Palliative and Supportive Care

Original Articles

Disparities in cancer care: Perspectives from the front line

Patricia A. Millera1 c1, Christina Sindinga2a3, Patti McGillicuddya4a5, Judy Goulda6, Donna Fitzpatrick-Lewisa2, Linda Learna7, Jennifer Wiernikowskia7a8 and Margaret I. Fitcha9

a1 School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada

a2 School of Social Work, McMaster University, Hamilton, Ontario, Canada

a3 Department of Health, Aging and Society, McMaster University, Hamilton, Ontario, Canada

a4 University Health Network, Toronto, Ontario, Canada

a5 Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada

a6 Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada

a7 Juravinski Cancer Centre, Hamilton Health Sciences, Hamilton, Ontario, Canada

a8 School of Nursing, McMaster University, Hamilton, Ontario, Canada

a9 Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada


Objective: The purpose of this qualitative study was to investigate how frontline healthcare professionals witness and understand disparity in cancer care.

Method: Six healthcare providers from a range of care settings, none with < 15 years of frontline experience, engaged with researchers in an iterative process of identifying and reflecting on equity and disparity in cancer care. This knowledge exchange began with formal interviews. Thematic analysis of the interviews form the basis of this article.

Results: Participants drew attention to health systems issues, the meaning and experience of discontinuities in care for patients at personal and community levels, and the significance of social supports. Other concerns raised by participants were typical of the literature on healthcare disparities.

Significance of results: Providers at the front lines of care offer a rich source of insight into the operation of disparities, pointing to mechanisms rarely identified in traditional quantitative studies. They are also well positioned to advocate for more equitable care at the local level.

(Received July 09 2012)

(Accepted August 24 2012)


  • Cancer;
  • Health disparities;
  • Healthcare providers;
  • Qualitative research;
  • Coordination of care


c1 Address correspondence and reprint requests to: Patricia A. Miller, 5 Undercliffe Avenue, Hamilton, Ontario, Canada L8P 3G9. E-mail: