Tag Archive for: Black

Overcoming Thyroid Cancer Care Barriers

Overcoming Thyroid Cancer Care Barriers from Patient Empowerment Network on Vimeo.

What are some thyroid cancer barriers to care and treatment? Expert Dr. Megan Haymart from the University of Michigan discusses obstacles that disadvantaged patients may encounter and  proactive patient advice to help ensure their best care. 

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“…ask your surgeon, how many operations have you done within the past year? High volume surgeons typically do 25 or more. And so I think that’s really important because you’re going to have a lower risk of complications. And so I would encourage all patients to speak up and to make sure they ask these questions.”

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Thyroid Cancer Explained: Types, Staging, and Patient Communication

Thyroid Cancer Explained: Types, Staging, and Patient Communication

Is There a Gender Disparity in Thyroid Cancer?

Is There a Gender Disparity in Thyroid Cancer?

Understanding Thyroid Cancer Treatment Options and Follow-Up Care

Understanding Thyroid Cancer Treatment Options and Follow-Up Care

Transcript:

Lisa Hatfield:

Dr. Haymart, what are the current barriers that disadvantaged patient populations face in receiving a timely diagnosis and, even more important, treatment of their thyroid cancer?

Dr. Megan Haymart:

So there are disparities in the care of thyroid cancer patients from diagnosis to treatment and even survivorship. For diagnosis, we know that there are certain groups that are at higher risk for presenting with advanced stage disease, so especially minority populations, Black and Hispanic. We don’t know why that is. We don’t fully know why that is at least, but my activation tip for diagnosis would be that if you feel a lump in your neck that doesn’t go away after a few weeks, especially lower in your neck, talk to your doctor.

We also see disparities in treatment. And I think we know a little bit more about why those occur. So there’s been recent data by Dr. Chen, who works with my group, who found that when patients call to get into the clinic, if they don’t speak English as their primary language, if they speak Spanish or Mandarin, they may have difficulty getting into the clinic for a visit. And so we think there are language barriers that occur.

We also know that there’s differences in treatment based on what doctors patients are seeing. So if patients are seeing low volume surgeons who don’t do a lot of operations, they may not get the best treatment for them, which could lead to downstream consequences, including increased risk of recurrence or complications from the surgery itself.

And so my activation tip for this question is that if English is not your primary language and if you run into obstacles scheduling an appointment, if you have any family members or friends that speak English that you can pull in to help you, I think that’d be important. Hopefully, eventually the system will be better where that’s no longer an obstacle, but for now I think that’s important to know.

And then my other activation tip for this question is, you want to make sure you know who your surgeon is in regards to if they’re a high or low volume surgeon. That’s extremely tricky to know, even for me as a physician. I know thyroid cancer because I do thyroid cancer, but if you asked me about GI cancer, I wouldn’t know. And so you have to ask your surgeon, how many operations have you done within the past year? High volume surgeons typically do 25 or more. And so I think that’s really important because you’re going to have a lower risk of complications. And so I would encourage all patients to speak up and to make sure they ask these questions.

Lisa Hatfield:

Okay, thank you. Would it be appropriate for a patient to ask specifically how many of those surgeries that physician has done every year?

Dr. Megan Haymart:

Yeah, it’s totally appropriate to ask because you can’t find that information on the web. So unless you have a doctor colleague or a friend who knows thyroid well, and knows who those high volume surgeons are, they might be able to identify them. But otherwise, if you’re just referred to your local surgeon, I think it’s very appropriate to ask them, how many surgeries have you done in the past year? What are some of the complications that might happen? How often do you see that in your patient setting? I think those would be very appropriate questions.

Novel AML Therapy Use | Impact of Socioeconomic Status and Other Factors

Novel AML Therapy Use | Impact of Socioeconomic Status and Other Factors from Patient Empowerment Network on Vimeo.

How do socioeconomic status and other factors impact novel acute myeloid leukemia (AML) therapy use? Expert Dr. Andrew Hantel from Dana-Farber Cancer Institute and Harvard Medical School  discusses major factors that impact novel AML therapy use, solutions to decrease the disparities in novel therapy use, and support resources for patients.

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“…for patients who are newly diagnosed and considering different treatment options that may be available to them to say working with both your clinical team and looking outside the clinical team to other well-known support services like Leukemia & Lymphoma Society to see if there are additional financial and other resources that can be obtained in order for you to be able to avail yourself of any treatment option that’s available, would be very helpful.”

