Racial differences in molecular subtypes between black and white patients with endometrial cancer

BACKGROUND: Evidence of inadequate pain treatment as a result of patient race has been extensively documented, yet remains poorly understood. Previous research has indicated that nonwhite patients are significantly more likely to be undertreated for pain.OBJECTIVE: To determine whether previous findings of racial biases in pain treatment recommendations and empathy are generalizable to a sample of Canadian observers and, if so, to determine whether empathy biases mediate the pain treatment disparity.METHODS: Fifty Canadian undergraduate students (24 men and 26 women) watched videos of black and white patients exhibiting facial expressions of pain. Participants provided pain treatment decisions and reported their feelings of empathy for each patient.RESULTS: Participants demonstrated both a prowhite treatment bias and a prowhite empathy bias, reporting more empathy for white patients than black patients and prescribing more pain treatment for white patients than black patients. Empathy was found to mediate the effect of race on pain treatment.CONCLUSIONS: The results of the present study closely replicate those from a previous study of American observers, providing evidence that a prowhite bias is not a peculiar feature of the American population. These results also add support to the claim that empathy plays a crucial role in racial pain treatment disparity.

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Racial Differences in Advanced Colorectal Cancer Outcomes and Pharmacogenetics: A Subgroup Analysis of a Large Randomized Clinical Trial

Journal of Clinical Oncology ◽

10.1200/jco.2009.21.9527 ◽

2009 ◽

Vol 27 (25) ◽

pp. 4109-4115 ◽

Cited By ~ 60

Author(s):

Hanna K. Sanoff ◽

Daniel J. Sargent ◽

Erin M. Green ◽

Howard L. McLeod ◽

Richard M. Goldberg

Keyword(s):

Colorectal Cancer ◽

Racial Differences ◽

Subgroup Analysis ◽

Dna Analysis ◽

Performance Status ◽

Dose Intensity ◽

Small Sample ◽

Black And White ◽

Response To Chemotherapy ◽

White Patients

Purpose Racial disparities in colorectal cancer (CRC) survival are documented, but there are few data on comparative response to chemotherapy. A subgroup analysis of a multisite National Cancer Institute–sponsored trial (N9741) was performed comparing outcomes of black and white patients with metastatic CRC receiving uniform treatment. Patients and Methods Adverse events (AEs), response rate (RR), time to progression (TTP), overall survival (OS), and dose-intensity were examined as a function of self-reported race in 1,412 patients treated with irinotecan/fluorouracil, fluorouracil/oxaliplatin, or irinotecan/oxaliplatin. Pharmacogenetic analysis was performed on 486 patients with blood available for germline DNA analysis. Results OS was 1.5 months shorter and TTP was 0.6 months shorter in black than white patients (OS: hazard ratio [HR] = 1.13; 95% CI, 0.90 to 1.42; TTP: HR = 0.91, 95% CI, 0.73 to 1.13); neither difference was statistically significant. RR was significantly higher in whites (41%) than blacks (28%; P = .008). Grade 3 or greater AEs were also higher in whites (48%) than blacks (34%; P = .004). These relationships were maintained in multivariate models adjusting for arm, age, sex, and performance status. There was no difference in dose-intensity of delivered therapy. Significant racial differences in prevalence of pharmacogenetic variants were observed, although small sample size precluded investigating the relationship between treatment, race, and genotype. Conclusion OS and TTP are similar in black and white patients treated per protocol with standardized therapy for metastatic CRC. However, RR and AEs vary considerably by race. The marked racial differences in relevant pharmacogenetics, a potential explanation for differing RR and AEs, are worthy of future study.

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Health Care Segregation, Physician Recommendation, and Racial Disparities in BRCA1/2 Testing Among Women With Breast Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2015.66.0019 ◽

2016 ◽

Vol 34 (22) ◽

pp. 2610-2618 ◽

Cited By ~ 57

Author(s):

Anne Marie McCarthy ◽

Mirar Bristol ◽

Susan M. Domchek ◽

Peter W. Groeneveld ◽

Younji Kim ◽

...

