Tag Archive for: African Americans

Can Self-Advocacy Close the Gap in Bladder Cancer Outcomes?

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Bladder cancer research insights show disparities for specific groups. Expert Dr. Shaakir Hasan from Beth Israel Lahey Health discusses highlights from his research study, the value of seeking medical attention and second opinions, and proactive patient advice. 

[ACT]IVATION TIP

“Just do your own research, find what’s available, discuss these options with your provider, look at multiple providers, and get multiple opinions if you can to kind of feel more comfortable with whatever decision you end up making.”

See More from [ACT]IVATED Bladder Cancer

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Related Programs:

Navigating Bladder Cancer Treatment: Understanding the Role of Academic and Community Centers

Navigating Bladder Cancer Treatment: Understanding the Role of Academic and Community Centers

 Addressing Disparities in Bladder Cancer Diagnosis and Treatment

Addressing Disparities in Bladder Cancer Diagnosis and Treatment

 Improving Access to Bladder Cancer Care: Impact of Insurance and Socioeconomic Factors

Improving Access to Bladder Cancer Care: Impact of Insurance and Socioeconomic Factors

Transcript:

Lisa Hatfield:

Dr. Hasan, your study found that certain demographics, including Black and female patients have reduced survival rates. So can you speak a bit about the study and what you think can be done to improve outcomes for these groups?

Dr. Shaakir Hasan:

Sure. So, I think that when it comes to the overall prognosis, the overall, you know, outcomes, the results as to how likely you are to get cured, survive is actually not so different. It’s a little different, but not so different among different groups, be it female, be it African Americans, the bigger issue is that they’re being diagnosed at a later stage. And that just makes care a lot more difficult. So, I think that’s the take home message there is that, going back to, I should just say, the biggest issue here is to look at preventive medicine and to kind of detect these symptoms early, detect bladder cancer early if it’s there, because that will eventually lead to better outcomes regardless of whatever group you belong to.

So, that does mean seeking medical attention early. That does mean addressing things like blood in the urine or just anything that’s off in your genital urinary system to address that early. Now, as far as reduced survival rates stage for stage, which is another thing that we showed, it could be a multitude of things. It could be that certain groups, demographic groups, just are predisposed to worst acting cancers. They could be more aggressive tumors. But there’s also certainly a lot of evidence that shows that certain ethnic groups just don’t get the same care, period.

Maybe they don’t have as much access insurance-wise. Maybe they don’t have the same coverage or they’re not seeking some of the expert care that’s out there. And so that certainly can contribute to worse outcomes, period. We’ve seen this in many different cancers. So, what I would say, what can be done to prevent this? I will again, encourage that those really advocate for themselves and say, look, do your own research, hop on Google and just bladder cancer treatments, plain and simple. And you’ll find a multitude of opportunities of different types of treatments. And you should ask your provider about them. The second you do that, they know you’re engaged. They’re going to engage back with you, and it’ll be much more of like a partnership in your management and your care.

And that will ultimately get you better results. I think another thing one can do is don’t, you know, in the business, in medicine, we call this doctor shopping, so to speak, but it’s not a bad thing, seek other opinions, be comfortable with your physician and be comfortable getting different opinions and seeing what’s all out there because, and we won’t be offended. I encourage all my patients to go get as many opinions as they feel comfortable with, because at the end of the day I want you to be comfortable with your management.

I want you to know what’s out there and you might just have a better fit, whether it’s location, you just like the position better. You like the facilities better, the opportunities, the nursing staff, whatever it might be, there’s going to be a better fit for certain patients in certain areas and you should explore that. So, I think regardless of your economic background, your ethnic background, your gender do this and then you, we kind of, so to speak, level the playing field for whatever type of care you get.

Start with doing your own research, you know, try to find what’s available for you, and you might not understand it all, but that’s okay. Just do your own research, find what’s available, discuss these options with your provider, look at multiple providers, and get multiple opinions if you can to kind of feel more comfortable with whatever decision you end up making.

Addressing Disparities in Bladder Cancer Diagnosis and Treatment

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Bladder cancer disparities have been examined for several decades. Expert Dr. Shaakir Hasan from Beth Israel Lahey Health discusses patient groups that show disparities and patient advice to advocate for optimal care.

See More from [ACT]IVATED Bladder Cancer

Download Resource Guide | Descargar Guía

Related Programs:

Navigating Bladder Cancer Treatment: Understanding the Role of Academic and Community Centers

Navigating Bladder Cancer Treatment: Understanding the Role of Academic and Community Centers

 Improving Access to Bladder Cancer Care: Impact of Insurance and Socioeconomic Factors

Improving Access to Bladder Cancer Care: Impact of Insurance and Socioeconomic Factors

 Can Self-Advocacy Close the Gap in Bladder Cancer Outcomes?

Can Self-Advocacy Close the Gap in Bladder Cancer Outcomes?

Transcript:

Lisa Hatfield:

Dr. Hasan, what are the most significant disparities that you’ve observed in the treatment of bladder cancer among different demographic groups?

Dr. Shaakir Hasan:

Yeah, so you know, unfortunately, we did find, and actually, before I even start, let me preface this by saying there was a study done about three decades ago, the early ‘90s, that looked at the diagnosis and prognosis of bladder cancer patients in the ’60s, ’70s and ’80s. And they found that there was a worse prognosis for African Americans, particular other minorities, but mostly African Americans, both when it comes to diagnosis, like they were diagnosed later, and then their outcomes, they had worse survival, worse cure rate. And I’m sorry to say that we repeated the study, they use theory data. It’s a national database, and we use the National Cancer Database, NCDB to do a similar study, looking much later. So we did this a few years back. And so we’re looking at the 2000s, 2010s, up to 2020.

Unfortunately, we actually found the same results. The overall prognosis is better, because the overall treatment and management is better. But the differences, unfortunately, still remain. So, Black patients were almost twice as likely to be diagnosed in later stages, i.e., stage IV, incurable stages than their white counterparts. And that obviously means that they’re going to, there’s going to be worse outcomes when it comes to cure rates and survival, overall survival. And so we still do see that today.

Lisa Hatfield:

Okay. Thank you for that information. I also have a follow-up question to that, because I read your study a little bit and learned a little bit more about some of the factors that lead to a later diagnosis. So if you have a patient sitting in front of you who is afraid maybe to, maybe they’re going in, they have blood in their urine, which is a symptom, could be a symptom of bladder cancer. Their PCP has told them originally, well, it might just be, you might be on your period, it could be something else, they go in once or twice, a patient is afraid to confront their doctor or say, you know, is there any way we can follow up on more, maybe they don’t want to offend their doctor, maybe they’re just afraid to do it. Do you have any piece of advice for that patient, just so they don’t get diagnosed in a later stage, if that is the reason why they might be diagnosed later, what would your advice be to that patient sitting there?

Dr. Shaakir Hasan:

Yeah, totally. So I think one would be surprised. First of all, never worry about offending your doctor. You know, that’s one thing that I start with. And it’s, and I say that a little tongue in cheek, but I actually mean that because there have been plenty of times where your doctor’s not trying to be dismissive, right? They’re not trying to just, obviously, you never want to be the one that missed something. You never want to be the one that bladder cancer, right?

And so you might just not be thinking about something at that moment, you might really be sitting there and going, oh, look, it’s very likely not this because I know my list of diagnoses. And I know like, what’s more common and what’s not, that’s part of my job. And so it’s not so much, you know, the attempts to offend or miss something. But the second you bring it up, the second that you advocate for yourself, far more likely, we’re far more likely to act on it.

