ALEXANDRIA, Va. – A new special series in JCO Oncology Practice, a journal of the American Society of Clinical Oncology (ASCO), explores the causes of disparities in cancer care and outcomes for Black people in the United States and examines potential solutions to begin to achieve health equity for this population. The “Disparities in Cancer Care for Black People in the United States” special series, which was published today as part of the journal’s May issue, features 16 articles and editorials that cover a wide range of relevant topics and present new data that examine the barriers many Black individuals face in receiving high-quality, equitable cancer care, and opportunities for clinicians and U.S. health systems to address these barriers.
Black people bear a disproportionate share of the cancer burden in the United States. They have the highest mortality rate and shortest survival across racial/ethnic groups for most cancers, and Black men have the highest cancer incidence rate.1 Nearly one in three Black men and women will be diagnosed with cancer in their lifetime, and one in five will die from the disease.2
“As a Black woman and a Black oncologist, I’ve seen firsthand the disparate outcomes for people of color in the United States,” said Lori J. Pierce, MD, FASTRO, FASCO. “I applaud JCO Oncology Practice, the editorial team, and all of the contributors for their leadership on this issue, for shining a light on these critical challenges we face as a society and within the oncology profession, and for offering concrete opportunities to make long-overdue progress. I am optimistic that with determination and persistence, change will come.”
The series was guest-edited by Karen Winkfield, MD, PhD; Blase N. Polite, MD, MPP, FASCO; Reginald Tucker-Seeley, MA, ScM, ScD; and Katherine Hicks-Courant, MD, who broadly categorized articles into four themes: biomarkers and race, clinical trial enrollment barriers, communication hurdles, and health care system reforms. While this special series is focused specifically on Black people in the United States, JCO Oncology Practice plans to focus future special series on other groups that experience health inequities.
“We believe that JCO Oncology Practice has a clear responsibility to disseminate significant, high-quality research that examines the extent to which disparities exist, the root causes of inequity, and tools, practices, and policy-level changes required to improve the delivery of high-quality care for all Americans,” said Linda D. Bosserman, MD, FACP, FASCO, Editor-in-Chief, JCO Oncology Practice. “My hope is that this special series provides the entire oncology community with a better understanding of disparities in cancer outcomes for Black people in the United States, along will new tools we can all adapt in our practices.”
The series also includes an editorial from Dr. Pierce, which provides an overview of some of ASCO’s recent initiatives targeted at increasing equity for this population, including a statement that condemns racism, acknowledges racism’s “profound impact” on public health, and strengthens ASCO’s commitment to taking bolder, more aggressive steps to address the complex forces and systems that are responsible for disparities in cancer prevention, diagnosis, treatment, and research.
“Research has shown us over and over again that Black people in the U.S. experience health disparities including worse cancer outcomes that are deeply linked to a history of discrimination and systemic exclusion,” said Dr. Karen Winkfield, one of the special editors of the series. “This special series aims to move beyond reporting of disparities and instead help us all move forward in understanding the mechanisms that create disparities and interventions needed to actually change the lives of people with cancer.”
In addition to the special series, the May special issue also includes an ASCO State of Cancer Care in America infographic that presents an overview of Black representation in the oncology workforce illustrating another area of significant disparity. The infographic illustrates that at every step in the journey to becoming an oncologist, the percentage of Black participants decreases. For example, while 13.4% of the U.S. population is Black, only 8.4% of recent medical school applicants are Black, and only 3% of oncologists are Black. An accompanying manuscript outlines some of ASCO’s ongoing efforts to address Black representation in the oncology workforce.
ASCO’s Activities to Increase Equity in Cancer Care for Black Americans
ASCO is committed to embedding an equity, diversity, and inclusion perspective into all Society programs. Building on its existing portfolio, ASCO has most recently:
- Appointed its first ASCO Diversity and Inclusion officer to guide ASCO internal and external initiatives aimed at achieving the Society’s equity, diversity, and inclusion goals;
- Formed a collaboration with the Association of Community Cancer Centers (ACCC) to increase clinical trial participation among Black and Hispanic/Latinx patients, an effort that will include providing research sites with a site assessment tool and implicit bias training;
- Produced a new educational series focused on the role of social determinants of health in cancer care and cancer outcomes;
- Successfully advocated for Medicaid coverage of routine costs associated with patients participating in clinical trials.
Later this month, ASCO will also convene a virtual roundtable with leaders in oncology to explore challenges to achieving equity in precision cancer care, along with the actions needed to ensure that high-quality equitable cancer care is available to every patient, every day, everywhere.
“In order to achieve equity, we must look critically at how social determinants of health result in racial disparities across the cancer continuum, from prevention to end-of-life care, and decide that these disparities are no longer acceptable,” said Dr. Tucker-Seeley. “My hope is that this special series will encourage the oncology community to further explore and intervene on the fundamental causes of disparities to ensure that patients who come from an ever-increasing number of diverse backgrounds and lived experiences can expect and receive equitable cancer care.”
The May print issue of JCO Oncology Practice includes thematic cover art by Mack Roach III, MD, FACR, a radiation oncology and artist.
Read the full special series in the May issue of JCO Oncology Practice.
