Future Oncology: a spotlight on articles addressing cancer care disparities
Cancer care disparities remain a pressing issue, particularly for Black and other ethnic minority patients who face systemic barriers to equitable treatment and clinical trial participation. This article summarizes research papers from Future Oncology investigating the difference in cancer care received by Black and other ethnic minority patients. Each study explores the need to close the gap in clinical trial participation and health outcomes between POC and white patients.
A spotlight on three journal articles
Understanding barriers to prostate cancer clinical trial participation among Black and African American patients
Data shows that participation from Black and African American patients in prostate cancer trials is significantly lower in comparison to other ethnic groups. In this study, researchers investigated the underlying cause of this disparity, identifying several barriers preventing the enrolment of diverse patients in prostate cancer clinical trials. Three advisory boards, involving patients, advocates and physicians, identified common systemic barriers such as mistrust, socioeconomics and poor trial execution strategies.
The study found that one way to better engage minority communities may be through female caregivers, such as wives and daughters, citing that they often play a highly influential role in treatment decision-making. By developing outreach programs targeting these decision-makers and partnering with sororities to disseminate information about prostate cancer, the researchers theorize that clinical trial sites could better reach diverse patient groups. Mobile prostate cancer screening units are also working to enhance awareness of prostate cancer for Black men.
Does race or income status affect the cancer treatments that patients with metastatic castration-sensitive prostate cancer (mCSPC) receive in the United States?
Clinical trials have demonstrated that the use of combined therapy approach (using androgen deprivation therapy with either novel hormone therapy or a chemotherapy (docetaxel)) allows patients with metastatic castration-sensitive prostate cancer to live longer. Given that trials investigating this treatment combination involved few Black patients and that Black patients face an increased mortality rate from prostate cancer compared to white patients, the researchers of this study sought to investigate whether Black patients and are receiving the recommended combined treatment and whether race and income affected how long patients with mCSPC live.
This real-world study reviewed data from more than 18,000 patients enrolled in Medicare (a healthcare insurance plan in the USA for those on low incomes) and more than 3,000 patients enrolled in the VHA , all of whom had mCSPC.
Across the board, few patients received the combined therapy approach despite it being US FDA approved and recommended in treatment guidelines (with clinical trial data to support its survival benefits). The study uncovered that 88% of Black patients and 83% of white patients enrolled in Medicare ( a US healthcare insurance plan USA for those on low incomes) did not receive the combined treatment. When age and locations were accounted for, Black patients enrolled in Medicare were 32% less likely than their white counterparts to receive the combined treatment regimen. Additionally, the study concluded that Black patients on Medicare had a 20% higher likelihood of dying from prostate cancer than white patients.
Similar disparities were observed in the Veterans Health Administration, a USA healthcare insurance for veterans. Black patients were 25% less likely than their white counterparts to receive the combined treatment. The chances of dying for those enrolled in this type of insurance plan were the same for both Black and white patients. The differences observed in the study could be a reason why Black patients are more likely to die from prostate cancer than white patients and the researchers call for more work to be done to overcome these disparities.
Impact of community recruitment and inclusion initiatives on enrollment in the biomarker-driven MyTACTIC trial
A key element of achieving healthcare equity hinges on the ability to address the lack of diversity in clinical trial populations. Researchers note that 80% of cancer patients in the USA receive treatments in a community as opposed to academic centers. It has previously been suggested that increasing clinical trial recruitment at community centers may facilitate the involvement of patients from minority groups. This study sought to understand whether inclusive initiatives, such as enrolling patients from community cancer clinics, resulted in a more racially and ethnically diverse trial study population through retrospective analysis of the MyTACTIC trial.
The analysis showed that despite the community clinics being in ethnically diverse areas, the participation from these communities was still low with 83% of the 252 patients being white.
The trial incorporated other inclusive measures, such as providing transportation assistance, which was utilized by only 14 of the 252 patients across all ethnicities. Researchers emphasize that running trials at community oncology sites does not, by itself, increase patient diversity and that additional barriers need to be addressed fora diverse study participation population. This includes reviewing eligibility criteria to reduce exclusion, improving language accessibility and educating communities to overcome cultural mistrust.
These studies highlight the persistent disparities present in cancer care and clinical trial participation amongst Black and other ethnic minority patients with systematic barriers, socio-economic challenges and mistrust being the most prevalent obstacles to overcome. By intentionally implementing inclusive research practices, better educating and engaging marginalized communities, researchers and healthcare providers can work towards equitable cancer care.