Andrew Hantel, MD, Center for Bioethics, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, discusses race-ethnic disparities in acute leukemia research participation, at the 64^th Annual ASH Meeting.

Transcript:

Hi, I'm Andrew Hantel from the Dana-Farber Cancer Institute in the Harvard Medical School Center for Bioethics, and I'm here at ASH 2022. I'm presenting some of my work on defining disparities across catchment areas for comprehensive cancer centers in acute leukemia. And our study came about because we had done a prior look at a cooperative group trial, the Alliance, and all of their prior studies from around 1999 to 2017, and found that there were large disparities by race and ethnicity amongst the patients [who] were recruited to their trials, both for acute myeloid and acute lymphoblastic leukemia. Within this, the largest disparities were for the comprehensive cancer centers and the patients [who] were recruited within their catchment areas, meaning the service areas that patients access them from. And these were self-defined by the catchment area that they had put into their cancer center grant, which is important because that's the way that... And the population that they are ostensibly responsible for, both in terms of cancer control and outcomes.

And so based on that, there were not only very large disparities, but there was a large variation between cancer centers. And so the next step was to say, we know that there's this disparity between the catchment area and the cancer center in terms of who gets on their trial, but we don't really know that intermediary step in terms of access from the catchment area to the center itself. And so starting small, this abstract that I'm presenting looked at our hospital, Dana-Farber Cancer Institute and how patients accessed it from across our catchment area of Massachusetts. And so we looked at the Massachusetts Cancer Registry count population level data and compared that to the patients who were seen at our Cancer Institute from 2014 to 2018. And in kind of broad strokes, we saw that actually about half of our patients for acute leukemia came from outside of the self-defined catchment area, which speaks a little bit to the lower prevalence of this disease and the fact that you have to have a single geographic designation for your entire cancer center irrespective of which types of cancer you're talking about.

But within that, we saw that we were actually fairly equitable in the recruitment by race and ethnicity of patients with AML and ALL for the state, meaning that there weren't large differences in patients who came to our center who were black, Hispanic or Asian compared to non-Hispanic White [patients]. However, within that kind of ~40% of patients [who] came from outside the state, there was an overabundance of non-Hispanic White [patients] relative to these other groups compared to our state breakdown by race and ethnicity of patients diagnosed with acute leukemia. Meaning that in the end we did see about 5% more non-Hispanic White [patients] due to this population coming in from outside the state than they were represented within this population that we ostensibly are responsible for. We also looked at this relative to things like socioeconomic status, distance from our cancer center and other variables, and found that there were some multivariable associations between age, between the year of diagnosis, between insurance type and between patient sex.

But that when we took all these other variables into account, there wasn't actually an independent association by race and ethnicity for cancer center treatment within those patients who got to our center. And so, while there are differences in access, in the univariate sense, that didn't really hold up, at least from the treatment standpoint, that there were differences by race and ethnicity.

So, we're focusing right now on how to make sure that we can provide access for the patients within our center's catchment area in order to equalize this overabundance of patients who are coming in from outside the state [who] are non-Hispanic White, and make sure that we have, are allowing access to patients who are coming from right around the hospitals area. And then we're also looking at linking these data on an individual level to the Massachusetts Cancer Registry data so we can really understand who is not getting into our centers. And then what happens in that next step between getting from the center onto the trial and how disparities exist across that spectrum. We're in the process of doing that now, and so those data will be forthcoming, but in a nutshell, we hope to expand this type of data work across other cancer centers and are working right now to do so using some novel data languages.