In the intricate web of modern healthcare, access to cancer services is often hailed as a critical pillar of public health. However, for a substantial portion of society living under structural marginalization, the reality is starkly different. A recent qualitative study led by Horrill, T.C., Crawford, J., Beck, S., and their colleagues delves into this pressing issue, exposing a profound misalignment between health systems and the needs of marginalized populations. Published in the International Journal for Equity in Health in 2025, their research reveals how systemic and organizational barriers impede equitable cancer care access, offering a crucial perspective on an often-overlooked dimension of healthcare equity.
Cancer, a disease that demands timely diagnosis and consistent therapeutic intervention, challenges even the most robust health infrastructures. For structurally marginalized individuals—those affected by overlapping social, economic, and political disadvantages—the hurdles multiply exponentially. This population frequently grapples with poverty, limited education, racial discrimination, housing instability, and other social determinants that intertwine to erode the likelihood of receiving adequate cancer diagnosis and treatment. Horrill and colleagues embarked on a comprehensive inquiry into how these multifaceted barriers manifest within healthcare systems intended to serve all equitably.
Through meticulous qualitative methodologies, including in-depth interviews and focus groups, the researchers gathered experiences and narratives from patients, healthcare providers, and organizational representatives. Their findings elucidate a complex landscape where healthcare policies, institutional practices, and frontline clinical interactions collectively shape the accessibility and quality of cancer services. The study points to a “mismatch” — a misalignment between standardized health system protocols and the lived realities of marginalized individuals. This mismatch fosters systemic exclusion, often rendering cancer services effectively out of reach for those most in need.
One of the core system-level challenges identified is inflexible bureaucratic processes that fail to accommodate the socio-economic instability common among structurally marginalized populations. For example, many individuals face difficulties in fulfilling administrative requirements such as documentation or appointment scheduling, which can lead to delays or denials in care. Moreover, rigid service hours and centralized locations pose further obstacles, particularly for patients lacking reliable transportation or stable housing. These structural limitations are compounded by fragmented communication pathways across care providers, often resulting in patients falling through the cracks during critical junctures of their cancer treatment journey.
The organizational culture within healthcare settings also plays a pivotal role in this dynamic. The research highlights pervasive gaps in cultural competence and sensitivity among healthcare staff, which can undermine trust and communication. Healthcare professionals may unintentionally perpetuate stigma or fail to recognize the broader social contexts influencing patients’ health behaviors and compliance. Such attitudinal barriers exacerbate feelings of alienation within medical environments, discouraging marginalized patients from seeking or continuing treatment. The study underscores the urgency of training and structural reforms aimed at fostering inclusive, patient-centered care paradigms that resonate with diverse cultural and socio-economic backgrounds.
More technical insights from the study reveal multiple system failures in care coordination and patient navigation. Fragmentation across different tiers of cancer services—ranging from screening and diagnosis to treatment and follow-up—creates discontinuities that disproportionately impact vulnerable populations. Patients often encounter inconsistent information, conflicting advice, and bureaucratic inertia that stall clinical decision-making. The authors advocate for integrated care models leveraging multidisciplinary teams, robust case management, and community-based supports to bridge these gaps. These approaches could mitigate attrition rates and enhance adherence to potentially life-saving cancer protocols.
In relation to health policy, the study critiques dominant models that promote standardized, one-size-fits-all approaches rather than flexible frameworks addressing social determinants of health. Existing cancer care pathways frequently neglect upstream factors such as poverty alleviation, housing security, and social inclusion—domains that significantly influence patients’ capacity to engage with healthcare services. Horrill et al. urge policymakers to recalibrate priorities, incorporating equity-focused metrics and resource allocations that target structural marginalization as a root cause of health disparities. Without such policy evolution, disparities in cancer outcomes are likely to persist or worsen.
