By embracing diversity, equity, and inclusion (DEI), oncology practices can work toward better patient outcomes and a more effective health-care system, according to Richard L. Martin III, MD, MPH, Medical Director of Health Equity and Community Engagement at Tennessee Oncology. At the 2023 Community Oncology Alliance Annual Meeting, Dr. Martin delivered a thought-provoking presentation about the importance of prioritizing community engagement, equity, and addressing social determinants of health in both clinical care and research.1
Richard L. Martin III, MD, MPH
“By incorporating DEI into community oncology practice, we can develop better treatments, improve patient outcomes, and promote health equity in our communities,” said Dr. Martin. “This requires a sustained commitment to understanding and addressing the unique needs of diverse patient populations and collaborating with community organizations and leaders to create a more inclusive, effective health-care system.”
Inclusive Research and Personalized Treatment
According to Dr. Martin, one of the significant challenges faced by minority patients is underrepresentation in clinical trials and a lack of tailored screening guidelines. Dr. Martin provided several anecdotes to illustrate these issues. For instance, a 63-year-old Black female patient with lung adenocarcinoma could not receive clear guidance on immunotherapy because of the underrepresentation of non-White minorities in clinical trials. Similarly, a 43-year-old Black male diagnosed with colon cancer faced outdated screening guidelines that did not reflect the increased risk of early-onset colon cancer among young Black men and women.
On the other hand, said Dr. Martin, when given equal treatment, equal outcomes are not only possible but probable. One pooled analysis of individual patient data from five modern randomized controlled trials could not detect a significant difference in overall survival for Black men with metastatic castration-resistant prostate cancer.2 Another race-stratified, multicenter study of abiraterone acetate plus prednisone demonstrated similar radiographic progression–free survival and overall survival between Black and White patients, despite higher comorbidity rates among the Black cohort.3
“There are at least 10 years’ worth of data showing that Black men with prostate cancer who are enrolled in randomized trials have outcomes that are just as good as White men, and yet in real-world data, their outcomes are not as good,” said Dr. Martin. “This raises two important points: 1) We should be getting more people on clinical trials; and 2) clinical trials are not a substitute for a good standard of care. We need more inclusive research practices and tailored strategies for different communities based on their unique needs and characteristics,” he added.
Incorporating DEI Into Health-Care Strategies
To promote health equity and improve patient care, Dr. Martin advocated for a more structured and committed approach to DEI work, incorporating it into an organization’s mission, values, and overall business strategy. As Dr. Martin explained, workforce development initiatives should focus on providing employees with the training and resources needed to address health disparities and deliver more personalized care. Mentorship programs and career growth opportunities can empower a diverse workforce to contribute their unique skills and perspectives to patient care. In addition, organizations should leverage workplace diversity to overcome language barriers and provide more accessible after-hours services.
According to Dr. Martin, simple changes, such as hiring diverse staff or initiating training, can have significant impacts, especially when they align with business and patient care objectives. However, he noted, these changes must be connected to the overall business strategy. “Superficial changes that do not align with the organization’s mission risk wasting so much untapped potential,” said Dr. Martin. “Equity cannot just be something we do for a single day.”
Positive examples highlighted by Dr. Martin included delivering services in neighborhoods where patients live and using workforce data to match Farsi-speaking patients with providers who speak the same language.
Community Engagement and Collaboration
According to Dr. Martin, community engagement efforts should also involve active and collaborative approaches, such as including community members in advisory boards and decision-making processes. “Building and maintaining advisory boards that function as a democracy are essential for breaking down power dynamics and hierarchies,” Dr. Martin explained. “These boards should include community leaders who can provide insights and perspectives from the community, ensuring their needs and concerns are considered in the decision-making process.”
Dr. Martin also emphasized the crucial role of community involvement and addressing social determinants of health in designing and implementing clinical trials and research. The aim of scientific enrollment should be to engage enough people from a specific population to address questions that are significant to them. “By fostering a sense of partnership with the communities they serve, health-care organizations can ensure that their services are more closely aligned with the needs and preferences of diverse patient populations,” he stated.
“If research is designed with these concepts in mind, outreach and participation will improve because we’re addressing scientific questions that the community has helped us to identify in the first place,” he continued. “Our goal is to generate information that is meaningful and actionable for the community.”
Finally, Dr. Martin underscored the importance of involving patients in the care process. “Patient-partnered care should prioritize collaboration with patients and their families, understanding and addressing the specific barriers and challenges faced by diverse patients,” he added. “This approach requires a shift in mindset, moving away from a one-size-fits-all approach and toward a more nuanced understanding of the factors that impact patients’ health and well-being.” By incorporating these factors, said Dr. Martin, health-care providers can develop better-targeted treatments, improve patient outcomes, and promote health equity in their communities.
DISCLOSURE: Dr. Martin reported financial relationships with Tennessee Oncology Practice Society, South Carolina Oncology Society, and Appalachian Community Cancer Alliance; and has received seed funding from Bristol Myers Squibb and AstraZeneca.
1. Martin III RL: Enhancing equity in clinical research: Lessons learned from community oncology engagement efforts. 2023 Community Oncology Alliance Annual Meeting. Presented March 23, 2023.
2. Spratt DE, Chen YW, Mahal BA, et al: Individual patient data analysis of randomized clinical trials: Impact of Black race on castration-resistant prostate cancer outcomes. Eur Urol Focus 2:532-539, 2016.
3. George DJ, Halabi S, Heath EI, et al: A prospective trial of abiraterone acetate plus prednisone in Black and White men with metastatic castrate-resistant prostate cancer. Cancer 127:2954-2965, 2021.