Racial/ethnic Disparities and Improving Health Outcomes

Transcript

00:00 --> 00:02Funding for Yale Cancer Answers is
00:02 --> 00:04provided by Smilow Cancer Hospital.
00:06 --> 00:08Welcome to Yale Cancer Answers
00:08 --> 00:10with Doctor Anees Chagpar.
00:10 --> 00:12Yale Cancer Answers features the
00:12 --> 00:14latest information on cancer care by
00:14 --> 00:16welcoming oncologists and specialists
00:16 --> 00:18who are on the forefront of the
00:18 --> 00:20battle to fight cancer. This week,
00:20 --> 00:22it's a conversation about GI cancers,
00:22 --> 00:24racial and ethnic disparities,
00:24 --> 00:25and improving health outcomes
00:25 --> 00:28with Doctor Jacquelyne Gaddy.
00:28 --> 00:29Dr. Gaddy is an assistant professor
00:29 --> 00:31of medicine and medical oncology
00:31 --> 00:33at the Yale School of Medicine,
00:33 --> 00:35where Doctor Chagpar is a
00:35 --> 00:36professor of surgical oncology.
00:37 --> 00:39Maybe we can start off
00:39 --> 00:42by you telling us a little bit more
00:42 --> 00:43about yourself and what it is you do.
00:44 --> 00:46Of course, I recently relocated to
00:46 --> 00:50New Haven from many different cities.
00:50 --> 00:51I am originally from Buffalo,
00:51 --> 00:53NY, where I was born and raised,
00:53 --> 00:55and that's where most of my family is.
00:55 --> 00:58I attended Spelman College during my
00:58 --> 01:00undergraduate education and then went on
01:00 --> 01:02to Loyola for medical school and also
01:02 --> 01:04did a little bit of graduate training,
01:04 --> 01:06graduate work at a combined
01:06 --> 01:08program with Roswell Park
01:08 --> 01:09Comprehensive Cancer Center,
01:09 --> 01:10University of Buffalo,
01:10 --> 01:13and then most recently I just completed
01:13 --> 01:15my medical oncology fellowship at
01:15 --> 01:17the University of North Carolina,
01:17 --> 01:19where I also obtained my Masters
01:19 --> 01:21of Science and Clinical Research.
01:21 --> 01:23As far as what I do,
01:23 --> 01:25I am a gastrointestinal medical oncologist
01:25 --> 01:28here at Smilow and
01:28 --> 01:30for those that may not be aware,
01:30 --> 01:33unlike certain solid tumors such as breast,
01:33 --> 01:34for instance,
01:34 --> 01:37GI cancers encompasses many,
01:37 --> 01:38many different tumor types.
01:38 --> 01:41So I see a wide variety of different
01:41 --> 01:42cancers within GI oncology.
01:42 --> 01:45And in addition to my clinical work,
01:45 --> 01:47I also am very,
01:47 --> 01:49very invested in research and my
01:49 --> 01:51research focus more specifically
01:51 --> 01:53is evaluating an equitable cancer
01:53 --> 01:56care delivery and ultimately hoping
01:56 --> 01:59to develop interventions that will
01:59 --> 02:01strive to improve cancer care equity.
02:02 --> 02:04So let's dive into that
02:04 --> 02:05a little bit further.
02:05 --> 02:08So you know we often talk about
02:08 --> 02:11diversity in our patient population,
02:11 --> 02:13but tell us a little bit more about
02:13 --> 02:16what the data tell us in terms of
02:16 --> 02:18disparities and its relationship
02:18 --> 02:21to outcomes, particularly in GI cancer.
02:22 --> 02:25Of course. Well as I said
02:25 --> 02:28earlier in regards to the large
02:28 --> 02:31variety of GI cancer tumor types,
02:31 --> 02:33it's important to note that
02:33 --> 02:35actually gastrointestinal tumors,
02:35 --> 02:37some of them are rather common
02:37 --> 02:39and some of them not as common.
02:39 --> 02:39Specifically,
02:39 --> 02:41when we think about colon cancer,
02:41 --> 02:43it's the third most common diagnosed
02:43 --> 02:45cancer and it's also unfortunately the
02:45 --> 02:48third leading cause of cancer death.
02:48 --> 02:50And that's both males and females.
