Metastatic Breast Cancer Video Perspectives
Nancy U. Lin, MD
Disclosures
Lin reports receiving research support from AstraZeneca, Genentech, Merck, Pfizer, Seagen and Zion Pharmaceuticals; honoraria from Affinia Therapeutics, Aleta BioPharma, Daiichi Sankyo, Denali Therapeutics, Olema Pharmaceuticals, Pfizer, Prelude Therapeutics, Puma, Seagens and Voyager Therapeutics; and royalties from Up-to-Date.
July 03, 2023
3 min watch
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VIDEO: Impact of structural racism personal bias on metastatic breast cancer
Transcript
Editor’s note: This is a previously posted video, and the below is an automatically generated transcript to be used for informational purposes. Please notify editor@healio.com if there are concerns regarding accuracy of the transcription.
So, you know, this is obviously a big problem, not only in cancer treatments, but also just medicine in general, not only in the United States, but around the world. My colleague Dr. Anesh Voss-Louise actually had done some analyses within SEER databases. One analysis was in SEER Medicare - so people over the age of 65 - showing that there were very dramatic racial differences in outcomes of patients with metastatic disease, most pronounced in people with HER2-positive breast cancer where the median survival was almost double in white patients compared to black patients. And this was probably resulting from less use of trastuzumab in a metastatic setting. And then a subsequent study that she did within the SEER database looked at patients who died within six months of their de novo stage four metastatic breast cancer diagnosis and overall about 25% of people-- it's very sobering-- died within six months of a de novo diagnosis. And the most important factors there were triple negative breast cancer status and lack of insurance. So patients without regular health insurance with triple negative breast cancer, over half actually died within six months of their metastatic diagnosis, which was really unbelievable. And she checked the numbers multiple times 'cause it was just so sobering. So I think that, you know, there are a lot of issues here. One is just access to health insurance, which networks people can go to, the ability to get to NCI-designated cancer centers, depending on insurance and how that gets covered. There's also the issue of out of pocket costs. There's a lot of out of pocket costs that cancer patients incur for their outpatient chemotherapy medications or targeted medications, for copays for things like antiemetics or supportive care medications. And then there's the issue of clinical trial access because, you know, we know that that's how we make progress in cancer. And the representation of certain groups in clinical trials is really very sub-optimal. And I think that's where both structural factors come in, like cost of transportation and being seen at a comprehensive cancer center that offers clinical trials. But also personal bias can come in because, you know, it really is up to the treating medical team to present clinical trials to the patient and if you have preexisting biases-- they may not be racially based, they may be like, this person is dealing with a lot of things in their life, maybe I'm not going to complicate it by presenting a clinical trial, but that's putting your, you know, that's putting the decision in the hands of the provider and not the hands of the patient. So I think, you know, there's a lot of factors. I suspect the structural factors are-- probably contribute more, although I don't know that that's really been studied, you know, structural versus personal. I suspect structural factors are really a a huge issue that that affect broadly.
So, you know, this is obviously a big problem, not only in cancer treatments, but also just medicine in general, not only in the United States, but around the world. My colleague Dr. Anesh Voss-Louise actually had done some analyses within SEER databases. One analysis was in SEER Medicare - so people over the age of 65 - showing that there were very dramatic racial differences in outcomes of patients with metastatic disease, most pronounced in people with HER2-positive breast cancer where the median survival was almost double in white patients compared to black patients. And this was probably resulting from less use of trastuzumab in a metastatic setting. And then a subsequent study that she did within the SEER database looked at patients who died within six months of their de novo stage four metastatic breast cancer diagnosis and overall about 25% of people-- it's very sobering-- died within six months of a de novo diagnosis. And the most important factors there were triple negative breast cancer status and lack of insurance. So patients without regular health insurance with triple negative breast cancer, over half actually died within six months of their metastatic diagnosis, which was really unbelievable. And she checked the numbers multiple times 'cause it was just so sobering. So I think that, you know, there are a lot of issues here. One is just access to health insurance, which networks people can go to, the ability to get to NCI-designated cancer centers, depending on insurance and how that gets covered. There's also the issue of out of pocket costs. There's a lot of out of pocket costs that cancer patients incur for their outpatient chemotherapy medications or targeted medications, for copays for things like antiemetics or supportive care medications. And then there's the issue of clinical trial access because, you know, we know that that's how we make progress in cancer. And the representation of certain groups in clinical trials is really very sub-optimal. And I think that's where both structural factors come in, like cost of transportation and being seen at a comprehensive cancer center that offers clinical trials. But also personal bias can come in because, you know, it really is up to the treating medical team to present clinical trials to the patient and if you have preexisting biases-- they may not be racially based, they may be like, this person is dealing with a lot of things in their life, maybe I'm not going to complicate it by presenting a clinical trial, but that's putting your, you know, that's putting the decision in the hands of the provider and not the hands of the patient. So I think, you know, there's a lot of factors. I suspect the structural factors are-- probably contribute more, although I don't know that that's really been studied, you know, structural versus personal. I suspect structural factors are really a a huge issue that that affect broadly.
