Undocumented patients with cancer face additional barriers to care.
The United States has an extensive history of immigration. However, several studies have demonstrated that people face health disparities because of their immigration status.1
According to the center of immigration studies, in November of 2021, the immigrant population is made up of 46.2 million documented and undocumented individuals. This represents 14.2 percent of the population in the United States.2
Undocumented immigrants are foreign-born individuals who have migrated to the United States without authorization.2 Contrary to negative connotations, political restrictions, and immigration policies, approximately 50% to 70% of the undocumented immigrant population pay federal and states taxes. Despite their contributions to the American economy, the undocumented population continues to face discriminatory policies.1 These disparities are particularly felt by those who have been diagnosed with cancer and their loved ones. These existing policies affect undocumented cancer patients emotionally, financially, physically, and socially.
Disparities Within the Health Care System
The Affordable Care Act is a federally funded initiative implemented in 2014 to allow more affordable healthcare options for millions of Americans. However, this initiative excludes many the undocumented population.
Research shows that those who are undocumented are rarely able to attain full insurance coverage, whether it is private insurance from the marketplace or Medicaid. Multiple states have expanded Medicaid policies to cover service gaps for undocumented individuals (Emergency Medical Treatment and Active Labor Act), but this extended policy varies by state and solely covers emergency services. This affects individuals who are diagnosed with cancer for any type of treatment. Individuals who seek emergency services due to a diagnosis may receive emergency medical attention; however, it typically does not cover cancer treatment costs.
Thus, those who are undocumented and uninsured usually do not seek medical assistance, or delay seeking care, for several reasons. Health insurance is closely linked to the number of times individuals seek medical assistance: this includes general check-ups, annual physicals, and cancer screenings.3 Cancer screenings are typically delayed unless or until individuals experience extreme discomfort or a medical emergency. Undocumented individuals are likely to live with pain and discomfort in order to avoid receiving high medical bills. They may avoid seeking medical attention or put off annual physical exams to avoid fees and copayments.
A delayed cancer diagnosis affects the prognosis and types of treatments that are available to patients. The quality of treatment is also compromised, as undocumented populations are more likely to be offered a less effective, yet more affordable, treatment as opposed to the best available treatment that is more expensive, that is linked to a higher survival rate.1
Undocumented individuals who are facing a cancer diagnosis are at higher risk of struggling with the financial burden of cancer treatment. Due to the nature of diagnosis and treatment, most patients with cancer who are undocumented are unable to work, resulting in ineligibility to receive federally funded benefits such as extended family leave, paid time off savings, paid sick days, short-term and long-term disability.
Furthermore, undocumented patients with cancer face traumatic experiences that cause stress levels to elevate—affecting their mental health. Some of these traumatic experiences include discrimination because of immigration status, stigma related to status, language barriers, and racism. These traumatic experiences also affect the likelihood of patients seeking medical assistance for their cancer treatment or diagnosis.1
Often undocumented individuals who may have a cancer diagnosis delay seeking medical assistance because of fear of deportation. It can be difficult for undocumented individuals to seek support as oftentimes they are the ones supporting their families—financially and emotionally.
These experiences can be isolating for patients and are correlated to depression, anxiety, posttraumatic stress disorder, and other mental health conditions. Higher stress and mental health conditions cause a direct impact on patients' physical health as well as response to treatment and survivorship.1
Helping Undocumented Patients Navigate Health Care Disparities and Impacts
Although there are plenty of challenges and barriers that prevent undocumented cancer patients from receiving adequate treatment, support, and information, there are a plethora of ways to help this population navigate challenges.
Cultural humility is defined as “a lifelong process of self-reflection and self-critique whereby the individual not only learns about another's culture, but one starts with an examination of their own beliefs and cultural identities.”4 By reflecting one's own core cultural identity and privileges one may hold, it allows the health care worker to empathize with structural and emotional challenges their patients may face. It also assists professionals with the emotional capacity of advocating for patients or assisting them with the tools for advocating for themselves.4
Faith and spirituality are also helpful factors at the micro-level that assist with coping skills and how individuals react to stressors and mental health challenges. Being connected with an outside force (whether it is religion or spirituality) assists patients to externalize traumatic experiences and it can create a sense of hope and belonging.
Health and policy literacy is an important component in assisting this population. Most undocumented cancer patients are unaware of policies that could assist them. As a professional, being informed of local and federal laws can help inform undocumented cancer patients what they are eligible for. Since there are very limited direct federal programs that assist financially, non-profit organizations and Catholic charities are the main source of financial and emotional support for patients. These organizations do not include immigration status as a form of eligibility to receive financial and emotional support.
Although there are a lot of factors and layers that affect this population, creating a safe space and providing appropriate empathetic care can create an impact on a patient’s perception of hope and motivation.