02:50 --> 02:52And you see similar findings
02:52 --> 02:53in esophageal cancer,
02:53 --> 02:55which is not as common as far
02:55 --> 02:56as diagnosis is concerned,
02:56 --> 02:58but also has a high amount of
02:58 --> 03:00cancer deaths being the 7th
03:00 --> 03:01leading cause of cancer death,
03:01 --> 03:03specifically among males and when
03:03 --> 03:06you when you start to really dissect
03:06 --> 03:08these numbers and think about top ten
03:08 --> 03:10or top three and things of that nature,
03:10 --> 03:11unfortunately,
03:11 --> 03:16when we stratify specifically based on race,
03:16 --> 03:17and overall background,
03:17 --> 03:20we see in many of these cases especially
03:20 --> 03:22when we consider mortality that it's
03:22 --> 03:24usually much higher for
03:24 --> 03:26our black patients and this is
03:26 --> 03:27seen in pancreatic cancer,
03:27 --> 03:29this is seen in colon,
03:29 --> 03:31and I could go on and
03:31 --> 03:32on about this of course,
03:32 --> 03:35but a lot of this is in some cases
03:35 --> 03:37related to screening but also just
03:37 --> 03:39strongly related to structural racism
03:39 --> 03:42and the social determinants of health.
03:42 --> 03:44And so you know that's always
03:44 --> 03:46been a question about
03:46 --> 03:49whether the disparities we see in
03:49 --> 03:52outcomes are genetic like biologic
03:52 --> 03:55or whether they actually do have
03:55 --> 03:58more to do with socioeconomic
03:58 --> 04:01status and and other issues,
04:01 --> 04:02what's your take on that?
04:02 --> 04:06We know from just in recent
04:06 --> 04:09years really being able to,
04:09 --> 04:11I always refer to the tumor type
04:11 --> 04:13signature meaning that when I have
04:13 --> 04:16a patient I can then get very rich
04:16 --> 04:18information in regards to the mutations
04:18 --> 04:21and things that are expressed on
04:21 --> 04:23that particular patients cancer.
04:23 --> 04:26So biology is always an extremely
04:26 --> 04:28important part of
04:28 --> 04:30cancer care delivery and also outcomes,
04:30 --> 04:32but when we control for all of
04:32 --> 04:34what I have just said,
04:34 --> 04:37we still see that there are overt
04:37 --> 04:39differences between non Hispanic
04:39 --> 04:42black patients and comparing them
04:42 --> 04:44to their white counterparts.
04:44 --> 04:46And recent data has really shown
04:46 --> 04:50that a lot of this is a result of
04:50 --> 04:52the social determinants of health.
04:52 --> 04:54And I really try to call things
04:54 --> 04:55as they are.
04:55 --> 04:57Sometimes it's the social
04:57 --> 04:57determinants of health,
04:57 --> 05:01but when we dig a little bit deeper,
05:01 --> 05:02those social determinants are
05:02 --> 05:04largely a result of as I said,
05:04 --> 05:06earlier structural racism.
05:06 --> 05:10We see that things such as food deserts,
05:10 --> 05:12we see that in red lining.
05:12 --> 05:15We see that in lack of screening.
05:15 --> 05:18We also see that in lack of
05:18 --> 05:20equitable representation amongst
05:20 --> 05:23cancer clinical trials and all of
05:23 --> 05:25these things that I just listed,
05:25 --> 05:29they strongly relate to cancer outcomes
05:29 --> 05:31and unfortunately inequitable outcomes.
05:32 --> 05:35So talk a little bit about how
05:35 --> 05:37structural racism kind of plays
05:37 --> 05:39into that because we certainly
05:39 --> 05:42know that there are food deserts.
05:42 --> 05:44We know that there are patients
05:44 --> 05:47that are more privileged than
05:47 --> 05:49others in terms of their
05:49 --> 05:50socioeconomic status,
05:50 --> 05:53but talk to us about the connection
05:53 --> 05:56that can be made between structural
05:56 --> 06:00racism and those other social
06:00 --> 06:04determinants of health.
06:04 --> 06:05When we and this is a really,
06:05 --> 06:07really hot topic right now,
06:07 --> 06:09but as a black female
06:09 --> 06:11oncologists raised in Buffalo, NY,
06:11 --> 06:13which is very much an inner city,
06:13 --> 06:14this is my lived experience.
06:14 --> 06:16So I've been seeing and being
06:16 --> 06:18actually impacted by this for much
06:18 --> 06:20of my life and largely a result
06:20 --> 06:22of why I'm currently in this as
06:22 --> 06:25far as my practice is concerned.
06:25 --> 06:27Let's take an example.
06:27 --> 06:30When we think about cancer clinical
06:30 --> 06:32trial representation or lack of
06:32 --> 06:34representation of minoritized patients,
06:34 --> 06:38a lot of that is a result of
06:38 --> 06:41ineligible criteria.
06:41 --> 06:45When cancer clinical trials are designed,
06:45 --> 06:47they have to determine what patients
06:47 --> 06:48are actually going to be eligible
06:48 --> 06:50for this and what patients are not.
