Ana Velázquez Mañana, MD, assistant professor, medicine, University of California, San Francisco School of Medicine, discusses findings from a study determining survivorship care needs in low-income, older patients with lung cancer.

Velázquez and colleagues are conducting research regarding the unique survivorship care needs of low-income, older adults with early-stage lung cancer. The main impetus for this research was identifying these needs and exploring patients’ preferred supportive care interventions, Velázquez says.

At the 2023 IASLC World Conference on Lung Cancer, Velázquez presented findings from an interim analysis of this study, which included data from 11 patients, 9 of whom spoke English and 2 of whom spoke Spanish. Velázquez notes that data from Asian patients enrolled in the study who spoke Mandarin and Cantonese are currently under evaluation. She also emphasizes that the diversity of the research team conducting this study ensures that the patients under evaluation receive care that accounts for their cultural nuances and needs.

This study found that informational needs were the most prevalent in the evaluable population, Velázquez says. Many of the evaluable English- and Spanish-speaking patients lacked information about their disease, treatment plans, and survivorship period. This included expectations for their plan of care as well as the type and stage of cancer they had.

Another key finding was the lack of coordination and support among the members of patient care teams, which was associated with a lack of adequate patient communication. For instance, many patients did not know their next steps after receiving surveillance scans, which members of their care team to follow up with, who could inform them of their risk of cancer recurrence, and how to improve their lifestyle to decrease this risk, Velázquez explains. Since many patients express interest in learning about steps they can take to live healthier lifestyles and reduce their cancer risk, it is important for them to receive adequate resources that can answer these questions, Velázquez emphasizes.

Investigators also found that older, low-income adults with cancer tend to lack the necessary social support to travel to surveillance and treatment appointments. Furthermore, these patients often have difficulty affording their medications and other aspects of their health care, according to Velázquez. Although barriers to careare expected in the low-income, public hospital population, these disparities should be addressed so patients can access and afford high quality care, Velázquez says.

Videos

Ana Velázquez Mañana, MD, discusses findings from a study determining survivorship care needs in low-income, older patients with lung cancer.

Dr Velázquez Mañana on Survivorship Care Needs in Older Patients With Lung Cancer

Ana I. Velazquez Manana, MD, MSc, assistant director, Diversity, Equity, Inclusion, and Accessibility (DEIA) for Trainees, Department of Medicine, assistant clinical professor, Medicine, Division of Hematology/Oncology, University of California San Francisco (UCSF), UCSF Helen Diller Family Comprehensive Cancer Center, discusses how systemic racism appears in oncology.

At the 2023 ASCO Annual Meeting, Manana presented information on the role of oncologists in ending systemic racism in oncology. Manana says there are many ways in which systemic racism appears in oncology. As individuals, everyone has certain implicit biases about how certain people should be treated or how they believe a certain person or group of people behaves, she explains. Awareness of those implicit biases is key to ensuring physicians do not harm patients. For example, if an oncologist has a specific idea or prejudice about how certain groups of people may tolerate pain or are more likely to abuse substances, it is possible that they may then treat patients from these groups differently than they treat other patients, including not managing their pain adequately, leading to suffering for those patients with cancer, Manana explains. Additionally, if an oncologist believes that certain groups of people are not going to agree to participate in a clinical trial, they may not offer that trial to patients from these groups, she adds. These are all reflections of individualbiases, Manana notes.

During this presentation at the 2023 ASCO Annual Meeting, Manana highlighted how people can take implicit bias tests to try to analyze their environment, their behaviors, and the reasons for their implicant biases. Additionally, she aimed to help participants better understand what drives these biases.

Systemic or institutionalized racism can also arise in areas of oncology such as policies that drive differences in access to insurance, Manana expands. It is known that people who don't have insurance cannot access cancer care equitably and have different mortality rates, she says. Some communities also have less access to food and a lower average socioeconomic status, and patients in these communities therefore may not have access to high-quality hospitals for their cancer care, Manana emphasizes. These are examples of ways in which systemic racism is part of the cancer care spectrum, Manana concludes.

Ana I. Velazquez Manana, MD, MSc, discusses how systemic racism appears in oncology.


Dr Manana on How Systemic Racism Appears in Oncology

Outbreaks of coronavirus disease 2019 (COVID-19) are on the rise in Latin America, with more than 4 million confirmed cases. In response to this health crisis, elective medical procedures, including cancer screening and care, as well as treatment for conditions beyond the virus, have been held.

Procedures that may not be considered elective are also being postponed, and patients are now being diagnosed with more advanced cancer, which in many cases are at incurable stages. For 2018, the International Agency for Research on Cancer (IARC) estimated 1.4 million new cancer cases in Latin America with more than 600,000 cancer deaths. It is projected that by 2040, cancer cases will increase by 91.4% in Central and South America.