Keyword(s):

Breast Cancer ◽

Black Women ◽

Racial Disparities ◽

Racial Differences ◽

White Women ◽

Physician Recommendation ◽

Study Objective ◽

Black And White ◽

Physician Characteristics ◽

White Patients

Purpose Racial disparities in BRCA1/2 testing have been documented, but causes of these disparities are poorly understood. The study objective was to investigate whether the distribution of black and white patients across cancer providers contributes to disparities in BRCA1/2 testing. Patients and Methods We conducted a population-based study of women in Pennsylvania and Florida who were 18 to 64 years old and diagnosed with invasive breast cancer between 2007 and 2009, linking cancer registry data, the American Medical Association Physician Masterfile, and patient and physician surveys. The study included 3,016 women (69% white, 31% black), 808 medical oncologists, and 732 surgeons. Results Black women were less likely to undergo BRCA1/2 testing than white women (odds ratio [OR], 0.40; 95% CI, 0.34 to 0.48; P < .001). This difference was attenuated but not eliminated by adjustment for mutation risk, clinical factors, sociodemographic characteristics, and attitudes about testing (OR, 0.66; 95% CI, 0.53 to 0.81; P < .001). The care of black and white women was highly segregated across surgeons and oncologists (index of dissimilarity 64.1 and 61.9, respectively), but adjusting for clustering within physician or physician characteristics did not change the size of the testing disparity. Black women were less likely to report that they had received physician recommendation for BRCA1/2 testing even after adjusting for mutation risk (OR, 0.66; 95% CI, 0.54 to 0.82; P < .001). Adjusting for physician recommendation further attenuated the testing disparity (OR, 0.76; 95% CI, 0.57 to 1.02; P = .06). Conclusion Although black and white patients with breast cancer tend to see different surgeons and oncologists, this distribution does not contribute to disparities in BRCA1/2 testing. Instead, residual racial differences in testing after accounting for patient and physician characteristics are largely attributable to differences in physician recommendations. Efforts to address these disparities should focus on ensuring equity in testing recommendations.

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Endometrial cancer: Stage at diagnosis and associated factors in black and white patients

American Journal of Obstetrics and Gynecology ◽

10.1016/0002-9378(95)90261-9 ◽

1995 ◽

Vol 173 (2) ◽

pp. 414-423 ◽

Cited By ~ 46

Author(s):

Rolland J. Barrett ◽

Linda C. Harlan ◽

Margaret N. Wesley ◽

Holly A. Hill ◽

Vivien W. Chen ◽

...

Keyword(s):

Endometrial Cancer ◽

Associated Factors ◽

Cancer Stage ◽

Stage At Diagnosis ◽

Black And White ◽

White Patients

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Distributed Counterfactual Modeling Approach for Investigating Hospital-Associated Racial Disparities in COVID-19 Mortality

10.1101/2021.09.14.21263596 ◽

2021 ◽

Author(s):

Mackenzie J Edmondson ◽

Chongliang Luo ◽

Nazmul Islam ◽

David Asch ◽

Jiang J Bian ◽

...

Keyword(s):