06:50 --> 06:53One of the common criteria for eligibility,
06:53 --> 06:57it really looks at comorbidities and
06:57 --> 06:59comorbidities being complicating factors
06:59 --> 07:02such as does this patient have hypertension,
07:02 --> 07:03do they have diabetes,
07:03 --> 07:04and if it is diagnosed,
07:04 --> 07:07is it controlled, is it not controlled?
07:07 --> 07:09We know that minoritized
07:09 --> 07:10patients unfortunately suffer
07:10 --> 07:13from a lot of comorbidities.
07:13 --> 07:15Specifically, hypertension and diabetes,
07:15 --> 07:17as I just said.
07:17 --> 07:18And oftentimes,
07:18 --> 07:20those two specific comorbidities
07:20 --> 07:23are a result of eating habits,
07:23 --> 07:26and they're also a result of obesity,
07:26 --> 07:28which largely is resulting from what
07:28 --> 07:31options do you have in your community
07:31 --> 07:33if you live within a food desert,
07:33 --> 07:36one defined as not having access to a fully
07:36 --> 07:38functioning grocery store that you can
07:38 --> 07:39ideally,
07:39 --> 07:42walk to so that means your options are limited.
07:42 --> 07:43That means you are at times only
07:43 --> 07:45allowed to go to the corner store
07:45 --> 07:47which doesn't have fresh produce and
07:47 --> 07:49which does not have fresh options that
07:49 --> 07:51you can actually go home and cook,
07:51 --> 07:53but instead
07:53 --> 07:55very quick food options that are high
07:55 --> 07:58in salt and just usually microwavable.
07:58 --> 07:59That's a great example,
07:59 --> 08:01because if these patients in
08:01 --> 08:02fact don't have the food options,
08:02 --> 08:05how are they really going to
08:05 --> 08:07have improved outcomes as far
08:07 --> 08:09as controlling hypertension?
08:09 --> 08:13Improved obesity or lack of obesity,
08:13 --> 08:14that's just an example.
08:14 --> 08:15But of course there are many
08:15 --> 08:16more other examples.
08:17 --> 08:19Yeah, and I think that
08:19 --> 08:21the socioeconomic status and
08:21 --> 08:23the social determinants of
08:23 --> 08:25health are interspersed in that
08:25 --> 08:28in the sense that
08:28 --> 08:30it also is not just that you live
08:30 --> 08:33in a food desert, but are you able to
08:33 --> 08:35afford fresh fruits and vegetables,
08:35 --> 08:38which may be more expensive
08:38 --> 08:40than your other alternatives?
08:40 --> 08:43And why were you living in a food desert?
08:43 --> 08:46Could it be that was the neighborhood
08:46 --> 08:48that you could afford to live in?
08:48 --> 08:51So just talk a little bit
08:51 --> 08:53it seems like there's so
08:53 --> 08:55many things that are at Interplay
08:55 --> 08:57that it's kind of all interwoven.
08:57 --> 08:59That's absolutely correct.
08:59 --> 09:01Within recent years,
09:01 --> 09:03I think it was actually
09:03 --> 09:04right during the pandemic,
09:04 --> 09:05at the start of the pandemic, Dr.
09:05 --> 09:08Lori Pierce, who is the first
09:08 --> 09:09black female president of ASCO,
09:09 --> 09:12the American Society of Clinical Oncology,
09:12 --> 09:15she did an amazing job of very much focusing
09:15 --> 09:17on the social determinants of health.
09:17 --> 09:19And that is not to say that prior to
09:19 --> 09:22her presidency we did not talk about
09:22 --> 09:24the social determinants of health,
09:24 --> 09:27but it was not as closely monitored.
09:27 --> 09:29It was not closely
09:29 --> 09:30evaluated especially within cancer
09:30 --> 09:32care delivery and when we think
09:32 --> 09:34about social determinants of health,
09:34 --> 09:36it's of course not just food options.
09:36 --> 09:38We think about education,
09:38 --> 09:40we think about finances,
09:40 --> 09:42we think about job options.
09:42 --> 09:44We think about going into it
09:44 --> 09:46a little bit deeper as far as
09:46 --> 09:48how many children do you have?
09:48 --> 09:49Are you a single parent?
09:49 --> 09:51Do you have two parents in the household?
09:51 --> 09:53If you're a single parent,
09:53 --> 09:54do you have a babysitter?
09:54 --> 09:56If you don't have a babysitter,
09:56 --> 09:58who watches the children when you go to work?
09:59 --> 09:59Etcetera.
09:59 --> 10:00These are very,
10:00 --> 10:02very much interwoven and I think
10:02 --> 10:04you bring up a good point because
10:04 --> 10:06they are so interwoven and they
10:06 --> 10:08very much closely align with
10:08 --> 10:11actually defining who that patient is.
10:11 --> 10:13It shows that when patients walk into
10:13 --> 10:15the door and they come to see me,
10:15 --> 10:17it's not just through cancer,
10:17 --> 10:18it's not just, OK,
10:18 --> 10:20this patient has stage 3B colon cancer.
