Anti-ableist oncology care: ensuring equity for people with physical disabilities

Ableism, broadly defined, is discrimination towards people with disabilities, including use of language that excludes the unique needs and skills of people with disabilities, normalises people with typical abilities, and suggests that those with disabilities require so-called fixing.1 Ableism in health care must be recognised and rejected. The respondents also overwhelmingly reported that they felt that quality of life was lower for people with disabilities than for people without disabilities.6 It is also concerning that a 2020 study found that over 80% of health-care professionals in the USA implicitly preferred treating people without disabilities.7 This bias might contribute to lower cancer screening rates for patients with disabilities and unclear treatment decision making.8 People with physical mobility deficits and cancer report a lack of accessible equipment, providers being uninformed about their unique needs, and the sense that their cancer might have been treated differently due to their pre-existing disability.9 Access to care must be easier, and shared decision making simplified, for this vulnerable population who receive less treatment and staging investigations, and have poorer outcomes compared with individuals with no disability. Little has been published on the topic of treatment decision making for people with disabilities, but a study among medical oncologists in Turkey regarding whether hypothetical patients with disabilities were suitable for antineoplastic treatment found discordance, although some suggested that treatment was appropriate.10 Measuring the performance status of a person with a disability can be challenging and requires a holistic look at their life beyond performance status assessments, including adaptations they use in daily life, the need for assistance, and environmental barriers they encounter. Language in performance status measures Karnofsky Performance Status Scale 100 Normal, no complaints, no evidence of disease 90 Able to carry on normal activity, minor signs or symptoms of disease 80 Normal activity with efforts, some signs or symptoms of disease 70 Cares for self, unable to carry on normal activity or do active work 60 Requires occasional assistance, but is able to care for most personal needs 50 Requires considerable assistance and frequent medical care 40* Disabled, requires special care and assistance 30 Severely disabled, hospital admission is indicated although death not imminent 20 Very sick, hospita