Recent advances in precision cancer care have transformed outcomes, offering the promise of turning advanced cancer into a manageable, chronic disease. However, this progress raises a critical question: who gets to live longer, and who is left behind? Structural inequities deeply influence the cancer landscape long before an advanced diagnosis occurs. Structurally marginalized populations experience higher rates of preventable and treatable cancers, frequently presenting at later stages due to systemic barriers to basic primary, diagnostic, and preventative care. For these individuals, the promise of extended survival remains out of reach, not because of biological limitations, but because of systemic failures.
Living longer through achieving meaningful cancer control necessitates an explicit commitment to health equity – designing health systems where all individuals, regardless of social position, can access and benefit from innovations in care. Drawing on research insights from the Canadian and Australian contexts, this presentation illustrates the compounding patterns of social disadvantage that shape advanced cancer outcomes and examines how systemic barriers impede timely access to care, symptom management, and essential social supports.
Moving beyond a standard model of care requires us to confront uncomfortable truths: equity requires directing greater resources toward those with the greatest need. To ensure precision oncology benefits everyone, we must actively dismantle embedded systemic barriers, reallocate resources intentionally, and partner meaningfully with marginalized communities.