10:20 --> 10:22I'm going to give them adjuvant
10:22 --> 10:24chemotherapy for three months and
10:24 --> 10:26then after that etcetera, etcetera.
10:26 --> 10:26No,
10:26 --> 10:28there's more steps that actually
10:28 --> 10:30need to happen prior to that
10:30 --> 10:32delivery of adjuvant chemotherapy
10:32 --> 10:34to even evaluate is this patient
10:34 --> 10:36going to actually be able to come
10:36 --> 10:39in for treatment on a regular
10:39 --> 10:40scheduled routine basis.
10:40 --> 10:42And again by evaluating those
10:42 --> 10:45prior to I can strive to actually
10:45 --> 10:47understand what are the true
10:47 --> 10:49needs of this patient and
10:49 --> 10:50by identifying those needs,
10:50 --> 10:52ideally I would identify things
10:52 --> 10:55that are targetable so that I can
10:55 --> 10:56actually provide patients with
10:56 --> 10:58additional supportive services that
10:58 --> 11:00oftentimes we do have here at Smilow
11:00 --> 11:02but we just don't even realize
11:02 --> 11:04that the patients are lacking
11:04 --> 11:05these actual resources.
11:06 --> 11:08Yeah, I mean you bring up such a good
11:08 --> 11:11point which is really in the
11:11 --> 11:13evaluation of the whole patient and
11:13 --> 11:16their social context which has direct
11:16 --> 11:20ramifications for their ability to both
11:20 --> 11:24comply with the treatment regimen as well as,
11:24 --> 11:26you know, make it to appointments
11:26 --> 11:28and so on and so forth,
11:28 --> 11:30which really needs to be addressed
11:30 --> 11:31if there are barriers to care.
11:31 --> 11:35Now this brings up the important point,
11:36 --> 11:39there are patients who may
11:39 --> 11:41not be be seen at Smilow,
11:41 --> 11:44they may not be seen at large
11:44 --> 11:46academic centers that are blessed
11:46 --> 11:49with social workers and perhaps other
11:49 --> 11:51resources and supportive services.
11:51 --> 11:53What do you say for patients who
11:53 --> 11:56are out in the Community being
11:56 --> 11:58seen by community oncologists?
11:58 --> 12:01How would you recommend that
12:01 --> 12:04community oncologists and that patient
12:04 --> 12:07work together on those barriers?
12:07 --> 12:10What resources are available for them?
12:11 --> 12:12That's a great question.
12:12 --> 12:13I think it's twofold.
12:13 --> 12:15One of the things that I always
12:15 --> 12:17strive to tell
12:17 --> 12:18my family, my friends,
12:18 --> 12:21and also my patients is that
12:21 --> 12:24self advocacy is so critical and
12:24 --> 12:26asking questions when things
12:26 --> 12:28are not explained clearly.
12:28 --> 12:31And as I'm describing this to you,
12:31 --> 12:34one of the most important factors
12:34 --> 12:36that we often mislabel within
12:36 --> 12:39the medical practice is trust.
12:39 --> 12:40We often say that these patients
12:40 --> 12:42are not trusting and they're
12:42 --> 12:44mistrusting for historical reasons,
12:44 --> 12:45which of course is true,
12:45 --> 12:47but what that really should
12:47 --> 12:50actually be flipped to is we
12:50 --> 12:52have not moved in a trustworthy manner.
12:52 --> 12:54So one of the most important
12:54 --> 12:56things that providers can do,
12:56 --> 12:58whether they're in the community or they're
12:58 --> 13:00associated with a large academic practice,
13:00 --> 13:02they first need to establish rapport.
13:02 --> 13:04They first need to move in a
13:04 --> 13:06way that is in a trusting way.
13:06 --> 13:09By doing that, you would allow ideally
13:09 --> 13:12your patients to become more comfortable.
13:12 --> 13:14So that way they are aware of what they can
13:15 --> 13:17share and they feel comfortable saying,
13:17 --> 13:21OK, I need this, I need that.
13:21 --> 13:22Social workers
13:22 --> 13:24may not be available in the community,
13:24 --> 13:26but some of this honestly is also just
13:26 --> 13:28the work of the physician saying,
13:28 --> 13:30OK, I'm aware of this,
13:30 --> 13:32if we can get you this transportation
13:32 --> 13:34service that is available in the Community,
13:34 --> 13:37I can get you here to your
13:37 --> 13:37actual appointments.
13:37 --> 13:39And I think again,
13:39 --> 13:41it's just really digging
13:41 --> 13:42deeper and being trusting,
13:42 --> 13:44moving in a trustworthy manner and
13:44 --> 13:47also being aware of actually what
13:47 --> 13:48is available in your community
13:48 --> 13:50and then ultimately seeing what
13:50 --> 13:52your patient needs if they are
13:52 --> 13:54willing ideally to share that with you.
