When discussing cancer disparities, it’s easy to focus on statistics—but behind those numbers are real families grappling with impossible choices. Eneida Nemecek, MD, MS, MBA, Professor of Pediatrics and Medical Oncology at Oregon Health & Science University, explored these complexities in her keynote address at the Summit on Cancer Health Disparities 2025 in Seattle, WA.1
A Complex Web of Factors
Dr Nemecek emphasized how social determinants of health shape access to treatment and overall health. These determinants span 5 domains—healthcare access, education, economic stability, neighborhood and environment, and social and community context—each with branches that influence opportunity and outcomes. “It’s not a circle; it’s a very big, convoluted and complex system,” she noted.
To illustrate, Dr Nemecek shared the story of Sam, a 2-year-old with high-risk leukemia. His family lives in a rural area, 6 hours from the nearest cancer center. His father, a seasonal farm worker, must stay behind to maintain the family’s only income, while Sam’s mother, who doesn’t drive, relocates with him to the city for treatment. This example, Dr Nemecek explained, underscores how social, economic, and geographic factors can combine to create daunting barriers to care, with each factor influencing and amplifying the others.
The Data Behind Disparities
Dr Nemecek highlighted national statistics that reflect these challenges: approximately 43% of the US population identifies as a race or ethnicity other than White, and 19% live in rural areas. In addition, more than 12% of the US population lives below the poverty line, with even higher rates among children (16%) and rural communities (15%). She noted that 41% of people report difficulty paying household expenses, 30% are facing home eviction or foreclosure, 12.5% experience food scarcity, and 8% lack internet access at home—factors that can limit preventive care, delay diagnoses, and reduce treatment adherence. “These challenges are compounded by systemic and structural barriers that keep people from getting the care they need,” she said.
Patient navigation, community-based strategies, and improved language access are key individual-level solutions, Dr Nemecek suggested. Telehealth and digital tools can help bring care closer to underserved communities, but these efforts must be paired with a healthcare workforce that reflects and understands its patients.
“The healthcare force should represent and know the communities they are serving. This is an important step to delivering equitable care,” she said, stressing that cultural competency should be instilled early and reinforced throughout training. “Cultural competency training should start early—the earlier the better,” she said.
The Role of Policy and Partnerships
Dr Nemecek called for policy reforms and cross-sector partnerships, both nationally and internationally. “Healthcare is influenced by political forces, and we have to continue the dialogue across party lines,” she said. Initiatives like the expansion of the Children’s Health Insurance Program have made progress, but gaps in coverage and care persist—especially in states without Medicaid expansion. Regularly reviewing local demographic data, she added, is essential to ensure that healthcare systems keep pace with changing community needs.
A Call to Action
According to Dr Nemecek, achieving cancer health equity requires combined structural reforms and individual-level support, along with sustained, collaborative commitment. Her presentation left attendees with a clear takeaway: meaningful progress is possible, but only if we work together at every level of care and society. The story of Sam serves as a reminder that behind every statistic is a child, a family, and a community in need of solutions.
“I leave you all with this challenge: Do not stay silent. Get involved,” she urged. “A lot of things have changed in our country, but one thing hasn’t changed, and that’s our desire and responsibility to improve health equity.”
Source
- Nemecek E. Keynote address. Summit on Cancer Health Disparities 2025. April 25-27, 2025; Seattle, WA.