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This content is from the “Advancing the Science of Cancer in Latinos: 2024 Conference Proceedings.”
Conclusion
To eliminate cancer disparities in Latinx populations, Advancing the Science of Cancer in Latinos brought together researchers, scientists, physicians, healthcare professionals, patient advocates, and students from across the US and Latin America. These presenters shared research advancements, identified gaps, developed actionable goals, updated clinical best practices, described effective community interventions, and detailed professional training programs aimed at addressing inequity. In the process, most of the speakers made recommendations, either specific to their field of study or more broadly. The following are some key recommendations abstracted from their conference presentations.
Recommendations
Addressing Systemic Inequities Behind Cancer Disparities
Access to prompt needed care is essential. Latinx patients with excellent experiences in getting care quickly have greater odds of receiving stage-specific guideline-concordant cancer treatment. [Farias]
Successful interventions should be adapted linguistically and culturally for a Latinx audience. Each Latinx audience, and each Latin American country, has its own opportunities and challenges, and training local clinicians is essential. Collaborative efforts make sustainable solutions possible. Furthermore, successful adaptation of interventions is not merely about translation, but includes cultural adaptation as well. [Costas-Muñiz, Tamí-Maury]
Language concordance between clinician and patient is vital to the Latinx cancer experience. Language concordance offers many advantages, including improved quality of care, with patients that are less likely to feel confused and frustrated, and greater patient satisfaction. Likewise, health outcomes are positively affected, with improvements noted in glycemic control, medication adherence, and understanding of medication and dosage. Finally, relationship factors are impacted by language concordance, with greater agreement with physician recommendations, more questions asked by the patient, and greater disclosure of sensitive information. [Martinez]
Toxicity in Latinx pediatric cancer patients should be reduced when possible. Strategies for reducing toxicity may include the following approaches: therapy reduction, including reduction of exposure duration, cumulative dosing caps, and risk-adapted therapy plans; the use of less toxic drugs including immunotherapy and CAR-T; the use of pharmacogenomics to drive drug dosing decisions; and increasing the number of supportive care trials. [Grimes]
Technology may be vital for patient education and engagement. Text messaging- and app-based systems have been used to remind and educate AYA survivors, improve the no-show rate for colonoscopies, and facilitate smoking cessation. Digital health solutions can also improve access to care, increase efficiency, and reduce costs for smoking prevention and control. Machine learning-based tools have proven useful in prediction of gastric cancer incidence using endoscopic and histologic features. Artificial intelligence can also be useful in diagnosis, prognosis, and staging; in the identification of pathology slides; in recommender systems to help patients navigate issues that are important to them; and through the use of natural language processing to improve patient-clinician interactions. [Casillas, Camargo, Cupertino, Piette, Hernandez-Barco, Chalela, Tamí-Maury]
Food programs are integral to the reduction of food insecurity. Federal food programs for mixed age groups include grocery programs such as food bank-operated pantry programs, ad hoc food pantries, home-delivered groceries, mobile markets and pantries, school or other pantries, and community gardens. Food pantry programs should emphasize food equity, meaning client choice is prioritized and a nutrition-based food selection system is utilized. Less food insecurity and healthier food are associated with lower colorectal cancer incidence and mortality. [Pruitt, Serra]
Young Latina mothers diagnosed with cancer need extra help. Medical assistance is needed for symptom management, including preparing Latinas on what to expect and strategies for managing extreme side effects. There is also a need for training and recruiting pain management and behavioral health specialists to underserved regions such as the border region, where there are high numbers of young Latina mothers diagnosed with cancer. Culturally adapted cancer parenting programs can help address disparities in social determinants of health. [Palacios]
Cancer Screening Disparities
Access to genetic counseling and testing must be expanded. The scarcity of Spanish-speaking genetic counselors may be overcome through alternative delivery models such as genetic counselor extenders (e.g. group counseling), telephone genetic counseling, patient-facing materials such as brochures and websites, or educational videos. Polygenic risk scores, often formulated based on European populations, may be adapted for use in predicting the risk of certain Latinx cancers. [Hurtado de Mendoza, Fejerman, Serra]
Prevention and screening programs are vital. Age-appropriate cancer screenings should be an emphasis for intervention, and should be nimble, incorporate more long-term disaster planning approaches, and use telehealth and improved data tracking tools. Clear policies and access to vaccination and antivirals should also be prioritized for all cancer patients. [Hernandez-Barco, Coronado, Vilar-Compte]
Latinx Cancer Research Methodology
Community engagement is needed to build trust for sustainable relationships. Research must be initiated in full partnership with community members, scientists, and the government. Scientists must listen to the concerns and problems of the community and decide on a research plan together. The research plan must be sustainable over time, have shared governance, provide tangible financial support, and include a partnership based on trust, mutual benefits, complementary skills, and a focus on health. One example of an NIH program working to build trustworthy partnerships is the Community Engagement Alliance (CEAL). [Perez-Stable]
Standardized measurements and questions are needed to ensure Latinos are not underrepresented. There is a need for validated instruments in the context of Latinx cancer clinical work and research in order to standardize Latinx identification and measure social determinants of health. One solution to the need for standardization of information across scientific studies is the use of the PhenX Toolkit to measure social determinants of health, developed in 2022. [Perez-Stable, Costas-Muñiz]
Appropriate data is needed to facilitate discovery science. Because the Latino population is overall younger than the national average, age-adjusted death rate (AADR) is a useful tool in facilitating accurate cancer mortality data. Clinical trials in Latin America are needed to convince governments to spend money on proven cancer treatments, and to shed light on Latino cancer in the US. Limiting clinical trial data collection in late phase trials to essential data elements may allow for greater efficiency and lower cost. Finally, multi-omics approaches can provide insight into cancer disparities research. [Perez-Stable, Sáenz, Cabrera, Doroshow, Velazquez]
