Cancer Disparities Continue To Impact Minority Populations In The United States

USA

A new report from the American Association for Cancer Research has identified several health disparities which disproportionately effect certain groups of people in the U.S. with cancer.

The report looks at several factors which influence cancer outcomes such as diagnoses, access to clinical trials and treatments and quality of life after cancer treatment. A main finding of the report was that African Americans have a 14% higher cancer death rate than white Americans. This has improved in the past few decades, reducing from a 33% gap in 1990, but a significant disparity still remains.

There are hundreds of different types of cancer and the death rate disparity varies with each of these, but a particularly striking example is prostate cancer, where African American men have a death rate which is more than twice that for white men.

There are numerous reasons underlying these disparities, but one which is receiving a lot of attention at the moment is clinical trial participation. Black Americans make up 13% of the population of the U.S. but only around 4% of people in cancer clinical trials. Similarly, Hispanic Americans, who make up around 16% of the U.S. population make up only 5% of cancer clinical trial participants.

So what is being done to try and increase participation of Black and other racial minority communities in cancer clinical trials?

“Trust is still a major issue for many under served communities including individuals who are Black, Hispanic, Native American, or belong to the LGBTQ+ community, for example,” said Karen Winkfield, MD, PhD, a radiation oncologist and director of the Office of Cancer Health Equity at Wake Forest Baptist Health in Winston-Salem, North Carolina.

Winkfield is part of a team of experts working with Stand Up To Cancer on their Health Equity Initiative, which aims to reduce racial and ethnic disparities in cancer research and to improve outcomes for minority populations.

One of the charity’s newest projects involving a $5 million grant and partnership with Bristol Myers Squibb seeks to address disparities in lung cancer survival. For lung cancer, deaths are 22.5% higher in Black men than in white men. People in rural areas also have worse survival outcomes than those in urban centers. So how does this project plan to promote change?

“Part of what we are trying to do is to work with advocates who have lived experiences, to address issues of trust. We want people of color in clinical trial teams to increase access,” said Winkfield.

Research has shown that by having culturally concordant team members involved in running the trial, enrollment from minority communities can be increased by up to 50% from baseline, according to Winkfield.

“Individuals in the Black community are interested in trials of course, but they need to trust the people that ask them to consider enrolling. Community advocates and organizations are important here and we need to make sure we do have individuals from these communities represented in everything that we are doing,” said Winkfield.

However not all cancer disparities are solely related to race. For example, those living in rural communities often have later diagnoses and worse outcomes than those living in larger, urban locations. In the AACR report, cancer survivors living in rural areas were found to be 23% more likely to report psychological stress than those in urban areas. In addition, people in rural areas often struggle to access clinical trials and even certain types of treatment.

“That geographical disparities affect cancer outcomes so much really surprises some people,” said Winkfield. “In North Carolina where I currently am, there are roughly 100 counties, 80 of them are designated as rural and generally in rural areas there is higher poverty and behavioral risk factors,” said Winkfield.

But people who experience cancer disparities can fit into more than one category, and it is here where the people who experience the poorest cancer outcomes are normally found.

“When we look at Black and rural communities and look at their cancer risk – its unbelievable. For example, in my region, if you are Black and rural, your risk for colorectal cancer is 30% higher than the U.S. average,” said Winkfield.

As well as contributing $5 million to the lung cancer disparities initiative in partnership with Stand Up To Cancer, Bristol Myers Squibb also recently announced a larger, $300 million initiative to address racial inequalities in healthcare.

“Despite the remarkable recent progress in the diagnosis and treatment of cancer, the disparities in care experienced by under-served patient populations are persistent and acute,” said Adam Lenkowsky, general manager and head, U.S., Oncology, Immunology, Cardiovascular, Bristol Myers Squibb (BMS). “Covid-19 has laid bare social and health disparities in the U.S. and now more than ever we understand the urgency to address the gaps in healthcare,” Lenkowsky added.

The BMS initiative includes a number of ventures to address these issues, such as increasing the number of clinical trial sites in areas where the population is racially diverse to improve access to trials. So what does the future hold for tackling these cancer disparities?

“There are big issues here that need to be solved by big organizations coming together to tackle these. We can’t be afraid of them,” said Winkfield.