.3390/ijerph19159187.

Magasi, S., Marshall, H.K., Winters, C.A. and Victorson, D. (2022). Cancer Survivors’ Disability Experiences and Identities: A Qualitative Exploration to Advance Cancer Equity. International Journal of Environmental Research and Public Health, [online] 19(5), pp.3112–3112. doi:https://doi.org/10.3390/ijerph19053112.