Equitable Cancer Care Research Articles

Equitable cancer care at any age

Equitable cancer care at any age

MP21-20 SOCIAL VULNERABILITY AND TREATMENT PATTERNS IN PATIENTS WITH PROSTATE CANCER

You have accessJournal of UrologyCME1 Apr 2023MP21-20 SOCIAL VULNERABILITY AND TREATMENT PATTERNS IN PATIENTS WITH PROSTATE CANCER Rishi Sekar, Kassem Faraj, Rodney L. Dunn, and Lindsey Herrel Rishi SekarRishi Sekar More articles by this author , Kassem FarajKassem Faraj More articles by this author , Rodney L. DunnRodney L. Dunn More articles by this author , and Lindsey HerrelLindsey Herrel More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003246.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Individual characteristics such as race, ethnicity, and socioeconomic status (SES) are well-established risk factors for poor outcomes across the care continuum in various cancers, including prostate cancer. However, these metrics may not capture the complexity of social determinants of health (SDOH) and systemic barriers that often underlie suboptimal care. We evaluate the association of community-level SDOH as measured by the Centers for Disease Control and Prevention’s Social Vulnerability Index (SVI) with diagnostic and treatment patterns in patients with newly diagnosed prostate cancer (PCa). METHODS: We used Medicare claims data to perform a retrospective cohort study of men >65 years with newly diagnosed PCa between 2015-2019. SVI was abstracted and linked to each beneficiary at the county-level and categorized into quartiles (i.e., least vulnerable to most vulnerable). Patient demographics, SES measures, diagnostic and treatment modalities were compared across SVI quartiles. Group comparisons were tested with chi-squared analyses. RESULTS: We identified 138,207 men with newly diagnosed PCa. A greater proportion of men residing in the most vulnerable counties were older, of minority status, more comorbid, living in rural locations with lower SES, and more often dual-eligible (all p<0.001). In terms of diagnosis, these men were less likely to undergo prostate MRI prior to or after diagnosis, but more likely to have a bone scan after diagnosis (all p<0.001). In terms of treatment, these men were less likely to be managed with active treatment (prostatectomy or radiation therapy), and more likely to be managed with primary ADT or active surveillance (all p<0.001). CONCLUSIONS: In a large cohort of Medicare beneficiaries with newly diagnosed PCa, men residing in higher SVI counties were more disadvantaged, less likely to undergo appropriate diagnostic testing, and less likely to be managed with definitive local therapy. Measuring, understanding, and mitigating SDOH is necessary to provide equitable cancer care for patients with PCa. Source of Funding: Prostate Cancer Foundation © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e294 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rishi Sekar More articles by this author Kassem Faraj More articles by this author Rodney L. Dunn More articles by this author Lindsey Herrel More articles by this author Expand All Advertisement PDF downloadLoading ...

Deficient state-supported cancer care: A source of deep concern

Deficient state-supported cancer care: A source of deep concern

Abstract A063: Multimorbidity and the association with patient reported access to care and physician relationships among racially and ethnically diverse patients with colorectal cancer

