Sep 12, 2022
By Geraldine Carroll, ASCO Publishing
Despite Hispanic/Latinx people making up one-fifth of the population of the United States, there remain significant disparities in cancer care and outcomes in this demographic—a state of affairs that JCO Oncology Practice (JCO OP) addressed in a recent special series. “Disparities in Cancer Care for Hispanic/Latinx People” includes 18 articles and editorials that explore disparities and strategies to improve health equity among Hispanic/Latinx patients with cancer.1
The series aims to increase the knowledge and awareness among oncologists and other oncology health care providers of the unique needs of Hispanic/Latinx patients. “Most of the clinical trials have excluded a significant number of these patients, and unfortunately the data that is used to treat these patients is extrapolated from a majority white male population,” said guest editor Narjust Florez (Duma), MD, of Dana Farber Cancer Institute and Harvard Medical School.
In the series, Ramirez et al explored the ongoing need to address multilevel and multifactorial barriers to participation in clinical research to ensure that Hispanic/Latinx patients benefit from advances in cancer treatment.2 Ledesma Vicioso et al outlined an intervention that addresses barriers, namely a successful collaboration through a community and academic partnership to increase representation in clinical trials.3
Disparities in Border Health Care
Mexican Americans living along the U.S./Mexico border have been carrying a higher burden of disparities in care and outcomes, according to Ju et al, whose study of adult non-Hispanic white and Hispanic patients with gastric cancer found that residents who live in the border counties are less likely to receive guideline-concordant care. These residents also had significantly worse survival outcomes, highlighting the lack of health care access and multiple social determinants of health.4
Nodora and Valesquez summarized the efforts and resources in Texas to address potential approaches to achieve quality cancer prevention and treatment for residents living along the U.S./Mexico border.5 Linguistically- and culturally- tailored health education, and timely access to cancer screening, diagnosis, and treatment via universal insurance coverage, they note, would significantly advance health equity. However, the absence of Medicaid expansion in Texas and the lack of a robust rural and urban clinical services infrastructure pose significant challenges.
Advancing Diversity in the Oncology Workforce
The series highlights the importance of workforce diversity to stem some of the existing health inequities. An ASCO State of Cancer Care in America infographic illustrates that Hispanic/Latinx participation decreases at nearly every step in the path to becoming an oncologist. For example, while 16.8% of the U.S. adult population identifies as Hispanic/Latinx, only 6.2% of recent medical school applicants and only 4.7% of oncologists are Hispanic/Latinx.6
Dr. Florez and her coauthors reviewed the status of Hispanic/Latinx physicians in oncology and challenges to achieving equitable representation and propose potential solutions to advance workforce diversity.7
“Previous studies show that over the last 10 years we have not increased the number of Hispanic/Latinx oncologists or oncology fellows, and oncology remains one of the least diverse specialties within internal medicine,” Dr. Florez said. She noted that strategies such as ASCO’s Oncology Summer Internship program are trying to reverse this trend. The program enables underrepresented first- and second-year medical students to get early exposure to the field, especially to oncologists who have a similar racial/ethnic background.
Increasing equity and diversity in oncology is everyone’s responsibility, Dr. Florez said. Mentorship of Hispanic/Latinx fellows should not solely be the work of oncologists of the same background, for example, because there are not enough of them to fill this need.
Furthermore, improving inclusion practices in training is vital. Dr. Florez cited research presented at the 2022 ASCO Annual Meeting by Dame Idossa, MD, showing that underrepresented groups in medicine are less likely to receive appropriate mentorship or receive appropriate sponsorship.8 Dr. Idossa cited the important efforts implemented by ASCO, including a portfolio of awards programs that are focused on longitudinal support and career development of underrepresented medical students and residents.
Overcoming Stereotypes as a Latina in Medicine
In addition to her role as guest editor of the JCO OP special series on “Disparities in Cancer Care for Hispanic/Latinx People,” Dr. Narjust Florez discussed her personal experience in an essay,
“My White Coat Doesn’t Fit,” published in the Art of Oncology section of the Journal of Clinical Oncology (JCO) in June 2022. She expanded on her story in an episode of JCO’s Cancer Stories: The Art of Oncology podcast.
In the essay and the podcast interview, Dr. Florez shares her deeply personal account of the challenges she experienced navigating depression, isolation, and microaggressions during her medical residency. “Over time, I felt pigeonholed into a constricting stereotype due to my ethnicity and accent. Back home, I was one of many, but in this new setting, I was one of a few, and in many instances, I was the only Latina in the room,” she said.
With resilience and determination, Dr. Florez overcame negative stereotypes and has since emerged as a leader and mentor who is committed to creating an inclusive and safe environment for younger colleagues and mentees. She co-founded the Latinas in Medicine group (twitter.com/latinasinmed), which includes more than 6,000 members. In 2019, she established the Florez Lab (previously Duma Lab), a research group that addresses discrimination in medical education, gender equity imbalance in medicine, and cancer health disparities.
“My message to Hispanic/Latinx residents and fellows is that you belong in medicine,” Dr. Florez said.
- Bosserman LD, Duma N, Villalona-Calero M, et al. Disparities in Cancer Care and Scientific Knowledge in Hispanic/Latinx People in the United States. JCO Oncol Pract. 2022;18:367-9.
- Ramirez AG, Chalela P. Equitable Representation of Latinos in Clinical Research Is Needed to Achieve Health Equity in Cancer Care. JCO Oncol Pract. 2022;18:e797-e804.
- Ledesma Vicioso N, Lin B, Gomez DR, et al. Implementation Strategies to Increase Clinical Trial Enrollment in a Community-Academic Partnership and Impact on Hispanic Representation: An Interrupted Time Series Analysis. JCO Oncol Pract. 2022;18:e780-e785.
- Ju MR, Wang SC, Mansour JC, et al. Disparities in Guideline-Concordant Treatment and Survival Among Border County Residents With Gastric Cancer. JCO Oncol Pract. 2022;18:e748-e758.
- Nodora J, Velazquez AI. Are Quality Cancer Prevention and Treatment Along the Texas US-Mexico Border Achievable? JCO Oncol Pract. 2022;18:385-7.
- 2022 Snapshot: State of the Oncology Workforce in America. JCO Oncol Pract. 2022;18:396.
- Duma N, Velazquez AI, France I, et al. Dónde Están? Latinx/Hispanic Representation in the Oncology Workforce: Present and Future. JCO Oncol Pract. 2022;18:388-95.
- Idossa D, Velazquez AI, Horiguchi M, et al. Are we doing it right? Mentorship challenges for oncology fellows and early-career faculty from backgrounds underrepresented in medicine. J Clin Oncol. 2022;40(suppl 16; abstr 11047).