Experience of Racism Associated With Negative Effects on Cancer Care Delivery for Black Women With Gynecologic Malignancies

Racial disparities exist in patient care for many diseases across the United States, and gynecologic cancers are no different, explained Dana Lewis, DO, during a presentation at the Society of Gynecologic Oncology annual meeting. Across these diseases Black patients tend to have far worse outcomes than White patients, even when matched for age, income, and disease severity.

For Black women, these disparities begin at a young age and appear to persist throughout their life course, Lewis noted. In gynecologic cancer, Black women are at an increased risk of dying from cancer of any type compared to White women, but gynecologic cancers have some of the widest survival gaps.

“Malignancies of the uterine corpus and cervix have a large racial disparity gap, between non-Hispanic Black and non-Hispanic White women at 4.3% and 1.5%, respectively,” Lewis said. “Black women have a greater than 2 times incidence of dying as compared to their White counterparts, which furthermore highlights this important racial disparity gap.”

Racism, discrimination, and prejudice are all inherent risk factors for worse outcomes from malignancies in minority populations, Lewis explained. However, there remains little data to examine the impact of racism on cancer care, demonstrating the need for further exploration of its impact on patient outcomes.

Lewis and her team conducted a cross-sectional observational study to investigate this topic by evaluating the association between race-related stress and treatment interruptions in women with gynecologic cancers. To accomplish this, her research team approached patients who attended visits for cancer treatment or surveillance at a single institution for recruitment in the study.

Lewis explained that her team then collected data on the patients’ health history and their responses to the 22-item Index of Race-Related Stress Brief version (IRRS-B) survey tool, which has been validated in a clinical setting. The survey measures race-related stress in the clinical population using 3 subscales that include cultural racism, institutional racism, and individual racism.

In total, 200 women were invited to participate with 70 women enrolling in the trial. Any women aged 18 years and older with confirmed gynecologic malignancies and surgical pathology were invited to participate, Lewis noted. Among the 70 patients who enrolled, 49 identified as Black and 21 identified as White. The mean age of participants was 60.6 years, with 61.1% of those patients reporting that they were unmarried.

“The majority of our patients were either privately insured or insured by Medicare. The most commonly seen malignancy was uterine cancer, with just over half of our patients reporting it, followed by ovarian cancer and cervical cancer,” Lewis said. “Of note, over half at 54.9% of our patients had advanced stage disease, with either stage 3 or stage 4 at diagnosis.”

In the analysis of the responses compiled from the IRRS-B survey, the investigators assigned scores from 0 to 4, with the higher score correlating to a higher race-related stress experience. With 22 questions included in the survey, the highest score possible would be 88.

The results of the survey data analysis showed that Black women had a median score of 38, which was significantly higher than White women with a median score of 10. The range of the scores among participants was 6 to 52, with the highest score of 52 being reported by a Black participant, Lewis explained.

“Among all participants, the median time to treatment initiation was 21 days, and the average length of treatment interruption was 7 days,” Lewis said. “Treatment interruptions were experienced by 18.1% of our patients, and the patients who experienced interruptions reported higher race-based stress as compared to those without interruptions. There is a statistically significant correlation between IRRS-B scores and length of interruption, as well as time to treatment initiation.”

Lewis noted that there were limitations to the study, as it was a single-institution study with a relatively small sample size. Additionally, she noted that there may also be an element of sampling bias due to the recruitment strategy used during the trial.

“A few conclusions can be drawn from this study,” Lewis said. “The experience of racism is associated with negative impacts on cancer care delivery for Black women with gynecologic malignancies. In particular, Black patients undergoing treatment for gynecologic cancers report higher race-related stress as compared to White patients, and the experience of racism was associated with increased treatment interruptions, increased length of treatment interruptions, and increased time to treatment initiation.”

Lewis also noted that there are a lack of data available on this subject for further assessment, highlighting the need for additional research to identify and assess the impacts of racism on cancer care.

“Looking toward the future, focused interventions for patients who have experiences of racism should be developed to decrease inequities in cancer care,” Lewis said.

REFERENCE

Alvarez AC, Lewis D, Karkal S, Freed N, Geng X, Temkin SM. The effect of racism on cancer care in women with gynecologic cancers. Society of Gynecologic Oncology 2022; March 18, 2022; Phoenix, AZ.