Racial Differences ◽

Hospital System ◽

Black And White ◽

Patient Level ◽

Modeling Approach ◽

Black Patients ◽

The Difference ◽

Using Data ◽

The Impact ◽

White Patients

Several studies have found that black patients are more likely than white patients to test positive for or be hospitalized with COVID-19, but many of these same studies have found no difference in in-hospital mortality. These studies may have underestimated racial differences due to reliance on data from a single hospital system, as adequate control of patient-level characteristics requires aggregation of highly granular data from several institutions. Further, one factor thought to contribute to disparities in health outcomes by race is site of care. Several differences between black and white patient populations, such as access to care and referral patterns among clinicians, can lead to patients of different races largely attending different hospitals. We sought to develop a method that could study the potential association between attending hospital and racial disparity in mortality for COVID-19 patients without requiring patient-level data sharing among collaborating institutions. We propose a novel application of a distributed algorithm for generalized linear mixed modeling (GLMM) to perform counterfactual modeling and investigate the role of hospital in differences in COVID-19 mortality by race. Our counterfactual modeling approach uses simulation to randomly assign black patients to hospitals in the same distribution as those attended by white patients, quantifying the difference between observed mortality rates and simulated mortality risk following random hospital assignment. To illustrate our method, we perform a proof-of-concept analysis using data from four hospitals within the OneFlorida Clinical Research Consortium. Our approach can be used by investigators from several institutions to study the impact of admitting hospital on COVID-19 mortality, a critical step in addressing systemic racism in modern healthcare.

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Racial differences in the perception of lung cancer: Data from the 2005 Health Information National Trends Survey (HINTS)

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.6556 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 6556-6556

Author(s):

C. S. Lathan ◽

C. Okechukwu ◽

B. F. Drake ◽

G. Bennett

Keyword(s):

Lung Cancer ◽

African Americans ◽

Racial Differences ◽

Lung Cancer Mortality ◽

Weighting Method ◽

Cancer Data ◽

Black And White ◽

Incidence And Mortality ◽

Nationally Representative ◽

White Patients

6556 Background: Black men have the highest rates of lung cancer incidence and mortality in the US, and yet continue to obtain treatment at lower rates than White patients. Racial differences in the perception of lung cancer in the population could contribute to racial disparities in seeking timely treatment. Methods: Data are from the 2005 HINTS survey. Sample design was random digit dialing of listed telephone exchanges in US. Complete interviews were conducted on 5491 adults, of which 1872 respondents were assigned to receive questions pertaining to lung cancer. All analyses were conducted on this subset of respondents. SAS callable SUDAAN was used to calculate χ2 tests and perform logistic regression analyses to model racial differences in perceptions of lung cancer. All estimates were weighted to be nationally representative of US population; jack knife weighting method was used for parameter estimation. Results: Black and White patients shared many of the same beliefs about lung cancer mortality, and etiology. African Americans were more likely than Whites to agree that its hard to follow recommendations about preventing lung cancer (OR 2.05 1.19–3.53 95% CI), to avoid evaluation for lung cancer due to fear of having the disease (OR 3.32 1.84–5.98 95% CI), and to believe that patients with lung cancer would have pain or other symptoms before diagnosis (OR 2.20 1.27–3.79 95% CI). Conclusions: African Americans are more likely to hold beliefs about lung cancer that could interfere with prevention and treatment of lung cancer. No significant financial relationships to disclose. [Table: see text]

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Histopathologic, Genetic and Molecular Characterization of Endometrial Cancer Racial Disparity

Cancers ◽

10.3390/cancers13081900 ◽

2021 ◽

Vol 13 (8) ◽

pp. 1900

Author(s):

Pouya Javadian ◽

Christina Washington ◽

Shylet Mukasa ◽

Doris Mangiaracina Benbrook

Keyword(s):

Endometrial Cancer ◽

Black Women ◽

Racial Disparity ◽

Treatment Strategies ◽

Specific Treatment ◽

Significant Differential Expression ◽

Black And White ◽

Incidence And Mortality ◽

Aggressive Histology ◽

White Patients

In contrast to the decline in incidence and mortality of most other cancers, these rates are rising for endometrial cancer. Black women with endometrial cancer have earlier diagnosis, more aggressive histology, advanced stage and worse outcomes compared with their White counterparts. Socioeconomic status, a higher incidence of aggressive histology, and comorbid conditions are known factors leading to racial disparity in patients with endometrial cancer; nevertheless, they do not account for the entire racial disparity; which emphasizes the roles of molecular, histopathological and genetic factors. We performed a comprehensive review of all published scientific literature up to January 2021 reporting histopathologic, genetic and molecular factors associated with racial disparities in patients with endometrial cancer. The interactions and pathways of molecules reported to have significant differential expression in endometrial cancers from Black and White patients were identified with Ingenuity Pathway Analysis. The majority of studies compared Black and White patients; however, limited data are available for other racial and ethnic groups. Reported differences that could account for the worse survival of Black endometrial cancer patients include more aggressive histopathologies and molecular alterations, including upregulation of molecules driving cell cycle progression, and p53 and HER2/NEU signaling. Several of these molecules are targeted by existing pharmaceuticals. These findings encourage further study and the development of race-specific treatment strategies.

