February 20, 2021
A long-standing problem that requires immediate action by physicians
- Dr. Karen Winkfield wants organizations to focus on concrete action such as dedicating new resources to diversity, rather than coming out with more reports describing the problem
- One way to improve racial bias, according to Dr. Winkfield, is adding more racial and ethnic staff at cancer care centers
- She says other steps include having cancer survivors of color speak in their communities and encouraging more minority participation in clinical trials
Both anecdotal evidence and multiple studies have documented disturbing disparities in cancer care, morbidity, and mortality among various populations. “We’ve known that cancer disparities have existed for decades,” Dr. Karen Winkfield, radiation oncologist at Vanderbilt University, tells SurvivorNet Connect. She explains that CDC graphs and charts as far back as the 1970s show Blacks dying from cancers at a much higher rate than other racial or ethnic groups. “Black men, for example, are dying of prostate cancer at about twice the rate of white men,” she says.
But recognizing the problem is only the first step to addressing it. And Dr. Winkfield urges organizations to resist the impulse to generate more reports, and instead focus on action. “This is an epidemic,” she says. “And if we don’t start addressing these issues now, and putting resources towards these disparities, the gap is only going to widen.” Currently, a large and diverse body of literature exists describing the inequities in patient outcomes attributable to the social determinants of health. While describing a problem is central in developing actionable solutions, Dr. Winkfield encourages the medical community to move beyond quantification of the problem into an action-oriented approach.
According to Dr. Winkfield, an actionable step cancer centers can take in the present is to staff cancer centers with more individuals of color at every level. “That’s not to say that a white person can’t provide excellent care to someone who is a racial or ethnic minority,” she says. “But it’s important for people to see other individuals who look like them, particularly around the issue of clinical trials.”
Black participation in clinical trials has been unacceptably low and while issues of trust may be part of the problem, in many cases it’s simply that this population isn’t afforded the opportunity to participate. “When there’s someone who looks like they’re from the same community talking about the importance of research, it makes a difference,” says Dr. Winkfield. “Having cancer survivors go into their communities to speak about their experiences and urge others to enroll in clinical trials also makes a difference. It’s time to shore up those communities that have been disenfranchised for decades.”
The social determinants of health arguably contribute more to clinical outcomes compared with any interventional or screening strategy. There is a wealth of data describing this issue across multiple disciplines and interventions including oncology. Dr. Winkfield believes the medical community must take action to end this pandemic of racial inequity now.