Review
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Sep 24, 2020; 11(9): 705-722
Published online Sep 24, 2020. doi: 10.5306/wjco.v11.i9.705
Healthcare delivery interventions to reduce cancer disparities worldwide
James C Dickerson, Meera V Ragavan, Divya A Parikh, Manali I Patel
James C Dickerson, Meera V Ragavan, Department of Internal Medicine, Stanford University, Stanford, CA 94305, United States
Divya A Parikh, Manali I Patel, Division of Oncology, Department of Medicine, Stanford University, Stanford, CA 94305, United States
Manali I Patel, Center for Health Policy/Primary Care Outcomes Research, Stanford University, Stanford, CA 94305, United States
Manali I Patel, VA Palo Alto Health Care System, Palo Alto, CA 94306, United States
Author contributions: All authors contributed to the design and writing of the paper. Patel MI provided additional oversight.
Conflict-of-interest statement: The authors have nothing to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: James C Dickerson, MD, Doctor, Department of Internal Medicine, Stanford University, Lane Building L154, 300 Pasteur Dr, Stanford, CA 94305, United States. jcdicker@stanford.edu
Received: April 12, 2020
Peer-review started: April 12, 2020
First decision: April 22, 2020
Revised: July 7, 2020
Accepted: September 1, 2020
Article in press: September 1, 2020
Published online: September 24, 2020
Abstract

Globally, cancer care delivery is marked by inequalities, where some economic, demographic, and sociocultural groups have worse outcomes than others. In this review, we sought to identify patient-facing interventions designed to reduce disparities in cancer care in both high- and low-income countries. We found two broad categories of interventions that have been studied in the current literature: Patient navigation and telehealth. Navigation has the strongest evidence base for reducing disparities, primarily in cancer screening. Improved outcomes with navigation interventions have been seen in both high- and low-income countries. Telehealth interventions remain an active area of exploration, primarily in high income countries, with the best evidence being for the remote delivery of palliative care. Ongoing research is needed to identify the most efficacious, cost-effective, and scalable interventions to reduce barriers to the receipt of cancer care globally.

Keywords: Intervention, Cancer, Disparity, Health services research, Global oncology, Navigation, Telehealth

Core Tip: Equitable delivery of cancer care requires the study of interventions that can improve access for historically disadvantaged groups. In this review we examine two approaches, patient navigation and telehealth, that have been implemented globally to reduce cancer disparities. Navigation has the most robust evidence, largely for improving cancer screening, and telehealth remains an area of exploration, primarily for the remote delivery of palliative care.