Hadassah University Hospital Jerusalem, Israel
Director of Breast Oncology, Sharett Institute of Oncology Co-Director of the Comprehensive Breast Cancer Program Associate Clinical Professor, Faculty of Medicine, Hebrew University
Working to reduce health care disparities in culturally diverse, special needs, and disadvantaged populations in Israel
Jerusalem is one of the poorest and culturally diverse cities in Israel – 60 percent of residents are Jewish (40 percent of whom are ultra-orthodox) and 38 percent are Arab (mostly Muslim). Many Arab and Jewish ultra-orthodox residents live in poverty. Despite all residents being covered by the National Health insurance law, disparities exist in health care access and use, in disease outcomes and in psychosocial wellbeing across these populations. Dr. Paluch-Shimon was the first to explore disparities in advanced breast cancer (ABC) outcomes in this diverse ethnic-religious population beyond mammography screening uptake. Health care disparities across ethnic-religious groups limit equitable access to breast cancer prevention, screening and treatment, negatively impacting outcomes. Disparities can only be addressed once studied in the context of the local socio-economic and ethno-religious landscape.
The research team recently completed the first study on disparities amongst these groups of women with ABC. Key findings were that Jewish Ultra-orthodox and Muslim women were more likely to have metastatic disease at diagnosis, have a significantly shorter overall survival and far higher likelihood of death than the general population. Ultra-Orthodox patients reported superior health related quality of life, spiritual well-being, and lower levels of depression compared to other groups. Arab patients reported poorer health related quality of life, higher levels of depression and lower levels of spiritual well-being. Health care professionals reported barriers to communication and understanding of both minority groups and associated frustration and helplessness.
No data exist on health care disparities in Israel for women with newly diagnosed and early breast cancer (all stages). Since the initial study only focused on women already living with ABC, the team will focus on early breast cancer. The goal is to generate data on the disparities, identify further areas of necessary research in these groups, and use the findings to tailor interventions and care to bridge the gaps and improve outcomes.
Shani Paluch-Shimon, MBBS, MSc is a medical oncologist at the Hadassah University Hospital in Jerusalem, Israel. She completed her medical degree at Monash University in Melbourne, Australia and a masters in epidemiology at the London School of Hygiene & Tropical Medicine. She completed her oncology training at the Sheba Medical Centre in Israel and was a fellow of the Talpiot physician-researcher leadership program. She pioneered care of young women with breast cancer in Israel establishing the first clinical service for young women with breast cancer. Her research focuses have been on young women with breast cancer, hereditary breast cancer and health care disparities amongst culturally diverse populations in Israel. She was chair of the Breast Cancer in Young women (BCY) international conference and lead author on guidelines for the treatment of young women with breast cancer. She served three terms as subject editor for breast cancer in the ESMO (European Society of Oncology) clinical practice guidelines committee. She has been lead author on screening and prevention guidelines for women with a hereditary breast and ovarian cancer syndrome and is a member of the ABC (Advanced Breast Cancer) Global Alliance consensus panel.
Dr. Paluch-Shimon is a member of the Israeli National Cancer Council and has been part of the Ministry of Health committees on national breast cancer screening policy and Ministry of Health sub-committee on medical care of individuals with mental health disorders as a representative of the national cancer council. To date, her career has focused on niche groups with breast cancer (young women, individuals with a hereditary cancer syndrome, disadvantaged minority groups) and optimizing best care delivery through research and her work on international guidelines. Currently, her research focus is on bridging the healthcare gap for culturally and ethnically disadvantaged groups with breast cancer.
2024
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