13:54 --> 13:57So important to kind of really
13:57 --> 13:58understand what Community resources
13:58 --> 14:01you might have available to you to try
14:01 --> 14:03to address some of those disparities.
14:03 --> 14:05We're going to pick up this
14:05 --> 14:06conversation right after we take
14:06 --> 14:08a short break for medical minute.
14:08 --> 14:10Please stay tuned to learn more
14:10 --> 14:12about the care of GI cancers with
14:12 --> 14:14my guest doctor, Jacquelyne Gaddy.
14:15 --> 14:17Funding for Yale Cancer Answers
14:17 --> 14:19comes from Smilow Cancer Hospital,
14:19 --> 14:20where their one-of-a-kind
14:20 --> 14:21Sexuality, intimacy,
14:21 --> 14:24and menopause program combines medical
14:24 --> 14:25and psychological interventions
14:25 --> 14:28for women who experience sexual
14:28 --> 14:29dysfunction after cancer.
14:29 --> 14:31Smilowcancerhospital.org.
14:33 --> 14:35Genetic testing can be useful for
14:35 --> 14:37people with certain types of cancer
14:37 --> 14:39that seem to run in their families.
14:39 --> 14:41Genetic counseling is a process that
14:41 --> 14:43includes collecting a detailed personal
14:43 --> 14:46and family history, a risk assessment,
14:46 --> 14:49and a discussion of genetic testing options.
14:49 --> 14:51Only about 5 to 10% of all
14:51 --> 14:52cancers are inherited,
14:52 --> 14:55and genetic testing is not recommended
14:55 --> 14:58for everyone individuals who have a
14:58 --> 15:00personal and or family history that
15:00 --> 15:02includes cancer at unusually early ages,
15:02 --> 15:03multiple relatives
15:03 --> 15:05on the same side of the
15:05 --> 15:07family with the same cancer,
15:07 --> 15:09more than one diagnosis of
15:09 --> 15:10cancer in the same individual,
15:10 --> 15:11rare cancers,
15:11 --> 15:14or family history of a known altered
15:14 --> 15:17cancer predisposing gene could be
15:17 --> 15:19candidates for genetic testing.
15:19 --> 15:21Resources for genetic counseling and
15:21 --> 15:23testing are available at federally
15:23 --> 15:25designated comprehensive cancer centers,
15:25 --> 15:27such as Yale Cancer Center
15:27 --> 15:29and Smilow Cancer Hospital.
15:29 --> 15:31More information is available
15:31 --> 15:32at yalecancercenter.org.
15:32 --> 15:34You're listening to Connecticut
15:34 --> 15:35Public Radio.
15:35 --> 15:37Welcome back to Yale Cancer Answers.
15:37 --> 15:39This is doctor Anees Chagpar
15:39 --> 15:41and I'm joined tonight by my guest,
15:41 --> 15:42doctor Jacquelyne Gaddy.
15:42 --> 15:44We're discussing the care of
15:44 --> 15:46patients with GI cancer as well
15:46 --> 15:48as racial and ethnic disparities
15:48 --> 15:50and improving health outcomes.
15:50 --> 15:52Now one of the things,
15:52 --> 15:55right before the break that you
15:55 --> 15:57mentioned was the fact that it's
15:57 --> 15:59really important to develop a trusting
15:59 --> 16:01relationship with your patient and
16:01 --> 16:04to address their needs.
16:04 --> 16:06But another thing that you mentioned
16:06 --> 16:09was how there were inequities in
16:09 --> 16:12terms of clinical trials and you
16:12 --> 16:14did in passing touch
16:14 --> 16:17upon the idea that African American
16:17 --> 16:19patients may be distrusting of
16:19 --> 16:22the entire healthcare system,
16:22 --> 16:24let alone the physician sitting
16:24 --> 16:27in front of them with regards to
16:27 --> 16:29participation in clinical trials
16:29 --> 16:31due to historical unethical
16:31 --> 16:35behavior on the part of the medical
16:35 --> 16:36and scientific community.
16:36 --> 16:39How do we address that barrier
16:39 --> 16:40now going forward?
16:40 --> 16:42I want to be a little bit
16:42 --> 16:44more clear when I say this.
16:44 --> 16:47And exactly what you just asked me is,
16:47 --> 16:51often how it's framed within the data
16:51 --> 16:54and within social media is that the black
16:54 --> 16:57or the African American community is
16:57 --> 17:01distrusting of the entire medical practice.
17:01 --> 17:05That framework is what often actually perpetuates
17:08 --> 17:10this idea of OK, well, they they don't trust this.
