In conversation about health equity with Dr. Aisha Lofters

We sat down with Toronto’s Dr. Aisha Lofters, family physician, Scientist at Women’s College Research Institute, Walnut Foundation partner and friend of Movember to discuss health equity and what it would take to truly close the cancer care gap.

Can you tell us about your work in the cancer space and health equity?

I'm a family physician, but I spend most of my time doing research. My research really focuses on the intersection of health equity, cancer care and primary care. I started out doing a lot of work focusing on cancer screening and cancer prevention, but in more recent years I’ve done work looking at the entirety of the cancer continuum.

Specifically, when it comes to prostate cancer, I've been involved in research looking at inequities in prostate cancer care for Black men specifically. All of this work that I have done has been in partnership with the Walnut Foundation, which is a prostate cancer support group primarily for Black men. They’re an amazing group in the community trying to provide support and also looking for evidence to justify why there is a need for a group like theirs.

What has the focus been in your equity research?

The first prostate cancer-related project I did was actually a descriptive study, looking at provincial data to understand prostate cancer incidence among immigrant men from various parts of the world. We hear that there is an increased incidence of prostate cancer among Black men. But, much of that data comes from the US and the UK. There is not much race-based data in Canada. This was the first piece of work that we did with the Walnut Foundation, and we found a higher incidence for men from the Caribbean and West Africa. That research question really came from them, because they wanted that backing evidence to help support the need for their group.

But then we wanted to go beyond just knowing that there’s a higher incidence. We wanted to understand it more fulsomely. What barriers did these men face? Dr. Jackie Bender and I held an information gathering session with the members of the Walnut Foundation, and found many gaps in the system that could be improved. The men talked about biases that their providers had, information that was not shared with them, treatment options that were not shared and then having to deal with issues around the side effects of prostate cancer treatment, misinformation and disinformation about prostate cancer.

For prostate cancer care specifically for Black men, we are just getting started with a project where we’re recruiting Black men and their caregivers, to hear from them directly about what their experience has been with the prostate cancer care continuum. We want to know where the gaps are, what the barriers are, and where there are opportunities to improve. We then want to use those findings to be able to educate and raise awareness in the Black community, but also to develop some actionable outputs for providers and for the system.

The theme of World Cancer Day earlier this month was “close the care gap”. If we’re looking to take action in closing the cancer care gap from a health equity point of view, what do we need to be talking about?

Obviously, we want to shine a light on where there are inequities. But I think to then be able to do something about those inequities -- that's where the real challenge lies. We need to really engage with people with lived experience. If you don't have that lived experience, you can speculate and wonder and hypothesize about what the gaps are, but there's nothing like just talking directly to people who've experienced it. Because we all have our blinders on when it comes to particular systemic barriers, things that we just can't see because we don't experience it. The real key is to recognize who we need to bring to the table, not just have one voice or one person, but recognize that we really need to rethink who's voices we listen to, but also who's at decision making table and making sure that is a truly inclusive process.

What are some of the biggest strides that have been made in closing the care gap?

I don’t think, to be honest, gaps are closing yet, but I think one of the biggest strides that has the potential for closing gaps is – as simplistic as it may sound – the fact that we’re actually now having open conversations about race. Up until a few years ago, it was very challenging to have conversations about racism and health, about racial disparities in Canada. It was very much seen as “an American thing”. In the past, we would talk about differences for immigrants, making it more about people’s cultures and not acknowledging that systemic racism exists here. Now we can build on these conversations, take that discourse and lead to meaningful change.

If we look ahead 20 years from now, what’s your hope for the future state of equitable cancer care for all men?

I would like to see systems and a cancer care space where all men really feel comfortable being able to ask the questions that they want to ask, getting answers that they understand, being able to feel that they are welcome in the healthcare space and not feeling that they’re alone.

What drives you in your work in cancer care equity?

What drives me are the partners I work with. People like Ken and Anthony from the Walnut Foundation and hearing their stories and seeing their passion. The fact that somebody could have gone through this disease and could be going through treatment, and still has the energy and the passion and the motivation to want to seek change. Anything that I can do to help to support that and move forward is what drives me. In general, they say cancer affects one in two people – and I’ve seen it in my family and my friends – it’s such a pervasive health issue. It affects us all. So, anything that we can do to make that a better experience or reduce those numbers? I’m here for it.