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Since well before the horrific Tuskegee Experiment, Black patients have had a complicated relationship with health care systems, steeped in generational mistrust and compounded by personal experience. The “father of modern gynecology” perfected gynecologic techniques on enslaved women—without consent or anesthesia.
The COVID-19 pandemic magnified health inequity while we watched the daily statistics of the virus on television. Live data showed people of color were at higher risk of getting sick and dying than white people.
Unfortunately, recent research shows that the same may be true for women of color with gynecologic cancer. Data presented by MedStar Health investigators at the Society of Gynecologic Oncology 2022 Annual Meeting on Women’s Cancer showed that race-based factors cause treatment interruptions for women of color with gynecologic cancer, increasing the risk of serious complications, including death.
The complex reasons why disparities still occur run deep. Black and brown patients encounter fewer clinicians with similar faces as theirs. Fewer than 5% of U.S. doctors identify as Black or African-American and fewer than 9% as Hispanic or Latino. Additional stressors such as insufficient food, housing, transportation, or mental health care disproportionately impact communities of color, compounding inequity for some patients.
MedStar Health Research Institute is collaborating with centers across the country to establish screening guidelines we hope will help improve patient care and the provision of resources throughout the clinical experience and beyond.
The goal of this national initiative is to identify inequities early in care and connect patients of color with expertise and resources to prevent treatment gaps—and deliver a standard of care that is equal to that which white patients receive. It is one example of our team’s work to examine how we (and all providers) can better deliver care to our patients.
Race and Racism Interrupt Care.
The team of investigators from MedStar Health and Georgetown University screened 200 women and surveyed 72 women undergoing treatment for gynecologic cancers, such as cervical, endometrial, or uterine cancer.
Via paper or electronic forms, participants submitted a brief health history and completed the Index of Race-Related Stress-Brief Questionnaire (IRRS-B), one of the most commonly used tools to measure race-related stressors. The IRRS-B is “designed to capture stress associated with common, day to day racial hassles experienced by Black Americans.”
The survey conveyed questions that stemmed around cultural, institutional, and individual racism experienced in the patient population. An example of a question in the IRRS-B survey was: “You were refused at an apartment or other housing; do you suspect it was because you were Black?.”
When the data was analyzed, there were higher levels of race-related stressors for Black patients. Stress levels were higher still among Black patients whose cancer treatment was interrupted.
Among women whose treatment was interrupted, there was a significant correlation between high levels of stress and length of interruption. The experience of racism was also associated with women waiting longer to begin cancer treatment. Anecdotally, some patients concerns have been dismissed by other doctors or who have delayed care until they could be seen by a Black practitioner.
Building the Evidence Base for Solutions.
This small study has shown important results, but more data is needed to support the equity work. Expanding clinical study access is an important next step to have more diverse women involved. Women of color are historically misrepresented in gynecologic cancer clinical trials.
MedStar Health Research Institute is advocating to host leading-edge studies here in D.C. so our diverse patient population can access breakthrough treatments. One such trial set to begin here soon, AFT-50 EndoMAP, could be transformational for DC women with endometrial cancer. Endometrial cancer is the most common gynecologic cancer, and Black women have five-year mortality risk 90% higher than white women. Patients interested in clinical trials should talk with your doctor to find out if they are eligible.