This research also highlights the critical role of patient advocacy and community engagement in fostering equitable access. Marginalized groups often lack representation in healthcare governance, leading to policies and practices misaligned with their needs. The inclusion of patient voices, especially those with lived experiences of marginalization, into decision-making processes can yield more responsive and adaptive care strategies. Community partnerships, peer support networks, and culturally tailored education programs emerge from the study as vital components to empower patients and dismantle barriers.
From a technological perspective, while digital innovations hold promise for enhancing cancer care delivery, the study acknowledges a digital divide that disproportionately excludes marginalized populations. Telemedicine, electronic health records, and mobile health applications can increase reach and streamline services but depend on access to reliable internet, digital literacy, and privacy considerations. Consequently, technological adoption must be accompanied by deliberate strategies to ensure inclusivity, such as providing devices, digital training, and safeguarding sensitive data. Without these supports, technological advances risk deepening the equity chasm.
The intersectionality of marginalization further complicates efforts to improve access. Individuals may concurrently face racial discrimination, gender biases, immigration challenges, and disability-related obstacles that intersect with economic deprivation. The study deftly examines this complexity, cautioning that interventions must avoid broad generalizations and instead adopt nuanced, intersectional frameworks that address compounded disadvantages. Tailored interventions acknowledging the multiplicity of social identities and the structural forces shaping them are essential for transforming cancer care accessibility.
In summarizing their findings, Horrill and colleagues stress that addressing the mismatch in cancer service accessibility requires systemic transformation rather than piecemeal fixes. Coordination between government bodies, health institutions, community organizations, and patients themselves is paramount. This transformation entails redesigning organizational policies, revising care protocols, expanding workforce training in cultural competency, and embedding equity goals into the fabric of health systems. The study serves as a clarion call for renewed commitment to health equity as a fundamental dimension of cancer care.
Importantly, the implications of this research extend beyond cancer services, resonating with broader concerns about health disparities in chronic and acute conditions. The structural and organizational barriers illuminated here are not unique to oncology but represent pervasive challenges undermining health justice globally. As such, the study contributes vital empirical evidence to ongoing dialogues in public health, health policy, and social medicine regarding the necessity of structural reforms to achieve universal health coverage.
The study’s qualitative lens provides depth and nuance, capturing the lived realities behind statistics and healthcare frameworks. By centering marginalized voices, the research moves beyond abstract policy discussions to highlight tangible experiences of exclusion and frustration. This human-centric approach enriches understanding and motivates stakeholder engagement grounded in empathy and social accountability. As health systems worldwide grapple with inequities spotlighted by recent global events, such as the COVID-19 pandemic, lessons from this study assume amplified salience.
Looking forward, the authors propose several avenues for future research and action. Longitudinal studies examining the impact of implemented changes could validate effective strategies and reveal unintended consequences. Additionally, expanding the research to diverse geographic and demographic settings would enhance generalizability and inform context-specific interventions. Policymakers, practitioners, and researchers are thus invited to collaborate in translating these insights into sustainable improvements that bridge the cancer care gap for structurally marginalized populations.
In conclusion, the study by Horrill, Crawford, Beck, and colleagues represents a pivotal contribution illuminating the hidden fractures in cancer service accessibility. It challenges healthcare stakeholders to confront uncomfortable realities and galvanizes efforts towards inclusive, equity-driven health systems. As the global burden of cancer continues to rise, ensuring that no one is left behind emerges not just as a moral imperative but as an achievable goal contingent on systemic transformation and social justice.
Subject of Research: Health systems and organizational-level barriers to accessing cancer services among structurally marginalized populations.
Article Title: “There’s just such a mismatch”: a qualitative exploration of health systems and organizational-level barriers to accessing cancer services among people experiencing structural marginalization.
Article References:
Horrill, T.C., Crawford, J., Beck, S. et al. “There’s just such a mismatch”: a qualitative exploration of health systems and organizational-level barriers to accessing cancer services among people experiencing structural marginalization. Int J Equity Health 24, 181 (2025). https://doi.org/10.1186/s12939-025-02554-8
Image Credits: AI Generated
