Addressing disparities in cancer care: key journal articles
This article summarizes four articles from across T&F’s oncology portfolio, looking at cancer care for Black and POC patients. These works share a key theme in seeking to address disparities in cancer health outcomes between Black and POC patients, as compared to White patients.
Everyday discrimination and cancer screening: A cross-sectional analysis
Some researchers hypothesize that differences in adherence to screening appointments exacerbate disparities in cancer severity among different groups. In this paper, Herbach et al. theorize that experience or fear of discrimination may impact Black or POC patients’ choices about whether to get screened. They addressed this theory through a survey of 716 patients in South Florida to assess whether individuals who experience higher levels of perceived everyday discrimination were more likely to be overdue for breast, cervical or colorectal cancer screenings.
Among the survey respondents, experience of discrimination was associated with being overdue for cervical cancer screening, but not screening for the other two cancer types. The authors suggest that this could be related to the sensitive nature of cervical examinations in particular. Studies like this highlight that trust in healthcare providers likely plays an important role in encouraging people to adhere to cancer screening recommendations.
Race/ethnicity and socioeconomic position in emergency department utilization in patients with hepatocellular carcinoma
For cancer patients, emergency department (ED) visits can be an indicator of access to care and its quality. Higher rates of ED visitation may reflect poorer or less specialized outpatient care. This means that cancer patients at higher income levels are generally predicted to require fewer ED visits, as they often have better access to higher-quality care. In this retrospective analysis, Lin et al. sought to explore the intersectional relationship between socioeconomic standing and race/ethnicity with ED visits for patients with hepatocellular carcinoma (HCC). They collated insurance claims from over 22,000 patients, which included representatives from Black, White, Hispanic and Asian HCC patient populations.
At lower income levels, ED use did not differ significantly across Black, White and Hispanic HCC patient populations – which is indicative of similar standards of care across the groups. However, pronounced differences were seen at higher income levels, with Black and Hispanic patients 43% and 18% more likely to visit the ED than White patients, respectively at the highest income category. The authors suggest that this could be explained by a ‘diminishing returns’ hypothesis, whereby Black and Hispanic patients in higher income groups derive less protection from negative health outcomes than White patients do, despite a similar reduction in financial barriers to care. The paper concludes with a call for further research into the intersectional differences in cancer outcomes for patients of different races/ethnicities and socioeconomic standings, to reduce disparities across patient populations.
BIPOC involvement in oncological research: insights from Future Oncology
This editor’s highlights looks at three articles concerning greater engagement and representation for BIPOC people in oncological research.
The impact of race and ethnicity on diffuse large B-cell lymphoma outcomes within the Veterans Health Administration
With a continually increasing incidence, diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma in adults. Advances in chemo and immunotherapy regimens are improving prognoses for DLBCL patients, but disparities persist among different racial and ethnic groups. For example, Hispanic patients are more likely to be affected by environmental exposure to DLBCL carcinogens, while non-Hispanic Black patients, on average, receive a diagnosis at a younger age, but at a later stage of disease progression than non-Hispanic White patients.
To assess some of the factors contributing to these differences in DLBCL outcomes, Ta et al. retrospectively reviewed the records of 6266 DLBCL patients treated by the Veterans Health Administration (VHA). The VHA is a US organization that provides a nationalized healthcare service available to those who’ve served in the US Army, Navy or Air Force. Its patients comprise a study population where healthcare access and quality remain consistent across different socioeconomic standings and income levels.
The study found no significant difference in DLBCL survivorship across different racial and ethnic populations among VHA patients and emphasized that when standard of care therapy is provided within an equal access system, short-term treatment and survival outcomes are the same for all. This suggests that variations in disease severity and survivorship seen elsewhere are not the result of intrinsic biological or genetic factors but are actually the product of disparities in the standard of healthcare for different groups.
The authors also note that the study corroborates other findings that non-Hispanic Black patients tend to be diagnosed at a younger age. This could indicate that there are intrinsic genetic factors within this population that cause cancer to develop earlier in life.
Nature and nurture: addressable causes of disparities in prostate cancer care and survivorship in Black men
In this Editorial article, Kim et al. summarise some of the themes covered in the earlier articles through their discussion of the biological/genetic (‘nature’) and environmental or societal (‘nurture’) factors thought to contribute to disparities in prostate cancer occurrence and outcomes between Black and White men.
The probability of a prostate cancer diagnosis is 67% higher for Black men compared with White men, and Black patients remain around twice as likely to die from the disease. Numerous studies have identified biological and genetic variations between Black and White populations that could explain some differences in prostate cancer risk and treatment response and may contribute to disparate health outcomes. Genetic variations include differences in the prevalence of prostate cancer risk variants of chromosome 8q24 and the BR2CA1/BR2CA2 damage repair genes. Studies have also identified differences in the androgen receptor signalling pathway, which is known to be associated with prostate tumorigenesis – with higher mutation rates and androgen receptor expression among Black patients compared with White individuals. The degree to which these, alongside several other intrinsic factors, contribute to higher prostate cancer risk in Black men is not known, but categorization of genetic and biological variations could help to inform research into differences in treatment response between populations.
The authors also stress that the genetic and biological differences between Black and White prostate cancer patient populations do not fully explain the large discrepancies that persist in overall health outcomes and survivorship. They point out that, in populations with equal access to treatment and care (like those included in Ta et al’s analysis of VHA patients), Black men have similar outcomes and survival rates as compared to White men. This highlights the existence of ongoing and systemic environmental (or ‘nurture’) factors that continue to contribute to Black men overall receiving comparatively substandard treatment. Kim et al. emphasize the need for better representation of Black patients in clinical trials and encourage awareness and vigilance to reduce barriers in the healthcare system, urging providers to remain updated on national advice, modify policies that can widen disparities in the timeliness of care and to address personal conscious or unconscious biases that may impede the quality of care they give.
Across these articles, the authors identify a range of possible causes for discrepancies in cancer health outcomes between Black and POC patients, compared with White patients. While it is clear that genetic and biological factors are at play, all authors ultimately highlight systemic societal barriers to cancer care as a key factor in determining disease severity and survivorship. Further research will be instrumental in driving down discrepancies.