Anti-oppressive, anti-racist, and trauma-informed practice in cancer care

As part of Macmillan’s strategic objective to address inequities in cancer care, Macmillan is working to support health professionals to develop better awareness of their own biases, understand the needs of marginalised groups, and work to create inclusive, responsive care.

Cancer does not occur in isolation. It unfolds across bodies, histories, and systems that hold both care and harm. Anti-oppressive, anti-racist, and trauma-informed practices remind us that every clinical encounter is shaped by structural forces - colonialism, racism, sexism, ableism, classism, heteronormativity, and medical authority. These forces influence not only who becomes ill and who recovers, but also who is believed, supported, or dismissed.

In cancer care, where fear, uncertainty and vulnerability are common, the impact of these forces is even more pronounced, especially for communities that are marginalised by systemic inequities. Anti-oppressive, anti-racist and trauma informed approaches can support health care professionals to improve the experiences and outcomes for people living with cancer, and work to support change in health care systems.

Anti-oppressive practice

An anti-oppressive approach begins by acknowledging that inequities in cancer rates, screening, diagnosis, and treatment are not the product of individual behaviour, but due to social and political conditions that impact on risk and access. It requires clinicians and systems to notice where power sits in the clinical relationship and to intentionally redistribute it.

In practice, this means involving people in decisions about their care and treatment and respecting their cultural and personal knowledge, which informs their decision-making. Alongside this, it is important to hold space for people’s embodied experience. This is the way people experience life through their physical bodies, senses, and lived realities. A person’s understanding of illness and treatment may be shaped by physical pain, emotional responses, cultural, religious and social meanings and their own personal history, including previous trauma and intersecting aspects of their identity. In cancer care, a person’s decision-making about cancer treatment isn’t only based on clinical facts, it’s influenced by how their body feels during chemotherapy, their cultural beliefs about healing, and their past experiences with healthcare. Recognising embodied experience means valuing this lived knowledge as legitimate and integrating it into care planning.

Anti-racist practice

Anti-racist cancer care deepens this by recognising racism as a determinant of health in its own right. Racism is a chronic stressor, a barrier to access, a cause of delayed diagnoses, and a driver of mistrust rooted in a long history of medical exploitation and neglect. Practising anti-racism in cancer care means tackling both the systemic and everyday forms of racism, and recognising that the issue lies within the structures that fail and harm people, not within the communities affected. In practice this might look like creating culturally relevant screening campaigns in partnership with trusted community organisations and using language and imagery that reflect the community they aim to reach. In clinical settings this may look like cultural responsiveness training, that would support staff to identify and interrupt racial biases in how they assess symptom and pain management, ensuring equitable treatment and delivery of culturally competent care.

Trauma-informed practice

Trauma-informed practice brings an additional lens. We recognise that individual, collective, intergenerational, and structural trauma, shapes how people interact with healthcare. Cancer diagnosis and treatment themselves can be traumatic, but for many communities, the trauma came before the diagnosis: colonisation, forced displacement, anti-Black violence, medical abuse, and chronic social and economic marginalisation. Trauma-informed oncology cares for the nervous system as much as the tumour; it seeks to support agency, predictability, safety, and connection in every interaction. It recognises that what may appear as “non-compliance” or “avoidance” is often a survival response to environments that feel unsafe. In clinical practice this may look like clinicians actively reinforcing consent and autonomy at every stage, especially during invasive procedures. Alongside this, providing predictable care by explaining procedures step-by-step and providing clear timelines to reduce uncertainty. For some communities affected by cancer, environmental considerations may support access and safety, this might include co-designed specialist clinics, quiet rooms and sensory-friendly areas.

When woven together, these three frameworks move cancer care toward justice-oriented healing. They remind us that effective cancer care is not only about treatment protocols but about relationships, context, power, and dignity. They call on clinicians, practitioners and systems to ask: Who is not in the room? Who is not surviving? Whose pain is unheard? What am I doing about it?

This is an invitation for you to reflect on your own practice in relation to anti-oppressive, anti-racist and trauma informed principles. You can use the reflective questions set out below in your clinical supervision, reflective practice groups, or for personal reflection.

1. Power & Positioning

In my recent clinical interactions, where did power sit in the room, and how did I intentionally (or unintentionally) reinforce or redistribute it?

Consider consent, decision-making, language, pacing of information, and moments where a person’s expertise or embodied knowledge could have been more centred.

2. Identity, Bias & Structural Awareness

How did my own social identity, assumptions, or biases shape the way I interpreted this person’s symptoms, communication style, or choices, and what systemic patterns might be influencing my perception?

This can include exploring racialised assumptions about pain, gendered expectations of coping, class-based interpretations of “engagement,” or cultural differences in expressing distress.

3. Trauma, Safety & the Body

What signs of trauma (individual, collective, intergenerational or structural) might have been present in the interaction, and how did I respond to support emotional, cultural, and physical safety?

Reflect on tone, predictability, body language, sensory environment, re-establishing consent, and whether anything in the setting could have been triggering or overwhelming.

4. Systems, Equity & Responsibility

When I notice inequity or exclusion (missed screening, delayed diagnosis, communication barriers, mistrust), how do I understand my responsibility, and what actions can I take at the individual, team, or organisational level to address the structural causes?

Move beyond the interpersonal to consider what you can do in relation to advocacy, escalation, system redesign, and collaborative problem-solving.