Dana-Farber Researchers Uncover Disparities in Lived Experiences for Patients and Physicians

Dana-Farber Cancer Institute investigators have found that people experience discrimination in different ways and in various realms of cancer care.

Four teams of Dana-Farber Cancer Institute investigators have found that people experience discrimination and bias in different ways and in more realms of cancer care than previously understood. The findings, in different studies, suggest that oncology professionals and the systems they work in have more work to do to adapt to the realities of increasing diversity and inclusion, not only in the patient population but also in the oncology workforce. The research teams presented their findings at the 2024 Annual Meeting of the American Society of Clinical Oncology (ASCO) in Chicago. ASCO is the world's largest clinical cancer research meeting, attracting more than 30,000 global oncology professionals.

"We need to transform our health systems so that they work for everybody," says presenter Shail Maingi, MD, a member of Dana-Farber's Cancer Care Equity Program and a physician at the Dana-Farber Brigham Cancer Center at South Shore Health. "These findings bring to light disparities and interpersonal dynamics that are surprising and important for us to pay attention to as we strive to build medical systems that see and take care of everyone."

LGBTQ+: Patient and Physician Experiences

Maingi presented 2 abstracts and reported data from a survey of 817 LGBTQ+ cancer patients and 115 oncology professionals from a wide range of treatment centers in the U.S. The survey revealed that while 84% of physicians reported feeling comfortable treating LGBTQ+ patients, only 24% of patients felt comfortable disclosing their LGBTQ+ status. In addition, a scant 4% of patients felt that their care team treated their partner with respect. At least 30% of physicians reported being unsure how LGBTQ+ status affected treatment considerations or how to discuss LGBTQ+ status with their patients.

Maingi's team used the survey responses to develop a toolkit to improve LGBTQ+ patient experiences. Her team shared that toolkit with several community sites and discussed initiatives the sites could implement rapidly, within 30 days.

Many of these initiatives are already in place at Dana-Farber. "Dana-Farber is becoming more approachable and diverse, so we are starting to understand the lived experiences of our patients. This knowledge is making the Institute stronger," says Maingi. "But we don't have this solved."

International Medical Graduates Face Unconscious Bias and Limited Opportunities

Three other abstracts presented during the conference focused on oncology professionals who are international medical graduates, meaning they attended medical school outside of the US or Canada but completed residency and fellowships and are now practicing in the US. Approximately 30% of US oncology professionals are international medical graduates.

International medical graduates, like author Narjust Florez, MD, Associate Director of the Cancer Care Equity Program and a thoracic medical oncologist at Dana-Farber, help diversify the oncology workforce so that it more closely mirrors the populations of patients it serves. Florez, however, will report that being an international medical graduate in the US is difficult.

Her team's survey of 97 oncologists who are international, or Puerto Rican medical graduates revealed that over half experienced racial or ethnic discrimination during training and independent practice. In addition, women were more likely to face racial or ethnic discrimination during training than men and were more likely to experience gender discrimination during training and clinical practice, demonstrating the power of intersectionality between different types of biases, including gender bias.

"Unconscious bias is an extra thing that international medical graduates need to deal with," says Florez, who has personal experience with bias. "My race and my accent come through the door before any of my credentials, titles, and publications."

International medical graduates may also have fewer opportunities to be invited as faculty. Findings by senior author Toni Choueiri, MD, Director of the Lank Center for Genitourinary Oncology at Dana-Farber, were presented from an analysis of event programs from the two previous ASCO annual meetings. This team found that international medical graduates who are practicing oncologists in the US are less likely to be invited as faculty presenters at ASCO than their American medical graduate counterparts, even when they produce the same amount of original research.

Experiences of Discrimination and Financial Stress, Not Race, Associated With Mistrust in Health Care Systems

Social determinants of health (the conditions a person is born, lives, and ages in) and not race were associated with a lack of engagement with and trust of health care systems, according to findings reported by Dana-Farber's Breast Oncology Program. Rachel Freedman, MD, MPH, a clinician-scientist in Dana-Farber's Breast Oncology Program is the senior author of the study, which was presented and led by Olga Kantor, MD, MS, of Dana-Farber Brigham Cancer Center.

The team surveyed 297 women (a mix of 60% white, 25% Black, and 15% Hispanic people). Analysis associates experiences of discrimination in daily life and in health care, such as being treated with less courtesy or as if dishonest, with avoiding information about cancer, not initiating recommended treatment for cancer, and mistrust of physicians. Financial strain, such as concerns about medical bills or not having insurance, was also associated with these end results. Race and ethnicity were not associated with any of these outcomes.

These findings are among more than 80 studies presented at ASCO that are led by Dana-Farber-affiliated researchers.

A full list of Dana-Farber Oral Presentations at the 2024 ASCO Annual Meeting is available here.

A full list of Dana-Farber Poster Discussions at the 2024 ASCO Annual Meeting is available here.

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