And that’s just kind of a universal principle. There might be something that they missed, there might be, maybe you’re perimenopausal, and you haven’t had menses in a couple years, and the doctor just missed that. There could be something that you, you know your body, you should advocate for yourself in those situations, do not worry about offending, because honestly, you’re not like, I can’t really imagine I couldn’t, I’ll admit, there definitely been times where someone asked about something that I wasn’t thinking about, not intentionally. And I just Oh, yeah, of course, we’ll look into that. There’s no offense, you know, taken. So I wouldn’t worry about that.

And even if they were offended, this is your body, it could be life or death, you shouldn’t worry about that. The second thing I want to mention, though, is that, you know, it’s probably not as likely that everyone is seeking medical care, and then one is just being dismissed certainly is possible. Certainly, we do have evidence of that happening, and unfortunately in different situations, but it’s probably more a reflection of certain people will have primary care and certain people just don’t.

If you don’t have insurance, for example, you’re not as likely to go have a routine checkup. And these routine checkups, they’ll check the urine, they’ll do urinalysis, and you might not notice blood in the urine, but they can tell it microscopically. But if you’re not routinely doing this, as a screening process, then you’re not going to detect it. And so I think one recurring theme in healthcare in general is just preventive medicine. And I think that we really have to work hard to implement that for all groups. And certainly, there’s a disproportionate lower primary care coverage of certain minorities and socioeconomic groups that we really have to do better at. And I think that will translate into detecting more bladder cancer earlier for whatever ethnic group you want to.

Navigating Inequities in Diagnosis and Treatment of Bladder Cancer

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For bladder cancer diagnosis and treatment, how can inequities be navigated? Expert Dr. Shaakir Hasan from Beth Israel Lahey Health discusses groups that experience disparities in bladder cancer outcomes, factors that may impact outcomes, and proactive patient advice.

[ACT]IVATION TIP

“…if you see something abnormal, again, going back to the blood and the urine, please, get medical advice, please go, address this with your PCP. Again, it may be nothing, but it’s something that’s definitely worth investigating, because it literally could save your life. And then I hope this doesn’t have to be the case…but you do have to kind of be your own advocate if you do notice that you’re getting dismissed…”

See More from [ACT]IVATED Bladder Cancer

Download Resource Guide | Descargar Guía

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Bladder Cancer Awareness: The Power of Early Detection

Bladder Cancer Awareness: The Power of Early Detection

 Bladder Cancer Breakthroughs: Immunotherapy and Preservation Strategies

Bladder Cancer Breakthroughs: Immunotherapy and Preservation Strategies

 When Is Immunotherapy Recommended in Bladder Cancer?

When Is Immunotherapy Recommended in Bladder Cancer?

Transcript:

Lisa Hatfield:

Dr. Hasan, can you explain how race and gender might influence a patient’s experience with bladder cancer, particularly in terms of diagnosis and treatment?

Dr. Shaakir Hasan:

All right, now this is a difficult topic to kind of explore, but a very important one. And the reason why it’s difficult, not just because it has some just the terminology a hot button issue, so to speak because it’s really important that we address all of these hot button topics to kind of get the best outcomes for everyone. But  what makes it complicated is if you look at the data, and this is throughout many cancers, bladder cancer included, you will see that certain ethnic groups, certain communities, they end up doing worse, stage for stage or different stages with whatever cancer that they have. And the reason why it’s complicated is because we can definitely report what’s happening. That’s indisputable. For example, instance, African American patients, regardless of gender do worse. They’re diagnosed later, and they do worse, stage for stage with whatever cancer that they have, including bladder cancer.

That part is not controversial. No one’s going to dispute that. The controversial parts, the two of them are, well, why is that the case? And then what do we do about it? If you look at stage for stage one might say, okay, well do certain ethnicities, are they predisposed to having worse cancers is the cancer themselves, the worse actors, more aggressive? Is it harder to handle? And then others will say, no, it’s the exact same cancer, but they’re just not getting as good care for whatever reason. I do think based on what we see that it is probably more of the latter, but I don’t want to ignore the former, I don’t want to then just dismiss the idea that certain groups, certain people might be predisposed to a worse version of the cancer, because then, maybe I don’t treat as aggressively, and therefore I’m not treating as appropriately.

So it’s a difficult one that we have to have an open mind to really difficult question that we have to have an open mind to truly address appropriately. Let’s tackle gender first. Okay, so independently of race. This is particularly interesting with bladder cancer, because women often can miss this diagnosis, can misreport the initial symptoms. They might be peri-menopausal or premenopausal or even postmenopausal, and they have just an occasional menses or just kind of used to seeing blood in the urine from time to time, and just kind of ignore that symptom. Whereas men see something like that, they’re right away, they’re going to go talk to a, speak to a physician, get that addressed. And I would urge all people to get that addressed, because it is abnormal to have blood in the urine period.

But women might miss it and miss that early diagnosis. Therefore, they’re diagnosed later, and therefore, there is a worse prognosis for women that have bladder cancer. Now stage for stage, it does not appear to be worse. So that does suggest that once it’s diagnosed, women and men are getting the same care, and their prognosis is pretty similar, okay? And that’s a good thing. But it does also say that women are…were missing this diagnosis in a lot of women. So, it’s definitely important to get checked out. Now as far as race goes, and this was an unfortunate finding in our research that we did, but it’s pretty glaring about twice as likely to get diagnosed at any later stage of bladder cancer if you’re an African American versus a non-African American, and I don’t have the why, the answers of why. But I can tell you based on the research that if you’re diagnosed later, certainly your prognosis is worse. Certainly, the chances of cure are worse, and the overall life expectancy is worse.

Is it possible that there might be some biologic components to this, regardless of when one was diagnosed? It is, but in our research we try to isolate these factors. So, for example, grade of tumor, which is the intrinsic aggressiveness of how the cancer might behave. We do tend to see a higher correlation in African Americans in high grade tumors. So, that does suggest that biologically there’s a component here that maybe confers a worse prognosis. However, we also did try to control for that as one of our variables in our multi-variable analysis, meaning we filter that part out, we accounted for that, and we still see that African Americans were diagnosed at a later stage and had a worse prognosis overall. So the answer is kind of a little bit of both when it comes to nature versus nurture type of thing. But at the end of the day, we do, unfortunately, see a worse experience for African Americans when it comes to bladder cancer.

Lisa Hatfield:

Okay. Thank you. And how about an [ACT]IVATION tip for this question?

Dr. Shaakir Hasan:

Yeah, so, it’s probably going to be a consistent theme here,  but if you see something abnormal, again, going back to the blood and the urine, please, get medical advice, please go, address this with your PCP. Again, it may be nothing, but it’s something that’s definitely worth investigating, because it literally could save your life. You do have to kind of be your own advocate if you do notice that you’re getting dismissed for whatever reason if you, because there might be a physician that says, oh, hey, you’ve stayed your period, don’t worry about it. You say, you know what, that’s fine, but I do want to get this checked out. This is abnormal. This just doesn’t happen to me. I do want to understand what’s going on here. So I would, you kind of have to be your own advocate sometimes.

Do Disparities Exist for Black and Latinx Veterans Facing Lung Cancer?

