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In 2009, it was estimated by the Statistics Portal that there were 970,000 doctors

in the United States. Of those, 10,000 were reported to be oncologists, which are
physicians that specialize in the treatment of cancer. Upon exploring the niche
community of oncologists in the United States, an interview with Dr. Michael Kasper -an
oncologist from the Lynn Cancer Institute in Delray Beach, Florida- denoted that the
biggest trends in his concerns with his practice were related to the health disparities that
manifested themselves in his waiting room. Dr. Kaspers sentiments were echoed in
numerous research outlets with the two biggest disparities seemed to stem from two
major factors: physical access to care, and ability to afford care.
There are as many types of oncological specialists as there are cancers. Some
oncologists treat cancers that take the form of benign moles or small tumors, while others
may be specialists for the more dangerous and exotic cancers found in the neck, brain, or
even in the bone marrow. That said, it is important to note that while oncologists make up
their own niche in the medical field, this niche is actually the result of a rainbow of
oncology sub-specialties coming together to make the oncology community.
One may wonder why so many doctors would gravitate towards becoming
oncologists. The truth is, this community exists out of sheer necessity: cancer is the
second leading cause of death in America (CITE). It is responsible for up to 1,600 deaths
per day (CITE). What is more, although that figure that cited 10,000 in the United States
sounds large, it could not be further from the truth: according to the Oncology Times, by
2020, the United States will not not have enough oncologists to accommodate its needs
(CITE). Perhaps more unnerving is the fact that the Center for Disease Control predicted
that between 2010 and 2020 there would be almost two million new cancer patients in the
United States (CITE). Thus, not only does this community exist out of present necessity,
but will also grow in response to future anticipation of cancer diagnoses.
In addition, another factor that both maintains- and will likely increase the size ofthe community is the salary involved. Although many oncologists report being drawn to
the humanitarian nature of oncology, it would be naive not to note the substantial salaries
that draw some medical students to becoming oncologists. Altruistic motivations aside,
one may affirm that many medical students are motivated to become oncologists as
cancer is one of the most lucrative diseases for medical professionals. To illustrate the
point, it is estimated that Americans spend up to $32.6 billion per year on oncology
treatment each year CITE. Although it is undeniably a less idealistic explanation for the
number of oncologists entering the profession, the data does suggest that the number of
present and future cancer patients, compounded with the fact that as of this writing there
is no cure for the disease, makes oncology a very popular choice for medicine.
One may wonder why so many doctors would gravitate towards becoming
oncologists. The truth is, this community exists out of sheer necessity: cancer is the
second leading cause of death in America according to the American Cancer Society.
Similarly, the American Cancer Society reports that cancer is responsible for up to 1,600
deaths per day in the United States alone. Although that figure that cited 10,000 in the
United States sounds large, it could not be further from the truth: according to the
Oncology Times, by 2020, the United States will not have enough oncologists to

accommodate its needs (Rosenthal, 2007). These facts are furthered confirmed by an
interview obtained with radiation oncologist Dr. Michael Kasper from the Lynn Cancer
Center. Perhaps more unnerving is the fact that the Center for Disease Control predicted
that between 2010 and 2020 there would be almost two million new cancer patients in the
United States (Thompkins, 2015). Thus, not only does this community exist out of
present necessity, but will also grow in response to future anticipation of cancer
diagnoses.
To begin, the first issue plaguing the community is related to actually being in a
locale in close proximity to the patients. Unfortunately, many patients reside in rural
areas and are unable to be diagnosed with their condition, much less receive treatment
regularly. Although this has very obvious consequences for the would-be patients, it also
tremendously affects the oncologists. For example, assuming that a patient in a rural area
is able to make it to a cancer treatment facility at all, the oncologist may have to tailor
their treatment schedule to accommodate for patients having to make tremendous
journeys (Groux & Szucs, 2013). To illustrate, one study found that oncologists will give
higher doses of cancer medication less frequently (versus lower doses more frequently) to
patients they knew had to experience a longer journey to the facility that way the patient
would not have to travel to the facility as often (Groux & Szucs, 2013).
Ultimately, this issue is generally viewed as disappointing by the oncologists. By
having to structure their treatments around a patient's availability rather than what they
genuinely believe is best, oncologists may lose some of the freedom to treat their patients
in a manner most congruent with their professional opinion. This invites the risk that the
patient may not be getting the treatment that is best for them, but rather the treatment that
is the most convenient. However, once again, one must keep in mind that in some cases,
intermittent treatment is the best case scenario for patients in rural areas: there is also the
chance that the oncologist may not be able to get to the would-be patient at all if they live
in a very remote location.
Take, for example, the oncologists that join Remote Area Medical, a clinic that
pops up in different rural areas for a few days out of every year to examine (and
potentially diagnose) thousands of people with myriads of diseases including cancer
(Reichert et al. 2013). The doctors who diagnose these citizens with cancer are frequently
unable to treat the same citizen for their cancer, as they're destined to return to their home
after the clinic closes. If they're unable to find continuing treatment for their newly
diagnosed patient before they leave the area, the patient could suffer, which places stress
on the oncologists.
That established, because doctors cannot reach these remote areas physically, they
frequently try to prevent the issue of being a rural citizen with cancer from ever occurring
in the first place. They do this by publishing information about prevention, via the
Internet or print. To expand their reach, they make use of organizations such as the
American Cancer Organization to reach a larger following. Furthermore, they have even
attempted to incorporate preventative measures on the culprits themselves. For example,
in the United States, it is now mandated by law that all tobacco products carry a warning
from the surgeon general about the risk of cancer. In California, carcinogenic substances
must be labeled as such. Although these print warnings are meant to target all citizens,
when employed in rural areas, they can serve the prevention function to keep one from
developing cancer and being unable to journey to a treatment facility. In sum, although

