Cancer is a jarring and potentially sensitive subject, and that requires asking hard, even uncomfortable questions — especially when it comes to the quality of oncology care that marginalized patient groups receive.
When Chadwick Boseman, a popular African American actor, died in 2020 from stage IV colorectal cancer at age 43, the world was heartbroken. We can learn from his story, though, and move beyond heartache toward solution-finding strategies.
Compared with their White counterparts, Black and Hispanic men like Boseman have higher colorectal cancer mortality rates. In addition, Black women have a 41% higher chance of dying from breast cancer compared with White women, after adjusting for disease incidence between both population groups.
Some sociodemographic factors contribute to these higher mortality rates among minority and socially disadvantaged populations. Some of these factors include lack of private insurance and a paucity of access to quality treatment. These sociodemographic components are characteristics of a broken system where the quality of healthcare available depends on one’s social class, as it does in the United States.
Do Cancers Present Similarly Across All Patient Groups?
In my honest opinion, the answer to this question is a hard “no.”
In regard to screening and early presentation, which does help nip some cancers in the bud, access to private insurance plays a crucial role.
Economic disempowerment as a whole has ripple effects that include poor health insurance, which has a greater bearing on minority populations as they tend to be more economically disempowered.
Statistics from the US Census Bureau reveal that 16.1% of Hispanics and 10.6% of African Americans are uninsured, compared with 6.3% of non-Hispanic Whites. Economically empowered White people with greater insurance have access to adequate follow-up and screening options, resulting in far lower chances of late diagnosis and death from cancer.
When coupled with the erosion of trust in the US healthcare system due to transgenerational trauma, Black population groups, for example, end up with poorer health outcomes (in the form of late diagnosis, poor care, and higher mortality rates) when it comes to cancer.
Are Minority Patients Underrepresented in Oncology Clinical Trials?
Adequate representation in clinical trials is another potent cause of cancer health disparities in the US. Enrollment in these trials is still tilted in the favor of non-Hispanic Whites when compared with Hispanics and African Americans.
Underrepresentation of racial minority subgroups in trials leads to a poorer understanding of the applicability of cancer research findings to patients in the aforementioned subgroups.
Checking Our Unconscious Biases as Physicians
Even as physicians, our judgment can be tainted by unconscious biases. What lenses do we use to view patients with drug addictions? Are we empathetic?
For the non-English-speaking minority patient, how careful are we to ensure that vital communication isn’t lost in the process of translation, bearing in mind that a lack of appropriate vocabulary on the patient’s end might lead to an inability to properly express pain or discomfort?
Failing to note such situations can further worsen health outcomes in minority patients.
What Can We Do Now?
In a healthcare system that continues to fail the most vulnerable population groups, now is the time to look inward to fix health disparities. Each of us can help close these gaps by doing the following:
Deliberately centering minority population groups in our conversations on cancer care;
Building strong patient-physician relationships, thereby increasing marginalized patients’ trust in the healthcare system, and their enthusiasm toward important preventive mechanisms such as screening tests;
Checking our personal biases and constantly cross-examining how our interactions with minority patients can be better;
Adequately representing minority populations in clinical trials; and
Encouraging more underrepresented physician populations to specialize in oncology, as their context is much needed in the field.
Viewing minority patients as worthy of the same level of empathy and providing proper access to care is crucial to achieving truly equal oncology care across population groups. It is something that we can all improve upon.
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About Dr Oyepeju Abioye
Oyepeju Abioye, MD, is an aspiring oncologist who is passionate about advancing equitable cancer care. Originally from Nigeria, she is currently pursuing US medical residency while completing a master’s degree in epidemiology and biostatistics.
Her major clinical and research interests include cancer survivorship among marginalized populations, diversity and inclusion in clinical oncology trials, and technological advances in oncology. She hopes to contribute meaningfully to these spaces through clinical practice and evidence-based research.
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The Duma Lab, formerly known as the Social Justice League, was founded in August 2019 and focuses on social justice issues in medicine, including discrimination and gender bias in academic and clinical medicine, cancer health disparities, and medical education.