Jun 30, 2021
By Geraldine Carroll, ASCO Publishing
The oncology community, like the rest of the world, was rocked by the murder of George Floyd last year, which caused a national reckoning about systemic racism, not just in law enforcement but in other sectors of American life, including health care. The COVID-19 pandemic, meanwhile, triggered a similar awakening, exposing inequalities in care and access to treatment that left Black and minority Americans disproportionately impacted by the disease. These trends inspired many leaders in the cancer care community to focus attention on pervasive health inequities and to consider how they might be mitigated. JCO Oncology Practice published a timely Special Series, “Disparities in Cancer Care for Black People in the United States,” that features an in-depth account of the disparities throughout the cancer experience and strategies to help reduce and eliminate them.
“What I hope our colleagues take from the special issue is that disparities for Black people are not a given for our cancer care delivery system,” said Reginald Tucker-Seeley, ScD, health equity expert and co-editor of the series. He serves as the Edward L. Schneider Chair and assistant professor of gerontology at the University of Southern California (USC) and cancer center member at the USC Norris Comprehensive Cancer Center. “I hope the manuscripts included in this issue will inspire our colleagues to work to alleviate current disparities experienced at the individual patient, practice, health care delivery system, and state/national policy levels.”
The series, which is comprised of 16 original contributions and editorials, reflects the extraordinary breadth of expertise and experience of its authors and editors who have spent decades conducting research with racial/ethnic minorities and taking care of underserved patients. They know better than most that although progress has been made in the United States over the past 20 years to lower cancer incidence and mortality, Black Americans have the highest death rate and shortest survival of any racial and ethnic group in the U.S. for most cancers.
Black people are the second-largest racial/ethnic minority group in the U.S., following Hispanic people; by 2060, it’s estimated that there will be 60.7 million Black people living in the U.S., making up 15% of the total population. According to the American Cancer Society, non-Hispanic Black patients experience a 9% higher incidence and 22% higher death rate compared with non-Hispanic white patients for all cancers combined, and incidence and deaths are also higher for the most common cancers, including prostate, lung, colorectal, kidney, liver, and pancreas. In contrast, non-Hispanic Black women have a 7% lower risk of being diagnosed with cancer than non-Hispanic white women, but have a 13% higher risk of death from cancer. Notably, despite slightly slower incidence rates of breast and uterine cancers, non-Hispanic Black women have death rates for these cancers that are 41% higher for breast cancer and 98% higher for uterine cancer than white women.
Socioeconomic status (i.e., education and household income) and where people live, work, and the environments they are exposed to have a substantial impact on their cancer care; socioeconomic resources are patterned by race and ethnicity, with Black people having substantially fewer of these resources to manage and navigate their care. In the series, Dr. Tucker-Seeley explores these social and economic conditions, known as social determinants of health (SDOH), and their influence on cancer outcomes, which can serve clinicians and stakeholders across the cancer care continuum as an organizing framework for understanding the inequities Black patients experience as they navigate their diagnosis, treatment, and survivorship.
“Recently there has been much more attention on the social determinants of health, social needs of patients, and health equity in health care delivery generally and in cancer care more specifically,” Dr. Tucker-Seeley said. “Dr. Lori J. Pierce was a much-needed champion on these issues during her term as ASCO president. I think we can maintain this momentum by continuing to name the root causes of health care disparities, such as interpersonal and systemic racism and poverty, and to view disparities in our cancer care delivery system as unacceptable.”
The series focuses on four themes—Biomarkers and Race, Clinical Trial Enrollment Barriers, Communication Hurdles, and Health Care System Reforms—and aims to not only illustrate inequity in cancer care, but highlights interventions to strive for health equity.
“I think for many of us working in health disparities research, we are well aware of how disparities can persist across time and various outcomes when the root causes have not been addressed,” Dr. Tucker-Seeley said. “So, one of the first conversations among the co-editors was that this special issue would move past merely describing disparities, but attempt to highlight strategies for disparities reduction and efforts attempting to achieve health equity.”
The series includes an article by 2020-2021 ASCO president Lori J. Pierce, MD, FASTRO, FASCO, who championed the theme “Equity. Every Patient. Every Day. Everywhere.” Her article outlines ASCO’s commitment to addressing equity, diversity, and inclusion of Black patients with cancer and survivors.
Dr. Pierce’s efforts to galvanize the oncology community and other stakeholders to move the needle in patient care equity culminated in an ASCO Annual Meeting in June that incorporated the concept of equity into the content of sessions to demonstrate how research findings can be translated into improving outcomes for all patients.
Katherine Hicks-Courant, MD, co-editor of the Special Series and a fellow in gynecologic oncology at the Hospital of the University of Pennsylvania, noted that medical journals have a responsibility to publish research that shines a light on racial inequities and strategies to address them.
“Journals are responsible not only for the dissemination of research, but also for the determination of what is high-quality research, and therefore shape the future of the field,” Dr. Hicks-Courant said. “By promoting research that opens readers’ eyes to too-often overlooked experiences, inspires change and discussion, and provides tools to address racial inequities in cancer care, JCO Oncology Practice is doing its part to continue Dr. Pierce’s legacy.”
Dr. Tucker-Seeley said that health care providers, patient advocates, policymakers, and other stakeholders are emboldened by the devastating events of last year and that striving for equity each day will build better practices, healthier communities, and access to a brighter future for all.
“Health equity in our cancer care delivery system requires more than making the differences in outcomes less obvious, less painful for our racial/ethnic minority communities generally, and Black communities in particular. Health equity means that race, financial resources, or any demographic characteristic is not a barrier to cancer prevention, treatment, or survivorship,” he said.
Read the entire Special Series in JCO Oncology Practice.