Racial Minorities Face Disparities in Access to Cancer Care, Treatment

New research conducted by Cedars-Sinai shows disparities in access to cancer care for racial and ethnic minorities diagnosed with advanced liver cancer, as they did not receive early access to the cancer treatment, like immunotherapy.

Immunotherapy is an emerging treatment for patients with advanced cancer, the researchers stated. In comparison to the traditional treatment of chemotherapy, immunotherapy is more effective for advanced-stage liver cancer in a broader patient population.

“Although it is very encouraging to see the effectiveness of this promising treatment outside of clinical trials in a broader population, it is very unfortunate to see that Black and Hispanic patients have a lower chance of receiving such an effective treatment for their cancer,” Ju Dong Yang, MD, medical director of the Liver Cancer Program at Cedars-Sinai Cancer and senior author of the study said in the press release.

The effects of immunotherapy could be impactful on the Black and Hispanic communities, given their greater mortality rates and poor cancer outcomes, the researchers mentioned.

The study, published in the peer-reviewed journal Hepatology, examined the disparities and the effectiveness of immunotherapy for patients with advanced liver cancer.

Researchers used the US National Cancer Database and identified more than 3,900 patients with stage 3 or stage 4 liver cancer. 

Of the patients with advanced liver cancer, 3,250 patients were treated with chemotherapy, and fewer than 750 were treated with immunotherapy. However, between 2017 and 2018, the number of patients receiving immunotherapy steadily increased from 14.2 percent to 23 percent.

More White and Asian patients were treated with immunotherapy. In comparison, nearly 67 percent of White people were treated with immunotherapy while 62 percent were treated with chemotherapy.

Researchers also found that receiving immunotherapy over chemotherapy improved survival rates.

When compared to patients treated with chemotherapy, there was a lower proportion of patients with immunotherapy who were Hispanic (9.1 percent vs 12.4 percent) or Black (14.0 percent vs 17.8 percent).

In addition, the study findings showed that both treatment groups were similar in age and were predominately male.

Yet, more patients who received immunotherapy were a part of the highest income bracket, lived in neighborhoods with high average education levels, and were treated at academic medical centers.

“Despite the positive results showing the overall efficacy of immunotherapy for patients with advanced liver cancer, this study highlights significant racial, socioeconomic and regional disparities in access to immunotherapy, which could be a surrogate for clinical trial participation and early access to novel experimental therapy,” said Robert A Figlin, MD, deputy director of Cedars-Sinai Cancer said.

Historically, racial and ethnic minorities have lacked representation in clinical trials and experimental treatments for cancer.

A comprehensive approach is needed to increase clinician trial diversity and reduce disparities for Black and Hispanic patients, Yang stated.

Now healthcare professionals are zeroing in on where health disparities exist. Currently, clinical trials do not have the diversity needed to evaluate the impact innovative treatments have on different populations.

On average, African American patients represent anywhere from 5 percent to absolutely none of the participants in a rare disease clinical trial. Latino representation also hangs in the single digits.

Krista Nelson, president of the Association of Community Cancer Centers, encouraged diversity in clinical trials, where she notices the most extensive breakthroughs in cancer care have happened.

“Clinical trials are essential in establishing quality care,” Nelson stated. “It’s how we understand how cancer care can be improved, in so many ways, clinical trials are just invaluable. But what we know is that people of color are vastly underrepresented.”

Increasing representation in clinical trials will require a collaborative effort ranging from community-based health partnerships for recruitment and attracting more clinicians of color into the oncology specialty, Nelson mentioned.