Viewpoint Calls on Hematology Community To Take Action Against Disparities

A recently published viewpoint called upon the hematologic community to “stop ignoring the numbers” when it comes to racial and ethnic survival disparities in patients with hematologic malignancies in the United States.

In the viewpoint, Bhavana Bhatnagar, DO, of West Virginia University Cancer Institute, and Ann-Kathrin Eisfeld, MD, of The Ohio State University Comprehensive Cancer Center, discussed survival disparities in adults with hematologic malignancies. Looking specifically at multiple myeloma (MM), which is more common in Black patients, studies have shown similar outcomes among Black patients and White patients with MM particularly among those who undergo stem cell transplantation.

However, White patients with MM are more likely to be treated with novel agents. One SEER-Medicare analysis showed that Black and Hispanic patients had a longer time from diagnosis to use of a novel therapy compared with White patients (P<0.05), and that Hispanic patients were less likely to receive transplant compared with White and Black patients.

There has also been substantial research into possible predisposing variants among Black patients with MM. Some somatic genetic features have shown strong racial associations, such as t(11;14), t(14;16), and t(14;20); however, del(17p) and monosomy 17 are less common in Black patients.

The authors also discussed existing disparities in other hematologic malignancies, pediatric populations, and survival disparities in recipients of stem cell transplantation. They suggested many action steps at both the individual level, the care-team level, and the institutional level to help end structural racism.

“The monumental task of addressing systemic racism involves a multipronged, societal, and inter-disciplinary approach,” they wrote.

“Unfortunately, for many decades and for many patients with a hematological malignancy, racial and ethnic survival disparities have persisted, and, sadly, have become the status quo within society. Such disparate survival outcomes between cancer patients based on race and ethnicity speak to the deeply embedded, yet oddly intangible, nature of structural racism that has been well recognized but unaddressed for far too long,” they wrote. “The onus is on us as a community of hematology specialists to combat such inequities and strike at the cause of systemic racism, which has made a powerful contribution to the deaths of millions of patients belonging to racially and ethnically minoritized groups. In essence, it truly is time to stop ignoring the numbers and take action.”