Leading Cancer Groups Issue Joint Statement on Disparities

Leading Cancer Groups Issue Joint Statement on Disparities

Despite advances in cancer care, disparities in outcomes persist.

Time and again, studies have shown worse outcomes in various medically underserved populations, including racial and ethnic minorities and patients of lower socioeconomic status.

Four leading national cancer organizations have now released a joint position statement to help guide the future of research into cancer health disparities. The American Association for Cancer Research, the American Cancer Society, the American Society of Clinical Oncology, and the National Cancer Institute have issued this guidance in order to “foster cooperation across the cancer research community to ensure that all patients – regardless of social demographics, socioeconomic status, or the communities in which they live – benefit from cancer research.”

The joint statement was published July 24 simultaneously in Cancer Research and the Journal of Clinical Oncology.

“Our hope is that these consensus recommendations will help guide stakeholders across cancer research, including public and private groups, toward actions that will meaningfully advance cancer health disparities research and ultimately ensure that all cancer patients are able to benefit from innovations that can improve cancer care,” said ASCO President Bruce E. Johnson, MD, FASCO, in a statement.

In their article, the four organizations identified what they believe are the most important research needs and priorities for reducing disparities, and offered recommendations to address each of these needs.

Needs and Priorities

The first recommendation is to define and improve the measures and tools that are used for research. The authors note that patient data are often incomplete, inaccurate, or overly simplified and often do not provide information about social and community environments. In addition, the manner in which data are collected and integrated in disparities research is often suboptimal, and research tends to be limited by a lack of comprehensive and consistent data on issues that affect disparities in cancer care.

For example, health literacy and numeracy are rarely assessed in practice and are generally unavailable in administrative and research databases, and methods for collecting data on sexual orientation and gender identity in more uniform fashion “are in their infancy.”

Second, disparities in cancer incidence need to be addressed. These disparities are quite pronounced and long-standing, and the underlying causes are multifactorial and multilevel. These include sociodemographic factors, access to healthcare, cultural perceptions, biologic differences, and genetic predisposition.

Eliminating disparities would require studies investigating biological and environmental determinants of cancer and studies that are focused on identifying the genetic contributors to higher cancer risk among certain populations.

Third, disparities in survival need to be addressed. The authors point out that even when the stage of cancer is controlled for in studies, survival disparities persist. The connection between system-level, biological, social, and environmental factors is often inadequately accounted for in current cancer research, and a more complete picture of the range of factors involved and how to track, identify, and address them are needed.

Fourth, strategies for engaging communities in cancer research need to be improved. The translation of cancer research into healthcare systems that care for diverse populations has been less than adequate. This in turn has negatively affected the use of new innovative therapies and advances in precision medicine on underserved patient populations. Strategies are needed to ensure all patient populations benefit from advances in cancer care, and this will require stronger community engagement in cancer research.

Finally, clinical trials need to be redesigned to address disparities. Currently, recruitment and retention rates are lower in clinical trials for some patient populations, and changes need to be made that will make findings generalizable and more applicable to underrepresented patient groups.

Recommendations

For each of the research needs and priorities, the authors present extensive recommendations for actions.

In summary, the authors recommend the following:

• Investigators, sponsors, and publications must insist on the use of the highest-quality data measurement tools and the most granular data when cancer disparities research is being conducted.

• A health disparities research network needs to be established, with multiple consortia to gather relevant patient contextual data and biospecimens.

• Best-practice strategies should be designed and utilized to engage underserved populations in research studies and to ensure they are informed of opportunities to participate in clinical trials.

• Researchers need to be adequately trained in community engagement research tactics, and promotions in the academic setting should appropriately account for time needed to conduct research that involves the community.

• Cancer treatment requires real-time monitoring of patient experiences in order to better understand how patients are being treated, and intervention is necessary when care and outcomes disparities are identified.

Several authors have disclosed relationships with industry, as noted in the original article.

Cancer Res. Published online July 24, 2017. Full text

J Clin Oncol. Published online July 24, 2017. Abstract

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