Background

For Black patients, endometrial cancer (EC) is the deadliest gynecologic cancer in the United States. Historic and current medical racism, higher prevalence of aggressive EC among Black patients, delayed diagnosis, lack of efficacy of diagnostic pathways, and increased stage at diagnosis are contributors to a significant racial disparity in survival. In prior work, patients have reported symptom minimization and dismissive responses from providers as key contributors. We investigated provider perceptions of racial disparities in EC.

Methods

In this qualitative study, semi-structured interviews surrounding evaluation of peri- and post-menopausal bleeding were conducted with providers serving patients at risk for EC. Interview structure was developed and refined using an iterative process. Inductive reasoning guided exploratory content analysis of sequential interviews.

Results

OB/Gyn (n=4), family medicine (n=3), internal medicine (n=3), and emergency medicine (n=2) providers in all regions of the US completed interviews.

Nearly half (n=5, 42%) of providers reported lack of knowledge regarding racial disparities in EC diagnosis; half also lacked knowledge about disparities in EC outcomes. Internal medicine, family medicine, and emergency medicine providers were less likely to endorse knowledge of racial disparities. Among those with understanding of disparities in EC, decreased access (n=6, 50%), inadequate listening to patients (n=4, 33%), patient interpretation of symptoms as not worrisome (n=4, 33%), and inadequate performance of transvaginal ultrasound among Black patients (n=3, 25%) were most commonly cited contributors to disparate outcomes.

Conclusions

Our findings—of a disturbing lack of knowledge of profound racial disparities in EC among providers caring for Black patients at risk for EC—echo results of previous work centering experiences of Black EC patients. This finding contributes to earned distrust of healthcare provider by patients; in the context of centuries of medical reproductive injustice, urgent emphasis must be placed on resource allocation towards provider and health system education.

Background: A growing body of literature is investigating how structural barriers, including policies, impact cancer outcomes among marginalized populations, including the 2SLGBTQ+ (two spirit, lesbian, gay, bisexual, transgender, queer, asexual, intersex, and gender non-conforming or gender non-binary)(sexual and gender minoritized (SGM)) communities. An under-researched area is how the state-level policy and sociopolitical environment shape the experiences and outcomes of SGM people who have experienced cancer. Using data from the Elsie Study, this research examines how SGM people who have experienced cancer are impacted by their state’s policies and sociopolitical context.

Methods: The Elsie Study is the largest qualitative survey of SGM people who have experienced cancer conducted within the U.S. To date the Elsie Study at the University of Minnesota has conducted a total of 58 semi-structured interviews with SGM people who have experienced cancer. Interviews were conducted nationwide over Zoom and phone beginning in June 2023 and continuing through June 2024.

Results: Among SGM people, participants identified as gay, bisexual, lesbian, queer, gender fluid, non-binary, transmen, transwomen and two spirit. SGM people experienced a variety of different cancers, including kidney, prostate, breast, testicular, lung, ovarian, cervical, uterine, colon, thyroid, bone, rectal, and blood cancer. A majority of SM and GM women and non-binary participants mentioned the importance of living in or being able to travel to “a queer and trans friendly state,” liberal cities, or states with marriage equality for aspects such as accessing culturally competent cancer care and participating in cancer research.

Conclusion: Narratives such as those expressed by our SGM participants who experienced cancer are important for understanding how state policy and sociopolitical contexts shape access to healthcare and even cancer research. Our study has wide implications for how affirming state policy and sociopolitical climates may afford more equity in cancer care for SGM people.

Background:

Self-collection using a primary HPV screening platform has the potential to increase access to cervical cancer screening and rebuild trust in the U.S. healthcare system, especially since cervical cancer screening can be stigmatized, inaccessible, and intimate for women and people with a cervix.

Methods:

We leveraged the relationship and convening infrastructure of the American Cancer Society (ACS) and the ACS National Roundtable on Cervical Cancer to host a summit to discuss the opportunities and barriers facing primary HPV screening and self-collection implementation. The Summit provided space to discuss role-delineation among various organizations to effectively and efficiently prepare for a future with these advancements in the cervical cancer screening landscape within the United States. Participants represented numerous stakeholder groups ranging from clinicians to researchers to industry partners. Attendees discussed: lessons learned from stool-based colorectal cancer screening, possible U.S. delivery model considerations for self-collection, clinical trials for self-collection, health equity in implementation, and primary HPV screening implementation case studies.

Results:

A thematic analysis was conducted with the qualitative data from the Summit discussion, breakout groups, and meeting evaluation. The six key themes that emerged around self-collection implementation support were: clinical champion support, logistics, bundling screening, educational campaigns, provider and healthcare professional messaging, and data needs. These themes helped inform and prioritize ten key actions the American Cancer Society and the ACS National Roundtable on Cervical Cancer and partners are doing to prepare for a screening landscape with self-collection.

Conclusions:

Collaboration is key to solving the biggest challenges in shifting a national healthcare paradigm equitably, effectively, and efficiently. This Summit was one critical step toward coordinating action across organizations to drive this work forward, and ultimately building trust to result in more people screened to prevent, detect, treat, and survive cervical cancer.

Background: Tumor genomic profiling (TGP) is a life-saving advance in cancer treatment, but disparities in uptake of genetic counseling and testing among is evident in Latinx patients.

Objective: To understand differences in Latinx patient’s perceptions of TGP by levels of patient self-advocacy (PSA) to identify potential patient-, provider-, and system-level factors that can be addressed in decision support interventions.

Methods: 50 Latinx English/Spanish-speaking cancer patients from two Philadelphia locations were surveyed. A k-means cluster analysis using Brasher’s PSA scale was used to differentiate those with high and low PSA; chi-squares and t-tests were used to compare perceptual items about TGP (0 to 10 scale).

Results: Respondents were 71% female with M=57 years; 72% had a high school education or less. 61% reported never having had genetic testing. No demographic differences between those with Low PSA (n=18) and High PSA (n=20) were found. Differences in concerns about TGP show that those with High PSA were more likely to be concerned having TGP might result in insurance discrimination (M=3.61 vs. 6.75, p=.008), their genetic information would be shared with others (M=4.00 vs. 6.65, p=.018), their doctor may not be able to explain TGP results in a way they can understand (M=4.06 vs. 6.90, p=.012), and that having TGP could upset their family (M=2.72 vs. 5.10, p=.046).

Conclusions: PSA is an important construct to understand Latinx cancer patient TGP perceptions. Importantly, those with higher PSA had more potential concerns about TGP. These findings can be used to develop novel communication tools to better explain TGP and assist patient decision-making.