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Differences by race in systemic oncologic end-of-life (EOL) care among patients with cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2020.39.28_suppl.137 ◽

2021 ◽

Vol 39 (28_suppl) ◽

pp. 137-137

Author(s):

Kerin B. Adelson ◽

Xiaoliang Wang ◽

Mustafa Ascha ◽

Rebecca A. Miksad ◽

Timothy N Showalter ◽

...

Keyword(s):

Racial Differences ◽

Routine Practice ◽

Practice Level ◽

Black And White ◽

Patients With Cancer ◽

Black Patients ◽

Causal Pathway ◽

Eol Care ◽

To Receive ◽

White Patients

137 Background: Prior studies indicate that Black patients with cancer are more likely to receive aggressive EOL care, including chemotherapy within 14 days (d) prior to death. However, most studies are limited to specific subgroups, and it is unclear if disparities remain in the immunotherapy era. In this study, we evaluated racial differences in systemic oncologic EOL treatment among a national all-payer cohort of patients treated in routine practice. Methods: We conducted a retrospective cohort study utilizing data from the nationwide Flatiron Health electronic health record (EHR)-derived de-identified database. Patients with confirmed cancer diagnosis, with documented treatment on or after 1/1/2011 and who died between 2015 and 2019, were included. Patients with documented race of White or Black or African American were included. We defined our outcome measures as receipt of any systemic oncologic treatment within 30d or 14d prior to death, and also stratified by mono-chemotherapy (Chemo) and immunotherapy ± targeted therapy (ICI). We used mixed-level logistic regression models to assess the likelihood of receiving each treatment, compared to patients without any EOL treatment, between Black and White patients, adjusted for patient- and practice-level characteristics as fixed effects and a practice-specific random intercept. Race-specific adjusted rates were estimated using stratified analysis. Results: A total of 40,675 White and 5,150 Black patients were included in the analysis. Compared to White patients, Black patients were younger at diagnosis, were more likely to be female and have Medicaid coverage. Black patients were more likely to be treated at practices with higher patient-to-physician ratio (25.8% in highest quintile vs. 18.7%) and with a high proportion (> 10%) of patients with Medicaid (38.1% vs. 31.6%). Compared to White patients within the same practice, Black patients were less likely to receive any EOL treatment within 30d (adjusted odds ratio [aOR]: 0.87; 95% CI: 0.81-0.93) or 14d (aOR: 0.87; 95% CI: 0.80-0.96). Adjusted rates of any EOL treatment within 30d prior to death were 33.8% and 37.6% among Black and White patients, respectively. When stratified by treatment types, Black patients were less likely to receive ICI within 30d prior to death, compared to White patients (aOR: 0.87; 95% CI: 0.76-1.00). Conclusions: Our findings differ from prior studies of oncologic EOL care and suggest that in contemporary practice Black patients are less likely to receive anti-cancer therapy near EOL, largely driven by lower rates of ICI use. Future research should investigate the complex causal pathway underlying observed racial differences among patient and practice-level factors.

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Racial Differences in the Prevalence of Atrophic-appearing Macular Lesions Between Black and White Patients With Retinitis Pigmentosa

American Journal of Ophthalmology ◽

10.1016/s0002-9394(14)72839-9 ◽

1994 ◽

Vol 118 (1) ◽

pp. 33-38 ◽

Cited By ~ 3

Author(s):

Gerald A. Fishman ◽

Byron L. Lam ◽

Robert J. Anderson

Keyword(s):

Retinitis Pigmentosa ◽

Racial Differences ◽

Black And White ◽

White Patients

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