17:10 --> 17:13Instead if we shift it to,
17:13 --> 17:16I need to move in a trusting manner,
17:16 --> 17:20I need to be more trustworthy as a physician.
17:20 --> 17:23That means that it's not the
17:23 --> 17:25responsibility of the minoritized
17:25 --> 17:27patient population such as the black
17:27 --> 17:30patients to to move more trusting.
17:30 --> 17:32It is really on the healthcare
17:32 --> 17:35system to move in a trusting way.
17:35 --> 17:37So we don't as a community
17:37 --> 17:39don't think that my patients
17:39 --> 17:41that are minoritized,
17:41 --> 17:43they have to shift their way of
17:43 --> 17:44thinking and things of that nature.
17:44 --> 17:46Because their
17:46 --> 17:47thinking is largely
17:47 --> 17:49a result of historical data.
17:49 --> 17:51And I'm using the word history very loosely
17:51 --> 17:53because it's still actively happens.
17:53 --> 17:55We saw that in COVID.
17:55 --> 17:57We saw that in many other things.
17:57 --> 17:59It's not just
17:59 --> 18:01the unfortunate events of Henrietta
18:01 --> 18:04Lacks or the Tuskegee syphilis study,
18:04 --> 18:06this happens every single day.
18:06 --> 18:08So again, it just shows that
18:08 --> 18:10this responsibility is really,
18:10 --> 18:12really on us as a healthcare
18:12 --> 18:14system and as providers.
18:14 --> 18:16So what can we do to move
18:16 --> 18:18in more of a trusting way?
18:18 --> 18:21We can be extremely transparent.
18:21 --> 18:25We can arrange the clinical trial
18:25 --> 18:28criteria to be more inclusive.
18:28 --> 18:29We can
18:29 --> 18:32actually have more providers that
18:32 --> 18:35show a concordance between the
18:35 --> 18:38provider and the patients and
18:38 --> 18:41the communities that they serve.
18:41 --> 18:44Those are things that when a patient
18:44 --> 18:46from a minoritized community walks
18:46 --> 18:48into a hospital and they don't
18:48 --> 18:51see anyone that looks like them,
18:51 --> 18:52that is the representation of
18:52 --> 18:54the health care system, right?
18:54 --> 18:57That means that we should be
18:57 --> 18:58striving to improve more,
18:58 --> 19:01more providers and increase
19:01 --> 19:02actual workforce diversity.
19:02 --> 19:04So that way, again,
19:04 --> 19:06it's more representative of the
19:06 --> 19:08community that we're serving.
19:08 --> 19:10And we see that right here in
19:10 --> 19:11the New Haven community.
19:11 --> 19:14We should strive to be more
19:14 --> 19:17representative of that actual
19:17 --> 19:18patient population,
19:18 --> 19:19if that makes any sense.
19:19 --> 19:24You know, I find that for the general
19:24 --> 19:28population and for minoritized patients
19:28 --> 19:33as a segment of that general population,
19:33 --> 19:37many patients and I don't think that this
19:37 --> 19:40is necessarily particular to minorities,
19:40 --> 19:44but could often come
19:44 --> 19:47with a sense of
19:47 --> 19:52I don't want to be experimented upon.
19:52 --> 19:55And I think that your
19:55 --> 19:57point about building a trusting
19:57 --> 19:59relationship is a good one,
19:59 --> 20:02but how else can we kind of convey
20:02 --> 20:05to patients the
20:05 --> 20:07importance of clinical trials?
20:07 --> 20:10Because the other thing is that
20:10 --> 20:13clinical trials are so important to
20:13 --> 20:15actually improving health outcomes to
20:15 --> 20:18a given population and we saw that
20:18 --> 20:21even in looking at gender disparities
20:21 --> 20:23right when a lot of the studies
20:23 --> 20:25when cardiac medications were done on
20:25 --> 20:28men and then we discovered that cardiac
20:28 --> 20:30disease is very different in women,
20:30 --> 20:32but when women were excluded
20:32 --> 20:34from clinical trials,
20:34 --> 20:36it really leads to this void
20:36 --> 20:40of data for that population.
20:40 --> 20:42So can you address that?
20:42 --> 20:44Of course and you said something
20:44 --> 20:46that was extremely important.
20:46 --> 20:48So when we think about clinical
20:48 --> 20:50trials whether it's in cancer care
20:50 --> 20:52delivery or in other chronic illnesses,
20:52 --> 20:56they are as you just mentioned the
20:56 --> 21:00initial steps that are critical for drug
21:00 --> 21:04discovery along with drug development and
21:04 --> 21:06one of the most important components of
21:06 --> 21:09studies and specifically clinical trials
21:09 --> 21:12we're speaking about is to be generalizable.