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Do Disparities Exist for Black and Latinx Veterans Facing Lung Cancer? from Patient Empowerment Network on Vimeo.

Do Black and Latinx veterans face lung cancer disparities? Expert Dr. Michael Kelley from Duke University School of Medicine discusses past and current health outcome disparities and comparisons of molecular genetic alterations between Black and white veterans.

[ACT]IVATION TIP

“…if you are experiencing a challenge in working with the VA healthcare system, regardless of what community you are in, please communicate that to someone at the VA. That could be your provider, that could be the patient advocate. Every VA hospital has a patient advocate or that could be someone else at the medical center. We want to know how we can help you in what problems you’re experiencing.”

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See More from [ACT]IVATED NSCLC Veterans

Related Resources:

Equitable Access: Overcoming Challenges in Precision Medicine for Veterans with Lung Cancer

Equitable Access: Overcoming Challenges in Precision Medicine for Veterans with Lung Cancer

 Are There Lung Cancer Clinical Trials Studying Veterans?

Are There Lung Cancer Clinical Trials Studying Veterans?

 Navigating Lung Cancer Clinical Trials: VA Support and Resources for Veterans

Navigating Lung Cancer Clinical Trials: VA Support and Resources for Veterans

Transcript:

Lisa Hatfield:

Dr. Kelley, what specific challenges do veterans from the Black and Latinx communities face when trying to access lung cancer healthcare services?

Dr. Michael Kelley:

So in VA, there are several different ethnic and racial populations, and we’ve looked at the outcomes of Black and white veterans. Latinx veteran population is still relatively small, so we don’t have good statistical power to be able to draw strong conclusions there. But the comparison between Black and white is very clear in VA in lung cancer in terms of the outcomes.

And the result is, is that Black veterans do just as well, or better than white veterans at every stage of lung cancer. That is quite different than it is in the rest of the country. So that is one area that I think VA as an integrated healthcare system with wraparound services is able to brag about that we are able to provide all the care that is necessary to derive that outcome.

That wasn’t always the case. In the early 2000s, there was a difference in surgery rates for Black veterans with early stage lung cancer. And we were studying this, and what we saw was that, that difference went away about 2009 or 2010, and it hasn’t come back since we last looked at it. We don’t know what caused it, and we don’t know why it went away, but we’re glad to see it did go away. There are a long list of other possible challenges that veterans in Black or Latinx communities might face. These may be overlapping with those that everyone faces, but VA probably has a service to help with it.

And so my activation tip for you is, is that if you are experiencing a challenge in working with the VA healthcare system, regardless of what community you are in, please communicate that to someone at the VA. That could be your provider, that could be the patient advocate. Every VA hospital has a patient advocate or that could be someone else at the medical center. We want to know how we can help you in what problems you’re experiencing.

Lisa Hatfield:

Are there any differences in the characteristics of the cancer for these populations for the Black and Latinx communities that you have seen?

Dr. Michael Kelley:

We have looked at a lot of comparisons between Black and white groups of veterans, not so much around Latinx because of the smaller numbers. There are not a lot of differences in terms of molecular genetic alterations. And so there are some differences in the geography. So the Black African Americans veterans tend to live more in the Southeast, where actually there’s the largest collection of military veterans who are enrolled in VA care anyways.

But in terms of the outcomes, we don’t really see any outcomes. There are some other differences in medical care that are appropriate, such as a variation of normal in terms of the white blood cell count that happens in some individuals predominantly in of African descent. And those individuals might be at risk for having their chemotherapy doses reduced, because their white count goes down more than other individuals. But in general, we don’t see a lot of differences between those populations medically.

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Can Race or Ethnicity Impact CAR T-Cell Therapy Response?

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Can Race or Ethnicity Impact CAR T-Cell Therapy Response? from Patient Empowerment Network on Vimeo.

Can CAR T-cell therapy response be impacted by patient race or ethnicity? Expert Dr. Sikander Ailawadhi from Mayo Clinic discusses some impacts to CAR T-cell therapy response for African Americans and some clinical methods to help reduce impacts to patients.

[ACT]IVATION TIP

“…there is a lot of work happening, research happening around how to predict and prevent side effects from CAR T so that the patients are much more informed, aware, can make an informed decision, and as clinicians, we can do whatever is within our control and is at our disposal to help prevent those side effects and make CAR T an even safer and more beneficial treatment for patients.”

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See More from [ACT]IVATED CAR T

Related Resources:

How Can Equitable CAR T-Cell Therapy Access Be Increased?

How Can Equitable CAR T-Cell Therapy Access Be Increased?

 How Can Information Disparities on Emerging Therapies Be Addressed?

How Can Information Disparities on Emerging Therapies Be Addressed?

 How Are Rural CAR T-Cell Therapy Barriers Being Addressed?

How Are Rural CAR T-Cell Therapy Barriers Being Addressed?

Transcript:

Lisa Hatfield:

Dr. Ailawadhi, is there data around ethnicity and response to CAR T-cell therapy and whether genetic factors may affect treatment outcomes? And can the side effects of CAR T-cell therapy be predicted or prevented?

Dr. Sikander Ailawadhi:

So Lisa, a very important question of whether there are racial ethnic factors that can affect CAR T-cell therapy benefit or side effects, and what are we doing to prevent some of these side effects? We know side effects can happen, what can we do to actually prevent them? So I’ll take this question in two different subgroups. The first one of talking about racial ethnic groups or differences. So we know patients who are African Americans. This is one study reported that African Americans are more likely to have side effects from CAR T-cell therapy.

So while it’s not a specific “genetic factor,” but race ethnicity can sometimes be associated with more side effects, and that is just because these are very inflammatory delivered or inflammatory mediated side effects like CRS. It’s also important to know that there are certain other factors, disease or treatment-related factors, that can help predict potentially more side effects with CAR T. For example, patients who are very heavily pre-treated, patients who have a very high disease burden, patients who did not respond to bridging therapy that was given to them prior to the CAR T.

These are all factors where we know that side effects are going to be more, and the success of the treatment might be lesser. What we are trying to do to mitigate some of these side effects, there are now studies which are giving either some low doses of steroids as a prophylaxis before, right around the time of CAR T, so that side effects may not happen. Studies that are giving a low dose or even standard dose of what’s called tocilizumab (Actemra), toci, or tocilizumab.

This toci drug is an antidote for CRS or cytokine release syndrome. The thought is, well, why wait for the toci to be given after the side effect happens? Why not give it beforehand and prevent the CRS? Historically, there was a concern that steroids or toci given early on could affect the CAR T-cell viability or activity, but that’s not the case. For example, in lymphomas, there are clinical trials that have shown very clearly given prophylactic or preventative steroids could help. Using steroids or toci in a preventative manner is helping mitigate some of the side effects. 

Well, by preventing the side effects, we are being able to give the treatment in a way that the patients may have lesser side effects and can get it done closer to home or at home sometimes, and their time to stay in the hospital is lesser. You can imagine that some of these barriers are being further mitigated.

My activation tip for this question is that there is a lot of work happening, research happening around how to predict and prevent side effects from CAR T so that the patients are much more informed, aware, can make an informed decision, and as clinicians, we can do whatever is within our control and is at our disposal to help prevent those side effects and make CAR T an even safer and more beneficial treatment for patients.

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How Do Race and Ethnicity Impact CAR T Side Effects?

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How Do Race and Ethnicity Impact CAR T Side Effects? from Patient Empowerment Network on Vimeo.

