Oncologist coleads research into cancer care inequities among Black, Hispanic patients

The American Cancer Society and Flatiron Health presented a grant to Dawn Hershman, MD, MS, FASCO, to support research into the use, toxicity and efficacy of oral antineoplastic drugs among Black and Hispanic patients.

Healio spoke with Hershman, a professor of medicine and epidemiology at Columbia University, about the 2021 Real-World Data Impact Award, her past research into health inequities and her plans for the upcoming research.

Hershman said that she is coleading the research with a junior faculty colleague, Melissa Accordino, MD, who has worked with Hershman in the past on lack of access and nonadherence to medications, such as hormone therapies for breast cancer treatment.

“With an increasing use of oral antineoplastic agents in patients with advanced cancer, issues related to access, toxicity and compliance [have] become of increased interest, especially in the era where we’re thinking about factors that can be modified to improve health inequity,” Hershman said. “The delivery of cancer care is something that we know can result in disparities in outcomes, and that’s also something that can be fixed.”

She continued that being able to look at Flatiron Health’s large database of approximately 2.5 million patients will provide an opportunity to evaluate subgroups of patients more specially than would be available through a prospective clinical trial.

“We have the ability to look at patients with metastatic cancer and look at uptake of some of the new oral antineoplastic agents and see if there are disparities in uptake, time on treatment or adverse events between various ethnic and racial groups,” she said. “The goal would be to try and identify factors that could be modified or mitigated to reduce disparity.”

From the past research she conducted at her institution and with Accordino, they had found a variety of factors that can result in high out-of-pocket costs for patients, including expensive oral antineoplastic drugs, as well as complications with insurance.

“For patients that are vulnerable, they may be more subject to losing insurance and not being able to get medications, they may be more vulnerable to out-of-pocket costs that can accumulate, and there may be differences in terms of toxicity,” Hershman said.

In terms of her upcoming research project, she addressed the growing awareness of health inequities and issues related to structural racism. Although there are “many things in the world that we can’t fix, we can focus our research on fixable solutions that are going to have the biggest impact on outcomes,” she said.

Hershman also highlighted the importance of involving junior faculty, especially women, in these kinds of projects.

“It’s our obligation to try to raise the careers of the people around us so they can take leadership roles and have opportunities going forward,” Hershman said. “We know during COVID-19, junior faculty, especially women with young kids, can be vulnerable considering competing demands. We’ve made an enormous amount of progress in terms of equity in this profession, and in terms of more women having leadership opportunities and national prominence. We just have to make sure that we do everything we can so that we don’t go backward.”

For more information:

Dawn Hershman, MD, MS, FASCO, can be reached at dlh23@cumc.columbia.edu or on Twitter @DrDawnHershman.

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