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AACR Report Urges Action to Increase Diversity & Achieve Health Equity

Eastman, Peggy

doi: 10.1097/01.COT.0000854144.15938.dd
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diversity; health equity:
diversity; health equity

The American Association for Cancer Research (AACR) held a virtual Congressional briefing to release its “AACR Cancer Disparities Progress Report 2022.” The purpose of the report is to increase public awareness of cancer health disparities, highlight progress in reducing them, and make recommendations for achieving cancer care equity for all Americans. Launched in 2020, the annual report is a cornerstone of the AACR's educational and advocacy efforts to achieve U.S. health equity for the medically underserved.

The virtual briefing featured a keynote address by the report's steering committee chair, remarks by two members of Congress, and a panel discussion with cancer researchers who served on the steering committee and cancer survivors. The survivors' personal stories are included in the report.

The AACR has a long history of working proactively through concerted initiatives to eliminate cancer health disparities, said Margaret Foti, PhD, MD (hc), CEO of the AACR. “All of these initiatives are crucial,” she noted. They include working to ensure strong federal funding for cancer research, which is stressed in the new report.

The report concludes that the negative impact of structural racism is pervasive throughout the cancer care continuum. There continues to be an “enormous public health challenge posed by cancer health disparities,” said AACR President Lisa M. Coussens, PhD, FAACR, MD, Chair of the Department of Cell, Developmental, and Cancer Biology and Associate Director for Basic Research for the Knight Cancer Institute at Oregon Health and Science University School of Medicine. Stating that the AACR is committed to getting to the biological, systemic roots of the problem, Coussens stated, “It is clear that we must do better as a nation to confront the problem of cancer health disparities.”

Rep. Brenda Lawrence (D-Mich) noted that systemic health inequities impose “an incredible burden” on minorities, and it is important to learn more about them to help reduce this burden. Sen. Shelley Moore Capito (R-WV) said she has seen firsthand the devastating impact of health disparities on the rural residents of her state, including gaps in cancer screening.

In introducing the new AACR report on cancer health disparities, the report's steering committee chair, Lisa A. Newman, MD, MPH, FACS, FASCO, noted, “It is with a heavy heart that I do so.” These health disparities “really shouldn't exist,” stressed Newman, Chief of the Section of Breast Surgery at NewYork-Presbyterian/Weill Cornell Medical Center. She cited major progress in cancer research, including targeted therapies and immunotherapies, and said it is imperative that all Americans benefit from this progress.

Newman noted that the COVID-19 pandemic has forced the U.S. to confront the legacy of systemic racism and its consequences, including inferior housing and food insecurity—which can lead to obesity and other risk factors for cancer. She said it is predictable that communities of color will experience excess cancer mortality “unless we act.” Newman particularly stressed the need for more diversity in cancer clinical trials, stating that when trials lack diversity, the results cannot be generalized to the U.S. population as a whole. “We have to approach all of our patients with clinical research opportunities,” she said.

Noting that there are now some 17 million cancer survivors, Newman also said that medically underserved cancer survivors do worse, experiencing more adverse effects, a poorer quality of life, and higher financial toxicity after a cancer diagnosis—demonstrating the need for programs that help them achieve healthy lifestyles.

“We must do better,” said Mariana C. Stern, PhD, Professor of Clinical Population and Public Health Sciences and Urology, as well as Associate Director for Population Sciences in the Norris Comprehensive Cancer Center at the University of Southern California. Stern decried what she called “predatory advertising” on the part of tobacco companies and emphasized it must stop. The report notes that the harms of tobacco products are greater for minority populations, and that the tobacco industry has used menthol-flavored cigarettes to aggressively target minority communities; some 85 percent of African Americans who smoke use menthol cigarettes.

Steven R. Patierno, PhD, cited the Just Ask program at Duke University, whose aim is to increase diversity for oncology clinical trials by providing education for patients and researchers. In addition to medical mistrust and fear, simply not being asked to enroll in a trial reduces the diversity of patients who participate, said Patierno, who is Professor of Medicine and Deputy Director of the Duke Cancer Institute. He added that patient navigators are critically important in helping disadvantaged cancer patients receive high-quality care.

Cancer survivors also stressed the critical need for patient navigators to help the medically underserved make their way successfully through a complex cancer care system. Breast cancer survivor Sandra Morales, who is a patient navigator, said navigation help is especially important for patients for whom English is not their first language.

Mathew Knowles, a Black survivor of male breast cancer who has a BRCA2 gene mutation, said that after his diagnosis, “I made a whole lifestyle change,” adding “I do this for my grandkids.” He said there should be much more awareness of the need for early detection of cancer in the U.S. population; he noticed red dots on his shirts and sheets from nipple discharge, and knew he needed to seek care. Like the AACR, Knowles emphasized that federal funding for cancer diagnosis and care must be robust. “We have to hold our government accountable,” he said.

The new report's recommendations include the following.

  • There needs to be increased federal funding for medical research and public health initiatives that are tasked with reducing cancer health disparities.
  • Policies are needed to promote environmental justice, since environmental carcinogens have disproportionately harmed racial and ethnic minorities. In early 2022, the Environmental Protection Agency (EPA) announced the Environmental Justice Initiative, which includes strong actions to reduce industrial air pollution, primarily in Texas, Louisiana, and Mississippi. These actions include reinstating regulations for power plant emissions of hazardous air pollutants.
  • Improved collection of disaggregated cancer data is necessary to enhance research and knowledge on racial, ethnic, sexual, and gender minority groups, including American Indian/Alaska natives, Asians, Black/African Americans, Hispanic/Latino or Latina subpopulations, and native Hawaiian or other Pacific Islander groups.
  • There needs to be sustainable financial support for patient navigators and community health workers, via a Payroll-Based Journal job title code by the Centers for Medicare & Medicaid Services, which would enable reimbursement for their services.
  • Advocacy must continue for universal access to high-speed broadband Internet services in underserved areas of the country. The report states: “Federal and local support for Internet access will be vital for bridging the digital divide and creating equity in health care and in educational and economic opportunities.”
  • Continuing efforts are needed to improve vaccination rates to prevent human papillomavirus (HPV)-related cancers. The PREVENT HPV Cancers Act of 2021 aims to do exactly that; this act would educate health care providers and the public about HPV, its association with certain cancers, and the importance of HPV vaccines.
  • The FDA should ban the sale of menthol cigarettes. On April 28, 2022, the FDA announced a proposed product standard whose rules would prohibit menthol as a characterizing flavor in cigarettes. Health and Human Services Secretary Xavier Becerra said the proposed rules “represent an important step to advance health equity by significantly reducing tobacco-related health disparities,” while FDA Commissioner Robert M. Califf, MD, said “it is clear that these efforts will help save lives.”
  • There should be continued support for the National Institutes of Health (NIH) UNITE initiative—established in February 2021—which facilitates inclusivity and diversity, and addresses structural racism within the scientific community, including at the NIH. Similarly, there should be continued funding for NIH's All of Us Research Program, which has the goal of building a diverse database of one million volunteers from diverse backgrounds.
  • Efforts should continue to support increased diversity in the health care workforce, especially through specific science, technology, engineering, mathematics, and medicine educational programs such as trainee programs.
  • Safety net hospitals must receive strong financial support, as they represent a lifeline to medically underserved populations.

Peggy Eastman is a contributing writer.

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