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Striving for Equitable Outcomes in Oncology Patient Care with a Focus on Health Disparities and Outcomes Research

May 31, 2022

The AACR Annual Meeting 2022 was held April 8-13, 2022 and was attended by more than nineteen thousand attendees (onsite and virtual). The theme of this year’s meeting was Decoding Cancer Complexity, Integrating Science, Transforming Patient Outcomes: in essence, leveraging the boom of next-generation technologies in cancer science and medicine to positively impact the clinical care of patients, the quality of life for survivors, and the prospects of preventing and curing all cancers.

While great strides have been made in these arenas, there remain certain areas—and certain patient populations—in which progress has not been as expedient. Cancer health outcomes in Black, Indigenous, and other minoritized race groups suffer from significant disparities imposed by societal and economic barriers. Several informative and edifying sessions were held throughout the meeting on identifying these barriers and making strides to address them. For instance, the underlying discriminatory practices of economic, health and housing systems perpetuate the marginalization of Black and Hispanic populations, which result in inequity of life-saving and wellness resources. Even living a lifetime dealing with these limitations results in psychosocial harms, caused by chronic exposure to racism stressors, which also translates into biological effects. Healthcare settings are not traditionally equipped to address these issues, or have not prioritized them in context of cancer care. But several advances and educational sessions have unveiled new opportunities to reframe our approaches to improve cancer outcomes and better serve minorities.

Although major aspects of disparities in healthcare access and outcomes are deeply rooted in the systems and structures of our society, some disparities factors are also rooted in our lack of knowledge about diversity in human biology. Even with the advent of next-generation and high-throughput technologies, which have given us unprecedented ability to examine the genome, epigenome, transcriptome, and proteome, questions remain as to whether these advances will equitably serve traditionally underserved communities. For example, we know that African-Americans harbor more extensive admixtures of genetic ancestries from diverse geographic lineages, compared to their European-American counterparts. This poses challenges to analyzing -Omics data with analytical tools that do not account for high levels of admixture in genetic backgrounds, since the reference data are built around the more homogenous European data. This raises the question of whether certain cancer-predisposing genetic events, such as BRCA1 mutations in breast cancer, are as prominent or common in individuals without European ancestry—or whether individuals of African, Asian, or other lineages may harbor other gene mutations that should be considered equally predisposing.

Many questions remain to be answered and we believe that Cancer Research Communications is perfectly positioned to help communicate these important findings to the broader community as the work continues to grow. The Health Disparities and Outcomes Research section seeks to be the sounding board and beacon of informative evidence that will raise awareness of disparities causes, establish feasibility to implement change and transform the historical inequity of cancer research into a new era of healing, accountability and open access.

To exemplify this commitment, this month’s Cancer Research Communications Editors’ Pick is from the Health Disparities and Outcomes Research Section. Please read on for a summary of these important findings, as well as a Q&A with the section’s Senior Editor, Dr. Melissa B. Davis.

 

May Editors’ Pick: Race-associated Molecular Changes in Gynecologic Malignancies

African-American (AA) cancer patients are frequently faced with worse prognoses than their European-American (EA) peers. In addition to disparities in stage at diagnosis and disease-associated mortality, many AA patients present with more aggressive cancer subtypes than EA patients—for example, Black women are more likely to develop triple-negative breast cancer than white patients. These differences speak to the potential for underlying genetic differences across racial groups that may predispose to different disease presentations. However, databases and clinical trials have historically fallen short of representing the diversity of cancer patients in the United States, leaving a gap in our understanding of the genetic underpinnings of racial health disparities in oncology. In this article, Asare and colleagues present an analysis of the Cancer Genetic Ancestry Atlas, which sorts data from The Cancer Genome Atlas by ancestry. Using large-scale, comparative analyses, the authors identify both shared and ancestry-specific alterations at the methylome and transcriptome level for breast, ovarian, cervix, and uterine cancers. These data provide key insights into the underlying causes of all gynecologic malignancies across AA and EA groups, nominating new avenues for investigation and clinical intervention.

Q&A with Health Disparities and Outcomes Research Senior Editor, Dr. Melissa B. Davis, PhD:

  • What was the last book you read?
    • I re-read The Alchemist, seeking a bit of a reminder to trust the universe, follow the hope of my faith.
  • What would you have done if you weren’t in your current occupation?
    • With my same education, I would have built a science school for middle and high school. Or, perhaps, would have been a backup singer for my favorite R&B singer.
  • Which scientist (living or dead) do you admire most?
    • Leonardo DiVinci, his polymath genius gives those of us with ‘lesser than’ beginnings special permission to do brilliantly do ‘all the things’ with superb passion.
  • What do you like to do when you are not working on cancer research?
    • I love to cook (testing various recipes), spend time being active outdoors (snorkeling or hiking) and watching (Marvel) movies with my kids.
  • Who is your favorite musician?
    • I don’t have a single favorite, I can’t live without music! I could no sooner choose my favorite child. But I do have trends of favorites that change with each season (it’s John Mayer season right now), but Jill Scott and Marvin Gaye are timeless.
  • What is your favorite food?
    • Savory: Salmon (in any form) Sweet: Dark Chocolate (in any form – but at this moment, as red wine)
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