How Social Determinants Impact Cancer Outcomes: Insights from ASCO 2021

To help reinforce the American Society of Clinical Oncology’s (ASCO) dedication to addressing racial and ethnic disparities in healthcare, day 3 of the 2021 Annual Meeting included a session titled “Social Determinants, Not Biology: Time to Reappraise Genetics-Based Theories of Racial/Ethnic Cancer Outcome Disparities.” Featuring Drs. Robert Dess, Marvella Ford, and Nestor Esnaola, this session tackled some of the biggest issues in cancer care today relating to racial and ethnic disparities.

Here’s a breakdown of what each presenter discussed.

Prostate Cancer: Rejecting the Biologic Basis for Outcomes Disparities

First up was Dr. Robert Dess, a radiation oncologist at the University of Michigan who shared his research on the racial disparities seen among prostate cancer patients.

According to data, Black men are 1.7 times more likely to be diagnosed with prostate cancer and 2.1 times more likely to die from it, leading to the perception that race is a prognostic factor associated with worse prostate cancer outcomes.

However, when Dr. Dess and his team looked at the association of race with prostate cancer mortality by analyzing data from a variety of sources ranging from SEER to randomized trials, they found no differences in outcomes between Black and white men, proving that race is not an accurate indicator of prostate cancer outcomes.

This shows that significant disparities exist in prostate cancer care, but as Dr. Dess found, equal outcomes are possible if we recognize and address the effect of structural racism.

Race, Ethnicity, & Cancer Disparities: Ending the Genetic Debate

Next was Dr. Marvella Ford, who’s a Professor in the Department of Public Health Sciences and Hollings Cancer Center at the Medical University of South Carolina. Dr. Ford’s research focused on how social determinants of health impact obesity and cancer outcomes.

This research is especially important since there’s a biologic association between obesity and cancer in that obesity raises the risk of cancer and the inflammation in cancer is associated with obesity.

To learn more about this association and its impact on Black patients, Dr. Ford and her team zeroed in on a rural area of South Carolina known as the I-95 Corridor. In South Carolina, 27 percent of the population is Black, and most live in the I-95 Corridor, which is plagued by economic disadvantages such as food deserts and high rates of poverty. Dr. Ford also listed the following examples of social determinants that often impact the I-95 Corridor:

• Densely populated and segregated areas
• Increased distance to grocery stories and healthcare centers
• Multi-generational households

Due to the social determinants of health like the ones listed above, Dr. Ford found that some of the highest mortality rates of cardiovascular disease, breast cancer, and prostate cancer deaths were clustered in the I-95 Corridor.

This demonstrates the importance of considering a patient’s circumstances since socio-environmental factors, such as inadequate housing and low-wage jobs, and even a patient’s environment and stressors can lead to poor health behaviors like drinking and smoking, which in turn increases their susceptibilities to diseases like obesity and cancer.

A Blueprint for Addressing Cancer Disparities

The third session was led by surgical oncologist Dr. Nestor Esnaola, who spoke about the racial disparities seen in early-stage non-small cell lung cancer (NSCLC) outcomes.

Since racial disparities in lung cancer care tend to be the most pronounced, Dr. Esnaola began by exploring the various factors contributing to this disparity, including:

• Cancer Stage at Presentation: Black men are more likely to present at a more advanced stage.
• Treatment-Related Efficacy: Even though there are similar survival rates when patients are treated with radiation versus chemotherapy, there’s still a difference in survival rates among races.
• Failure to Provide Optimal Treatment: This can relate to either the underuse of cancer treatment or the fact that patients receive suboptimal cancer treatment. For example, despite the fact that surgical resection is a cornerstone of NSCLC therapy, only 47 percent of Black patients undergo resection compared to 63 percent of white patients.

Expanding upon the failure to provide optimal treatment, Dr. Esnaola discussed the two factors involved: patient factors, like preferences and misconceptions, and healthcare system factors, such as transportation barriers. In fact, the top three barriers reported in Dr. Esnaola’s study were fear, transportation issues, and suboptimal communication with medical personnel.

So what can be done to address this problem? Dr. Esnaola believes that the failure to provide optimal cancer care may be driving racial disparities in cancer care and that future studies are needed to identify modifiable and targeted patient care avenues.

But in the meantime, Dr. Esnaola stressed the importance of improving access to care, enhancing diversity in the physician workforce, and helping minority cancer patients navigate the healthcare system by organizing enhanced protocol-driven patient navigation interventions.

To round out the session, Drs. Dess, Ford, and Esnaola all agreed that while cancer care isn’t being delivered equally across all races, we’re no longer simply defining disparities; we’re developing strategies to overcome them—which is key to achieving equitable outcomes and providing optimal care.