Reducing disparities in cancer care, including those affecting research and treatment, requires a better understanding of the history of racism, noted experts during a panel discussion at the 11th Annual Summit of the Association for Value-Based Cancer Care in 2021. The panel, which was moderated by Sybil Green, JD, RPh, MHA, Diversity and Inclusion Officer, American Society of Clinical Oncology, examined barriers to equitable care and potential solutions to remove these barriers.
Community involvement in oncology clinical trials is a first step toward getting better representation of minorities, said Barbara Bierer, MD, Faculty Director, Multi-Regional Clinical Trials Center, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, and Director, Regulatory Foundations, Ethics and the Law Program, Harvard Clinical and Translational Science Center, Boston.
These trials must be “conducted in a way that decreases the burden and increases participation,” she explained. 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, the use of trial end points and surrogate markers that may be predictive of clinical outcomes in certain underrepresented ethnicities may be helpful.
A shortage of black doctors has contributed to this underrepresentation, said Edith Mitchell, MD, MACP, FCPP, FRCP, Director, Center to Eliminate Cancer Disparities, and Associate Director, Diversity Affairs, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA; 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,” she said, adding that African Americans constitute only 3% of clinical trial participants. 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 materials with tips on clinical trials from colorectal cancer advocates. Within 2 years, trial participation among blacks in Philadelphia improved from 7.9% to 24%, she noted.
In general, community physicians should ask patients questions about their home, community, and local resources, which can serve to increase trial participation. Discussions between the physician and the patient should be in the patient’s preferred language to minimize translation errors. Trust in the healthcare team is also essential to enhance participation.
Jennifer Mills, PhD, MPH, MSW, Vice President, Patient and Professional Partnerships, Foundation Medicine, said that disparities in biomarker testing and next-generation sequencing have 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. Furthermore, in a study of patients with non–small-cell lung cancer, only 11% of Medicaid patients versus 17% with commercial insurance coverage received next-generation sequencing. Patients of low socioeconomic status are less likely to undergo biomarker testing (even when it is requested), 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 (OneR), said Dr Mills. With a focus on precision oncology, OneR 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, Jumpstart Health Investors, and Founder and General Partner, Jumpstart Nova, Nashville, TN, spoke about improving the proportion of black individuals in healthcare entrepreneurship and innovation. His group’s fund, 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.”
