OBJECTIVES:

To describe interventions evaluated in randomized controlled trials to address healthcare disparities among cancer patients and survivors in the United States.

METHODS:

PubMed, EMBASE and Cochrane Central were searched from database inception to 30 September 2022. Studies were eligible if they (i) targeted individuals with a history of cancer, (ii) aimed to reduce healthcare disparities in socially disadvantaged patients, (iii) included a study arm of disadvantaged individuals or planned subgroup/interaction analyses of disadvantaged individuals, (iv) were randomized controlled trials and (v) were conducted in the United States. Search results were screened independently by two reviewers. Study details and intervention characteristics were extracted. Qualitative synthesis was performed to identify strategies used to implement interventions to reduce healthcare disparities.

RESULTS:

A total of 82 articles, representing 70 studies, were eligible. Most studies (74.3%) recruited patients with breast cancer. Race-related disparities were targeted by most interventions (65.9%), followed by disparities due to socioeconomic status (19.5%), place of residence (9.8%), sexual orientation (1.2%) and immigrant status (1.2%). Most interventions provided cancer education (61.0%) or counseling/coaching (35.4%). Strategies used to implement interventions in disadvantaged groups include incorporating cultural elements (35.4%), translating interventional material (30.5%), employing role models disadvantaged individuals identify with (19.5%), training facilitators to increase awareness towards needs and sensitivity of disadvantaged individuals (18.3%), including content specific to disadvantaged group (15.9%) and adapting intervention delivery methods to disadvantaged individuals (8.5%). Although interventions were evaluated using randomized controlled trials, most studies only assessed effectiveness in the disadvantaged group (87.1%) No comparison groups with non-disadvantaged individuals were included; hence the reduction in healthcare disparities between disadvantaged individuals and the general population cannot be characterized.

CONCLUSIONS:

Several strategies have been employed to implement interventions to address healthcare disparities among cancer patients and survivors. Study methodology can be improved by including non-disadvantaged individuals as comparison to assess changes in healthcare disparities.