Andrew Hantel, MD, discusses eligibility criteria associated with racial and ethnic disparities in clinical trial participation in acute myeloid leukemia.

Dr Hantel on Eligibility Criteria Associated With Racial/Ethnic Disparities in Clinical Trial Enrollment in AML

Andrew Hantel, MD, physician, Dana-Farber Cancer Institute (DFCI); instructor, medicine, Harvard Medical School, discusses eligibility criteria that may perpetuate racial and ethnic disparities in clinical trial participation in patients with acute myeloid leukemia (AML).

Hantel and colleagues conducted a study evaluating data from 1,283 real-world patients with newly diagnosed AML from the Dana-Farber Cancer Institute and 6 other hospitals across the greater Chicago area. The study focused on differences in clinical trial eligibility between Non-Hispanic White patients (n = 878) and those from minoritized populations (n = 405). Researchers aimed to determine how many of these newly diagnosed patients would have been eligible for clinical trials based on standard enrollment criteria, examining disparities by race and ethnicity.

 highlighted significant disparities in trial eligibility between racial and ethnic groups, both for intensive criteria often used in trials for younger adults and less intensive criteria applied in trials for older adults, Hantel reports. The findings revealed that patients from minoritized populations were eligible for 6.8% fewer trials compared with Non-Hispanic White patients (

 < .001). Non-Hispanic White patients had a 5% to 20% higher likelihood of meeting trial eligibility criteria than patients from minoritized groups, with differences observed across Hispanic, non-Hispanic Asian, and non-Hispanic Black populations, Hantel adds.

The study also identified specific eligibility criteria that contributed most to these disparities, which varied depending on the group, he continues. Key eligibility criteria contributing to these disparities included prior malignancy (22.5% of Non-Hispanic White patients vs 17.5% of patients in minority groups; 

 = .04), prolonged interval (20.5% vs 12.8%; 

 < .001), and coronary artery disease (4.0% vs 1.0%; 

 = .001). Pre-existing medical conditions, such as hepatitis B, were also identified as a contributing factor, Hantel notes.

These findings underscore the need for more inclusive trial designs and eligibility criteria that consider the diverse health profiles of all patient populations to ensure equitable access to clinical trials, he concludes.

Videos

Dr Hantel on Environmental and Health Impacts of Decentralizing Cancer Care

Andrew Hantel, MD, physician, Dana-Farber Cancer Institute (DFCI); instructor, medicine, Harvard Medical School, discusses findings from an evaluation of the environmental and health impacts of decentralizing cancer care in response to high emissions generated by United States health care.

, investigators reported that, in the initial phase of this study, patient care at DFCI was compared both before and during the COVID-19 pandemic, Hantel begins. The emissions generated by in-person visits prior to the pandemic were significantly reduced with the telemedicine-focused approach implemented during the pandemic, he reports.

Further, investigators conducted a hypothetical analysis, assuming the most decentralized care possible during the pre-pandemic period, and extrapolated the results on a national scale, Hantel continues. This approach revealed a reduction in emissions of approximately one-third, resulting in an estimated annual decrease of 72,171,554 kgCO2e. Although this is a figure that many professionals in the oncology field might not be familiar with, Hantel says investigators translated this data into a more relatable measure—human lives lost due to these emissions. The analysis showed that the excess deaths attributable to these emissions were minimal each year. Although the amount of CO2 reduction was substantial, the associated health risks were relatively low, he adds.

Regarding the future implications of this study, the examination highlights the need to balance the potential harms and benefits of different approaches to patient care, he states. The findings may influence decision-making, particularly in situations where there is uncertainty about the best course of action, he explains. Knowing that in-person care may contribute to downstream health risks due to associated emissions, health care providers might be more inclined to favor telemedicine or decentralized care when appropriate, according to Hantel. This shift could lead to better overall health outcomes by reducing the need for patients to visit health care facilities in person for all their care, Hantel concludes.

Andrew Hantel, MD, discusses the environmental and health impacts of decentralizing cancer care in response to high emissions generated by health care.

Dr Hantel on Socioeconomic Influences on First-Line Treatment in AML

Andrew Hantel, MD, physician, Dana-Farber Cancer Institute, instructor of medicine, Harvard Medical School, discusses the influence of race/ethnicity and socioeconomic status on the timeliness of first-line treatment initiation among patients with newly diagnosed acute myeloid leukemia (AML).

, Hantel and colleagues presented data from a retrospective study that utilized data from the Flatiron Health electronic database to identify patients at least 18 years of age diagnosed with AML between January 2014 to December 2022 who had 2 visits recorded within 3 months of diagnosis and underwent first-line treatment. Patients were divided into cohorts based on whether they received frontline treatment with intensive chemotherapy (IC).

The key findings indicated that in the IC cohort, the proportion of delayed treatment initiation was comparably low and not significantly different between the POC and White patient populations (24% vs. 25.2%; adjusted odds ratio [OR] 1.31; 95% CI, 1.05-1.63; 

 = .2). However, there was a marked disparity in patients who underwent stem cell transplantation (SCT) after remission in the POC population compared with the White population (31.3% vs. 47.7%; adjusted OR, 0.45; 95% CI, 0.35-0.59; 

However, in the non-IC cohort, there was a statistically significant difference in patients who experienced delayed treatment initiation among the POC population vs the White population (28% vs. 23%; adjusted OR, 1.31; 95% CI, 1.05-1.63; 

 = .02). Excluding Asian patients, the POC population in the non-IC cohort also experienced higher rates of delayed treatment vs the White population (27% vs 23%; adjusted OR, 1.22; 95% CI, 0.97-1.53; 

 = .032). Additionally, Black patients had a statistically significant higher rate of delayed treatment vs the White population (adjusted OR, adjusted OR, 1.50; 95% CI, 1.03-2.15; 

 = .032). This difference was numerically greater in the Latinx vs White populations (adjusted OR, 0.98; 95% CI, 0.60-1.55; 

Andrew Hantel, MD, discusses the influence of race/ethnicity and socioeconomic status on the timeliness of first-line treatment in acute myeloid leukemia.

Andrew Hantel, MD

Articles

Dr Hantel on Eligibility Criteria Associated With Racial/Ethnic Disparities in Clinical Trial Enrollment in AML

Dr Hantel on Environmental and Health Impacts of Decentralizing Cancer Care

Dr Hantel on Socioeconomic Influences on First-Line Treatment in AML