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How Bone Marrow Biopsies Impact Acute Myeloid Leukemia Treatment and Care

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Do AML Bone Marrow Biopsies Show Racial and Ethnic Variances?

Why Is Shared Decision-Making Important for AML Patients?

Why Is Shared Decision-Making Important for AML Patients?

Transcript: 

Lisa Hatfield:

Dr. Hantel, in your study focusing on sociodemographic associations with uptake of novel therapies for AML, can you describe those findings and what they might mean for patients from diverse backgrounds, particularly those with lower socioeconomic status?

Dr. Andrew Hantel:

So in our study of sociodemographic associations with the uptake of novel therapies for AML, we found that patients from diverse backgrounds, particularly those with lower socioeconomic status and those who identified as Black, Asian, or other in this case, non-Hispanic minoritized groups actually face disparities in accessing some of the new treatments that we have for AML. And we know that there are a number of new treatments for this disease, but that many of these treatments are more expensive and are given as outpatients.

And in these cases, this can be great, because it allows people to not have to remain in the hospital like some of our old therapies, but also means that really this is putting more of the like logistical burden on families and on patients. Meaning you have somebody who’s potentially more sick at home rather than in the hospital where there’s nursing and a lot of other caregivers that isn’t on the caregiver at home.

And then we also have the increased burden of actually bringing the person back and forth to the hospital, taking more time off work, and all of the money also that’s involved in that. And so this can translate into some disparities by socioeconomic status, which means that people with less means are less likely to get these medications. And these same groups are also less likely to be seen in practices where these newer drugs are likely to get prescribed.

And so together, some of the study findings that we saw were more that these drugs were being less taken up by people with those backgrounds and by practices that see those patients. And in the end, we know that these novel therapies are being approved, because they offer something new, either that’s better or that expands the treatments to newer groups who are unlikely to have as great options before.

And so we want to really provide these treatments to everybody who’s eligible for them. And we shouldn’t think that that eligibility requires really different amounts of money, or different types of personal characteristics could be equitably available to everybody.

And addressing these disparities kind of involves a very complex set of considerations, such as making sure that patients who are stable enough to do so they can go see AML specialists and consider more of these novel therapies that all patients are educated about, their treatment options and the logistics of different treatment choices and that they’re provided with all the avenues of support available to them.

Some of these can be through societies like The Leukemia & Lymphoma Society, which can connect patients with a variety of support services, including more informational services as well as direct financial support to be able to either obtain these drugs or work with companies and other places to figure out how to maintain or how to obtain these drugs.

So my activation tip for this question would be for patients who are newly diagnosed and considering different treatment options that may be available to them to say working with both your clinical team and looking outside the clinical team to other well-known support services like Leukemia & Lymphoma Society to see if there are additional financial and other resources that can be obtained in order for you to be able to avail yourself of any treatment option that’s available, would be very helpful.

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Addressing Disparities in Gynecologic Oncology | Key Challenges and Solutions

Addressing Disparities in Gynecologic Oncology | Key Challenges and Solutions from Patient Empowerment Network on Vimeo.

What are key challenges and solutions to gynecologic oncology research disparities? Expert Dr. Charlotte Gamble from MedStar Health shares specific factors that show up in research disparities and proactive advice to healthcare providers and researchers to help close the disparity gaps.

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“…for healthcare providers and researchers, is that we have to think about action and what, the evidence-based strategies are to help directly affect the disparate outcomes we see in America for our patients with cancers and to center patients and their concerns within these research questions.”

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Navigating Advanced Endometrial Cancer | Treatment, Prognosis, and Lifestyle Strategies

Navigating Advanced Endometrial Cancer | Treatment, Prognosis, and Lifestyle Strategies

How Is Gynecological Cancer Care Impacted by Social Determinants of Health?

How Is Gynecological Cancer Care Impacted by Social Determinants of Health?

How Can Gynecologic Oncology Racial Disparities Be Addressed

How Can Gynecologic Oncology Racial Disparities Be Addressed

Transcript:

Lisa Hatfield:

Dr. Gamble, what are the key challenges regarding the current paradigm of disparities research and gynecologic oncology, and what steps are proposed to overcome these challenges? And what is the role of the patient? 

