Despair and Disparity: Poverty and Advanced Cancer

It is unacceptable that people should die because they are poor and lack resources.

-- Harold P. Freeman, MD

My new patient lived in a tiny North Woods cabin, miles from the nearest town. He was an older man, on disability and rarely ventured anywhere. As near as we could tell, he spent his days at home, talking to his cats, eating soup, writing letters that betrayed an uncontrolled paranoia and smoking cigarettes. He was a person that virtually no one knew or would have ever missed.

His one regular contact with the outside world was the deliveryman from the grocery store. One day, the deliveryman convinced him that the sore that had been growing on his lower lip for at least three years should get some attention, so off they headed to a see a physician. Not long after that, they landed in our office.

This was a truly advanced cancer. Lip cancers are usually treated when they are less than 2 cm in size. His was at least 12 x 10 x 3 cm, growing into his mandible and involving his entire lower lip. The odor filled the room and seeped into the hallway. Treating him would be a real challenge.

Why did he wait so long? Recent studies have demonstrated a variety of associations with advanced cancer presentation. In a study of advanced cancer in Los Angeles, individuals were more likely to be poor, elderly, living in unsafe neighborhoods and/or needing to travel more than 45 minutes to see a doctor.

Entire neighborhoods with higher incidences were more likely to have high percentages of non-English speaking individuals, low educational levels, high unemployment levels and greater public transportation requirements.

These kinds of data can help target entire populations who are at risk. (Hamilton A, Cockburn M, Presentation at American Association of Cancer Research, 2007.)

Harold P. Freeman, MD, in his presentations at MCW and at the Wisconsin Comprehensive Cancer Control Conference in April, reinforced that it is our responsibility to improve everyone's cancer survival, but especially those who are disadvantaged. Dr. Freeman has written:

"The war against cancer has not been fought equitably on all fronts. We must tear down the economic, cultural and societal barriers to early diagnosis and treatment of cancer. We must apply what we know, at any given time, to all people." (Freeman HP, Surgical Oncology Clinics of North America 2005; 14:655-669)

Dr. Freeman provides us with a challenge. As scholars, we tend to note the disparities in cancer survival with interest. As fellow human beings, we should note the disparities with outrage. Dr. Freeman dedicated his career to addressing cancer care for the poor and he had an impact that reaches far beyond the borders of his neighborhood. We must do our best to emulate him.

Bruce H. Campbell, MD, FACS
Professor of Otolaryngology and Communication Sciences
Chief, Division of Head and Neck Oncology
Interim Director, The Medical College of Wisconsin Cancer Center

Dr. Freeman is the Medical Director of The Ralph Lauren Center for Cancer Care and Prevention in New York City. He is also the Associate Director of the National Cancer Institute (NCI) and Director of the NCI Center to Reduce Cancer Health Disparities.

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.