How are CAR T side effects impacted by race and ethnicity? Expert Dr. Sikander Ailawadhi from Mayo Clinic shares some research study results about CAR T response rates and disease progression in African American and Hispanic patients and solutions for clinicians.

[ACT]IVATION TIP

“…there are some differences by race, ethnicity, specifically for the side-effect profile, patients should be aware of it, and clinicians who are the CAR T specialists should be aware of it so that they can manage the side effects well in their patients.”

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See More from [ACT]IVATED CAR T

Related Resources:

How Can Equitable CAR T-Cell Therapy Access Be Increased?

How Can Equitable CAR T-Cell Therapy Access Be Increased?

 How Can Information Disparities on Emerging Therapies Be Addressed?

How Can Information Disparities on Emerging Therapies Be Addressed?

 Can Race or Ethnicity Impact CAR T-Cell Therapy Response?

Can Race or Ethnicity Impact CAR T-Cell Therapy Response?

Transcript:

Lisa Hatfield:

Dr. Ailawadhi, real-world data from one of the available CAR-T-cell therapies, ide-cel (Abecma), has shown some differences in the side effect profile and benefit by patient race and ethnicity. What is your take on this, and how do you utilize this in your clinical practice? And also, what do you think researchers should do next to learn more about how CAR T therapies affect different people?

Dr. Sikander Ailawadhi:

This is an extremely important question, looking at what is the data currently on the risks and benefits of CAR T-cell therapy in patients from different racial ethnic groups, and then how are we using that in the clinic today and where should the field go about research in this area. So, Lisa, you’ve correctly pointed out that this study that was published recently is based on some real world data from one of the CAR T cells available, ide-cel.

Now, I shouldn’t say that this is specifically to ide-cel, but basically, ide-cel has been around a little bit longer than cilta-cel (Carvykti), and so the real-world data on ide-cel was to the point that this racial ethnic analysis could be done, and it was reported. That said, we don’t know how cilta-cel would be. That data just does not exist. So, I’m not saying that this is applicable to cilta-cel or not, because at least this study was specifically for ide-cel because that data was mature enough to be reported. That was just a qualifier of this particular question.

Now, what that study showed was that some of the side effects, including CRS, the cytokine release syndrome, and certain markers that can be an accompaniment of CRS, like the ferritin or what’s called CRP, C-reactive protein, which are inflammatory markers. So, inflammatory markers were higher in African Americans, and the CRS was also higher in African Americans from that real-world data.

The other thing that it showed was that the response rates were lower in Hispanics, but the progression-free survival, meaning time it took for the disease to progress and require more treatment, was lower in African Americans or overall survival was same across the racial ethnic groups. So, side effects a little bit more in African Americans, and the immediate response, a little bit less in Hispanics, but overall outcome, similar across races. Now, this is important for us to know because African Americans tend to have certain inflammatory disorders more frequently, like even asthma is seen more frequently in African Americans.

So, CRS, which is an immune system mediated inflammatory response, I can imagine that some of it might be higher in African Americans. So, in our clinics, what we are doing is when we are monitoring the patients, every patient is getting monitored the same way, but when it’s an African American patient, we are putting a little bit more focus on those inflammatory markers that can sometimes start showing up even before the CRS happens. I don’t think the response rate portion of Hispanics that we’re really taking into account much because the overall outcome or the long-term outcome was not really different between races and ethnicities.

Of course, there needs to be much more research, so I think we need longer-term follow-up data, we need larger number of patient data, and what I alluded to in the very beginning, we do need data on cilta-cel also, which has not yet been presented, but we are hoping that it will come out very soon. So, my activation tip for this question is, that there are some differences by race, ethnicity, specifically for the side-effect profile, patients should be aware of it, and clinicians who are the CAR T specialists should be aware of it so that they can manage the side effects well in their patients.

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Roadblocks for Black and Latinx Patients From CAR T Trial Access

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Roadblocks for Black and Latinx Patients From CAR T Trial Access from Patient Empowerment Network on Vimeo.

What are CAR T-cell therapy roadblocks for Black and Latinx trial access? Expert Dr. Sikander Ailawadhi from Mayo Clinic discusses barriers that have been documented in clinical research and solutions and patient advice for overcoming barriers.

[ACT]IVATION TIP

“…please seek out a specialist center that specializes not only in myeloma, but also in CAR T and in clinical trials, and even at that center, seek out the physician who has part an experience of participating in clinical trials.”

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How Can CAR T-Cell Therapy Be Explained to Patients and Families?

How Can CAR T-Cell Therapy Be Explained to Patients and Families?

 Reducing CAR T-Cell Therapy Barriers for Relapsed/Refractory Myeloma

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 How Are Cultural and Language Barriers to CAR T Therapy Being Addressed?

How Are Cultural and Language Barriers to CAR T Therapy Being Addressed?

Transcript:

Lisa Hatfield:

Dr. Ailawadhi, there is so much promise around CAR T-cell therapy, but barriers exist. Can you speak to the roadblocks that prevent Black and Latinx patients from participating in CAR T-cell therapy trials that you have witnessed?

Dr. Sikander Ailawadhi:

Lisa, this question about healthcare disparities and access to care, especially based on patient race ethnicity, it’s very near and dear to my heart. I do a lot of work around this and also a lot of research. Not just for CAR T, data has been very clear over years and decades that in multiple myeloma and frankly, in all cancers also. Clinical trial access is dismal when it comes to African Americans and Hispanic patients. Unfortunately, a lot of that data does not even exist about Hispanic patients.

But the publications are very clear with, so we’ve had one publication of ours, and then there has been one other from national data where FDA-approved drugs clinical trials were evaluated. And it was noted that while African American patients make up about 20 percent of the U.S. myeloma population, less than 5 percent of them participated in clinical trials that led to FDA approval of myeloma drugs.

I’m not saying that is specific for CAR T. In recent years when the CAR T trials were happening, the numbers have improved a little bit. They’re still not the same numbers representing myeloma population in the US, but some improvements happened, for sure. The barriers to getting onto CAR T and clinical trials related to such resource and time intensive treatments are multifactorial.

A lot of times they are sociodemographic, patients need to take time away from work. They have to have a caregiver, they have to have appropriate insurance approvals for certain things. They have to be able to go to a center that may be close to them. These centers are hopefully going to be able to bring some other resources like social workers, navigators, et cetera, to help that patient get onto the trial. And then there is sometimes lack of awareness of CAR T, lack of awareness of clinical trials per se, clinical, and there are fears, anxiety, scares around getting on clinical research.

Lots of barriers, I think we can systematically take care of mitigating them. I would again say, just as I mentioned previously in a different context, one simple way of trying to overcome barriers or at least making attempts to overcome barriers, is to get to a center that specializes in CAR T, that specializes in clinical trials and speak with an expert, a physician who has a clinical trial track record.

Patients can research all of this, and if that falls in place, I’m sure some of these access barriers and some of these disparities can be overcome. My activation tip for this question is, please seek out a specialist center that specializes not only in myeloma, but also in CAR T and in clinical trials, and even at that center, seek out the physician who has part an experience of participating in clinical trials.

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Addressing Elevated Gastric Cancer Risks in Asian and Hispanic Communities

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Addressing Elevated Gastric Cancer Risks in Asian and Hispanic Communities from Patient Empowerment Network on Vimeo.

