Addressing Racial Disparities in Cancer Care
- Trevor Noah, comedian and host of The Daily Show, recently spoke with experts from the Fred Hutchinson Cancer Research Center, Noah spoke with leading scientists about all things from immunotherapy to COVID-19, but a big focus of his was racial disparities in cancer care.
- Poverty, a lack of access to health care services, lack of insurance and institutional racism have led to unacceptable racial disparities in cancer care.
- Increasing involvement from minority communities is essential to solving issues of racial disparities in cancer care, but it’s important to learn why some communities are understandably hesitant to partake in the medical community’s efforts to ‘close the gap.’
During a virtual event held by the Fred Hutchinson Cancer Research Center, Noah spoke with leading scientists about all things from immunotherapy, to COVID-19 and racial disparities in cancer care. Noah, host of Comedy Central’s The Daily Show, is used to confronting difficult topics, so he did not shy away from the ever-present issue of inequality when talking with Dr. Rachel Issaka, a gastroenterologist and clinical researcher with a focus on colon cancer at Fred Hutch.Read More
In response, Dr. Issaka offered the following three immediate solutions:
- Measure and report data surrounding health disparities.
- Come up with creative solutions to address the identified gaps that have often persisted for a long time.
- Go back and measure the impact of the solutions within the communities that are greatly impacted.
“[These communities] can no longer be a side conversation, but these are individuals and groups that have to be brought in throughout the process,” Issaka explained. “But when I kind of come back to the data piece, it’s a catch-22 because you need data to get funding, but then you need funding to get data.”
Digging further, Noah also asked about how to solve the problem of people of color all too often finding out they have something like colon cancer at advanced stages.
“In America, if you don’t have money, you don’t go to the doctor,” Noah said. “If you don’t go to the doctor, the doctor doesn’t know that you have a problem. If you don’t know that you have a problem, when you find out, it is oftentimes too late.”
And for Dr. Issaka, the answer lies in working to improve outcomes, of course, but even more so working to prevent colon cancer altogether by partnering with patients and with other people in these communities who are at risk.
“We ask them to tell us what are the questions we need to be asking, what are the resources that you need in order to get the care that you need?” she explained. “And then we use that to inform the work that we do… We really need to be able to move that science into community. And that means, you know, affecting the policies that have been historically leading to poor outcomes for these individuals and helping address the challenges that lead them to not seek care to begin with.”
But how can you get better involvement from a community that, rightly so, has been distrustful of the medical world for quite some time. According to Noah, scientists should focus on how to effectively communicate with the average American without a scientific background.
“The more I talk to scientists, the more I realize it is really complicated,” Noah said. “The method of delivery is as important as the medicine itself. And so if it cannot be absorbed then what’s the point of delivering it?
“Maybe the solution to this is to find people in the community. You find somebody who has colon cancer, you find somebody who has a family member who’s lost their life to colon cancer, and then you start the journey from there because when you can attach it to somebody that we trust, when we understand where the message is coming from, I think people are more likely to welcome that message as opposed to somebody just telling you a thing from the outside, which may be accurate, but unfortunately, you’ll be less likely to believe.”
Mistrust and Racial Disparities within the Medical World
Poverty, a lack of access to health care services and insurance have led to unacceptable racial disparities within cancer care. For example, we know that Black Americans have the highest cancer death rates and shortest survival times of any racial or ethnic group in the country. A Black woman who gets breast cancer in America has a 39 percent higher chance of dying than a white woman. African-American men with prostate cancer are almost twice as likely to die from their illness than white men with the same disease, and African Americans have more than twice the incidence rate of multiple myeloma compared to white Americans.
We also know that Hispanics and Latinos are more likely to be diagnosed at a later, less curable stage of liver, stomach and cervical cancers, and Asian Americans and Pacific Islanders are twice as likely to die from liver and stomach cancers as whites.
But in order to solve these issues of racial disparities, the medical world needs to earn the trust of communities of color. And trust, as we all know, is hard-earned and easy to lose. And mistrust of the medical world by communities of color unfortunately exists for good reason.
Take the Tuskegee syphilis experiment, for example. Otherwise known as the “Tuskegee Study of Untreated Syphilis in the Negro Male,” this not-so-distant ‘study’ ran from 1932 and only ended 40 years later with more than 600 African-American men in Alabama enrolled by the U.S. Health Service. The tragedy was that these men were never told what the study was truly about or given proper treatment to cure the disease.
Not much time has passed, but earning that trust is essential to combating the disparities that exist for minorities when it comes to cancer care. Clinical trial participation, for example, depends on it. In fact, the FDA’s Center for Drug Evaluation and Research’s (CDER’s) Drug Trials Snapshots Summary Report for 2020 illustrated the scope of this issue when it concluded that only eight percent of the total 32,000 patients who participated in the CDER’s clinical trials for the newest drug approvals of 2020 were Black. More diversity is needed because these trials serve as the basis for government approval of cancer drugs, and the approvals may not accurately reflect what is best for racial minorities with cancer when these trials lack diversity.
Similar to the point Noah was making, Dr. Luther Clark, deputy chief patient officer at Merck, previously told SurvivorNet at our ‘Close the Gap’ conference that collaborating with trusted voices in communities to increase awareness of the importance of clinical trials can help build that trust.
“When one participates in the research, you also participate in the development of healthcare solutions that lead to improved outcomes and decrease in inequities,” Dr. Clarke explained. “So it is important that there be representation so that we’re comfortable that treatments are not only effective and safe in all the populations that will be using them, but there is comfort and confidence in new therapies.”
Dr. Marilyn Fraser, CEO at the Arthur Ashe Institute for Urban Health, added at the SurvivorNet event that gaining trust requires acknowledgement of past wrongdoings, institutional racism, cultural biases and systemic issues, and early, intentional training for people entering the medical world can help with that. She also said that increasing the number of people of color and the diversity of nationalities and ethnicities within heath care professions can help with this issue.
“Diversity helps to bring to the forefront equity, and it brings to the forefront some of the challenges that we may have and that we can come together to try to tease those out,” she said.
Dr. Brandon Blue, an oncologist from Moffitt Cancer Center, told SurvivorNet training was important, but it probably wasn’t enough since it could take a whole generation to actually see improvements. At our ‘Close the Gap’ conference, he proposed financial incentives like a ‘health disparities report card’ of sorts to hold medical institutions accountable and, hopefully, give these underserved communities more concrete reasons to trust medical professionals.
“A lot of institutions are actually funded by the people who are paying taxes,” he said. “So, if you know that you are in the south side of Chicago, and you know that you have a ‘F’ for your ‘how you treat black people’ card, you know that you need to change something, right, because that’s gonna lose some of your funding.”