Alexandria, Va. – cToday, JCO Oncology Practice, a journal of the American Society of Clinical Oncology (ASCO), published a special series that examines the causes of disparities in cancer care and outcomes in the U.S. Hispanic/Latinx population and offers potential solutions to increase equity among this group. "Disparities in Cancer Care and Scientific Knowledge in Hispanic/Latinx People in the United States” features 18 articles and editorials that present new data and opportunities on a wide variety of topics, including prevention and screening, genetic testing, clinical trial enrollment and participation, access to affordable health care, and workforce representation, among others.
Nearly 61 million people in the United States identify as Hispanic/Latinx, representing almost 1 in 5 Americans.1 Research has shown that the Hispanic/Latinx population in the United States generally has low rates of health insurance2 and low clinical trial participation rates. Even though Hispanic/Latinx people are less likely to be diagnosed with common cancers, they typically experience higher rates of mortality compared to Non-Hispanic White people in the United States.3,4
“This special series provides a uniquely broad and deep examination of the barriers to cancer care that Hispanic/Latinx people face, and can serve as an important resource for identifying actions to improve outcomes for this population,” said ASCO President Everett E. Vokes, MD, FASCO. “I commend JCO Oncology Practice, the editorial team, and all of the contributors for their leadership and thank them for sharing insights, personal experiences that led to this impactful collection of articles.”
The series was edited by Linda D. Bosserman, MD, FACP, FASCO; Narjust Duma, MD; Miguel Villalona-Calero, MD; Gilberto Lopes, MD, MBA; and Pelin Cinar, MD, MS.
“In developing this special series, our aim was to reflect the diversity of challenges and opportunities related to cancer disparities in the Hispanic and Latinx population,” said John V. Cox, DO, FASCO, Interim Editor-in-Chief, JCO Oncology Practice. “The series reflects that complexity and, importantly, an inspirational body of knowledge that will stimulate readers to take action—through research, policy changes, or practice improvements—that moves us closer to equity in cancer care.”
The special series also includes a close look at underrepresentation of the Hispanic/Latinx population in the oncology workforce. An ASCO State of Cancer Care in America infographic illustrates that at nearly every step in the pathway to becoming an oncologist, participation by Hispanic/Latinx people declines. For example, while 16.8% of the U.S. adult population identifies as Hispanic/Latinx, only 6.2% of recent medical school applicants and only 4.7% of oncologists are Hispanic/Latinx. An accompanying report explores some of the factors contributing to the lack of representation, describes ASCO’s ongoing efforts to address Hispanic/Latinx representation in the oncology workforce, and outlines steps for individual oncologists and institutions to take in order to improve workforce diversity. A commentary by Michael A. Q. Martinez, an MD/PhD candidate, shares how lack of representation in the oncology workforce has shaped his experience in medical school.
“If we are serious about improving access to high-quality, culturally and linguistically sensitive care – and ultimately, to eliminating health disparities, we must increase the representation of Hispanic/Latinx individuals in the oncology workforce,” said special series editor Narjust Duma, MD. “All members of the oncology care team can take action—starting right now—to create an inclusive and equitable work environment, mentor students and trainees, and improve recruitment and retention of oncologists who are Hispanic/Latinx or from other historically underrepresented groups in medicine.”
In May 2021, JCO Oncology Practice issued a similar special series focused on the Black population in the United States, and the Journal plans to produce future special series, topical issues, and articles on health inequities. Later this year, JCO Global Oncology plans to publish additional research on disparities in populations treated outside of the United States.
The special series comes on the heels of ASCO’s recent release of the ASCO Equity, Diversity, and Inclusion (EDI) Action Plan, which aims to infuse equity into all of the organization’s activities. Organized around ASCO’s mission pillars of research, education, and quality, the ASCO EDI Action Plan builds on the Society’s long-term commitment to advancing health equity in cancer care, and describes specific initiatives ASCO plans to continue, expand, or initiate, including efforts to increase workforce diversity and increase representation in clinical research. ASCO aims to address the wide variety of factors—including race/ethnicity, age, gender, sexual orientation, and geography—that can impact access to cancer care and outcomes, both in the United States and internationally.
More detailed information on each article is provided below.
Disparities in Cancer Care and Scientific Knowledge in Hispanic/Latinx People in the United States (Linda D. Bosserman, et al.) – Commentary by authors of the special series about the journal’s mission and commitment to publishing manuscripts focused with the goal of reflecting the diversity of issues, science, and expertise in disparities in cancer care in the Hispanic and Latinx population living in the US.
A Global Approach to Cancer Equity in the Hispanic/Latinx Population (Sybil R. Green, et al.) – Provides an overview of some of ASCO’s work to address cancer equity for the Hispanic/Latinx population globally.
Challenges in Genetic Testing and Treatment Outcomes among Hispanics with Lung Cancer (Luis E. Raez, et al.) – Article discusses significant disparities in Hispanics with lung cancer in the United States and Latin America and points to the need for point data on molecular testing, access to targeted therapy, and immunotherapy in the United States and abroad.
Do I Belong? (Michael A. Q. Martinez) – Commentary by MD/PhD candidate about the need for more Hispanic/Latinx representation in the oncology workforce.