 How can higher gastric cancer risks for Asian and Hispanic populations be overcome? Expert Dr. Jun Gong from Cedar-Sinai Medical Center discusses H. pylori risk and screening and advice to patients to be proactive in their care.

[ACT]IVATION Tip

“…for the risk factors that are specific to the Asian and Hispanic populations is to understand the symptoms of H. pylori, which is one of the most common causes of stomach cancer, because they can be very effectively treated with antibiotics over a period of two weeks, oftentimes, and they’re very effective. This can be done at multiple provider levels from the primary care setting to the subspecialist setting. And also to know that symptoms, if they occur in family members that reside with the patient that is infected with h pylori or has stomach cancer, for them to be tested and the importance for their treatment as well.”

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See More from [ACT]IVATED Gastric Cancer

Related Resources:

How Does Gastric Cancer Screening Differ for High-Risk Groups?

 What Gastric Cancer Challenges Do Asian and Hispanic Groups Face?

 How Can Gastric Cancer Patients in Rural Areas Access Specialists?

Transcript:

Lisa:

Dr. Gong, what can be done on an individual and systemic level to address the elevated risk for gastric cancer in the Asian and Hispanic populations?

Dr. Jun Gong:

To address the elevated risks for gastric cancer in Asian and Hispanic populations, I think it’s very important to understand what are probably some of the universal risks to both groups. And here, there’s been growing evidence that H. pylori infection affects both Asians and Hispanics and is one of the more pivotal risk factors to address on a systematic level. Here, there have been ongoing research where they’re just identifying H. pylori as a procedure and eradicating it with treatment.

This is usually with antibiotic containing treatment for about two weeks. And this imposes what we call a primary prevention method if we can actually eradicate one of the primary causes of stomach cancer. Is this the best way to address the greatest risk factor on a systematic level for Asians and Hispanics and other ethnic groups at high risk? On an individual level, I think again, this comes to tailoring what the diagnosis is with the respect of ethnicity of the patient and their cultural and their background as well as their familial background. Here, H. pylori, dietary lifestyle, hereditary causes are important to address, to minimize risk for stomach cancer.

And it’s also important to know that on the individual level, that family members that are living with patients with stomach cancer may also have what we call H. pylori incidence around the entire family. So it’s important to advise that sometimes your family members, because of the close living facilities and the shared utilities and restroom and how we dine together, that this shares a familial risk. And oftentimes it may need to be that your family needs to be treated if H. pylori is detected within the family as well.

Lisa:

So if a patient comes in and their family members are concerned, would it be advised that maybe their family members can go see their primary care provider and say, “Hey, my family member has gastric cancer. Will you test me for H. pylori? Is that…would that be a valuable question to ask?

Dr. Jun Gong:

So I think that raises the big question about should we systematically test all high-risk subgroups for H. pylori? And I think the jury is still out on that. There has to be formalized guidelines. What I recommend is family members who are with another family member that’s diagnosed with H. pylori and/or stomach cancer, if they are having any concerning symptoms of H. pylori infection, this is usually abdominal discomfort. It can actually be gastritis type symptoms of acid reflux. If you have any of those symptoms, then those are certainly indications for you to be tested either at the primary care level for H. pylori.

My activation tip for the risk factors that are specific to the Asian and Hispanic populations is to understand the symptoms of H. pylori, which is one of the most common causes of stomach cancer, because they can be very effectively treated with antibiotics over a period of two weeks, oftentimes, and they’re very effective. This can be done at multiple provider levels from the primary care setting to the subspecialist setting. And also to know that symptoms, if they occur in family members that reside with the patient that is infected with h pylori or has stomach cancer, for them to be tested and the importance for their treatment as well.

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How Is Gastric Cancer Screening and Care Impacted by Culture?

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How Is Gastric Cancer Screening and Care Impacted by Culture? from Patient Empowerment Network on Vimeo. 

How can culture impact gastric cancer screening and care? Expert Dr. Jun Gong from Cedar-Sinai Medical Center discusses solutions for improving screening rates and patient advice for reducing barriers.

[ACT]IVATION Tip

“I think one of the most important things is always for providers to be culturally aware that certain ethnic groups may have certain preferences with how news is delivered, how news is handled, how treatment is decided upon.”

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What Early Phase Gastric Cancer Trials Are Showing Promise?

 Expert Guidance: Stomach Cancer Basics for Newly Diagnosed Patients

 Do Gastric Cancer Risk Factors Differ Among Hispanic Communities?

Do Gastric Cancer Risk Factors Differ Among Hispanic Communities?

Transcript:

Lisa:

Dr. Gong, how do cultural beliefs and practices impact the prevention, diagnosis, and treatment seeking behavior of individuals with stomach cancer? And how can healthcare providers better address the cultural barriers to care?

Dr. Jun Gong:

Cultural beliefs have a huge impact on access to care in stomach cancer, and I think we can do better with addressing cultural barriers to care. I think one of the innovations here at our center is that we have a center of community outreach and a disparities core here where we recognize that certain cultures and this can expand beyond Asians and Hispanics into all racial groups, that there’s a heavily…there’s an important influence of church in this sector here.

And so what we do is we actively engage leaders in the churches, in the local churches for Asians, Hispanics, and a lot of different other subgroups. And we find this a great, great relationship and partnership to have for promoting awareness and educating patients about resources that we have within a culturally specific location where patients and family members find a great deal of trust in the church.

And we also have other innovations as well. So this is more from…more of a day-to-day lifestyle from a clinical trial, a research perspective here at Cedars, we also have a designated specialist from a diversity and inclusion research group where we actually move along the disease groups from stomach cancer to colon cancer to other cancer types.

And we have this specialist sit in, usually in our weekly meetings. And whenever there is a new study, a new clinical trial, this diversity inclusion specialist will raise the question, what racial groups, ethnic groups will be of interest to hear? And how can we expand outreach and participation in these clinical trials? So these are some of the innovations that I think we can do to address cultural barriers to care.

Lisa:

Dr. Gong, do you have an activation tip?

Dr. Jun Gong:

So, my activation tip is that yes, there are growing and emerging concepts to address cultural barriers. I think one of the most important things is always for providers to be culturally aware that certain ethnic groups may have certain preferences with how news is delivered, how news is handled, how treatment is decided upon.

And additionally, I think it’s important for patients and providers to promote awareness and education in a setting where patients and family members are very comfortable with. This can be the church setting as we recognize the importance of this in the day-to-day lives of many patients and family members across multiple cultures.

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Are There Worldwide Links to Aggressive Prostate Cancer?

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Are There Worldwide Links to Aggressive Prostate Cancer? from Patient Empowerment Network on Vimeo.

Does aggressive prostate cancer occur more often in specific population groups? Expert Dr. Isaac Powell from Karmanos Cancer Institute discusses some regions with high prostate cancer incidence outside the U.S., the impact of inflammatory cytokines, and how screening recommendations may change.

See More from [ACT]IVATED Prostate Cancer

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How Can Advanced Prostate Cancer Care Barriers Be Overcome?

 How Can Prostate Cancer Disparity Gaps Be Overcome?

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How Can Advanced Prostate Cancer Disparities Be Reduced?

Transcript:

Lisa Hatfield:

So, Dr. Powell, worldwide are there factors that drive aggressive prostate cancer?

