Disparities in Cancer Care for Black Americans

 

Disparities in Cancer Care for Black Americans

Inequality in our society can be measured by wealth, educational level, opportunities, and other factors including healthcare. Inequality in cancer care for Black Americans was the subject of one-page graphic presentation in the “Clinical Oncology Update” section of the New England Journal of Medicine few weeks ago.

The article titled “By the Numbers: Racial / Ethnic Disparities” is the subject of this blog.

According to the American Cancer Society’s estimate, there will be 1.89 million new cases and 608,00 deaths due to cancer in the USA this year.

The good news is that the death rate from cancer has continued to decline in the United States. From 1991 to 2018, the overall cancer death rate has fallen 31%. The bad news is that Black Americans have not benefited from this decline as much as other citizens have.

While the decrease in the death rate is mostly due to decrease in smoking, it is also due to the discovery, approval and availability of modern anti-cancer drugs. The Black Americans do not participated in the drug discovery process such as clinical trials as robustly as White Americans do.

The journey of a new molecule and compound from the lab to the pharmacy is a long and a complicated one. First, it must be tested in the lab against cancer cells or animals called the pre-clinical phase and then by phase I studies that are designed to determine the appropriate dose of the compound. Phase II includes testing a small group of healthy volunteers to determine safety and efficacy of the compound. Once it passes that hurdle, it is then tested in real patients in large multi-institution, multi-national studies called phase III trials. The results of positive phase III trials are then presented to the FDA. If approved, the drugs can then be sold in marketplace. Phase IV involves post-marketing data collection and analysis.

Unfortunately, very few patients in general volunteer to participate in clinical trials. This recent article stated that nationwide only 61,763 patients enrolled between 2014 and 2018 in clinical trials that resulted in subsequent FDA approval of certain anti-cancer drugs.

Of those 61,763, only 7.5% (about 4,600) participants were Black Americans.

The reasons for low participation in the clinical trials by Black Americans include inadequate access to care, high cost of care, lack of health insurance, poor health education and importantly, lack of trust in the institutions.  

Can one say with certainty that those newly approved cancer drugs will have the same efficacy and safety for all Black American patients if only 7.5% participated in the clinical trials?

The disparities in cancer care were presented graphically in this article. Here are some numbers that illustrate the point:

• Black Americans rank # 1 among the racial and ethnic groups in the USA for the highest death rate and the shortest survival for most cancers. 
• Black women have 40% higher likelihood of breast cancer related deaths compared to White women. 
• The rate of major depression in cancer patients who do not receive effective therapy is 73%. 
• Only 5% of cancer patients with major depression seek care from a mental health professional. 
• Only a dozen or so states have allowed Medicaid to cover some of the routine costs of participation in clinical trials in the year 2020.

Our society and our institutions have a lot of work to do to reduce and eliminate the disparity in cancer care. Civic, healthcare and institutional leaders must increase the efforts to enroll greater number of Black Americans in research clinical trials so that the scientists can learn what works and what does not work in that group of the society, develop effective drugs and reduce the cancer related mortality in Black Americans.