More detailed information on each article is provided below.
Enhancing JCO Oncology Practice’s Cancer Care Delivery and Quality Improvement Mission With Equity and Value Components – Commentary by JCO Oncology Practice Editor-in-Chief Dr. Bosserman about the journal’s mission and commitment to publishing manuscripts focused on actionable components of cancer care disparities and value-based care that can lead to improved models of care, health care systems, and policies for patients with cancer.
ASCO’s Commitment to Addressing Equity, Diversity, and Inclusion of Black Cancer Patients and Survivors – Editorial by Dr. Pierce on ASCO’s work to increase equity for Black patients with cancer by successfully advocating for the recently-passed CLINICAL TREATMENT Act to increase access to cancer clinical trials; supporting Medicaid expansion and other policies to address cost of cancer to improve access to high-quality cancer care; and accelerating efforts to foster a diverse oncology workforce, including by mentoring leaders.
Health Equity for Black Americans: The Past Cannot be Prologue – Editorial from editors of the Special Series provides an overview the series’ goals, articles included, and perspectives on the work needed to achieve equity.
Effect of Medicaid Expansion on Receipt of Definitive Treatment and Time to Treatment Initiation by Racial and Ethnic Minorities and at Minority-Serving Hospitals: A Patient-Level and Facility-Level Analysis of Breast, Colon, Lung, and Prostate Cancer – Investigates the association between Medicaid expansion under the Affordable Care Act and access to stage-appropriate definitive treatment for breast, colon, non–small cell lung, and prostate cancer for underserved racial/ethnic minorities and at minority-serving hospitals (MSH).
Fragmentation of Care Among Black Women With Breast Cancer and Comorbidities: The Role of Health Systems – Analyzes types of practice setting for primary and breast cancer care to assess care fragmentation.
Building Toward Antiracist Cancer Research and Practice: The Case of Precision Medicine – Editorial asserts that precision oncology represents a tremendous opportunity for the delivery of personalized, targeted cancer care, but that significant gaps in research and practice threaten to exacerbate disparities for Black, Indigenous, and other people of color.
Participation of Black Americans in Cancer Clinical Trials: Current Challenges and Proposed Solutions – Editorial discusses some current challenges and proposed solutions to help in increasing the enrollment of Black Americans in cancer clinical trials.
Multilevel Influences on Black Cancer Patient Experiences With Care: A Qualitative Analysis – Identifies multiple aspects of health care that intervention researchers, healthcare administrators, and providers may target to improve care experiences for Black patients with cancer.
Barriers to and Facilitators of Recruitment of Adult African American Men for Colorectal Cancer Research: An Instrumental Exploratory Case Study – Examines successful and unsuccessful strategies for recruiting African-American men into focus groups centered on identifying barriers to and facilitators of CRC screening completion.
Social Determinants of Health and Disparities in Cancer Care for Black People in the United States – Editorial asserts that strategies for incorporating social determinants of health and social needs into cancer care must account for unique factors related to historical and social discrimination across multiple levels.
Perceived Institutional Barriers Among Clinical and Research Professionals: Minority Participation in Oncology Clinical Trials – Assesses the perspectives of cancer center professional stakeholders on institutional factors that can potentially influence racial and ethnic minority recruitment for cancer clinical trials.
Cancer Disparities and Black American Representation in Clinical Trials Leading to the Approval of Oral Chemotherapy Drugs in the United States Between 2009 and 2019 – Evaluates the reporting of race and inclusion of Black Americans in clinical trials that led to the approval of oral chemotherapy medications by the Food and Drug Administration (FDA) from 2009-2019 in the United States, showing that only 2.3% of clinical trial participants were Black and 2.4% of participants were Hispanic.
Prevalence of Targetable Mutations in Black Patients With Lung Cancer: A Systematic Review and Meta-Analysis – Meta-analysis on the prevalence of lung cancer EGFR, ALK, ROS-1, and BRAFmutations in Black patients compared with White, Hispanic, and Asian patients.
Black is Diverse: The Untapped Beauty and Benefit of Cancer Genomics and Precision Medicine – Editorial asserts that the vast majority of people carrying pathogenic variants of common cancer susceptibility genes are yet to be identified, in part due to the lack of diversity in genetic and genomics studies.
African Americans With p16+ and p16- Oropharyngeal Squamous Cell Carcinomas Have Distinctly Poor Treatment Outcomes Independent of Medical Care Access – Study shows the association between cancer disparity and p16 status in an OPSCC cohort with time to treatment initiation (TTI), a surrogate for medical care access, information.
Impact of Patients’ Companions on Clinical Encounters Between Black Patients and Their Non-Black Oncologists – Study examines effects of the presence and active participation of companions on encounters between Black patients with cancer and non-Black oncologists and finds bringing a companion to oncology appointments may be beneficial to Black patients.
1DeSantis, C. E., Siegel, R. L., Sauer, A. G., Miller, K. D., Fedewa, S. A., Alcaraz, K. I., & Jemal, A. (2016). Cancer statistics for African Americans, 2016: Progress and opportunities in reducing racial disparities. CA: a cancer journal for clinicians, 66(4), 290-308.