Breast cancer awareness month

By Jay Bhatt, D.O., managing director of the Deloitte Health Equity Institute and the Deloitte Center for Health Solutions, Deloitte Services, LP.

Today is the last day of October and the last day of Breast Cancer Awareness Month.¹ About 1 in 8 women will develop breast cancer at some point in their life. This year, nearly 300,000 women in the United States will be diagnosed with the disease.² But when detected early, the five-year survival rate is 99%.³

In my hometown of Chicago, I’m known by some as the dancing doctor because I used to teach a dance class. I once had a patient who had late-stage breast cancer, she was also one of my dance students. Her cancer wasn’t detected early because she decided not to get a mammogram. She worried about having to tell her children if she had cancer. I had another patient who was similarly reluctant to get screened even though she had a family history of breast cancer. One day, I asked her if she liked music, and invited her to my dance class. She wasn’t necessarily interested in dance but liked music and wanted to meet others. I wanted to help build trust in the health system by forging a personal connection. Both women were Black and had similar lived experiences. The woman with late-stage breast cancer convinced the younger woman to get screened. Early-stage breast cancer was identified and treated. Black women are more likely to die from breast cancer than women of any other racial or ethnic group.⁴ Triple negative breast cancer disproportionately impacts Black women.⁵

Creating connections like that one, and helping people effectively navigate the health system, can improve trust and help address long-standing challenges. Racism and biases, for example, can negatively influence preventive care, screenings, diagnoses, and treatment. The Deloitte Health Equity Institute (DHEI) is focused on identifying the root causes of inequity and addressing the disparities.

Can technology help to humanize cancer care?

Earlier this month, I attended the annual HLTH conference in Las Vegas. I joined Shanthi Sivendran, M.D., in a session that explored ways technology could help make cancer care more equitable. Dr. Sivendran is a hematology/oncology physician who recently became the American Cancer Society’s (ACS) first senior vice president of cancer support. She explained that cancer can affect anyone, but it doesn’t affect everyone equally. Systemic racism, biases, and Zip codes can make it difficult to prevent, diagnose, treat, and survive cancer. 

Deloitte is supporting ACS’s development and nationwide expansion of a non-clinical patient-facing mobile app that can help cancer patients navigate the health system and their prevention or treatment journey. ACS CARES (Community Access to Resources, Education, and Support) connects users to curated content about cancer and information about services that fit each patient’s specific cancer journey.

Dr. Sivendran noted that once someone is diagnosed with cancer, they typically want to talk with someone who had a similar diagnosis and who has a similar lived experience. She explained that there is no truly effective way to connect cancer patients. Typically, it requires the physician to sift through patient lists and try to find potential connections. This can be a time-consuming process that is particularly challenging for busy physicians who are caring for multiple patients. Getting the right information at the right time to a patient can make it easier to navigate a difficult point in their lives.

The ACS CARES app dashboard includes three layers of navigation, Dr. Sivendran explained. The base layer provides access to evidence-based information about the patient’s cancer screening, diagnosis, and treatment options. Patients complete a health-related needs assessment and can be directed to resources to address those needs based on their Zip code. The information is tailored to where the patient is in their journey. The second navigation layer provides digital peer support from community volunteers who share similar lived experiences with the patient. These volunteers include caregivers and cancer survivors of all ages. The app might match patients to volunteers of the same race or ethnicity. A rural patient might be connected to a person from a rural community, or a military veteran might be connected to volunteers who are veterans. The third layer of support is in-person navigation at selected health system sites. Student volunteers provide an additional layer of support for patients.

Dr. Sivendran explained that the technology is not meant to replace the human touch. It's meant to augment it. More than 1,800 people, representing more than 60 different cancers, have used the app since its initial launch in June, she told attendees.

Many different touch points take place once someone is diagnosed with cancer, and that journey can be difficult for new patients to navigate. Dr. Sivendran noted that helping patients understand and navigate the health care system can help ensure they find the most appropriate treatment. This can lead to better outcomes, and a better quality of life.

Challenges should be identified before they can be addressed

Screening for cancer and other diseases can help detect the disease in its earliest and most treatable stages. But it is equally important to assess patients for factors that might limit their ability to access screenings and preventive care. Structural racism and systemic bias are among the underlying root causes of many inequities including economic inequality, limited access to health care, and food insecurity. Such disparities have made certain ethnic and minority populations, as well as people who live in rural areas, more susceptible to preventable illnesses. If we don't identify the challenges, and address their root causes, it will likely be impossible to address them. Here are three challenges that should be addressed to help make health more equitable:

• Lack of trust: We know that trust deficits can be a major challenge for people who need health care. Trust can influence a patient’s willingness to seek important medical care or to participate in preventive screenings. People who don’t trust clinicians or the health care system are less likely to seek care when they need it (see Rebuilding trust in health care). Trust between a patient and a health care provider can be linked to the patient’s perception of the quality of care they receive. People can lose trust in clinicians or the health system when certain expectations are not met.
  
• Language differences: A patient might not be willing to make an appointment for a screening or office visit if they are uncomfortable talking with a clinician who doesn’t speak their native language. Our recent survey data shows that over 50% of people who live in predominantly Black and Hispanic communities want to be seen by clinicians and care teams that look like them and use the same language (see Advancing health equity through community-based ecosystems). 
  
• Drivers of health: The average life expectancy for a person without stable housing is 27.3 years less than someone who has stable housing⁶ (see Addressing the drivers of health). A 2022 survey found that people who cut back on utilities also cut back on medical care and health spending. And among people who skipped a meal, 71% also cut back on medications and health care.⁷ These drivers of health can impact 80% of the health outcomes, according to Deloitte research.
  

I often say that health equity should not be a bolt-on or side gig. Hospitals and health systems can make real progress on health equity, but they should embed those efforts into every part of their operations. It should be embedded in everything they do from strategy to finance and operations.

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Endnotes:

^{1_{National Breast Cancer Foundation, Breast Cancer Awareness Month, October 2023}}

^{2_{Breast cancer facts and statistics, Breastcancer.org, 2023}}

^{3_{Breast cancer early detection, National Breast Cancer Foundation}}

^{4_{Breast cancer risk: Race and Ethnicity, Susan G. Komen, 2023; Breast cancer statistics, Centers for Disease Control and Prevention, June 8, 2023}}

^{5_{Breast cancer death rates are highest for Black women—again, American Cancer Society, October 3, 2022}}

^{6_{Housing and health: A roadmap for the future, the American Hospital Association, March 2021}}

^{7_{98 million Americans skipped treatments, cut back on food, gas or utilities to pay for healthcare, westhealth/Gallup, August 4, 2022}}

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