Addressing cancer disparities in Hispanic populations in the US and in low and middle income countries

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Published: 7 Jul 2023
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Dr Luis Raez and Dr Eduardo Cazap

Dr Luis Raez (Memorial Healthcare System, Hollywood, USA) and Dr Eduardo Cazap (Editor in Chief ecancermedicalscience, SLACOM President, Argentina) discuss equity and disparities in Latin populations in the United States and around the world.

Dr Eduardo Cazap begins by defining what the term Hispanic constitutes and states that this discussion is about underserved populations in the world that do not have access to the proper prevention and treatment of cancer.

They discuss the under-representation of Blacks, Hispanics and Asians in clinical trials and why this is an important issue.

Dr Cazap highlights that the term underserved population includes all populations, whether they are low-income or not, who do not have the appropriate facilities, technicians, doctors or resources to treat cancer according to the high standard set by the leading oncological organisations.

They conclude by inviting the audience to their video symposium covering the proposals that they have for the future of cancer care.

 

LR: Good day everybody, it’s a pleasure today to be here at the Best of ASCO Miami. My name is Luis Raez, I’m the Medical Director of Memorial Cancer Institute, Memorial Healthcare System here in Florida. I am here with Dr Eduardo Cazap, who probably doesn’t need any presentation because he is the Editor in Chief of ecancer and a well-known authority in cancer. We are going to present together with ecancer today a symposium regarding equity and disparities in Latin populations in the United States and around the world. So welcome to the meeting, Dr Cazap.

EC: Thank you, thank you Dr Raez.

LR: So can you give us a perspective about what we’re going to discuss today?

EC: Actually it’s a challenging topic. Why? Because it speaks about disparities and the world has many disparities but this is a particular discussion about the Hispanic population in the US, and also the so-called Latino population, that has a particular definition for doctors and for studies and trials that does not fit very well with the definition or the concept of Hispanic in Latin America. Actually, Hispanic means a person who speaks Spanish or from Spanish origin. Actually, Mexicans and other people, Peruvians, Argentinians, we all speak Spanish but in Brazil, for example, they speak Portuguese and they are also considered Hispanic. Or other countries in the region of the Caribbean that speak French or Dutch or English. So one of the concepts to define today and make very clear is that underserved populations are Hispanic. Any person in the world that has not access to the proper prevention and treatment of cancer is a Hispanic, is a person who has not access to all the possibilities that today the science provides for cancer patients. That, I think, is a point to discuss, Dr Raez.

LR: Yes, this is very important because, for example, in the United States, as Dr Cazap said, Hispanics, we're a group of individuals, as Dr Cazap said; we are not a race. And the problem with the clinical trials and the research in the United States and Europe is that it’s easier to do the research in a high-tech facility, you want the best hospitals, but usually the recruitment of individuals is very biased against white individuals. It’s hard to recruit Blacks, Hispanics, Asians, and thus when you have the results of the studies, for example the PACIFIC study, the standard of care for lung cancer stage 3, is a study that recruited in Europe and the United States, 98% were white population, 2% were Black and they don’t even ask what ethnicity you are. So we don’t even know if they enrolled Hispanics. That is why when we present our real-world data the results don’t match the results of the study because in Black populations, for example here in South Florida, we did specific in Blacks, specific in Hispanics, they don’t match the results. That is why we need to do research for everybody and not only one group of individuals. 

EC: Exactly. We think that we need to redefine the populations. Why? Because we need data and for data you need information, studies. For that you need to unify the concept. If not, the trials cannot be compared because you are talking about different populations. So perhaps we need also to reanalyse the denomination of low- and middle-income countries. Because low- and middle-income countries means a country that has an economic definition, only economic, it’s the PIB per capita. But, for example, there are cities that are middle-income countries, Uruguay, Costa Rica, in our region, that they have very good cancer control plans and actions. On the contrary, you have, for example, the opposite situation in countries like some Arab countries – they have money but they don’t have technicians, they don’t have nurses. So the idea is we should try to get a definition that makes a real idea about what means underserved and underserved personal populations in the world, not only by the income, also by the social, cultural aspects, the type of barriers that they have. So this is an interesting discussion – we need to redefine several concepts in order to unify the different studies around the world.

LR: Yes, this is very important because for some people in the United States there is a very famous publication about the city of New Orleans, about the zip codes. It’s incredible that if you are born in a zip code, the next zip code has an inferior survival of 20 years and it’s the same city. So depending on which zip code you were born in, your survival against cancer is different and you’re talking about the same city, the same country, the same healthcare system. That is why, for example, here in Florida, North Florida the outcomes… it’s a very rural area. We talk here also about rural disparities that affect Hispanics, that affect non-Hispanics too. So that is why, although these topics are very interesting, there’s always value to see the video, we’re going to have today, a video of the symposium about disparities in the world with Dr Cazap and other real-world cancer experts about this.

EC: Yes, Dr Raez, there are other data about the distance from the patient to the cancer centre. Each I don’t know how many kilometres in addition, the results are poor.

LR: Yes.

EC: That is very similar. Why? Because many people have no money to access periodically to the treatment centre. That is unacceptable today.

LR: Yes. So we invite you to see our video symposium, it’s a 60 minute video that you’re going to find very interesting, very challenging and very innovative about the proposals that we have for our future in cancer care. Thank you.

EC: Thank you very much.