Society of Gynecologic Oncology Annual Meeting

Society of Gynecologic Oncology Annual Meeting

Issue: May 10, 2021
Perspective from Kemi M. Doll, MD, MCSR
Source:

Jones NL, et al. Abstract 10966. Society of Gynecologic Oncology Annual Meeting on Women’s Cancer (virtual meeting); March 19-25, 2021.

Disclosures: Jones reports no relevant financial disclosures. Please see the abstract for all other researchers’ relevant financial disclosures.
March 29, 2021
3 min read
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Interventions overcome endometrial cancer clinical trial inequity in Deep South

Issue: May 10, 2021
Perspective from Kemi M. Doll, MD, MCSR
Source:

Jones NL, et al. Abstract 10966. Society of Gynecologic Oncology Annual Meeting on Women’s Cancer (virtual meeting); March 19-25, 2021.

Disclosures: Jones reports no relevant financial disclosures. Please see the abstract for all other researchers’ relevant financial disclosures.
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Interventions designed to improve care for Black women with endometrial cancer can help overcome clinical trial inequities, according to findings presented at the virtual Society of Gynecologic Oncology Annual Meeting on Women’s Cancer.

“[In addition], our data show disparate progression-free survival is no longer present between races when patients are enrolled in clinical trials,” Nathaniel L. Jones, MD, assistant professor at University of South Alabama Mitchell Cancer Institute, said during a presentation.

Nathaniel L. Jones, MD, assistant professor at University of South Alabama Mitchell Cancer Institute

The cancer burden varies widely based on region of the country, with the southern United States assuming an unequal burden of cancer mortality, Jones said. Alabama ranks eighth highest of all states with regard to cancer mortality, he added.

“The burden of cancer also is not shared equitably among racial and ethnic groups,” Jones said.

“The Deep South is home to the vast majority of Blacks and African Americans, who account for 50% of the population across a wide range of southern states. Given the unequal burden of cancer in this region, it is no surprise that Black women in the Deep South have disparate outcomes for gynecologic malignancies compared with white women.”

Black women account for 7% of endometrial cancer diagnoses across the country but 15% of all deaths, Jones said. In addition, Black women are up to 80% more likely than white women to die of their disease.

Equity in gynecologic oncology care has been hindered by underrepresentation of certain racial groups on clinical trials. Previous work from Jones’ institution showed enrollment of Black patients onto national Gynecologic Oncology Group (GOG) trials was 9.8-fold less than that of white patients.

“These data also suggest that enrollment has worsened over time,” Jones said. “Prior to 2000, more than 20% of GOG trial participants were Black, compared with just 6% by 2013.”

Enrollment rates for immunotherapy trials have been even lower, Jones said.

“The onus is on us as providers to provide an approach to cancer care that allows our patients to trust us and provide equitable cancer care for the women we serve,” he said.

To that end, Jones and colleagues implemented patient-based programs designed to increase enrollment of Black patients onto clinical trials at their institution, and then assessed the impact of those interventions on trial enrollment and of race on survival.

They established a lay navigation program at their cancer center in conjunction with oncology care models that focused on improving quality of care by helping to educate patients about the benefits and risks of clinical trials. They also hired a diverse lay navigation workforce that reflected the demographics of the catchment area.

“Given our minority population is over two times the national average, we intentionally hired Black women to act as our patient navigators,” Jones said.

Jones and colleagues then conducted a retrospective cohort study of all women with endometrial cancer diagnosed and treated at their institution between 2012 and 2018.

Investigators used CDC age-adjusted endometrial cancer incidence for race data to calculate expected and observed white-to-Black ratios of racial participation in clinical trials.

The study included 1,021 women with endometrial cancer who had adequate follow-up. Each woman was assigned a lay navigator, and the clinical trial education module was required for all patients.

Eighty-four women enrolled in clinical trials during the study period. This cohort included 23 of 277 Black women (8.3%), as well as 61 of 718 white women (8.5%). The groups were similar with regard to age (mean, 62.1 years for Black vs. 62 years for white) and BMI (37.1 kg/m2 vs. 34.8 kg/m2).

In the entire cohort, Black women had more aggressive histology (P < .01), more advanced-stage disease (P < .01), and were more likely to have Medicaid or self-pay status (P < .01). However, when researchers limited analyses to women who enrolled in clinical trials, they reported no significant differences with regard to stage, grade, histology, insurance status or performance status.

When researchers accounted for age-adjusted endometrial cancer incidence in the United States (27.2 per 100,000 for white vs. 27.5 per 100,000 for Black), they reported the observed enrollment of Black women was similar to the expected enrollment (1.03-fold lower than expected but no statistically significant difference). When researchers used incidence data specific to the Deep South (21.8 per 100,000 for white vs. 24.7 per 100,000 for Black), the observed enrollment for Black patients was 1.15 times higher than expected, once again not reaching statistical significance.

In the entire cohort of women with endometrial cancer, researchers observed a PFS advantage for white women compared with Black women (median, 20 months vs. 14 months; P = .02). However, when they stratified by clinical trial enrollment, they reported no statistically significant difference in PFS between white women and Black women (14 months vs. 13 months).