Cancer Care Inequities: Social Determinants, Diagnostic Delays, and Health-System Strategies for Equitable Access
DOI:
https://doi.org/10.64784/312Palabras clave:
cancer inequities, oncology access, social determinants of health, cancer diagnosis, treatment delay, health disparities, financial toxicity, geographic barriers, patient navigation, health systems, cancer care, health equityResumen
Inequities in access to cancer diagnosis and treatment remain a major challenge for contemporary health systems, particularly among populations affected by socioeconomic disadvantage, financial vulnerability, geographic isolation, limited health literacy, and fragmented healthcare pathways. This study analyzed the interaction between social determinants of health and structural characteristics of healthcare systems that influence timely access to oncology services. A documentary, integrative, descriptive, and analytical review was conducted using the Scientific Method as the methodological framework. Scientific evidence from international settings, Latin America, and Mexico was examined and organized according to socioeconomic, geographic, financial, organizational, and healthcare-process determinants. The results showed that socioeconomic factors were the most frequently represented dimension in the reviewed literature, followed closely by organizational and health-system barriers. Diagnostic evaluation was identified as the stage of the cancer-care continuum in which access barriers were most frequently documented, followed by treatment initiation and continuity of care. Referral fragmentation, prolonged waiting times, insufficient specialist availability, financial barriers, geographic concentration of services, and diagnostic infrastructure limitations were recurrent findings. Evidence from Mexico demonstrated that substantial delays may occur after patients have already entered the healthcare system, emphasizing that formal coverage does not necessarily guarantee effective access. The most frequently identified health-system strategies included integrated care pathways, rapid referral and diagnostic mechanisms, strengthening of diagnostic capacity, financial protection, decentralization of selected services, and patient navigation. The findings support the hypothesis that cancer-care inequities arise from the cumulative interaction of social vulnerability and modifiable health-system barriers. Reducing these disparities requires coordinated, multilevel interventions capable of improving diagnostic timeliness, treatment initiation, continuity of care, geographic accessibility, and financial protection. Equity in oncology should therefore be understood as the capacity of health systems to provide timely, continuous, affordable, and appropriate care according to clinical need rather than socioeconomic position, place of residence, or financial capacity.
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