Dr. Charlotte Gamble:

I love this question. This is such a great question because this is like my happy space and where I live, when I’m not taking care of patients directly and kind of where my research interests lie. So to take each question, each question, each part of this question, what are the key challenges regarding the current paradigm of what’s called disparities research? So I think a couple of challenges. One, historically disparities research just meant like looking and seeing what these patient outcomes were and who lived longer and, oh, no, it looks like Black patients are not living as long as white patients, and it looks like poor patients aren’t living as long as rich patients.

And it looks like patients who are living rurally don’t live as long as patients who live in the cities. And so just finding differences and seeing kind of how, again, this critical race practice and how the systems and structures in the United States have contributed or might contribute to these differences that we’re seeing, has classically and historically been easy low hanging fruit.

You look at these large cancer databases, you look at the SEER database, the National Cancer database as well, and can get, pull all these statistics and come up with pretty graphs that just show really wide disparities in Black versus white and versus Hispanic versus non-Hispanic and just say, hey, there are differences and people who are historically marginalized or vulnerable just don’t do as well, which is, okay, fine and good and maybe necessary to have that data to know where we’re starting from. But a challenging in that is that just shows some associations. There is not necessarily causation. There is no attempt to fix the system. It’s merely just stating these are where, this is where we’re at. And at this point, frankly, in 2024 and honestly for the past 15 to 20 years, it’s not anything new. It’s nothing that’s surprising.

 Like these have been trends that have been pretty ingrained in this social system and healthcare system that we have in the United States. And so doing kind of disparities that just discusses these differences is a little bit outdated at this point. I think, to answer the second part of that question, what are steps proposed to overcome these challenges? Really moving into, okay, so these differences are there, what are we going to do? So what are these solutions? What are the evidence-based solutions to these differences in how we overcome? So that spans anything from looking at sometimes the molecular tumor makeup that might be different based on ancestry or maybe based on exposure to racism. How does exposure to racism and or stress and over a lifetime influence cancer biology?

If someone has been minoritized and has been exposed to stress because of this for their entire lives, does that change their cancer risk or change the type of cancer they have or change how when they are diagnosed with cancer, how they respond to treatment. None of this has really been very aggressively studied within the gynecologic cancer space.  Some of this within the breast cancer space has been looked at, but not very much with the gynecologic cancers.

But then also importantly in this space that I love to live in is, okay, so like, how are we going to overcome the barriers that we discussed earlier? How do we get patients into the healthcare system a little bit earlier when they have abnormal symptoms? How do we get them to a subspecialist if they have transportation barriers, insurance barriers, health system barriers, and how do we actually address what we already know is the problem if they face delays in care, how do we shorten those intervals so they get timely care? And those are harder questions.

It’s harder to publish, it’s harder to get these studies done. They’re really messy. And I think that, there’s a lot of need to actually look at how the system is working or not working for patients and actually doing evidence-based strategies that we know, ie for example, care navigation to help improve the timeliness of care that patients receive.

To answer, and this dovetails well into the third part of the question, which is what is the role of the patient? This is critical because as we start thinking about actually designing interventions to work or to address these barriers, to care, to influence disparities and outcomes, of, patients with these cancers, patients are the center of what we do, and they have to be the center of the research, and they cannot be consulted on the back end after someone has come up with a very pretty project that sounds really nice and like can get funded easily.

 They have to be at the center at the start of the project. And so I think it’s really important to center voices of patients in designing research protocols, center them in designing clinical trials, center them in designing community-based outreach programs. This has to, not only come from patients, but feel like it is a patient almost run program. And, I think Kemi Doll really in the gynecologic cancer space, has, been a fierce advocate for, including patients and centering patients and, having patients lead as opposed to follow, as opposed to being adjacent to the project, but being really central to it and to its functioning.

And so when we think about the interventions, when we think about the research questions that are yet unanswered, oftentimes these answers as well as the, logistics of how to get these programs done lies within patients, their communities, their loved ones themselves, and failure to involve them early in the process is a failure of the research project in general. I think my activation to this question is actually for healthcare providers and researchers, is that we have to think about action and what, the evidence-based strategies are to help directly affect the disparate outcomes we see in America for our patients with cancers and to center patients and their concerns within these research questions.


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