Electronic health records (EHRs) may be used to support clinical trials. Clinical trials may be improved by vendors creating mechanisms for automatically integrating study-specific documents into local implementations of their products, and resolving the logistical and data quality challenges of extracting clinical trial data from electronic health records. [Doroshow]
Clinical trial workforce issues must be addressed. This can be accomplished by streamlining and standardizing trial activation processes, reducing the volume of trials staff are responsible for, increasing flexibility for remote work, improving alignment of institution and cancer center hiring processes related to staff recruitment and retention, and using a virtual clinical trials office. Furthermore, diversity of the scientific and clinical workforce should be promoted. [Perez-Stable, Doroshow]
Latinx Clinical Trial Participation
Approaches to improve enrollment must be tailored to specific settings, and should address structural barriers to Latinx participation. This is in addition to ensuring that demographics of patients enrolled in clinical trials are comparable to the US population. Trials must intentionally recruit in Latino-dense regions, and include public health and clinical collaboration leading to Spanish consent forms and culturally adapted recruitment and study materials. Structural barriers for Latino participation should be considered during study design and informed consent design. Paying community organizations to get involved could be an effective approach. [Aristizabal, Palacios, Rios, Adjei]
Provider-level training focused on patient-provider communication is important. Linguistically appropriate tools and culturally-aware staff are vital to clinical trial enrollment. [Aristizabal, Adjei]
Patient-level factors are key. These factors include building trust; education and awareness of clinical trials; culture, language, and health literacy-focused interventions; and initiatives to address socio-economic barriers. [Aristizabal, Adjei]
Latinx Cancer Survivorship
More research is needed in the area of Latinx cancer survivorship. First, the disaggregation of Latinx cancer survivorship data is imperative to fully understand outcomes among different groups of Latinx survivors. Evidence-based strategies must be adapted to reduce disparities in symptom burden, and investment must be made in cancer survivorship research, community partnerships, training, and diversifying the cancer survivorship research and clinical workforce. [Graves]
Effective patient-provider communication is central to timely, targeted integration of palliative care. The preferred approach to palliative care is patient-centered with a needs-based approach, systematically identifying patients who are likely to benefit from palliative care through screening, deploying care in response to their symptoms and supportive care needs, and proactively avoiding symptom crises and improving quality of life. [Moreno]
Latinx adolescent and young adult (AYA) survivorship needs must be considered. In light of disparities in survivorship for some AYA cancers such as leukemia, AYA-specific interventions are needed: cancer prevention and health promotion counseling must be provided for risk reduction, screening must be prioritized for early detection of late effects, hereditary genetic predispositions and appropriate genetic counseling should also be considered, and assessment of cultural beliefs, environment, and inclusion of Latinx participants in research should be prioritized in order to develop interventions to achieve health equity in cancer survivorship care. [Casillas]
Exercise programs can be effective for survivors. Such programs can reduce metabolic syndrome in sedentary, overweight or obese breast cancer survivors, and high-intensity interval training programs are associated with significant improvements in cardiometabolic, physical, and psychosocial health outcomes among sedentary, overweight or obese breast cancer patients. [Dieli-Conwright]
Self-acupressure may be a useful tool in symptom management. The stimulation of acupoints triggers the hypothalamic-pituitary-adrenocortical axis in order to influence sympathetic and peripheral nervous system function. It can also be performed at home for no monetary cost. [Graves]
Further Resources
The Division of Cancer Control and Population Sciences (DCCPS) seeks to expand and enhance research to understand and mitigate the impacts of the environment and climate change on cancer across the care continuum. [Ellison]
The Formación de Investigacion Psicosocial Oncológica Latinoamenricana (FIPOL) was founded to connect clinicians, educators, and researchers from Latin America and Spanish-speaking countries interested in psychosocial oncology, behavioral medicine, and palliative care. [Costas-Muñiz]
The National Association of Medical Spanish was formed to build a pipeline of Spanish-speaking providers to address cancer in Latinos. [Martinez]
The Physician Oral Language Observation Matrix (POLOM) is a rater-based tool for assessment of medical oral language skills as contextualized for patient care. This matrix provides a way to reliably evaluate whether a physician is ready to perform their patient care responsibilities in a non-English language. [Martinez]
The ÁRBOLES Familiares Training Program seeks to address disparities in awareness and uptake of genetic risk assessment among Latinos. [Graves]
COMPRENDO (ChildhOod Malignancy Peer REsearch NavigatiOn) is a peer-navigation intervention to improve research literacy and diversity in pediatric cancer clinical trials. In the program, peer-navigators provide in-hospital support, telephone support, and in-home support. [Aristizabal]
The Persistent Poverty Initiative (PPI) aims to address structural and institutional factors to alleviate the cumulative effects of poverty on cancer outcomes by building research capacity, fostering cancer prevention research, and partnering with communities to promote the implementation of community-based programs. [Srinivasan]
The National Hispanic Medical Association (NHMA) is a nonprofit started in 1994 with the mission of empowering Latino physicians and Latino-serving physicians to improve the health of Latinos. [Rios]
The All of Us Research Program is a historic, longitudinal effort to gather data from one million or more people living in the United States to accelerate research and improve health. By taking into account individual differences in lifestyle, socioeconomics, environment, and biology, the hope is that researchers will one day uncover paths toward delivering precision medicine – or individualized prevention, treatment, and care – for all of us. The All of Us Research Program is part of the broader Precision Medicine Initiative. [Mendoza]
By The Numbers
142
Percent
Expected rise in Latino cancer cases in coming years