Cancer Care Must Address Disparities and Inequities

The best and brightest oncology professionals from around the world are in Chicago to discuss the latest in cancer research and patient care at the 2022 American Society of Clinical Oncology (ASCO) Annual Meeting. Advances in therapies for rare and pediatric cancers, findings on disparities among patients with cancer and new treatment options for patients with advanced breast, colorectal and pancreatic cancers are among the topics that will be highlighted at this year’s meeting, themed “Advancing Equitable Cancer Care Through Innovation.” 

“Access to advanced cancer care and groundbreaking treatments continues to be a major challenge for thousands of patients across the U.S. Whether these barriers result from racial, ethnic or other sociodemographic group disparities, or lack of access to screening or novel drugs, there is a critical need for effective strategies to achieve and sustain health equity and eliminate disparities for patients with cancer,” said 2022 ASCO Annual Meeting Education Committee Chair Dr. Jhanelle Gray, who is also chair of the Thoracic Oncology Department at Moffitt Cancer Center.

More than 2,800 abstracts will be presented during the five-day meeting June 3-7, with more than 2,400 additional abstracts published online. Here are just a few of the disparity focused abstracts presented during an ASCO press program on May 26.

Increasing State Welfare Spending
New research finds that increasing state welfare spending can increase survival and mitigate racial disparities among patients with cancer. For this study, researchers reviewed the National Cancer Institute’s Surveillance, Epidemiology, and End Results cancer database of nearly 3 million adults newly diagnosed with cancer from 2007 to 2016. Annual state spending data came from the U.S. Census Bureau.

They evaluated the association between five-year overall survival and welfare spending by race, ethnicity and cancer site. Public welfare spending was a broad category including programs that aid those facing socioeconomic deprivation, such as Medicaid and Supplemental Security Income.

The results showed that for non-Hispanic white patients, there was no significant association between percent increase in overall survival for every 10% increase in investments in social services spending. However, for non-Hispanic Black patients, increased public welfare spending was related to 2.2% higher overall survival for every 10% increase in such spending.  These analyses also document that public welfare spending was linked to a decrease in racial disparities in survival between non-Hispanic Black and white patients for many different types of cancers.

#ASCO22 News: Public welfare investment improves overall survival in non-Hispanic Black patients w/ cancer. https://t.co/dTsmEznye1 #ASCO22 #ASCODailyNews #healthequity

— ASCO (@ASCO) May 26, 2022

Equitable Access to Telemedicine
Before the COVID-19 pandemic, very few patients with cancer used telemedicine. Now, the service is widely used among cancer centers and patients across the nation. However, new research indicates more should be done to provide equitable access.

A review of the health records of 24,164 adult patients who started first-line cancer treatment between March 2020 and November 2021 found that 15.9% used telemedicine within the first three months of therapy. Researchers looked at differences in the number of telemedicine visits across race/ethnicity, insurance coverage, rural vs. suburban vs. urban residence, and neighborhood socioeconomic status.

Key findings included:

• Black patients were less likely to use telemedicine services than white patients.
• Telemedicine use was lower among patients without documented insurance than those who were privately or Medicare-insured.
• Those in rural and suburban areas were less likely to use telemedicine services than patients in urban areas.
• Patients living in the lowest socioeconomic status areas were less likely to use telemedicine than those in the highest areas.

Suggestions to improve these inequities included improved access to health insurance and insurers who cover telemedicine services, as well as increasing access to technologies and providing education for its use.

#ASCO22 News: Public welfare investment improves overall survival in non-Hispanic Black patients w/ cancer. https://t.co/dTsmEznye1 #ASCO22 #ASCODailyNews #healthequity

— ASCO (@ASCO) May 26, 2022

Increasing Clinical Trials Education
Breast cancer is the most diagnosed cancer among women in the U.S. Approximately 15% of patients with breast cancer are Black, a population known to have the highest death rate and shortest survival for this disease. It is why early detection and access to care is paramount for these women.

New research focused on patients with metastatic breast cancer, meaning those with advanced disease that has spread to other areas of the body, found nearly half of Black patients were not informed about clinical trials that could provide access to new therapies for their disease. The study, part of the BECOME (Black Experience of Clinical Trials and Opportunities for Meaningful Engagement) initiative, surveyed 424 patients with metastatic breast cancer, and 102 participants self-identified as Black.

Key findings included:

• 40% of Black participants reported their care team had not discussed clinical trial enrollment, compared to 33% of non-Black respondents
• Black respondents were:
  • Less likely to trust clinical trials and that people of all races/ethnicities get fair treatment in trials
  • More likely to believe unstudied treatments may be harmful
  • More likely to value receiving trial information from someone of the same race/ethnic identity, who had breast cancer or had participated in a trial

Increasing racial and ethnic diversity in clinical trials is crucial to advancing cancer care for everyone. Moffitt joined more than 70 research institutions for a pilot project launched by ASCO and the Association of Community Cancer Centers (ACCC) in 2020 testing a research site self-assessment tool and an implicit bias training program focused on increasing diversity among cancer treatment trial participants.

Dr. Susan Vadaparampil, Associate Center Director, Community Outreach, Engagement & Equity, @SVadaparampil

Now completed, the assessment and training will be made available to the public this summer. ASCO and ACCC also issued recommendations detailing specific actions that would engage the entire cancer clinical trial ecosystem to improve participation rates.

“Taken together, these important studies highlight the multipronged approach and diverse stakeholders needed to address cancer related disparities,” said Dr. Susan Vadaparampil, associate center director of Community Outreach, Engagement and Equity at Moffitt. “To achieve equity, we must engage in intentional strategies where care is delivered to support both patients and those that deliver their care. To achieve the greatest impact, we must also incorporate larger scale efforts through policy and technology, while keeping the needs of all patients at the forefront.”

#ASCO22 News: Public welfare investment improves overall survival in non-Hispanic Black patients w/ cancer. https://t.co/dTsmEznye1 #ASCO22 #ASCODailyNews #healthequity

— ASCO (@ASCO) May 26, 2022