Introduction: 2022 Advancing the Science of Cancer in Latinos

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This is part of the “Advancing the Science of Cancer in Latinos: 2022 Conference Proceedings,” which summarizes findings and discussions of the 2022 Advancing the Science of Cancer in Latinos Conference on Feb. 23-25, 2022, in San Antonio, Texas.

Healthcare Improvement in the Latino community

The United States healthcare system is rife with challenges affecting the Latino community, with a population of 60.6 million [Estrada]. Health challenges include higher rates of infant mortality, stroke, cancer, heart disease, diabetes, hypertension, and COVID-19. [Webb Hooper, Duma] Latino patients, especially those who are uncomfortable discussing care in English, are often labeled as unintelligent and non-compliant. [Duma]

In the COVID-19 pandemic, cases among the Latino population have been 1.3 times higher than in the White population, with 3.2 times more hospitalizations and 2.3 times higher death rates. [Del Rio] Furthermore, among high-risk patients, such as pediatric cancer patients, those of Latino background were affected differently compared to people from other backgrounds and experienced more symptomatic illness. [Flatt] Such challenges are often due to non-medical drivers of health, which account for at least 60% of the variance in health outcomes, a much greater percentage than the pure effects of biological and genetic factors. [Nunez-Smith] Incorrect information is another challenge affecting the Latino community, with social media incorrect information even more prevalent in Spanish posts than in English. [Goddard]

Non-medical drivers of health include spatial patterns of poverty, lack of access to nutritious food, environmental toxins, educational disadvantage, health literacy, and more. [Nunez-Smith] One of the more important non-medical drivers of health, income status, shows a startling association with mortality. US residents in a household of four with an income less than $25,000 show a mortality ratio of 3:1 when compared to those with a household income of greater than $115,000. [Perez-Stable] In Texas, Latino men and women are the least likely to have health insurance of any background. Among those 18 to 64 years of age, 26% of Latino individuals were uninsured, compared to 9% of White individuals in 2017-2018. [Estrada]

Cancer Challenges

Cancer is the leading cause of mortality in the Latino population, accounting for 20% of deaths. [Estrada] In fact, 1 in 3 Latino men and women will be diagnosed with cancer in their lifetime, with 1 in 5 men and 1 in 7 women dying from the disease. [Estrada] From 1999 to 2016, cancer cases increased by 106.0% in the Latino community, compared to a 17.5% and 50.0% increase in White communities. [Sáenz]

Lung cancer is the leading cancer killer in Latino men, and breast cancer is the leading cancer killer in Latina women. [Taverna, Velazquez] Latino lung cancer patients die earlier than White patients, with 5.2 years of potential life lost compared with just 4.3 years for White patients. [Cress] Latino background and living in the lowest-income neighborhoods are associated with a higher risk of gastric cancer diagnosis, and Latino populations have the highest incidence rates of liver cancer compared with other backgrounds. [Long Parma, Setiawan] B-Cell acute lymphoblastic leukemia (B-ALL), the most common childhood malignancy, affects Latino children, who are 1.2-1.75 times more likely to develop ALL than their White counterparts; and Latino adolescents are 2.09 times more likely. [Dovat]

The Cancer Care Continuum

These challenges affect Latino cancer patients across the entirety of the cancer care continuum. Obesity, for example, has been shown to increase cancer risk, cause delays in diagnosis, alter treatment plans, and increase complications associated with comorbidities. [Bandera] Latinos have the second highest rate of obesity in the US at 44.8%. [Bandera, Rodriguez-Rodriguez] Cardiometabolic comorbidities are also higher in Latino populations, which are often found in background enclaves. [Maras, Diaz] These background enclaves are associated with higher obesity rates, and can often be food deserts, have high poverty rates, lack green spaces, and be areas of high stress due to violence. [Diaz]

Another part of the cancer continuum affecting Latino patients is stress management and mental health. [Costas-Muniz] End-of-life care is another concern, with Latino patients less likely to complete do-not-resuscitate orders, have living wills, or have designated health care proxies. [Maciejewski] This results in a higher likelihood of aggressive EoL care, including increased ICU admissions and chemotherapy use. [Tergas]

Differences in Clinical Trial Representation

Despite representing 18% of the population, Latino participants only represent 4-8% of clinical trial participants. [Lynce, Fashoyin-Aje, Trevino]

In a recent study of almost 6000 precision oncology trials, all non-White background participants were limited, with Latinos showing the greatest difference. [Lynce] ] In trials for oncology drugs approved by the FDA from 2008 to 2018, only 630 of the 70,201 patients who reported they were Latino. [Rodriguez] When comparing participants in clinical trials from 1996-2002 with participants from 2003-2016, Latino participation has decreased, with 3.1% Latino participation prior to 2002 compared with 2.6% Latino participation after 2003. [Rivera] The Cancer Genome Atlas (TCGA) program, a large publicly available genomic database, also has a very low number of Latino participants with only 3% of participants identifying as Hispanic or Latino. [Ziv, Dutil]

Practical steps for addressing inequity

Advancing the Science of Cancer in Latinos, a conference held from February 23rd to 25th, 2022, brought together leading Latino healthcare voices in San Antonio, TX to discuss these challenges and share practical approaches for moving forward. Presenters included physicians, researchers, survivors, policy makers, and industry leaders from across the US and Latin America. It was agreed that dismantling non-medical drivers of health in the healthcare system must involve different stakeholders at every level, from educators to physicians to administrators to legislators. A wide array of voices always leads to a broader understanding of patient experience. [Santos, Winn]

Intervention in Latino populations must also begin with an understanding of language and understanding, and these communities should be engaged with sincerity and a willingness to listen to those affected by the issues being studied. [Sanchez-Johnsen] Successful health care interventions are often driven by multi-layered community networks through the identification of root causes and solutions, as well as community resources. [Molina, Tortolero-Luna] Community-based health workers can provide education, screen for non-medical drivers of health, schedule screenings, and follow patients until screenings are complete. [Jones]

Latino participation in clinical trials must also be increased through more purposeful study design, more flexible criteria, and fewer income challenges to participation. [Duma, Dovat, Rodriguez, Trevino, Penedo, Perez, Kuri] Through greater Latino participation and more different genomic testing, Latino presentations across all diseases can be better understood. [Ziv, Lynce, Dutil, Cress, Dovat] In this way, more individualized treatment plans with fewer side effects can be implemented. [Taverna]

Cooperation between research programs, especially across borders, is another necessary strategy moving forward. Many initiatives can be emulated in this regard, including the Latin American Cancer Research Network (LACRN), the Mexican National Institute of Public Health, the Puerto Rico Breast Cancer Genetics and Genomics Study (PUR-BCGG), and the Avanzando Caminos Hispanic/Latino Cancer Survivorship study. [Lajous, Llera, Dutil, Penedo]

The presentations outlined below discuss the findings of Latino leaders in the areas of cancer research, healthcare differences, COVID policy, clinical trial challenges, international cooperation, community intervention, end-of-life care, and more. The information presented, however, merely represents a beginning, with the hope that dialog and collaboration will continue into the future, providing new solutions for the elimination of health challenges among Latino populations.