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      Racial and ethnic disparities in hematologic malignancies

      review-article
      Author(s): ,
      Publication date PMC-release:
      Journal: Blood
      Publisher: American Society of Hematology

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          Abstract

          Publisher's Note: There is an [Related article:]Inside Blood Commentary on this article in this issue.

          Abstract

          Racial and ethnic disparities in patients with solid malignancies have been well documented. Less is known about these disparities in patients with hematologic malignancies. With the advent of novel chemotherapeutics and targeted molecular, cellular, and immunologic therapies, it is important to identify differences in care that may lead to disparate outcomes. This review provides a critical appraisal of the empirical research on racial and ethnic disparities in incidence, survival, and outcomes in patients with hematologic malignancies. The review focuses on patients with acute myeloid leukemia, acute lymphocytic leukemia, multiple myeloma, non-Hodgkin lymphoma, Hodgkin lymphoma, myeloproliferative neoplasms, and myelodysplastic syndrome. The review discusses possible causes of racial and ethnic disparities and also considers future directions for studies to help decrease disparities.

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          Barriers to recruiting underrepresented populations to cancer clinical trials: a systematic review.

          Jean Ford, Mollie W Howerton, Gabriel Lai … (2008)
          Racial and ethnic minorities, older adults, rural residents, and individuals of low socioeconomic status are underrepresented among participants in cancer-related trials. The authors conducted a systematic review to determine the barriers to participation of underrepresented populations in cancer-related trials. Their search included English-language publications that reported original data on the recruitment of underrepresented groups to cancer treatment or prevention trials between 1966 and December 2005 in multiple electronic databases. They also hand-searched titles in 34 journals from January 2003 to December 2005 and they examined reference lists for eligible articles. Titles and abstracts were reviewed to identify relevant studies. Data on barriers to participation were synthesized both qualitatively and based on statistically significant associations with trial enrollment. Of 5257 studies that were cited, 65 studies were eligible for inclusion in the current analysis, including 46 studies on recruitment into cancer therapeutic trials, 15 studies on recruitment into prevention trials, and 4 studies on recruitment into both prevention and treatment trials. Numerous factors were reported as barriers to participation in cancer-related trials. However, only 20 of the studies reported statistically significant associations between hypothesized barriers and enrollment. The available evidence had limitations in quality regarding representativeness, justification of study methods, the reliability and validity of data-collection methods, potential for bias, and data analysis. The results indicated that underrepresented populations face numerous barriers to participation in cancer-related trials. The current systematic review highlighting the literature on recruitment of underrepresented populations to cancer trials and may be used as the evidence base toward developing an agenda for etiologic and intervention research to reduce the disparities in participation in cancer-related trials.
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            Barriers to Clinical Trial Enrollment in Racial and Ethnic Minority Patients With Cancer.

            Lauren Hamel, Louis Penner, Terrance Albrecht … (2016)
            Clinical trials that study cancer are essential for testing the safety and effectiveness of promising treatments, but most people with cancer never enroll in a clinical trial - a challenge exemplified in racial and ethnic minorities. Underenrollment of racial and ethnic minorities reduces the generalizability of research findings and represents a disparity in access to high-quality health care.
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              Comorbidity and survival disparities among black and white patients with breast cancer.

              Christine Neslund-Dudas, Carolyn S Feldkamp, David Nerenz … (2005)
              Reasons for the shorter survival of black breast cancer patients compared with their white counterparts are not completely understood. To evaluate the role of comorbidity in this racial disparity among breast cancer patients. Historical cohort from the Henry Ford Health System (a large comprehensive health system in Detroit, Mich) followed up for a median of 10 years. Patients (n = 906) included 264 black (29.1%) and 642 white (70.9%) women diagnosed as having breast cancer between 1985 and 1990. Detailed comorbidity data (268 comorbidities) and study data were abstracted from medical records and institutional, Surveillance, Epidemiology, and End Results, and Michigan State registries. Associations were analyzed with logistic and Cox regression. Breast cancer recurrence/progression and survival to death from all, breast cancer, and competing (non-breast cancer) causes. Of blacks, 64 (24.9%) died of breast cancer and 95 (37.0%) died of competing causes. Comparable data for whites were 115 (18.3%) and 202 (32.1%). Blacks had worse all-cause survival (hazard ratio [HR], 1.34; 95% confidence interval [CI], 1.11-1.62), breast cancer-specific survival (HR, 1.47; 95% CI, 1.08-2.00), and competing-causes survival (HR, 1.27; 95% CI, 1.00-1.63). A total of 77 adverse comorbidities were associated with reduced survival. Adverse comorbidity count was associated with all-cause (adjusted HR, 1.29; 95% CI, 1.19-1.40) and competing-causes survival but was not associated with recurrence/progression or breast cancer-specific survival. At least 1 adverse comorbidity was observed in 221 (86.0%) blacks and 407 (65.7%) whites (odds ratio, 3.20; 95% CI, 2.17-4.72). Comparisons of unadjusted and comorbidity-adjusted HRs indicated that adverse comorbidity explained 49.1% of all-cause and 76.7% of competing-causes survival disparity. Diabetes and hypertension were particularly important in explaining disparity. More black breast cancer patients die of competing causes than of breast cancer. Effective control of comorbidity in black breast cancer patients should help improve life expectancy and lead to a reduction in survival disparities.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Blood
                Journal ID (iso-abbrev): Blood
                Journal ID (hwp): bloodjournal
                Journal ID (pmc): blood
                Journal ID (publisher-id): Blood
                Title: Blood
                Publisher: American Society of Hematology (Washington, DC )
                ISSN (Print): 0006-4971
                ISSN (Electronic): 1528-0020
                Publication date (Print): 12 October 2017
                Publication date (Electronic preprint): 19 July 2017
                Publication date PMC-release: 12 October 2018
                Volume: 130
                Issue: 15
                Pages: 1699-1705
                Affiliations
                [1]Division of Medical Oncology, University of Washington, Seattle, WA; and
                [2]Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA
                Author information
                http://orcid.org/0000-0003-2600-6390
                Article
                Accession ID: PMC5639484 Pmcid ID: PMC5639484 Pmc-uid ID: 5639484 Publisher ID: 2017/778225
                DOI: 10.1182/blood-2017-04-778225
                PMC ID: 5639484
                PubMed ID: 28724539
                SO-VID: 2786d253-2aeb-4295-9d10-8999b23beb37
                Copyright © © 2017 by The American Society of Hematology
                History
                Date received : 10 April 2017
                Date accepted : 08 July 2017
                Related
                Landgren
                Page count
                Pages: 7
                Funding
                Funded by: National Institutes of Health;
                Categories
                Subject: 5
                Subject: 8
                Subject: 39
                Subject: 33
                Subject: Review Article

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