 Unfortunately, during the COVID-19 pandemic, diagnostic procedures, research activities, and treatment plans have been disrupted; the clinical implications of these changes are still unknown.

Despite the measures implemented by some Latin American governments, the number of cases continues to climb. Some presumed reasons for this include lapses in social distancing implementation, in addition to crowded living conditions in urban areas. To date, 2.35 million confirmed cases of COVID-19 infections have been confirmed in Brazil, with over 85,000 deaths.

 Similarly, 378,000 positive cases have been reported in Mexico with over 42,000 deaths, and over 234,000 cases in Colombia with reports of 7,975 deaths. Notably, experts warn that the peak hasn’t been reached yet in that region.

As of May 2020, Central and South America were considered to be the new epicenter of the COVID-19 pandemic. Clinics and medical offices have been forced to close, raising concerns that healthcare systems could collapse, as has already happened in countries such as Ecuador. In March 2020, many European governments suspended breast, cervical, and colon cancer screening programs.

 In the United States, cancer screening programs were considered to be low priority.

 Although these practice changes are reasonable in light of this crisis, the negative impact could directly affect mortality in patients with cancer. Among Latinos, the cancer screening rate is already low, and COVID-19 may significantly worsen this situation.

In a national population-based modelling study done in the United Kingdom, investigators used linked National Health Service cancer registrations and hospital administrative datasets to estimate how the COVID-19 pandemic has delayed the diagnosis of cancer during lockdown measures. Compared with pre-pandemic figures, the authors estimate an 8% to 10% increase in the number of deaths due to breast cancer. It is estimated that for colorectal cancer, the number will increase from 1,445 to 1,563 additional deaths, and for lung cancer, additional deaths will jump from 1,235 to 1,372, a 4.8% to 5.3% percentage increase, respectively.

We have seen the severity of the impact of the pandemic on the United States. Despite clear data demonstrating the higher impact of COVID-19 in the Latino community, the effects of this virus in patients with cancer who live in Latin American countries is not well reported. Our study will focus on the effects of COVID-19 in oncology practices in Latin America. Data from the United Kingdom suggested that new cancer referrals decreased significantly due to concerns of contracting COVID-19; surgeries were delayed for more than 3 months across all stages of cancer and new chemotherapy practices were adopted by oncologists to avoid disruptions in cancer care.

 Our goal is to determine the extent of which the COVID-19 pandemic is affecting the care of patients with cancer in Latin America.

Understanding how the care of patients with cancer in Latin America has adapted during these unprecedented times, and the specific challenges experienced by providers caring for these patients, is essential to understand current limitations and disruptions in resource-limited healthcare systems. This survey will serve as an opportunity for hematologists/oncologists to share their perspectives on how COVID-19 has affected their communities.

 will take 10 minutes to answer and will be anonymous. These insights will hopefully guide future emergency preparedness plans on how to best deliver cancer care during a pandemic in low-income countries, and avoid cancer deaths due to lack of screening, surgeries, or availability of chemotherapy.

Horton J. Coronavirus: what are the numbers out of Latin America? BBC News. July 31, 2020. Accessed August 4, 2020. https://bbc.in/2DBbdo2.

Richards, M, Anderson, M, Carter, P, et al. The impact of the COVID-19 pandemic on cancer care. 

. 2020;1:565-567. doi:10.1038/s43018-020-0074-y 

Latin America and the Caribbean facts sheet. World Health Organization. March 2020. Accessed August 4, 2020. https://bit.ly/2ENQLB3. 

Andreoni M. Coronavirus in Brazil: what you need to know. New York Times. August 3, 2020. Accessed August 4, 2020. https://nyti.ms/3fu0s4m.

Resuming bowel cancer screening post-COVID-19. 

. 2020;5(8):711. doi:10.1016/S2468-1253(20)30200-4

Gorin SS, Heck JE. Cancer screening among Latino subgroups in the United States. 

. 2005;40(5):515-526. doi:10.1016/j.ypmed.2004.09.031

Maringe C, Spicer J, Morris M, et al. The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in England, UK: a national, population-based, modelling study. 

 Published online on July 20, 2020. doi:10.1016/S1470-2045(20)30388-0

Sud, A, Jones ME, Broggio J, et al. Collateral damage: the impact on outcomes from cancer surgery of the COVID-19 pandemic. 

 2020;31(8):1065-1074. doi:10.1016/j,annonc.2020.05.009

Articles

Outbreaks of coronavirus disease 2019 are on the rise in Latin America, with more than 4 million confirmed cases. In response to this health crisis, elective medical procedures, including cancer screening and care, as well as treatment for conditions beyond the virus, have been held.

Ana Velázquez Mañana, MD

Articles

Dr Velázquez Mañana on Survivorship Care Needs in Older Patients With Lung Cancer

Dr Manana on How Systemic Racism Appears in Oncology

Survey Aims to Identify COVID-19–Related Health Care Challenges in Latin America