oncologists may not be able to make it into those rural areas, the cigarettes and
carcinogens still will, and by labeling them as hazardous, oncologists hope to prevent
cancers from developing.
Perhaps somewhat obviously, the constraint of the print labels is that not
everybody reads them, and even if they do, not everybody is may not be cancer-literate
enough to understand what that means (Cite) In addition, these ads are typically printed
in English, so if one is a native-Spanish or native-Chinese speaker living in the United
States, there is a chance the warning may not be heeded.
Unfortunately, for the most part, this seems to be a rather insular issue between
the providers and the patients they do or do not serve in these rural communities. Thus,
the most relevant community to this issue, outside of the oncologists themselves, is rural
citizens. As illustrated in the documentary Remote Area Medical, many rural citizens are
frustrated and upset with the lack of care in their communities (and as we will later see,
the high cost of treatment if that care is even available).
The issue of oncologists being unable to treat patients in rural areas creates an
avalanche of issues. In addition to frustration on the part of the oncologists, patients go
untreated or undiagnosed. The consequences of this are not just tangible, but guaranteed:
researchers in Remote Area Medical showed that they have successfully managed to
predict one's chances of beating their cancer based on their geographic location and
socioeconomic status. Predictions aside, other data makes it clear that access to cancer
treatment and patients' outcome are undeniably related (CITE Furthermore, as a
consequence to their lack of treatment, the patients' quality of life diminishes at an
exponential rate. As they become ill, these patients are more likely to require government
assistance in the form of disability and unemployment assistance, which already costs the
United States 59 billion dollars per year. Thus, it is not just one issue that spawns from
this phenomenon, but several.
The most promising solutions to this issue spans a timeline: intervention programs
for youths to prevent cancer from occurring in these communities in the future, and
outreach programs to mitigate situations in which adults already have cancer or are at risk
of it. To illustrate, in regards to the first component that focuses on youths, the most
potent genres of communication may likely be on social media. In the year 2015, it was
reported by the United States Department of Health and Human Services that 3,800 kids
aged 12-17 try a cigarette for the first time each day. Simultaneously, it was found by the
American Academy of Child and Adolescent Psychology that 60% of students aged 13-17
had a social media account. An organization such as the American Cancer Association
could use the social media genre to create an account that appeals to the aesthetic taste of
these young adults that would simultaneously spread the message of cancer awareness
and prevention.
In regards to helping older individuals whom the window of prevention may have
already closed for, a potential solution is the use of pop-up clinics, such as Remote Area
Medical. These clinics can help make up for the lack of oncological care in these areas,
albeit temporarily. Although it does create the issue that oncologists may get diagnose the
patients with cancer and have to leave them with no readily available form of treatment, it
does at least give these rural adults a chance to see an oncologist and plan around their
diagnosis accordingly. This is a better alternative than the off chance of being diagnosed
later in life, as the timing of one's diagnosis is inevitably related to their prognosis. Pop-

