Racial determinants of treatment delays in gynecologic malignancies

Patient navigators help reduce racial disparities in outcomes for endometrial cancer

CHICAGO (March 25, 2021)—Two new studies highlight the importance of addressing racial inequities in gynecologic cancer, including improving minorities’ low participation rates in clinical trials of women’s cancers. The findings are presented at the Society of Gynecologic Oncology (SGO) 2021 Annual Meeting on Women’s Cancer.

Racial-ethnic minorities are underrepresented in clinical studies, which is a concern because people of different races and ethnicities may react differently to medical treatments. This underrepresentation is worse in the Deep South for many reasons, said the study’s presenting author, Nathaniel Jones, MD, University of Alabama Mitchell Cancer Institute, Mobile.

“This is particularly worrisome for Black women with endometrial cancer, one of the few gynecologic cancers with increasing incidence and one that disproportionately affects Black women with worse survival rates,” Dr. Jones said.

To encourage Black women with endometrial cancer to participate in clinical trials, the researchers relied on the cancer institute’s patient navigation program. In place since 2012, the diverse navigation workforce mirrors the demographics of their patient population, Dr. Jones noted. The program trains laypersons to guide all cancer patients through cancer care and educate them about benefits of clinical trial participation.

Over seven years, a similar proportion of Black and white women with endometrial cancer enrolled in clinical trials: 8.3 percent of Black patients (23 of 277) and 8.5 percent of whites (61 of 718), Dr. Jones reported. The researchers found their institution had a higher enrollment among Black patients than expected Black enrollment in the Deep South for endometrial cancer patients.

Importantly, clinical trial participants had comparable progression-free survival by race. Black women were alive without cancer recurrence at 13 months on average versus 14 months for whites, Dr. Jones said.

In another study presented at the SGO meeting, Tanvi Joshi, MD, reported that Black and Hispanic women had longer delays in starting appropriate treatment after diagnosis of gynecologic cancer than white women. For all gynecologic cancers, more Black and Hispanic women than white women experienced treatment delays longer than six weeks, according to data from the National Cancer Database including 652,565 women. By cancer type, treatment delays were as high as nearly 12 days among Hispanic women with vaginal and vulvar cancers.

Overall, Black patients had a 25 percent higher risk of death compared with whites with the same cancer type and stage, said Dr. Joshi, Abington-Jefferson Hospital, Abington, VA.

“Whether treatment delays affect survival remains unknown, but even short delays can increase patient care costs and illness,” Dr. Joshi said. “Treatment delays remain an important modifiable factor for achieving health care equity.”