Coral Olazagasti, MD
Narjust Florez, MD, FASCO
On January 20, 2025, newly sworn-in President Donald J. Trump signed Executive Order 14151, “Ending Radical and Wasteful Government DEI Programs and Preferencing,”1 effectively eliminating all diversity, equity, and inclusion (DEI) programs, preferences, and activities across the federal government, as well as equity-related grants and contracts. The new order overturned Executive Order 13985, “Advancing Racial Equity and Support for Underserved Communities Through the Federal Government,”2 issued by President Biden in 2021, swiftly unwinding generational progress in scientific research addressing racial and social disparities in health care, including cancer care.
The effect of this action on those of us involved in the clinical care of minority patients with cancer and in research efforts to mitigate disparities in cancer care has been chilling. We are here following in the footsteps of many visionaries who sought to investigate cancer disparities in underserved populations, including the pioneering work of clinician/researcher Edith P. Mitchell, MD, who died in 2024; and Robert A. Winn, MD, Director and Lipman Chair in Oncology at Virginia Commonwealth University Massey Comprehensive Cancer Center, who has spearheaded interdisciplinary approaches to cancer disparities research. They and we have dedicated our careers—and lives—to ensuring access to high-quality cancer care for all patients, regardless of race, ethnicity, gender identity, sexual orientation, disability and socioeconomic status, or where they live. We can’t abandon this ideal, especially at a time when so much progress is being made in cancer prevention, early detection, treatment, and cancer survivorship care. We have to continue to strive to end disparities in cancer care through increased funding for research and programs, improved access to care, and policies that promote health equity.
Evening the Unequal Playing Field
The term DEI emerged in the mid-1960s, when the Civil Rights Act of 1964 made it illegal to discriminate in hiring and promotion practices based on a person’s race, color, religion, sex, and national origin and banned segregation in public places.3 Contrary to today’s narrative, DEI was never intended to favor unqualified individuals over qualified ones. It was just meant to even an unequal playing field.
History has shown us that merit alone is not sufficient to overcome hundreds of years of systemic discrimination, especially for racial, ethnic, and gender minorities, even in scientific research. We now have data showing the large racial disparities in federal research funding for Black scientists compared with their White colleagues, despite equal or similar grant scoring to the majority of minority applicants.4-6 Diversity, equity, and inclusion programs are designed to provide equal opportunity, not to lower standards for those who are unqualified, and they are not in conflict with the principles of meritocracy. In fact, merit-based policies are at the cornerstone of DEI work.
For minorities in academic medicine, DEI initiatives have provided a platform for us to earn our seat at the table by showcasing the value of our hard work and dedication. We work harder because we know our journey is not one of privilege but of determination. The executive order signed by President Trump undermines all our efforts, not just minority clinicians, to provide the best care for every patient with cancer and ignores the sacrifices made by many who came before us.
We fear that this shift will discourage future generations of minority students from choosing a career in medicine, which will be crucial in closing the ever-widening gap in health disparities. Studies have shown that patients tend to have more positive health-care experiences when their provider shares a similar racial or ethnic background.7 We also need to remember that the elimination of DEI policies goes beyond affecting people of color; it includes other vulnerable groups as well, including women, who make up 51% of the population,8 and LGBTQ+ individuals.
Protecting Diversity in Clinical Trials
Dissolving DEI initiatives is also having direct repercussions on cancer research. In response to the new executive order, the U.S. Food and Drug Administration removed its previously published guidance on diversity in clinical trials from its website, which will likely result in decreasing minority participation in clinical trials. Minority patients are already underrepresented in oncology clinical trials, with only 4.4% of Black and 4.2% of Latinx patients participating in these studies vs 7.2% of White patients.9
Protecting and promoting diversity in clinical trials are not about advancing a DEI agenda but rather about ensuring that enrollment in these studies accurately represents the diverse demographics of our country. We then can better understand how different genetic, biological, and socioeconomic factors impact treatment response and side effects.
