Overcoming Cancer Screening Discrepancies in the Latinx/Hispanic Communities

Systematic changes at the institutional level have the potential to decrease disparities in cancer incidence, care, and survival within Hispanic and Latinx communities. The incorporation of promotoras, as well as offering transportation assistance, meal vouchers, and parking validation, can significantly increase clinical trial participation within these communities.

Promotoras are bilingual, lay navigators within the community who have been trained by the institution on cancer screening and information. Their job is to help distribute clinical trial information within the community and help to establish trust in the health care system.

Rodolfo Gutierrez, MD, hematology and oncology specialist with Providence Saint John's Health Center Cedars-Sinai Medical Center, The Angeles Clinic, recently spoke to OncLive®, a sister publication of Oncology Nursing News®, about how promotoras have positively affected 1 communities’ trial participation, as well as the importance of maintaining diversity across clinical trials.

Gutierrez works on many phase 1 trials at the Angeles Clinic and Research Institute that assess novel immunotherapies. He has recognized a lack of Latinx participation in these trials, which is an important issue because “if we don't have diverse participation in clinical trials, our results and outcomes are going to be very difficult to be generalizable to the entire population,” Gutierrez said.

Disparities to Address

There are multiple barriers that curb participation. Some obstacles include a lack of insurance or difficulty finding transportation to the university or cancer center with available trials.

Bias can unfortunately contribute to trial participation barriers as well. Studies have identified that biases from providers, researchers, and clinical research coordinators can result in the dismissal, or exclusion, of patients of lower socioeconomic status (such as the Latinx community members) for clinical trial participation, explained Gutierrez. Preemptively dismissing candidates is harmful to these studies because the inclusion of diverse patients helps to enrich and enhance the study results, he continued.

Furthermore, certain cancers, such as breast cancer, are more prevalent or are associated with worse outcomes within the Latinx community.

“For a variety of reasons, we are seeing patients being diagnosed with [cervical cancer at] more advanced stages, having worse survival, and higher incidence. Some of this has to do with education, background, and risk of certain infections for [the disease] like the human papillomavirus [HPV], but some of it is just access to care. Cervical cancer is a great example of this. A big reason why a disparity [exists] between Latina and Hispanic women and White non-Hispanic women [has to do with] access to screening. Now that we have a vaccine available for HPV, [it means that] access and utilization of these vaccines are a big part of why we have this discrepancy.”

One notable study evaluated a Latinx community in Texas and assessed their relationship with hematologic malignancies, specifically acute lymphoblastic leukemia [ALL], which is more prevalent within the Latinx community. Gutierrezobserved that, within the study, patients who lived closer to the Mexico/Texas border had worse overall survival (OS) outcomes than throughout other populations in Texas.

“If you really think about that,” he said, “it's probably because they don't have access to these cancer centers where clinical trials are available or higher-resource medical centers. The mere fact that where someone lives can have an effect on their cancer outcome [is important to be aware of].”

Providers Can Minimize Disparity Gap

Health care providers can help minimize the gap through a variety of implementations. At Gutierrez’s own practice, the use of promotoras has had a significant positive impact on community participation.

In addition, a recent study showed that the implementation of transportation assistance (30%), meal vouchers (21%), and parking validation (40%) significantly increased clinical trial participation within a Hispanic community local to the Wake Forest School of Medicine.1 Within 1 year, participation increased from 20% to 34%. This is a “significant jump [because of a] fairly simple [intervention]. Every cancer institute or every institute that has clinical trials needs to take a deep look into some of the easy changes that can be made to increase participation,” he said.

The Cedars-Sinai Medical Center has multiple task forces to promote engagement across Latinx, Korean American, and LGBTQ+ communities. Gutierrez is a member of the Hispanic task force. These forces seek to decrease differences in OS, incidence, and clinical trial participation.

His interactions with the promotorashas been a particularly positive experience. “I have participated in these training sessions with the promotoras and they had many questions that I was happy to answer,” he shared. “If we can educate them, this [knowledge] will be disseminated into the community in a trustworthy way. There is a lot of distrust in the medical system as a whole in certain groups—definitely in the African American and Latinx communities. Having these point people, mostly women, to serve as a starting off point has been helpful.”

The Future of Cancer Care in Latinx Communities

Future studies need to address the mutations besides BRCA that are more common in the Latinx community. There also needs to be a focus on how certain cancers, such as gastric cancer, differ biologically across the separate communities.

The University of California Davis Cancer Center is currently bringing light to some of the genetic differences in tumor biology in different subgroups. Medical professionals are optimistic that this knowledge can help with combatting racial disparities. Gutierrez said, “[the cancer space as a whole is] focusing more on precision medicine. By understanding [disease] biology better, our treatment options will grow. Hopefully, as a result, outcomes will also improve.”

Reference

1. Strom C, Weaver KE, Ruiz J, et al. Abstract A20: Hispanic patient navigation: an intervention to increase clinical trial participation. Cancer Epidemiol Biomarkers Prev. 2018;27(suppl 7):A20. doi:10.1158/1538-7755.DISP17-A20

A version of this article was originally published on OncLive as “Examining Interventions to Increase Participation of Hispanic/Latinx Populations to Clinical Trials for Cancers”