The theme of the 2022 American Society of Clinical Oncology (ASCO) Annual Meeting is Advancing Equitable Cancer Care Through Innovation. From June 3 to 7 in Chicago, Illinois, and online, cancer researchers and clinicians from around the world will gather to discuss the latest research and how to ensure that all people receive the cancer care they need.
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Increased spending by states in social services is associated with improved 5-year overall survival for Black people with cancer
Who does this study affect? Black people with cancer who are eligible for social services.
What did this study find? An analysis of health and demographic information from nearly 3 million adults with cancer in the United States found that increased public spending by states on social services was associated with higher 5-year overall survival among Black people with cancer. Increased spending on such social services as Medicaid and programs that provide cash assistance for individuals, such as Supplemental Security Income, also narrowed the differences in survival between Black and White patients for many different types of cancers.
The researchers used data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program for this study. They looked at records of nearly 3 million adults aged 18 and older who were newly diagnosed with cancer from 2007 to 2016. For information about state spending on social services, the researchers used data from the U.S. Census Bureau. Using this information, the researchers looked to see if there were connections between 5-year overall survival and social services spending based on race, ethnicity, and type of cancer.
The analysis of the data first revealed that Black people have a 5-year overall survival that is nearly 11% lower than that of White people. However, the researchers saw that for every 10% increase in a state’s spending on social services, the difference in 5-year overall survival between Black and White patients closed by nearly 4.6%. For specific types of cancer, increased social services spending translated into higher overall survival rates for Black patients, as well as closing the gap in outcomes between Black and White patients:
Breast cancer: 6.15% increase in overall survival for Black people led to a 39% narrowing of the gap
Cervical cancer: 11.9% increase in overall survival led to a 46% narrowing of the gap
Colorectal cancer: 4.42% increase in overall survival led to a 48% narrowing of the gap
Head and neck cancer: 9.41% increase in overall survival led to a 38% narrowing of the gap
Liver cancer: 7.02% increase in overall survival led to a 49% narrowing of the gap
Ovarian cancer: 8.95% increase in overall survival led to a 41% narrowing of the gap
Bladder cancer: 8.18% increase in overall survival led to a 44% narrowing of the gap
Uterine cancer: 14.1% increase in overall survival led to a 40% narrowing of the gap
What does this mean for patients? Existing research has shown that there are connections between cancer survival and social determinants of health, such as financial stability, education, community, nutrition, and access to health insurance. States with increased spending on social services lessened some of the impact of these social determinants of health and improved overall cancer survival for Black people.
"There is evidence that spending by states on various social services can mitigate structural racism and partially address social determinants of health, such as financial stability, education, place of residence, and insurance status, but such spending has also been associated with declines in racial and ethnic disparities, leading to unknown overall survival outcomes for patients with cancer. Our study provides some answers to some of these vexing issues.”
— lead study author Justin Michael Barnes, MD, MS
Washington University School of Medicine in St. Louis
St. Louis, Missouri
Who does this study affect? Black people with metastatic breast cancer.
What did this study find? A survey of patients with metastatic breast cancer found that 83% of Black respondents were somewhat or very likely to consider participating in a clinical trial. However, 40% of the respondents reported their care team had not informed them about the opportunity to enroll. This study is part of the BECOME initiative (Black Experience of Clinical Trial and Opportunities for Meaningful Engagement), which is sponsored by the Metastatic Breast Cancer Alliance.
In the United States, Black people are more likely than White people to die of breast cancer. About 15% of people with cancer in the United States are Black, but only 4% to 6% of people participating in clinical trials are Black. If the people participating in clinical trials do not match the populations affected by cancer, then it is more difficult to tell how a treatment will work for all patients.
The survey was sent to 424 women with metastatic breast cancer, and 102 of them self-identified as Black. In addition to revealing that many Black patients would consider a clinical trial, yet 40% were never told about joining one, the survey results also reported:
Black respondents had a 90% trust and satisfaction level with their cancer care team and 83% were somewhat or very likely to consider joining a clinical trial
73% of respondents had concerns about side effects
63% of respondents had concerns about whether the treatments in clinical trials were effective
Black respondents (57%) were more likely than other respondents (31%) to believe unstudied treatments may be harmful
Black respondents (73%) were less likely than other respondents (91%) to indicate they trust clinical trials
Black respondents (32%) were less likely to trust that people of all races and ethnicities get fair treatment in clinical trials than other respondents (56%)
Black respondents were more likely than other respondents to value receiving information about clinical trials from someone with the same racial or ethnic identity (67% vs. 10%), who had breast cancer (73% vs. 44%) or metastatic breast cancer (73% vs. 51%), or who had participated in a clinical trial (72% vs. 48%)
Black respondents (83%) were more likely than other respondents (51%) to be motivated to participate in clinical trials to help other people with cancer with the same racial or ethnic identity
Based on these survey results, the researchers have suggested several ways to improve the way that people are informed of and enrolled into clinical trials in order to increase participation from Black people. Their suggestions included that more people need to be made aware of open clinical trials, increasing patient education about clinical trials, training health care providers to deliver patient-friendly information in an unbiased way, and engaging people of the same racial or ethnic identity and health experience to share these messages. Also, the researchers noted that clear communication is needed to build trust in clinical trials, including addressing concerns about side effects, treatment effectiveness, and whether treatment is given in a fair and equitable way. In addition, the researchers also suggested that people should be given help in finding and accessing clinical trials.
What does this mean for patients? The people who participate in cancer clinical trials need to represent the populations that are affected by the disease. This is why more Black people with metastatic breast cancer are needed in breast cancer clinical trials; so that it is clear whether the treatments being studied help this group of patients live longer. These survey results show the gaps in clinical trials access and information, and the researchers offer some options for closing these gaps.