Dr. Isaac Powell:

Yes, let me address that. In 2015 it was reported that in Ghana, the incidence of prostate cancer was higher than in the United States. It’s also been found in the Caribbean, Jamaica specifically in Haiti, that the incidence in prostate cancer is greater than among African Americans in this country. So that takes us to the question of what is it about Africa that’s responsible for this aggressive cancer. And so I’ve been looking into that issue and finding that it’s not all Sub-Saharan Africa, it’s the West Africa. It’s consistent with the slave trade and what is it about West Africa and also Central Africa that is causing this. And I also found that in East Africa, the incidences of prostate cancer as well as breast cancer is less than West Africa. So what now we’re talking about the environment. What is it about the environment of West Africa versus East Africa. And the environment is in West Africa considered a rainforest and in East Africa is considered a different environment. 

The diseases are different. In West Africa, you have such disease as a malaria and yellow fever, acute inflammatory diseases, West Africa, I mean East Africa, you don’t have that you have other things. So it’s the environment of West Africa, the rainforest specifically that causes those particular diseases. Now the genetics is, in those poor inflammatory cytokines that we’ve discussed that causes prostate cancer and, in fact, other benign diseases to be more progressive, protect against these acute infections. So this is…the immune system is very complex. In some cases it protects, in some cases it drives the cancers. This is what is…therefore, cancer is what is called an autoimmune disease. And so what the protection does, it selects the population in West Africa. The population that’s selected, because people don’t die from malaria because of these high expressions of poor inflammatory cytokines but, they do then die from chronic diseases such as cancer because those same genes drive the cancers.

 Now, the worldwide scientific organizations have shown a map of West Africa and Central Africa where malaria is very high. That same map shows that prostate cancer is more aggressive in that same area where malaria causes diseases. So the environment has a significant impact on the genome. The environment specifically impacts what I mentioned earlier, the oxidative stress, which is activated by reactive oxygen species. The reactive oxygen species is what is called an unpaired electron which makes it inactive and want…and therefore interacts with various environmental factors. These environmental factors also will activate through RNA methylation. Those two factors are the part of the genome that interacts with the environment, and those two factors interact with pro-inflammatory cytokines. So there is a triangle there that interacts or interplays during cancer and other diseases, and that’s where the environment impacts on the genome causing more cancers in particular populations.

Now, in terms of European Americans, there’s a difference between the Northern European genome gene pools and Southern European gene pools and prostate cancer. And Northern Europe prostate cancer is more aggressive compared to Southern Europe. So it’s not just among people of color. In fact, the color makes very little difference in whether you have an aggressive cancer, particularly in Sub-Saharan West Africa as well as in European. So I just wanted to make that point. And not many people are talking about this, because this is what is called population genetics. Epigenetic, transgenerational, hereditary genetics, those genes are transferred through populations over generations. So that’s what I’ve been learning more recently and there needs to be more discussion about population genetics. We know about familial hereditary, but this is different. This is population hereditary genetics.

Lisa Hatfield:

That is so interesting. So do you think over time there will be recommendations for…I think it depends too on funding for it, but for screening in certain areas of the world for prostate cancer or for any type of cancer where they have found this to be the case?

Dr. Isaac Powell:

Absolutely. That’s going to be a little while, but that I think should happen, yes.

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How Can Advanced Prostate Cancer Disparities Be Reduced?

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How Can Advanced Prostate Cancer Disparities Be Reduced? from Patient Empowerment Network on Vimeo.

What are some ways that advanced prostate cancer disparities can be reduced? Expert Dr. Isaac Powell from Karmanos Cancer Institute discusses early detection, recommended screening ages for African Americans versus European Americans, and how some government agencies can aid in reducing disparities.

See More from [ACT]IVATED Prostate Cancer

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Are There Worldwide Links to Aggressive Prostate Cancer?

 Advanced Prostate Cancer Outcomes: Addressing Disparities and Exploring Solutions

Advanced Prostate Cancer Outcomes: Addressing Disparities and Exploring Solutions

 Do Prostate Cancer Genetics Differ in African Americans?

Do Prostate Cancer Genetics Differ in African Americans?

Transcript:

Lisa Hatfield:

So, Dr. Powell, in your work, have you come across any innovative approaches or interventions that have shown promise in reducing racial disparities and improving outcomes for patients with advanced prostate cancer?

Dr. Isaac Powell:

Yes. Number one, educating the community about prostate cancer. Early detection is extremely important. I tell them that they should get their PSAs and digital rectal exams. I also tell them again, about obesity and exercise, how important it is to do that because it may prevent prostate cancer. And in terms of advanced disease, to just try to do the best they can and prolong in the survival by participating in clinical trials. And so I do quite a bit of educating in the African American community. In fact, in the ‘90s, we went to 51 churches, African American churches to talk about the prostate cancer and we also did testing. And what we learned in the ‘90s that mistrust factor was a major factor that prevented men from going in to be tested.

We also learned that men really don’t take care of their bodies as they should, and women have played a major role in the healthcare of men. So we start educating women about prostate cancer and encouraging their husbands to come in for examination, and very frequently, the wives have to bring their husbands in for testing or insist that they do that. I have this statement, I have a slide that says, men, they better care of their cars than they do of their bodies. And, in fact, they deny that they have any symptoms, and when they do, they don’t do anything about it until it’s too late.

Lisa Hatfield:

I have one follow-up question to that too, so you mentioned screenings, and I looked up prior to talking with you just to see what the general guidelines are for screenings for men, for prostate cancer, and it seems like they run the gamut. Do you have recommendations, or do you think the recommendations will change guidelines for screening and given your data and your research, is there a difference in screenings between European Americans versus African Americans?

Dr. Isaac Powell:

Yes. Because of what I’ve been talking about the cancer grows faster, and the significant cancers, the ones that are growing faster and become metastasized began in the 40s in African Americans, and so for European Americans has been recommended testing at age 50. I recommend age 40, American Cancer Society recommends age 45. Now, I believe at age 40, and I tell my patients that’s when they should start, African Americans that is, start testing for prostate cancer, specifically the PSA and digital rectal exam, and particularly if they have a family history. Now, the family history, if they only have one or two members is not much different than the aggressiveness among African Americans or European Americans.

If they have five or six members, not just a prostate cancer, but breast cancers as well, that means that they have a strong family history for having prostate cancer. If they have breast cancer, ovarian cancer in their family, or colon cancer, lung cancer, all those cancers are responsible for having a cancer and any specific cancer, if you have prostate cancer, breast cancer, you’re at risk for having colon cancer, for example. So that’s more recently talked about, multiple cancers in the family are even more important than having just prostate cancer in your family.

Lisa Hatfield:

Dr. Powell, given your expertise, what policy changes or healthcare system reforms do you believe are necessary to tackle the racial disparities in advanced prostate cancer care on a broader scale?

Dr. Isaac Powell:

Yes, policies are made by the government essentially. And so you have to encourage CDC, Centers Disease Control, US Preventive Services, which has done a disservice and prostate cancer. In fact, in 2012 they had that PSA did not show any evidence of preventing death from prostate cancer. They rescinded that 2017 recognizing that their recommendation 2012 was incorrect, and so US Preventive Services and the CDC, as well as the National Institute of Health NIH, have to come together and say, this disease is not only prostate but breast cancer, triple-negative breast cancer, colon cancer, lung cancer, all of these are more aggressive among African Americans, and we have to make a statement that screening has to be done earlier, education has to be emphasized.