21:12 --> 21:14And all that means is that what we
21:14 --> 21:16take from this trial or this study,
21:16 --> 21:19we should be able to generalize it
21:19 --> 21:21to the patients that are in fact
21:21 --> 21:23impacted by said disease.
21:23 --> 21:24So we know that cancer in fact
21:24 --> 21:25does not see color,
21:25 --> 21:28meaning that cancer does not pick
21:28 --> 21:31one to actually develop in because they
21:31 --> 21:34are black, they are white, etcetera.
21:34 --> 21:37And when we do these studies in
21:37 --> 21:40largely non Hispanic white patients
21:40 --> 21:42and we do not include non Hispanic
21:42 --> 21:45black or Hispanics etcetera or
21:45 --> 21:47other minoritized patients,
21:47 --> 21:50then how in fact is that
21:50 --> 21:51information generalizable?
21:51 --> 21:53And that is critical and I just
21:53 --> 21:54want to make sure that that is
21:55 --> 21:57conveyed here as you just said is
21:57 --> 21:59that we should strive to make sure
21:59 --> 22:01that the patients that are hopefully
22:01 --> 22:04going to be treated with this drug are
22:04 --> 22:05actually those that it is studied in,
22:05 --> 22:07so then we can actually generalize
22:07 --> 22:09it to the population.
22:09 --> 22:11The way that I think that we can
22:11 --> 22:14do this is to actually increase
22:14 --> 22:17awareness to educate the community.
22:17 --> 22:20And I think that's one of the most
22:20 --> 22:22important things is actually to
22:22 --> 22:24include the community in the research.
22:24 --> 22:26Community outreach is very,
22:26 --> 22:28very critical for advancing research
22:28 --> 22:30because these are the patients
22:30 --> 22:31that we need to be touching.
22:31 --> 22:33So we should be including
22:33 --> 22:34them from the very beginning,
22:34 --> 22:37developing stages all throughout because
22:37 --> 22:39again, that's the Community that is
22:39 --> 22:41largely minoritized and unfortunately
22:41 --> 22:43not receiving Equitable care
22:43 --> 22:47and I think to your point getting the
22:47 --> 22:50Community involved early on allows
22:50 --> 22:53for that building of trust allows for
22:53 --> 22:56for people to really get engaged and
22:56 --> 23:00be interested in moving
23:00 --> 23:03forward with with clinical trials.
23:03 --> 23:05You know, the other question that
23:05 --> 23:08I have is that so often when we
23:08 --> 23:10talk about disparities and we talk
23:10 --> 23:11about minority populations,
23:11 --> 23:15very often the conversation really
23:15 --> 23:18revolves around race and ethnicity.
23:18 --> 23:22But we've seen that a similar story can
23:22 --> 23:25be told for other minority populations,
23:25 --> 23:28whether that is people who are
23:28 --> 23:29sexual minorities.
23:29 --> 23:33So the LGBTQ plus community who
23:33 --> 23:36very similarly have
23:36 --> 23:40not necessarily a great trusting
23:40 --> 23:44relationship with their healthcare
23:44 --> 23:47providers and often suffer poor
23:47 --> 23:50health outcomes as a result.
23:50 --> 23:54Religious minorities who may similarly
23:54 --> 23:58be faced with certain stigma.
23:58 --> 24:03How can we learn from our experience?
24:03 --> 24:06Looking at racial and ethnic disparities,
24:06 --> 24:08to expand that,
24:08 --> 24:11to look at other minority populations for
24:11 --> 24:14whom the same situations may occur.
24:15 --> 24:18I think the way that there's so
24:18 --> 24:22much to have learned from in
24:22 --> 24:24these last two to three years.
24:24 --> 24:272020 was such a rough year
24:27 --> 24:28for the entire world.
24:28 --> 24:31But then if we think about the minoritized
24:31 --> 24:34communities and how they were impacted by
24:34 --> 24:36COVID and we think about George
24:36 --> 24:38Floyd and we think about so many
24:38 --> 24:41others that have endured so many
24:41 --> 24:43other structurally racist consequences,
24:43 --> 24:46a lot of that is a result,
24:46 --> 24:49as I said earlier, from structural racism.
24:49 --> 24:50But also what's very critical here,
24:50 --> 24:52to answer your question,
24:52 --> 24:53is implicit biases.
24:53 --> 24:55We walk into the room oftentimes,
24:55 --> 24:58and I'm using we importantly because we all
24:58 --> 25:02in fact carry implicit biases as humans.
25:02 --> 25:03That is understood because
25:03 --> 25:04that is human nature.
25:04 --> 25:06One of the most important things to do,
25:06 --> 25:07in fact with that implicit bias
25:07 --> 25:09is to be aware of it.
25:09 --> 25:11To actually hone in and say,
25:11 --> 25:13why am I thinking this?
