Solutions

“African American men with prostate cancer usually have discordant ethnic pairing because there are very few black urologists,” Dr Moses said. One of the possible steps towards eliminating these racial disparities in prostate cancer treatment is, according to Dr Moses, diversification of the workforce.


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“There is plenty of research showing that African American and Hispanic physicians are more likely to see patients of color without insurance or with public insurance,” Dr Moses said. “They provide a higher quality of care to these patients and patients have better outcomes.”

Stabilization of the insurance marketplace is also an important factor: greater access to affordable health care may provide disadvantaged populations greater access to care.

“In certain states like Massachusetts, Oregon, and California, health outcomes are tremendously better because they have participated in these insurance exchanges and expanded Medicaid,” Dr Moses said. “In states like where I live, Tennessee, and Mississippi and Alabama, for example, it is the exact opposite.”

Finally, increased inclusion of different racial groups into medical research will also help to educate and inform clinicians.

“If you look at most cancer trials that come out they include anywhere from 1% to 5% African Americans,” Dr Moses said. “If you are not including African Americans you can’t make a generalized statement that this drug works for everybody. You are creating disparity right off the bat.”

The American Association for Cancer Research, the American Cancer Society, the American Society of Clinical Oncology, and the National Cancer Institute together released a statement to help guide the future of cancer health disparities research.7

The organizations outlined several research needs and priorities, including redesigning clinical trials to acknowledge and address cancer disparities.

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“The reason clinical trials are so expensive is that they pay for patient care,” Dr Moses said. “For patients who have access or insurance issues, if they get on a trial, that helps pay for care and gives them the opportunity for survival without the cost. Inclusion of all populations is critical.”

References

  1. Cancer health disparities. National Cancer Institute website. https://www.cancer.gov/about-nci/organization/crchd/cancer-health-disparities-fact-sheet#q9. Accessed August 2, 2017.
  2. Haiman CA, Patterson N, Freedman ML, et al. Multiple regions within 8q24 independently affect risk for prostate cancer. Nature Genetics. 2007; 39(5); 638-644.
  3. Moses KA, Orom H, Brasel A, Gaddy J, Underwood W 3rd. Racial/ethnic differences in the relative risk of receipt of specific treatment among men with prostate cancer. Urol Oncol. 2016;34:415.e7-12.
  4. Presley CJ, Raldow AC, Cramer LD, et al. A new approach to understanding racial disparities in prostate cancer treatment. J Geriatr Oncol. 2013;4:1-8.
  5. Pollack CE, Armstrong KA, Mitra N, et al. A multidimensional view of racial difference in access to prostate cancer care. Cancer. 2017 Jul 20. doi: 10.1002/cncr.30894 [Epub ahead of print]
  6. Cooper LA, Roter DL, Johnson RL, Ford DE, Steinwachs DM, Powe NR. Patient-centered communication, ratings of care, and concordance of patient and physician race. Ann Intern Med. 2003;139:907-15.
  7. Polite BN, Adams-Campbell LL, Brawley OW, et al. Charting the future of cancer health disparities research: a position statement from the American Association for Cancer Research, the American Cancer Society, the American Society of Clinical Oncology, and the National Cancer Institute. Cancer Research. 2017 Jul 24. doi: 10.1158/0008-5472.CAN-17-0623 [Epub ahead of print]