The Problem of Hispanic/Latinx Underrepresentation in Cancer Clinical Trials (Manuel R. Espinoza-Gutarra, et al.) – Article discusses the lack of Hispanic/Latinx representation in cancer clinical trials and points to the need for policy change, stakeholder involvement, implementation of effective interventions, and community partnerships to increase equity in clinical trial participation.
Are quality cancer prevention and treatment along the Texas US-Mexico border achievable? (Jesse Nodora and Ana I. Velázquez Mañana) – Article examines the factors that have led to inequity in cancer prevention and treatment along the Texas US-Mexico border and identifies potential solutions to increase equity.
¿Dónde Están? Latinx/Hispanic Representation in the Oncology Workforce: Present and Future (Narjust Duma, et al.) – Article describes ASCO’s efforts to increase diversity in the oncology workforce and outlines individual actions that oncology leaders can take to improve representation and support colleagues who identify as Hispanic/Latinx.
2022 Snapshot: State of the Oncology Workforce in America (Caroline Schenkel, et al.) – Infographic presents the latest data on the oncology workforce, with a focus on the lack of representation of Hispanic and Latinx people in the oncology workforce.
Disparities in Guideline-Concordant Treatment and Survival Among Border County Residents with Gastric Cancer (Michelle R. Ju, et al.) – Article finds that residents with gastric cancer who live on the Texas-Mexico border are less likely to receive guideline-concordant care and have significantly worse survival outcomes than Texas residents who do not live on the border.
Proportion of early-onset gastric and esophagus cancers has changed over time with disproportionate impact on Black and Hispanic patients (Nataly Valeria Torrejon, et al.) – Article finds that early-onset gastric and esophageal cancer disproportionately affect Black and Hispanic patients, with the largest impact on Hispanic patients.
Colorectal Cancer Incidence in Texas Border Counties (Michael Brian LaPelusa, et al.) – Article analyzes the incidence rate for colorectal cancer in counties on the Texas-Mexico border, and finds the overall age-adjusted incidence rate of colorectal cancer was lower and decreased at a slower rate over time in border counties compared to non-border counties.
Implementation Strategies to Increase Clinical Trial Enrollment in a Community-Academic Partnership and Impact on Hispanic Representation: An Interrupted Time Series Analysis (Nahomy Ledesma Vicioso, et al.) – Article describes and evaluates the effectiveness of a set of implementation strategies on patient enrollment within radiation oncology clinical trials.
The Impact of Hispanic Ethnicity and Language on Communication Among Young Adult Childhood Cancer Survivors, Parents, and Medical Providers and Cancer-Related Follow-Up Care (Carol Y. Ochoa, et al.) – Article examines how language preference for young adult childhood cancer survivors, their parents, and medical providers can impact cancer-related follow-up care.
Equitable Representation of Latinos in Clinical Research Is Needed to Achieve Health Equity in Cancer Care (Amelie G. Ramirez and Patricia Chalela) – Article identifies barriers to participation in clinical trials among Latinos, summarizes strategies proven effective in increasing Latino representation in clinical trials, encourages oncology community to implement what has been shown effective, and recommends further research to address current gaps.
Disparities in Cancer Genetic Testing and Variants of Uncertain Significance in the Hispanic Population of South Texas (Stephanie Soweito, et al.) – Article finds that there are increased rates of Variants of Uncertain Significance (VUS) in the South Texas Hispanic population, which impacts clinical care and reflects the overall disparity in cancer genomics.
Disparities in Cardio-oncology Care in the Hispanic/Latinx Population (Giselle Alexandra Suero-Abreu, et al.) – Article outlines disparities cardio-oncologic care in Hispanic/Latinx populations and describes current barriers and potential solutions to improve cardio-oncology care delivery and patient outcomes.
Proyecto ELEVAR: Evaluating the Latinx Experience with the healthcare system through Variables on Access and Resources (Idalid Franco, et al.) – Article finds that implementation of the Affordable Care Act was associated with decreased healthcare access barriers in Hispanic/Latinx populations, however this population continues to experience disparities in chronic health conditions.
Disparities at the Intersection of Race and Ethnicity Examining Trends and Outcomes in Hispanic Women with Breast Cancer (Cosette D. Champion, et al.) – Article finds that Hispanic women had improved overall survival vs. non-Hispanic women, but racial differences in tumor subtype and nodal stage among Hispanic women highlight the importance of disaggregating racial/ethnic data in breast cancer research.
1 Miller KD, Ortiz AP, Pinheiro PS, Bandi P, et al., Cancer statistics for the US Hispanic/Latino population, CA:A Journal for Cancer Clinical Trials, https://acsjournals.onlinelibrary.wiley.com/doi/10.3322/caac.21695, accessed March 15, 2022.
2 KFF, Health Coverage by Race and Ethnicity, 2010-2019. https://www.kff.org/racial-equity-and-health-policy/issue-brief/health-coverage-by-race-and-ethnicity/
3 Ramirez AG, Trapido EJ. Advancing the Science of Cancer in Latinos. 2019 Dec 13. In: Ramirez AG, Trapido EJ, editors. Advancing the Science of Cancer in Latinos [Internet]. Cham (CH): Springer; 2020. Chapter 1. Available from: https://www.ncbi.nlm.nih.gov/books/NBK573259/ doi: 10.1007/978-3-030-29286-7_1
4 NCI 2021. Seer Cancer Statistics Review, 1975-2018. Table 1.20 https://seer.cancer.gov/csr/1975_2018/sections.html