And, in fact, COVID testing, it was almost mandatory on the circumstances that that happened. We used to demand that syphilis tests be tested if you got married. The government can also make it mandatory to be tested if your age, 45, American 50 for prostate cancer and maybe other cancers as well. So the government has to play a major role in establishing policies for testing, and I think that that would be very helpful in eliminating the disparity. 

Lisa Hatifield:

And then from the patient perspective, it sounds like, and just trying to clarify this to when you talk about screenings for a patient to get screened to the appropriate time, that includes both the PSA test and the digital rectal exam, is that correct?

Dr. Isaac Powell: 

Absolutely.

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How Can Advanced Prostate Cancer Care Barriers Be Overcome?

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How Can Advanced Prostate Cancer Care Barriers Be Overcome? from Patient Empowerment Network on Vimeo.

How can barriers to advanced prostate cancer care be overcome? Expert Dr. Isaac Powell from Karmanos Cancer Institute discusses medical mistrust in the African American community and advice he gives to patients about prostate cancer screening and prevention.

See More from [ACT]IVATED Prostate Cancer

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Advanced Prostate Cancer Outcomes: Addressing Disparities and Exploring Solutions

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 Are There Worldwide Links to Aggressive Prostate Cancer?

Are There Worldwide Links to Aggressive Prostate Cancer?

Transcript:

Lisa Hatfield:

Are there any challenges unique to minority communities that hinder access to advanced prostate cancer treatments and therapies? And do you have thoughts on how these barriers can be effectively addressed?

Dr. Isaac Powell:

I do. First of all, the diagnosis has to be made. And so that’s made by screening, by the PSA testing and digital rectal exams. Now, some people are talking about, well, we don’t need to do the digital rectal exam. That absolutely is not true. You can have a very aggressive cancer and have a normal PSA. We know that the PSA is not 100 percent accurate in diagnosing, predicting that you may have prostate cancer sometimes.

And I’ve had several patients who had normal PSAs, abnormal rectal exams, and as a result, I’m biased with them. If you don’t do the rectal exam and you have a normal PSA, you may miss aggressive cancers. So definitely have your usual rectal exam, excuse me. And once after that, if you have a biopsy, and if it is positive, then again I think that aggressive therapy is the way to go, if you’re in good shape.

Now, people are afraid of cancer. I mean, afraid of surgery. I’ve had surgery, so I can talk to them about what I’ve had and what you go through. Men are also concerned about losing their sexual function and those kinds of things related to the treatment of prostate cancer. And I can tell them that the quality of life is okay after that because we have ways of treating sexual dysfunction, the pill that everybody knows about, as well as injection and penis and ultimately the penile prosthesis. So that can be fixed.

And the other issue of losing control of the urine, that can be fixed as well. And so those are the things I tell people about not specifically among African Americans. There’s the genetic and the biology that I have to discuss, but one of the things that drives these genetic cells is obesity.

Obesity can produce these pro-inflammatory cytokines. So I always advise them to, if they are obese, to reduce their weight and their fat, particularly belly fat. That’s challenging because people have difficulty losing weight. The other thing is exercise. Exercise is a key that I think it is the most important factor in treating many health conditions, exercise. And what exercise does, and this has been studied in breast cancer, it decreases the expression of the genes that I described earlier. In terms of prior driving the cancer and breast cancer, they’ve found it decreases the pro-inflammatory cytokines. I described the tumor necrosis factors IL-6 and IL-8. So that’s important, exercise. So those are the things that I tell patients. And now in terms of advanced disease there are clinical trials that are there.

And we do these trials to decide what’s the best treatment for cancer, even though we don’t have “a cure.” Now, the problem among African Americans is that they don’t trust these clinical trials because of the abuse that African Americans have suffered through slavery and all the other kinds of things when they’ve been treated as less than human, like animals being operated on without having any anesthesia and many other abuses that have occurred. And so there’s this major distrust now that’s very difficult to eliminate in the Black community, especially if there are very few African American doctors to take care of them. So what I think that we have to fix that question of distrust, and that’s going to take a while, but I talk to them always about this mistrust issue, because I can’t see everybody, although we do need more African American doctors and nurses to take care of them and to encourage them to participate in clinical trials and to be seen as a person who is going to be taking care of them in clinical trials, that’s very important.

Often we talk about access to care, but particularly African Americans that mostly live in large cities where there is access to care. But, in terms of one particular example that’s brought up on occasion is what has occurred in Baltimore and other big cities where I talk to an African American, you know Johns Hopkins is right in the middle of the African American community. So it’s not about access again, it’s about mistrust. And I said, “Well, why don’t African Americans go to Johns Hopkins?” Well, she says, “If you walk past Johns Hopkins, they may steal your bodies.” I said, what? I didn’t believe that, but I’ve been reading literature, particularly one called the Medical Apartheid where they talked about African slavery, where they dug up the bodies of slaves to practice the anatomy.

And so that’s where this idea occurred. At night, they would dig up the bodies and do this, and not only in Baltimore, but other cities as well. So again, the mistrust issue is very difficult to resolve because of those issues. And people talk about that, well, I just don’t trust the white healthcare system, period. And don’t want to go until they’re having symptoms, and then they have no choice. They have to go. And by this time, the cancers are more advanced and cannot even prolong life expectancy in those particular patients. So I’m not sure I answered your question in terms of what a person or what I would do to activate participation in the healthcare of advanced disease.

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Do Prostate Cancer Genetics Differ in African Americans?

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Do Prostate Cancer Genetics Differ in African Americans? from Patient Empowerment Network on Vimeo.

Do the genetics of prostate cancer vary in African Americans? Expert Dr. Isaac Powell from Karmanos Cancer Institute discusses what research has shown about gene expression and what occurs in the body in African Americans versus European Americans.

[ACT]IVATION TIP

“…patients need to take charge by asking questions about the therapy. Again, ‘is it going to cure me, and is the chemotherapy going to cure, immunotherapy going to cure? If not, how long do we think that I will live?’ That’s a good question, that I’d like to know if I were a patient.”

See More from [ACT]IVATED Prostate Cancer

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How Can Advanced Prostate Cancer Disparities Be Reduced?

 How Can Prostate Cancer Disparity Gaps Be Overcome?

How Can Prostate Cancer Disparity Gaps Be Overcome?

 Advanced Prostate Cancer Outcomes: Addressing Disparities and Exploring Solutions

Advanced Prostate Cancer Outcomes: Addressing Disparities and Exploring Solutions

Transcript:

Lisa Hatfield:

So, Dr. Powell, I just read a bit about your really impressive research, particularly with regard to the biology and genetics of prostate cancer. Can you provide an overview of your research focus on how prostate cancer impacts African Americans in comparison to other ethnic groups?

Dr. Isaac Powell:

Yes, I would certainly love to do that. In 2010, we found that the cancer grows faster among African Americans compared to European Americans. And those are the terms we use now, as opposed to Black and white. In science, we use those terms. And so at that point, I thought that this may be driven by the genetics and biology. So in 2013, we used what now has been considered the artificial intelligence.

We use bioinformatics, which is computational biology, and gene interactive and network analysis to evaluate the cancer tissue. And so at that point, we identified, and we asked the question, are there genetic differences between African Americans and European Americans? And what they found were driver genes, driver genes being the genes that drive the cancer, that make the cancers carry out a function, a mechanistic function, as opposed to passenger genes that are just associated with the cancer, just as in a car, the driver is the one that controls the car, the passenger sits there. These passenger genes, yes, they’re associated with aggressive cancer, but they have minimal or no function. The driver genes are the ones that are controlling the cancer, the function mechanism of the cancer progression. And so we identified in our analysis 21 genes that were different between African Americans compared to European Americans, different in terms of the expression of the disease, not different genes, but different expression of the genes.

