Study findings suggest need for ‘urgent push’ to increase diversity in oncology workforce
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Key takeaways:
- Cancer survivors reported delaying or forgoing care more often than controls due to patient-clinician identity discordance.
- Age and income appeared significantly associated with decisions to delay or forgo care.
Cancer survivors delayed or forwent care more often than those in the general population because their clinician was of another identity, according to a research letter published in JAMA Oncology.
Younger age and lower income appeared associated with higher likelihood of delaying or forgoing care for this reason.
“Within the general theme of awareness of how we identify ourselves — whether it be race, religion, gender or sexuality — there is a growing question about how this is impacting care,” researcher Anne Blaes, MD, director of the division of hematology, oncology and transplantation at University of Minnesota, as well as director of cancer survivorship services and translational research at Masonic Cancer Center, told Healio.
“There needs to be an urgent push to increase diversity in our workforce, and that’s across the entire spectrum,” added Blaes, a Healio | HemOnc Today Editorial Board member. “It’s not just physicians. It’s advanced practice providers, lab techs and imagers. If we want the best opportunity in health care, we need people to see a broad spectrum of what they look like.”
Background and methods
Prior research showed identify concordance — related to factors such as gender, race and religion — between patients and clinicians contributes to greater patient satisfaction, trust and participation.
However, the extent to which identify discordance may become a barrier to care had not been established, according to study background.
Blaes and colleagues assessed the extent to which cancer survivors and the general population delayed or opted to forgo care due to patient-clinician identity discordance. They also sought to identify factors associated with cancer survivors’ decisions to delay or forgo care.
The nested case-control study included adults recruited to NIH’s All of Us Research Program — a prospective cohort study of approximately 1 million socially diverse participants — between May 2018 and June 2022.
The analysis included 21,919 cancer survivors (mean age, 65.4 years; standard deviation, 12.4 years) and 109,595 cancer-free individuals matched by age, race and gender.
All participants completed a health care utilization survey that asked if they had ever delayed or forgone care because their clinician was of a different religion, race, native language or other identity.
Researchers assessed the proportion of survivors and controls who reported delaying or foregoing care due to clinician-patient identity discordance, and they used multivariable logistic regression to assess clinical and sociodemographic factors associated with delayed or foregone care.
Results
Cancer survivors more often reported delaying or forgoing care due to patient-clinician identity discordance (7.6% vs. 5.1%; P < .001).
An analysis of non-Hispanic white survivors showed those diagnosed at a younger age (18 to 44 years) and low annual income (less than $25,000) reported the highest prevalence of delayed or forgone care due to patient-clinician identity discordance (26.5%).
An analysis of racial and ethnic minority individuals showed younger survivors (aged 18 to 44 years) had the highest prevalence of delayed or foregone care regardless of annual income, with a range of 28.8% for those with income less than $25,000 to 18.2% for those with income greater than $150,000.
Multivariable analysis revealed several factors significantly associated with delayed or forgone care. These included younger age (18 to 44 years vs. 65 to 74 years, OR = 3.1; 95% CI, 2.52-3.81), lower annual income (less than $25,000 vs. $50,000 to $100,000, OR = 1.58; 95% CI, 1.29-1.93) and race/ethnicity (Asian vs. white, OR = 1.81; 95% CI, 1.25-2.63; Black vs. white, OR = 1.39; 95% CI, 1.15-1.68; Hispanic vs. white, OR = 1.39; 95% CI, 1.11-1.74).
Other factors linked to this barrier included gender identity (woman vs. man, OR = 1.33; 95% CI, 1.15-1.53), sexual orientation (lesbian, gay or bisexual vs. straight, OR = 1.31; 95% CI, 1.06-1.63) and educational attainment (high school or lower vs. bachelor’s degree or higher, OR = 1.51; 95% CI, 1.27-1.78).
Researchers also observed differences based on primary tumor site. Compared with individuals who had gastrointestinal tract cancer, decisions to delay or forgo care appeared more common among those who had gynecologic cancer (OR = 1.3; 95% CI, 1.01-1.66), breast cancer (OR = 1.29; 95% Ci, 1.05-1.58), head and neck cancer (OR = 1.27; 95% CI, 1.02-1.59) or urologic cancer (OR = 1.26; 95% CI, 1.02-1.57).
Next steps
Researchers acknowledged study limitations, including limited clinical details — such as clinician features or the type of care impacted — and the potential for surveillance bias and recall bias.
In addition, the study took place amid the COVID-19 pandemic. It is unclear how that may have impacted the findings — particularly with regard to preventive care, Blaes said.
“Nonetheless, the charge for all of us is to think about how to diversify our workforce,” Blaes told Healio.
Members of the clinical community can contribute to this effort by engaging in committees that are conducting work in this area or financially supporting programs that aim to accomplish this mission, Blaes said.
Her cancer center conducts several programs for students from diverse backgrounds to learn more about what it is like to work in health care or conduct medical research, she added.
“From my perspective, we have to start re-evaluating the pipeline way back to the high school level,” Blaes said.
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