"This study was initiated in 2019 and led by a very special and ardent advocate of inclusivity in breast cancer trial enrollment. Sadly, she passed away from metastatic breast cancer, but we all strive to continue her efforts by bringing the patient voice and authenticity of advocacy to our work so that we can demonstrate the impact that patients can have on the clinical trials process.”
— lead study author Stephanie Walker, RN
Metastatic Breast Cancer Alliance
New York, New York
Telemedicine use for cancer care increased during the COVID-19 pandemic but varied by race, income, and other factors
Who does this study affect? All people receiving cancer care.
What did this study find? An analysis of data collected during the COVID-19 pandemic showed that while more people in the United States used telemedicine for cancer care overall, there were still groups of people who used telemedicine less. Telemedicine is the use of communication technology to support clinical care. It is also sometimes called telehealth or televisits. Telemedicine can help give people access to specialized health services, such as cancer care, that they would not normally be able to receive. Before March 2020, only a very small number of people with cancer used telemedicine services.
The researchers analyzed electronic health records of 26,788 people aged 18 or older who started cancer treatment at community-based cancer centers between March 2020 and November 2021, with follow-up through March 2022. The health records came from Flatiron Health, a health technology company that focuses on cancer.
The analysis showed that nearly 16% of the patients in the study used telemedicine services within the first 3 months after starting systemic cancer treatment. Among Black patients, about 13% used telemedicine, compared with nearly 16% of White patients. About 12% of people without documented health insurance used telemedicine, while 16% of those with private health insurance or Medicare did. Patients living in urban areas were more likely to use telemedicine, with nearly 18% using the services, compared with about 13% of patients in suburban areas and nearly 10% of patients in rural areas. About 11% of patients in the least affluent areas of the nation used telemedicine, compared with about 24% of patients in the most affluent areas.
What does this mean for patients? Telemedicine can help people receive care when in-person visits are not possible. Although more people used telemedicine during the early months of the COVID-19 pandemic, access to telemedicine was not equitable. Black people, people without insurance, people in rural areas, and people living in less affluent areas were all less likely to use telemedicine for cancer care.
"Our study provides the most recent and comprehensive evaluation of trends and inequities in telemedicine use across many sociodemographic characteristics. While telemedicine may expand access to specialty care, the proliferation of these services may widen cancer care disparities if vulnerable populations do not have equitable access.”
— lead study author Jenny S. Guadamuz, PhD
New York, New York
Race, ethnicity, and poverty are associated with lower overall survival in children with high-risk neuroblastoma
Who does this study affect? Children with high-risk neuroblastoma.
What did this study find? Previous studies of children with high-risk neuroblastoma have uncovered differences in survival based on race and poverty, even when they receive the same treatments in clinical trials. The majority of children with cancer are treated in clinical trials. This study added to that knowledge by analyzing data that shows Black children are more likely to be diagnosed with high-risk neuroblastoma and have higher rates of the disease returning after treatment. Research has also found differences in recurrence and survival among children living in poverty who received immunotherapy in a clinical trial after their initial therapy.
High-risk neuroblastoma is a tumor that arises in children and often requires intensive hospital-based treatment using several types of treatment for nearly 2 years. Almost 90% of neuroblastoma is found in children younger than 5, and the average age of diagnosis is between 1 and 2 years old.
For this study, the researchers looked at data from 3 clinical trials run by the Children’s Oncology Group (COG) from 2007 to 2016. COG is a clinical trials group supported by the National Cancer Institute that studies childhood and adolescent cancers. The analysis included data from 696 children in the COG clinical trials. Of those children, 16% were non-Hispanic Black, 11% were Hispanic, 4% were other non-Hispanic, and 69% were non-Hispanic White. One-third (33%) of the children were living in households that had public health insurance only, such as Medicaid and the Children’s Health Insurance Program, which the researchers used to represent poverty. About one-quarter (26%) of the children were living in ZIP code locations with high rates of poverty. And 15% of the children lived in rural communities. There were no differences in tumor stage and biology based on race, ethnicity, or exposure to poverty.
The researchers saw differences in 5-year overall survival based on race and ethnicity.
47% 5-year survival rate for Hispanic children
50% for other non-Hispanic children
61% for non-Hispanic White children
63% for non-Hispanic Black children
The researchers also saw differences in 5-year overall survival based on a child’s exposure to poverty.
53% 5-year survival rate for children in households with public insurance
54% for children in neighborhoods in high-poverty ZIP codes
62% for children in neighborhoods not in high-poverty ZIP codes
63% for children in households with private insurance
The analysis found no differences in 5-year survival between children living in rural areas and those in more urban areas. This may be because children who live in rural areas typically receive their care at cancer centers in cities.
What does this mean for patients? Race, ethnicity, and exposure to poverty influence survival rates in children with high-risk neuroblastoma even when the children receive the same treatment in a clinical trial. The results of this study may be used to lessen the impact of these disparities in clinical trials for children with high-risk neuroblastoma as well as children with other cancers.
"Many previous studies have shown racial, ethnic, and socioeconomic disparities across many different pediatric cancers, but we haven’t been able to comprehensively look at whether these disparities persist when you take into account the type of cancer treatment that children receive. To address this gap, we decided to look at whether outcomes were the same for children across racial and ethnic groups when they received treatment on the same clinical trials for high-risk neuroblastoma.”
— lead study author Puja J. Umaretiya, MD
Dana-Farber Cancer Institute and Boston Children’s Hospital
Visit the Cancer.Net Blog each day of the meeting for more scientific highlights from the 2022 ASCO Annual Meeting and how the new research will affect patient care. You can also keep up with the meeting’s news by following Cancer.Net on Facebook and Twitter, where you can follow the #ASCO22 hashtag.
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