What we found is that African Americans have a greater expression of inflammatory genes and transcript genes. And I’ll be more specific about that in a moment. Whereas European Americans had a higher expression of lipid metabolism genes. Those are genes that are associated with fatty acids as well as unsaturated fatty acids, specifically omega-6 as opposed to omega-3. But there is a connection between these two gene interactions at one particular molecule called tumor necrosis factor. And this gene then interacts with both the lipid metabolism genes as well as other inflammatory cytokines. And the genes that we found that were more specific in among the inflammatory genes were the pro-inflammatory cytokines, and those were IL-6 tumor necrosis factor, IL-8, and IL-1B as well as CXCR4.

These are what are called pro-inflammatory cytokines and chemokines. And they carry out functions that cause the cancers to invade. First of all, the cancer initial is cancer cells are stuck together. We call them adherent. They have to come apart before they can spread and go elsewhere. Well, these genes cause that it’s called epithelial mesenchymal transition. And once that happens, they’re capable of being transferred to distant sites such as the bone. And they also cause increased blood flow to the cancer. They also cause the oxidative stress that is driven by a molecule called reactive oxygen species.

And we’ll come back to that particular molecule because that’s important. Once it causes the oxidative stress, this causes DNA damaged repair genes to develop as well as mismatch genes. This mismatch means there are gene molecules that are stuck together, and there is an order. This order is upset by this particular oxidative stress, and those are mutated once they are repaired, and they impact on the mitochondria, which is a molecule in the cell nucleus that controls the chemistry of the cell.

And then this activates cancer stem cells, which is really important. And this is where we are going now with the cancer research. So TNF, the tumor necrosis factor IL-6 and IL-8, and the IL means interleukins. That’s what that stands for. They activate that pathway, the oxidative stress pathway. They also individually activate other pathways that lead to cancer stem cells. And I mentioned cancer stem cells because that’s the reason why chemotherapy and immunotherapy and all the drugs that we’ve used don’t work because the cancer stem cells undergo mutations and these mutations change the character of the cell. 

And that’s why the cancer cells resist that after a certain period of time, now these drugs will work and prolong survival, but they do not cure them because of the cancer stem cells. And so the cancer stem cells, in summary, are driven initially by the pro-inflammatory cytokines. So my research currently is to, well, how do we inhibit these pro-inflammatory cytokines? And that’s where we are now trying to develop a drug. We’re at the stage of mouse at this time, mouse biology and testing the drug in mice, not ready yet for human testing. So that’s where my research is headed, and I believe that that is going to work if the drug works.

Lisa Hatfield:

So just a follow-up question to that is, as a if I were a patient of yours or a family member, I might ask, so with your findings, do you think that this could lead to a cure, for example, for advanced prostate cancer?

Dr. Isaac Powell:

Yeah. I hate to use the word cure. The word I use is that we, our goal is to eliminate death from prostate cancer. That’s the term I prefer, because when we talk about cure, we have to know what causes it in order to really be certain as we are curing it. Because I don’t know whether what we’re doing is going to eliminate death, but that’s our goal. So I don’t like to use the word cure, because that’s the magic word and everybody gets excited. So I don’t want to get people excited too soon. So that’s where I am with my research.

Lisa Hatfield:

Well thank you so much for that. And do you have an activation tip for patients for this question, Dr. Powell?

Dr. Isaac Powell:

Yes. I think that, again, patients need to take charge by asking questions about the therapy. Again, is it going to cure me, and is the chemotherapy going to cure, immunotherapy going to cure? If not, how long do we think that I will live? That’s a good question, that I’d like to know if I were a patient. In fact, I’ve had prostate cancer and bladder cancer, so mine was early, so we didn’t get into those kinds of questions. But I like to know whether is this going to be something soon or later? Nobody can tell you when you may pass away from any cancer. I never give a patient any time. If they ask me, “Well, am I going to live six months or three years?” I don’t know. Because everybody’s different. Everybody responds differently to these particular treatments. So, but ask the questions as specific as possible that you’d like to know about the treatments, because there are several treatments, and there may be many answers.

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Graft-Versus-Host Disease Risk for BIPOC Patients

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Graft-Versus-Host Disease Risk for BIPOC Patients from Patient Empowerment Network on Vimeo.

Is there a higher graft-versus-host disease risk for some BIPOC patients? Expert Dr. Idoroenyi Amanam from City of Hope explains bone marrow transplant challenges for African American and Hispanic patients and where research stands on improving transplant outcomes.

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Transcript:

Lisa Hatfield:

Do certain populations have a higher risk of graft-versus-host disease after stem cell transplantation?

Dr. Indoroenyi Amanam:

Yes. So, we do know that there are differences in outcomes for African Americans and Hispanics compared to whites after transplant. And we think aside from just the fact that African Americans and Hispanics have a lower chance of having full matched donors, there are other genetic variations that we can’t account for currently that may explain the reasons why they have poor outcomes post-transplant. And one of those issues is related to graft-versus-host disease.

And so, we do know that if you have a donor who’s not a complete match, you have a higher risk of having graft-versus-host disease. And we also know that if you’re an African American and Hispanic, you also have higher risk for graft-versus-host disease. And so I think there’s still a lot of work to be done for us to really understand, one, why that’s the case. 

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Are There Disparities in Stem Cell Transplant Outcomes?

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Are There Disparities in Stem Cell Transplant Outcomes? from Patient Empowerment Network on Vimeo.

What do myeloproliferative neoplasm (MPN) patients need to know about disparities in stem cell transplant outcomes? Expert Dr. Idoroenyi Amanam from City of Hope explains key factors that impact the outcomes of stem cell transplants and the importance of finding fully matched donors.

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Transcript:

Lisa Hatfield:

Dr. Amanam, does race or ethnicity play a role in outcomes of stem cell transplantation?

Dr. Indoroenyi Amanam:

Yes. There have been some really great studies looking at this. And I think in general, we know that health disparities are a major issue for racial, ethnic, and socioeconomic disadvantaged groups. Stem cell transplant is a curative therapy for blood disorders. And we’ve looked at a variety of different, there have been multiple approaches to assess like where these disparities come from or if there are disparities from specific groups. And I think the Affordable Care Act was great in allowing expansion and insurance coverage to multiple groups and increased access to care. But that hasn’t solved the problem.

And so, one of the issues we’ve seen is that providers themselves do not refer patients proportionately. So from proportion if you’re African American, Hispanic, if you are coming from a ZIP code that your meaning income is lower, that there are some instances where referrals for transplant don’t occur in equal rates.

And we’ve also seen that even if you’re insured and you’re African American or Hispanic, referral rates are still lower. And so that’s something that, it’s something that we have to work to improve. And you know, one big thing for transplant is that you have to have donors. You have to have donors who are matches for these patients who have these disorders who need a transplant. And we do know that African Americans, Hispanics, and Asians have lower chances of finding a fully matched donor compared to white Americans. And so, why that’s really important is that when you look at rates of complications after transplant, we do know that the level of match of the donor does play a part in that. Namely the chances of the patient relapsing after the bone marrow transplant and the rates of graft-versus-host disease are significantly higher.

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