Understanding Barriers

Identifying Major Barriers Contributing to Disparities in Care

Complex and interrelated factors contribute to disparities in care. The factors may include, but are not limited to1-4:

  • Socioeconomic factors including status and reduced access to care
  • Cultural beliefs including a deep-seated distrust between African Americans and the healthcare system

Socioeconomic factors including annual income, lower education levels, greater unemployment, and occupation may contribute to the incidence and survival rates of multiple myeloma.4-6

Socioeconomic Status Graph

African Americans were more likely to fall into the 2 lower socioeconomic groups than Whites (78% vs 65%; P<0.001)7

In addition to socioeconomic barriers, there is a historical mistrust between
African Americans and the healthcare system. This mistrust is rooted in an infamous study (eg, The Tuskegee Syphilis Study§) and interactions with physicians. Due to the fact that minorities represent a greater proportion of un- and underinsured populations, lack of access correlates with quality of healthcare received. This lack of quality care then leads to further mistrust of the healthcare system.3

Mistrust Graph

Mistrust remains pervasive and present due to challenges within the healthcare system today.3,8

§The US Public Health Service Syphilis Study at Tuskegee was a clinical study conducted between 1932 and 1972. The study was intended to observe the natural history of untreated syphilis. As part of the study, researchers did not collect informed consent from participants and they did not offer treatment, even after it was widely available. After the study ended, sweeping changes to standard research practices were made. Efforts to promote the highest ethical standards in research are ongoing today.8

References: 1. American Association for Cancer Research. AACR Cancer Disparities Progress Report 2020. https://cancerprogressreport.aacr.org/wp-content/uploads/sites/2/2020/09/AACR_CDPR_2020.pdf. Accessed October 18, 2021. 2. Derman BA, et al. Blood Cancer J. 2020;10:80. 3. Pierre A, et al. Clin J Oncol Nurs. 2020; 24(4):439-443. 4. Marinac CR, et al. Blood Cancer J. 2020;10:19. 5. Chamoun K, et al. Cancers. 2021;13(590). 6. Omore I, et al. J Clin Oncol. 2020;38(15 Suppl):E12595. 7. Fiala MA, et al. Leuk Lymphoma. 2015;56(9):2643-2648. 8. Wells L, et al. Proc UCLA Health. 2020;24:1-3.