Oncology Data Advisor: Welcome to Oncology Data Advisor. I'm Keira Smith. This April, we're excited to be celebrating National Minority Health Month. Today, I'm joined by Dr. Shakira Grant, who will be sharing her research in the field of health care disparities. Dr. Grant, thank you so much for coming on today.

Shakira Grant, MBBS: Hi, I'm Dr. Shakira Grant. I'm an Assistant Professor at the University of North Carolina at Chapel Hill. I spend my time primarily engaged in patient-centered research, and our research is really focused on examining factors that contribute to disparate health outcomes for older Black adults with multiple myeloma.

Oncology Data Advisor: Great, thank you. This month we're excited to be raising awareness for National Minority Health Month, and I know you have a lot of research focusing on this area. What are some of the specific areas that your research in this field focuses on?

Dr. Grant: Currently, we are focused on patients with multiple myeloma. In particular, we are using qualitative approaches through interviews and focus group discussions to better understand some factors driving disparities in this population. Our approach has been to leverage this understanding through interviews and ask a broad range of questions about things such as difficulty paying for medications, transportation barriers, and barriers to clinical trial participation. In general, we are looking at their experiences with their providers to understand the role that potential bias and stereotyping may play when we think about delivering equitable care, especially for Black adults with myeloma.

Oncology Data Advisor: You touched on this, but what are some of the greatest barriers that patients of minority populations face in terms of access to hematology/oncology care, both in general as well as specifically for multiple myeloma?

Dr. Grant: What we have found, similar to other studies that have explored this from more of a quantitative perspective, is that patients encounter several different barriers that start even when they are trying to get a diagnosis of multiple myeloma. For instance, patients experience symptoms that can be non-specific and can often be dismissed by primary care providers or other non-specialty physicians who may not be familiar with multiple myeloma.

This leads to potential delays in the diagnosis of multiple myeloma and the need to see multiple specialists, ultimately resulting in patients being delayed from actually getting the diagnosis. Then once they are diagnosed, they experience additional barriers that limit their ability to start treatment in a timely manner.

Other things that we have found beyond the delays in diagnosis are barriers like transportation, parking, and financial concerns, which are often very prominent for our patient population. I believe this extends more broadly to other cancer populations, and a lot of this stems from either not having insurance or being underinsured. How that translates is that when we prescribe our cancer therapies, often, they have supportive care medications that go with them. Often, these medications may not be covered by insurance, and patients need to pay out-of-pocket costs.

We hear repeatedly and also see in practice that there is this compounding effect of financial challenges. Patients need to be able to pay for parking at most cancer centers or when they are going to their doctor appointments, and they also need to pay for gas. In addition, they are paying their copays for the medications needed to provide supportive care for their treatments. For older adults, especially those on a fixed income, these things can be challenging because they may not have the flexibility within their budget to afford these extra costs.

I will say the other barrier we do not often consider is the barrier that exists from the provider's perspective—the barriers to clinical trial enrollment, in particular. When we think about the existing literature, there are several barriers that Black patients with cancer, in particular, face in enrolling in clinical trials. We often tend to think about individual barriers such as knowledge and awareness about trials, but we don't think about the stereotyping and potential bias and discrimination that could occur from the provider's end in deciding whether or not to offer that patient a trial. Provider-based assumptions about patients and their willingness to participate may limit their willingness to offer patients that opportunity.

Oncology Data Advisor: Thank you, that was a great overview of all of the barriers. With all of these complexities, what are some steps that clinicians in the community setting can take to help mitigate these for their patients?

Dr. Grant: I think there is no easy fix to this. When we think about barriers to achieving health equity, especially regarding managing cancer patients, we need to think about this on all levels. The first, I would say, for the community is thinking about education—understanding what barriers exist for patients. What are the common barriers that may be seen within a particular community practice or geographic area? Once you are familiar with those barriers, there's an understanding of how you could start addressing them.

For instance, we talked about the barriers to financial concerns. Do patients have access, for example, to financial navigators or other resources within the community that could help provide them with financial counseling? Are there programs through which patients can access medications at a reduced cost? The other part is thinking about ways to partner with other community-based organizations already leading the charge around addressing health equity for this population. This is a great way to know what resources are available, about ongoing efforts, and how community clinicians may be able to partner with them to advance some of these existing and ongoing efforts.

Another part is thinking about those who have limited English proficiency and thinking about ways in which you, as a clinician, not only in the community but also in the academic settings, can deliver culturally and linguistically competent, sensitive care. That requires us to be thoughtful whenever we see patients who may be non–English-speaking about the way we communicate—ensuring that we have translators available and that materials about their treatments are being provided in their native language to help enhance communication.

Finally, I believe this is not just an effort where we could say that advancing health equity is the role of the academic physician or the community physician. I believe that we all have a role to play in advancing health equity. If we are truly intentional—especially, when we see patients, asking them about potential barriers rather than just focusing on just oncologic care—then I believe that we can start seeing changes in reducing these disparities that currently exist.

Oncology Data Advisor: Fantastic, thank you. That was some really practical advice, especially about bringing patients into it and asking them about the barriers that they face. Anything else you'd like to share about other ways to advocate for health equity, or anything else you'd like to mention?

Dr. Grant: Again, it ties back to this point around who is responsible for advancing health equity. I think the answer to that has to be that this is everyone's concern. I say that because there is this tendency to think that when investigators, clinicians, and researchers identify as being from a minoritized background, it should be their role to study health equity and find equity-driven solutions.