VIDEO: Racial disparities in metastatic triple-negative breast cancer

Editor’s note: This is an automatically generated transcript. Please notify editor@healio.com if there are concerns regarding accuracy of the transcription.

That's a great, great question. And goes into the heart of some of the stuff that we do here, very well at UAB. It is a common knowledge in the world of breast cancer that unfortunately there's a huge disparity when it comes to outcome of triple negative breast cancer. And this disparity, you can approach it from multiple dimensions. But the biggest disparity, and the ones that is unfortunately been the most remarkable, has been racial disparity. Some of the data that, you know, African-American population tend to have overall slightly less incidence of breast cancer compared to white Americans. However, they have a much higher mortality rate. And this is across the board when it comes to breast cancer and there's many active research involved in understanding and aligning and mitigating and fixing a lot of these disparities. But the work is fairly complex and it touches both social, organizational, and biological dimensions when it comes to this disparity outcome. If we were to take a niche out of this, a slice when we discuss triple negative breast cancer, the truth remains that one, it typically is more common in patients of African-American race, and part of that has to do with typically they get more aggressive types of breast cancer at an earlier age with less access to healthcare. Therefore higher disease burden. Or they basically come to us when the cancer is a little bit worse compared to their counterparts, white Americans. On top of that, there are factors that involve in the biology of the cancer itself that as I mentioned, make it slightly more worse, being more towards the triple negative subtypes and towards the chemo resistant subtype. And part of the difficulty in managing some of these cases has been again, social issues. So, you know, for example, in UAB we do serve a fairly large community and a catchment area. However, a lot of these patients have logistic challenges, or have family care challenges. They are the sole provider of their family, or they might not have any external support. And all of these factors just come together into making the care of these vulnerable population even more complicated. So what are the solutions. Well the first solution really is dependent on having an honest conversation with the patient and understanding barriers. Now, barriers have been classically when it comes to racial disparity, have been divided into barriers related to the patient logistic and financial barriers, and barriers related to the organization, typically insurance issues or catchment issues. And then barriers related to providers, and that touches on concepts like implicit bias a very active area of research. And understanding these barriers. The first step to try to address them one by one. There are numerous very successful endeavors to try to bring the outmost care to this vulnerable population. And one of the main things is involvement of social work. So for example, if there is logistic, financial, or otherwise patient variables that can be mitigated in social work, is typically we jump into that. Allowing patients to be enrolled into specific grants that can help them financially. Specific lodging options that can accommodate them during their treatments back and forth. Even sometimes getting them bus or cab vouchers. One successful project that was implemented in the DNF harbor is actually compensating certain underprivileged patient population financially, dependent on their zip code and the location they have to travel. It's a tiered system of grants and that actually proved fairly successful. This gets very important when we also talk about clinical trials. And clinical trials try as much to involve as many of the vulnerable population as possible. It's fairly known that clinical trials unfortunately do not represent minorities, especially African American, and a lot of the clinical trial efforts are trying to improve access to try to get patients from areas that typically are not able to come in and participate in big academic centers. Finally, organizations need to understand these barriers and need to develop internal protocols. For example, overcoming certain insurance barriers. UAB has what's called Project Access which allows patients who are not covered by insurance to have a policy under the UAB system to get their treatments. We have managed to treat both as a standard of care and on clinical trials, dozens of patients under Project Access and give them the care that they need. The physician part really has to do about educating clinicians that these barriers do exist, and that these barriers are something that unfortunately a lot of the clinicians feel uneasy to discuss with the patient. However, they are an integral part. I would say these are the real life part of the care. We can always talk about how we wanna treat our patients in ideal setting, but if you choose a chemo that is once a week for a patient that has two hours drive and no person to take care of her two kids, they're not going to come for that treatment. You know, so this is what we have to think about when we choose our treatment.