Oncologists Recognize Role of Racial Anxiety, Implicit Bias in Treatment Decisions

About one-quarter of medical/hematologic oncologists recognized the adverse role of racial anxiety and/or implicit bias (RA/IB) on standard of care treatment decisions for patients who are people of color or ethnic minorities, according to an abstract from the 2021 American Society of Clinical Oncology (ASCO) Quality Care Symposium.

Ajeet Gajra, MD, FACP, of Upstate University Hospital, Syracuse, N.Y., and colleagues surveyed 369 U.S.-based medical/hematologic oncologists on their perceptions regarding cancer care and outcomes in racial and ethnic minority patients as part of a broader survey of various clinical and practice-related concerns.

The majority of survey respondents (72%) worked in community oncology, and most were aged 40 to 59 years (64%). About one-third were White (32%) and one-third Asian (33%), with smaller percentages identifying as Black (7%) or Hispanic/Latinx (4%); 19% declined to disclose.

Survey respondents appeared to be split in their perception of the degree of racial/ethnic healthcare disparity experienced by people of color and ethnic minorities, with 33% saying disparity is moderate, 29% very high/high, 29% low/none, and 8% declining to answer. Looking at their own practice, 58% said RA/IB only rarely or never affected survival among racial/ethnic minority patients, 33% said very often/almost always, often, or sometimes, and 9% declined to answer.

This lower likelihood of perceiving RA/IB in their own practice suggests a need for better identification, Gajra and colleagues suggested.

Respondents were also asked to assess the frequency of which RA/IB affected certain treatment decisions. RA/IB very often/almost always, often, and sometimes affected clinical trial referral (35%), palliative/hospice care (31%), novel therapeutic regimen versus standard of care selection (28%), surgical treatment recommendation (26%), and genetic/genomic testing referral (24%).

The researchers noted that 19% of respondents decline to identify their own race/ethnicity and 10% consistently declined to answer all treatment decision-making questions related to disparity. This suggests “mistrust or apprehension in expressing true views”, the researchers wrote.