up clinics have the power to give this advantage on a massive scale such as the ones seen
in Remote Area Medical, as these clinics will be readily available to those who need to be
seen.
The second largest issue that affects the community is ironically enough, one of
the potential reasons a practitioner became an oncologist to begin with: the cost of
treatment. In some situations, a lucrative medical profession translates into a costly
medical bill for patients. Not only does cancer affect the poor, but also it has been
suggested to do so in a discriminate manner: studies have found that one's prognosis can
be related back to their socio-economic status. What this means is not only will scores of
disadvantaged Americans be diagnosed with the disease, but they will also be unlikely to
afford treatment for their ailment. This indeed leads to tough financial choices for
oncologists, as well as difficult emotional situations.
In terms of how oncologists within this community view this issue, several cited
discontent, but also motivation. On the condition of anonymity, several professions at the
Lynn Cancer Institute voiced their concerns. The focus centered on the personal
frustration they felt when they were presented with a situation where a diagnosis was
made for a destitute patient, but the patient both lacked insurance or the financial means
to pay. Often, the professionals would take it upon themselves to go through the usual
networks, such as Medicare, which was established to treat elderly patients who did not
have private insurance. Medicare currently treats 52 million Americans each year. There
is also the potential for Medicaid, which was established to treat low-income individuals
and currently reports treating about 65 million Americans each year. In the likely event
that they encountered more roadblocks, the oncologists still maintained a sense of
stewardship for their patients rather than abandoning them.
Frequently, they took it upon themselves to find charity funds to treat their
patients. When asked about how the cost of treatment is so high, one oncologist explained
that although the price of one Accelerator (a device that emits radiation to treat cancer)
was two million dollars, but it is a fixed cost that the facility took it on them to pay. To
him, it made no difference if a patient who could not afford treatment used the machine,
because it was a stagnant object that would've been in the room regardless. He cited the
more expensive component of treatment as being the drugs to treat cancer, and the price
of that was beyond his control. Ultimately, it was universally echoed by the oncologists
that although they viewed the issue as unfortunate, it could be easily overcame with a
sense of determination and altruism.
The issue of the cost of cancer treatment seems to be rather niche, and is a type of
information that to laymen is only sought for when researching cancer. That said, for this
paper, our outside subgroup would be non-medical professionals researching the cost of
treatment. Frequently, the genre of communication is broadcast media, such as CNN
news broadcasts. In the same vein, another genre may be articles in the form of print
media, such as the New York Times or USA Today. Just as rampant are informative
articles that fall under the virtual genre of communication; websites such as those owned
by Fox News or the British Broadcast Channel. Under the massive number of genres that
fall under this "news outlet" umbrella, information about the high cost of cancer
treatment is divulged to the public- and on a massive scale.

Although these genres have several constraints, which will be outlined, they have
a wealth of affordances. For example, online news articles can be downloaded and shared
rapidly, which spreads news about the price of cancer treatment at an unprecedented
speed. In addition, as 96.7% of Americans reported owning a television set in 2013
(CITE), television broadcasts about the prices of drug treatment have the potential to
reach the majority of Americans. However, like all genres, there are some constraints.
Some Americans may not have access to the specific channel that the program may be on.
Furthermore, there may be a general lack of interest in the topic and viewers choose to
watch a different program; one cannot assume that just because a program is on that the
people are going to watch it.
Outside of the oncologist community, many individuals seem outraged. Aside
from patients, members of other medical communities are similarly agitated. In an
interview with the National Public Radio news outlet, hematologist Dr. Ayalew Tefferi of
the Mayo Clinic expressed concern at his crying patients spending their life savings on
treatment, and accused the pharmaceutical industry of being greedy and completely
unregulated. The hematologist was particularly agitated by the fact that the drugs did not
even seem to be priced by the benefits they give or pain they alleviate, and thus thought
the pharmaceutical companies were not being as transparent as they should be.
That established, the problems that the price of cancer treatment create for
oncologists are innumerable. Many worry about the price of the treatment, which can
easily be more than half of their patients' family income.
In terms solutions to get around the price of cancer treatment, there have been
several sentiments yet there seems to be no clear consensus on the best way. On one
hand, some believe that universal healthcare will allow low-income patients to have a
better chance at being able to afford the treatment, especially for people who cannot get
private health insurance because of a pre-existing condition, or their age. On the other
hand, some individuals believe that such a measure is ineffective, as a universal
healthcare plan is likely to limit the network of doctors policyholders can see, thus
keeping them from seeing doctors who could potentially provide better treatment.
Furthermore, in the article featuring Dr. Taferri, he gave a list of recommendations to
lower the cost of cancer treatment. One of them was to set up a committee that
determines the price of a drug based on the benefits it gives patients. However, in
response, PhRMA, the trade group that represents pharmaceutical companies, said that
that would discourage innovation in pharmaceuticals.
Conclusively, the disparities present in the field of oncology and the healthcare field in
general are widely apparent and destructive of the well being of patients. As shown, the
health disparities of lack of access to treatment as well has the inability to afford care can
mean the difference between living and dying for patients with these various types of
cancer. Through effective communication practices, one can express optimism that these

disparities have a true potential to dissolve, and access to affordable and local healthcare
will become an obtainable service in the near future.