Why do groundbreaking cancer discoveries fail to reach all patients equally? In this roundtable, Dr. Nicole Rochester and Dr. Stacey Loeb of NYU Langone Health explore how representation gaps, systemic barriers, and outdated clinical practices create inequities in prostate cancer care and what providers can do to close the gap.
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Transcript
Dr. Nicole Rochester:
Dr. Loeb, you work across both the Veterans Affairs Systems and Academic Medical Centers. From your perspective, where does the breakdown happen between what we discover and who actually benefits from those discoveries?
Dr. Stacey Loeb:
Yes, this is a great question, and really, I think it’s at many different levels where the breakdown can occur. There’s systemic and societal factors, even piggybacking on what Dr. Burnham was talking about, we’ve looked at diversity of representation in online content about prostate cancer in general, and about prostate cancer clinical trials. And found, for example, limited representation of Black and Latinx individuals.
And these things actually do have downstream impact. For example, we found that among many Black males with prostate cancer, because they hadn’t seen any Black faces, some even thought they were at lower risk of prostate cancer, or perhaps that Black men don’t get prostate cancer. So, I think we need to think of these things very broadly, including even what people are exposed to when they look online about prostate cancer.
But then, you know, this leaky pipeline is something that occurs not just in prostate cancer, but really across the boards. You know, why does it take so many years for only a proportion of the great discoveries of research to get implemented in clinical practice?
You know, there can be barriers at the organizational level, the patient level, the physician level. For example, there are, you know, physicians have knowledge gaps and certain practice habits, so de-implementation of old pathways can actually be very challenging. And patients may or may not be interested in certain things, you know, we’ve done some studies on uptake of genetic testing for prostate cancer.
And, you know, some patients are very interested, but there’s also a lot of knowledge gaps among patients, or some just don’t really perceive the benefit to them. Perhaps they don’t have any children, or their children are already older and already have other cancers. So they feel like maybe it’s too late for it to benefit the family, so you know, really, I think at every different step of the process and every level there are barriers.
Dr. Nicole Rochester:
Absolutely. Thank you for sharing that. Again, you know, we’re seeing how the upstream effects trickle all the way down, I was really intrigued to hear you say that some Black men don’t think they’re at risk for prostate cancer, and that just shows the importance of seeing yourself and that representation that both of you spoke about.