25:13 --> 25:14And because I am thinking this,
25:14 --> 25:17how will this impact the Community
25:17 --> 25:19that I am trying to actually
25:19 --> 25:21touch and improve outcomes.
25:21 --> 25:24You can take that same statement that
25:24 --> 25:27I just said and apply that to other
25:27 --> 25:29minoritized communities such as you said,
25:29 --> 25:32based on race, based on gender,
25:32 --> 25:34based on religious preference,
25:34 --> 25:34etcetera.
25:34 --> 25:35It's really being
25:35 --> 25:38aware of your biases and trying
25:38 --> 25:41to strive to to get rid of those
25:41 --> 25:43or to educate yourself and others
25:43 --> 25:46about why you have them and how in
25:46 --> 25:49fact you can flip them so that
25:49 --> 25:51they're in more of a positive light
25:51 --> 25:53and then ideally would
25:53 --> 25:55result in more positive treatment
25:55 --> 25:57and outcomes for said patients.
25:58 --> 26:02Yeah, I think it's so important to
26:02 --> 26:06really think about our our biases because
26:06 --> 26:09it seems like we've had the
26:09 --> 26:12same song played many many times over.
26:12 --> 26:14Whether it's you know disparities
26:14 --> 26:17based on gender and women's rights,
26:17 --> 26:19whether we see disparities based
26:19 --> 26:22on race and and racial rights,
26:22 --> 26:24ethnicity, LGBTQ status.
26:24 --> 26:28You know people who are
26:28 --> 26:30anti-Semitic or Islamophobic,
26:30 --> 26:34I mean it's all under that
26:34 --> 26:37banner of implicit bias and truly
26:37 --> 26:41does have an impact on outcomes.
26:41 --> 26:44In our last few minutes I want to kind of
26:44 --> 26:47bring it back to your clinical practice,
26:47 --> 26:51you treat patients with GI cancers.
26:51 --> 26:53Can you talk a little bit about
26:53 --> 26:56differences in outcomes that you've seen
26:56 --> 26:58particularly in GI cancers between
26:58 --> 27:01various racial and ethnic groups
27:01 --> 27:04and how you're really trying to move the
27:04 --> 27:07needle on changing those outcomes?
27:07 --> 27:10So taking a step back,
27:10 --> 27:13when we think about gastrointestinal cancers,
27:13 --> 27:15as I alluded to earlier,
27:15 --> 27:19it is a large variety of tumor types
27:19 --> 27:22within GI oncology, for instance,
27:22 --> 27:24I see patients that have stomach cancer,
27:24 --> 27:27I see patients that have hepatocellular
27:27 --> 27:29cancer or carcinoma, excuse me.
27:29 --> 27:31I see patients that have colon cancer,
27:31 --> 27:33rectal cancer, anal, pancreatic,
27:33 --> 27:36neuroendocrine tumors and the list really
27:36 --> 27:40goes on within those particular tumor types.
27:40 --> 27:43We know that there is a larger representation
27:43 --> 27:46of certain patients that are in fact
27:46 --> 27:49going to have those particular tumor
27:49 --> 27:51types and colon being one of those,
27:51 --> 27:54HCC being one of those and actually
27:54 --> 27:58considering we are here right in New Haven,
27:58 --> 27:59we know that
27:59 --> 28:02colon cancer specifically and HCC
28:02 --> 28:04specifically are largely seen
28:04 --> 28:07within just our New Haven community.
28:07 --> 28:10So there are in fact differences as far
28:10 --> 28:14as diagnosis and actual incidence along
28:14 --> 28:17with unfortunately increased mortality.
28:17 --> 28:20So as I strive to develop my clinical
28:20 --> 28:21practice while also developing
28:21 --> 28:23my research practice,
28:23 --> 28:25I'll be hoping to evaluate why we
28:25 --> 28:28are seeing such differences and
28:28 --> 28:29also more importantly,
28:29 --> 28:32how we can change these outcomes?
28:32 --> 28:34Dr. Jacquelyne Gaddy is an assistant
28:34 --> 28:36professor of medicine and medical
28:36 --> 28:39oncology at the Yale School of Medicine.
28:39 --> 28:41If you have questions,
28:41 --> 28:43the address is canceranswers@yale.edu,
28:43 --> 28:45and past editions of the program
28:45 --> 28:48are available in audio and written
28:48 --> 28:49form at yalecancercenter.org.
28:49 --> 28:51We hope you'll join us next week to
28:51 --> 28:53learn more about the fight against
28:53 --> 28:55cancer here on Connecticut Public Radio.
28:55 --> 28:57Funding for Yale Cancer Answers is
28:57 --> 29:00provided by Smilow Cancer Hospital.

Information

Racial/ethnic Disparities and Improving Health Outcomes with guest Dr. Jacquelyne Gaddy January 1, 2023 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095