We cannot allow decades of progress in cancer care, aimed at benefiting all populations, to be wiped away with the swipe of a pen. We must persevere in advocating for our patients. As physicians, we have sworn an oath under Hippocrates to “do no harm.” Our ethical responsibility is to provide the best possible care for all patients, regardless of their racial, ethnic, socioeconomic, gender or sexual orientation background, or immigration status.
Speaking Out
How do we protect ourselves and our patients, including undocumented patients, in this new environment and continue to uphold and enforce the work we so passionately believe in? We create a safe medical space by aligning our interests and prioritizing communication and cultural sensitivity as well as limiting unauthorized access to sensitive patient information. We reassure our patients that we are their allies, fully committed to their cancer care. We conduct huddles and debriefing sessions to address potential concerns raised by our staff. We check in on our peers to safeguard both their mental and physical well-being.
Above all, we do our best to silence the noise and remain positive. We encourage our colleagues to raise their legislative voices and speak out to ensure adequate and consistent federal funding for cancer research and that scientific knowledge is optimized to improve care for all patients with cancer. One effective way is to use ASCO’s ACT Network to contact our lawmakers and make our concerns heard (https://asco.quorum.us/action_center/).
This is not a time to remain silent. In the end, silence is complicity.
DISCLOSURE: Dr. Olazagasti reported no conflicts of interest. Dr. Florez has held a consulting or advisory role with AstraZeneca, Daiichi Sankyo/Astra Zeneca, Genentech, Janssen, Jazz Pharmaceuticals, Merck, Mirati, NeoGenomics Laboratories, No-vocure, Nuvation Bio, Pfizer, and Regeneron; has received research funding from AstraZene-ca, Daiichi Sankyo/Astra Zeneca, and Genentech; and has other relationships with Clinical Care Options, CME Outfitters, IDEOlogy Health, Medscape, PER, and Precisca.
REFERENCES
1. Federal Register: Ending radical and wasteful government DEI programs and preferencing. January 29, 2025. Available at https://www.federalregister.gov/documents/2025/01/29/2025-01953/ending-radical-and-wasteful-government-dei-programs-and-preferencing. Accessed May 23, 2025.
2. Federal Register: Advancing racial equity and support for underserved communities through the federal government. January 25, 2021. Available at www.federalregister.gov/documents/2021/01/25/2021-01753/advancing-racial-equity-and-support-for-underserved-communities-through-the-federal-government. Accessed May 23, 2025.
3. National Archives: Milestone Documents—Civil Rights Act (1964). Available at www.archives.gov/milestone-documents/civil-rights-act. Accessed May 23, 2025.
4. Taffe MA, Gilpin NW: Racial inequity in grant funding from the US National Institutes of Health. Elife 10:e65697, 2021.
5. Nguyen M, Chaudhry SI, Desai MM, et al: Gender, racial, and ethnic inequities in receipt of multiple National Institutes of Health research project grants. JAMA Netw Open 6:e230855, 2023.
6. Ginther DK, Schaffer WT, Schnell J, et al: Race, ethnicity, and NIH research awards. Science 333:1015-1019, 2011.
7. Artiga S, Hamel L, Gonzales-Barrera A, et al: Survey on racism, discrimination, and health: Experiences and impacts across racial and ethnic groups. KFF, December 5, 2023. Available at www.kff.org/report-section/survey-on-racism-discrimination-and-health-findings/. Accessed May 23, 2025.
8. United States Census Bureau: Quick Facts: United States. Available at www.census.gov/quickfacts/fact/table/US/PST045217#PST04521. Accessed May 23, 2025.
9. Pittell H, Calip GS, Pierre A, et al: Racial and ethnic inequities in US oncology clinical trial participation from 2017 to 2022. JAMA Netw Open 6:e2322515, 2023.
Dr. Olazagasti is Assistant Professor of Clinical Medical Oncology at the University of Miami Miller School of Medicine. Dr. Florez is Associate Director of the Cancer Care Equity Program and a thoracic medical oncologist at the Dana-Farber Brigham Cancer Center in Boston.
Disclaimer: This commentary represents the views of the author and may not necessarily reflect the views of ASCO or The ASCO Post.
