An understanding of the history of racism is required to reduce disparities in cancer care, from investigational research to treatment, agreed a panel that examined barriers to equitable care and potential solutions to remove these barriers.
The panel was moderated by Sybil Green, JD, RPh, MHA, diversity and inclusion officer, American Society of Clinical Oncology.
Community involvement in cancer clinical trials is a first step toward getting better representation of minorities, said Barbara Bierer, MD, faculty director, Multi-Regional Clinical Trials Center of Brigham and Women’s Hospital and Harvard Medical School, Boston.
Cancer clinical trials must be “conducted in a way that decreases the burden and increases participation,” she said. Remedies may include decentralized trials conducted closer to patients’ homes to remove transportation barriers, use of health materials translated appropriately for non–English-speaking individuals, and eligibility criteria that are more inclusive. Increased use of patient navigators may facilitate some of these changes. In addition, she recommended the use of trial end points and surrogate markers that may be predictive of clinical outcomes in certain underrepresented ethnicities.
A shortage of black doctors has contributed to this underrepresentation, said Edith Mitchell, MD, director, Center to Eliminate Cancer Disparities; associate director, Diversity Affairs; Sidney Kimmel Cancer Center at Thomas Jefferson University; and president, National Medical Association.
“African Americans constitute 13% of the US population, but only 5% of clinicians are black, and this percentage has not changed significantly in decades,” and African Americans constitute only 3% of clinical trial participants, she said. At Thomas Jefferson, she spearheaded a program (FightCRC.org) to increase clinical trial participation, focusing on colorectal cancer, but the program applies more broadly. One element of the program was educational material with tips and stories from colorectal cancer advocates on clinical trials. Within 2 years, clinical trial participation among blacks in Philadelphia improved from 7.9% to 24%.
In general, community physicians should ask patients questions about their home, community, and local resources, which can serve to increase trial participation. Discussion between doctor and patient should be in the patient’s preferred language to minimize translation errors. Trust in the healthcare team is also essential to enhance participation.
Expanding the hours that the infusion center was open, including on weekends, and offering ride-share options were instituted in an effort to provide patients with greater choice and to ease transportation barriers.
Jennifer Mills, PhD, MPH, MSW, vice president, Patient and Professional Partnerships, Foundation Medicine, said that disparities in biomarker testing and next-generation sequencing (NGS) had a negative impact “on the data we rely on to investigate advances in cancer,” noting that blacks are less likely than whites to receive appropriate genetic testing. Further, in a study of patients with non–small-cell lung cancer, only 11% of Medicaid patients versus 17% with commercial insurance coverage received NGS. Even when they request it, patients of low socioeconomic status are less likely to undergo biomarker testing, and of the underserved population that does undergo such testing, 27% do not receive their results.
To enhance research support services and patient access to innovative oncology therapies, OneOncology, a partnership of independent oncology practices, formed the OneOncology Research Network, said Dr Mills. With a focus on precision oncology, OneOncology Research Network offers clinical trials across tumor types with innovative trial designs based on precision oncology to oncology practices (ie, basket and umbrella trials).
Marcus Whitney, co-founder and partner at Jumpstart Health Investors, Nashville, spoke about improving the proportion of black people in healthcare entrepreneurship and innovation. His group’s fund, called Jumpstart Nova, is the first black healthcare venture fund in the United States and has invested in more than 100 companies over 6 years. The aim is to empower black entrepreneurs to make progress toward achieving equity in healthcare.
By improving the proportion of blacks in healthcare entrepreneurship and innovation, Jumpstart Nova is designed to foster innovations that address systemic inequities in access and outcomes.
To begin to address these inequities, “let’s look at the power that has been consolidated [in Nashville] and the impact it’s had in terms of delivering care to the entire country; not just the population that reflects the power structure, but the entire population,” he advised. “Let’s look at who leads these companies and how capital allocation works. Capital allocation and who sits in the seats of power has a massive impact on disparities in care.”
Disparities result from “a sway of power in one direction that does not reflect the community,” Mr Whitney said. “We’ve all been living and complicit in this system in the way it was because this was not a viable conversation. There’s not a single aspect of our ecosystem that can’t be scrutinized.”