Abstract Background: Patient reported access to care and quality of physician relationships are influential determinants of outcomes following cancer diagnosis. Both poorer patient reported healthcare experiences and increased comorbidity loads are more common among racial and ethnic minority patients, contributing to disparities in cancer outcomes. We aimed to determine whether multimorbidity exacerbates racial and ethnic disparities in patient reported healthcare experiences. Methods: We used Surveillance, Epidemiology, and End Results-Consumer Assessment of Healthcare Providers and Systems (SEER-CAHPS) data to identify a cohort of patients diagnosed with non-metastatic colorectal cancer between 1999-2017 who were at least 65 at the time of diagnosis and who completed a CAHPS patient experience survey within two years after diagnosis. Main independent variables included CAHPS self-reported race/ethnicity and number of comorbidities. Patients with multimorbidity included those who reported at least one comorbidity, in addition to their colorectal cancer diagnosis. Dependent variables included validated CAHPS composite scores of getting needed care and physician communication (on a 0-100 scale). Multivariable linear regression was used to determine associations between patient race/ethnicity, multimorbidity status, and self-reported experiences with care controlling for sociodemographic and tumor prognostic factors. Models included a product interaction term between race/ethnicity and multimorbidity status to evaluate effect modification by multimorbidity. Results: We identified 4,201 SEER-CAHPS patients with colorectal cancer, consisting of 78.7% non-Hispanic white (NHW), 7.9% non-Hispanic Black (NHB), 7.6% Hispanic, and 5.9% non-Hispanic Asian (NHA) survivors. In addition, 41.2% self-reported having at least one comorbidity in addition to their diagnosis of colorectal cancer. The mean composite score of getting needed care was 88.2 out of 100 possible points and the mean composite score of physician communication was 89.0 out of 100. In multivariable analyses, NHA patients had a mean composite score of getting needed care that was 7.5 points lower than NHW patients (B=-7.45, 95% CI=-11.54- -3.55). Having multimorbidity (at least one self-reported comorbid condition in addition to colorectal cancer) did not affect mean composite scores of getting needed care or physician communication. However, NHB patients with multimorbidity had a mean composite score of getting needed care that was 7.7 points lower than NHW patients without multimorbidity (B=-7.73, 95% CI=-13.16- -2.30). Conclusions: Multimorbidity may substantially decrease the ability of Black colorectal cancer survivors to get needed care, which is an essential determinant of clinical cancer outcomes. Further research is needed to identify how cancer care can be targeted to racial and ethnic minority populations with multimorbidity to provide equitable cancer care for all patients. Citation Format: Stephanie Navarro, Mariana C. Stern, Afsaneh Barzi, Albert J. Farias. Multimorbidity and the association with patient reported access to care and physician relationships among racially and ethnically diverse patients with colorectal cancer [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A063.

Financial Toxicity: A Barrier to Achieving Health Equity in Cancer Care

Financial Toxicity: A Barrier to Achieving Health Equity in Cancer Care

Cancer care for people with dementia: Literature overview and recommendations for practice and research.

As many countries experience population aging, patients with cancer are becoming older and have more preexisting comorbidities, which include prevalent, age-related, chronic conditions such as dementia. People living with dementia (PLWD) are vulnerable to health disparities, and dementia has high potential to complicate and adversely affect care and outcomes across the cancer trajectory. This report offers an overview of dementia and its prevalence among patients with cancer and a summary of the research literature examining cancer care for PLWD. The reviewed research indicates that PLWD are more likely to have cancer diagnosed at an advanced stage, receive no or less extensive cancer treatment, and have poorer survival after a cancer diagnosis. These cancer disparities do not necessarily signify inappropriately later diagnosis or lower treatment of people with dementia as a group, and they are arguably less feasible and appropriate targets for care optimization. The reviewed research indicates that PLWD also have an increased risk of cancer-related emergency presentations, lower quality processes of cancer-related decision making, accessibility-related barriers to cancer investigations and treatment, higher experienced treatment burden and higher caregiver burden for families, and undertreated cancer-related pain. The authors propose that optimal cancer care for PLWD should focus on proactively minimizing these risk areas and thus must be highly person-centered, with holistic decision making, individualized reasonable adjustments to practice, and strong inclusion and support of family carers. Comprehensive recommendations are made for clinical practice and future research to help clinicians and providers deliver best and equitable cancer care for PLWD and their families.

Issue Information

Asia-Pacific Journal of Clinical OncologyVolume 18, Issue S3 p. 1-2 ISSUE INFORMATIONFree Access Issue Information First published: 26 October 2022 https://doi.org/10.1111/ajco.13858AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume18, IssueS3Supplement: COSA's 49th Annual Scientific Meeting Equitable cancer care for all: Gender, identity, culture, geography, and disease should not matter, 2–4 November 2022November 2022Pages 1-2 RelatedInformation

Promoting digital health equity through remote patient monitoring: A feasibility study.

441 Background: Remote patient monitoring (RPM) is a form of telemedicine involving collection and transmission of health data from patients to providers using non-invasive digital technology. RPM may offer earlier recognition of clinical deterioration to help reduce acute care use and improve healthcare outcomes. Studies of digital interventions in oncology have demonstrated reduction in symptom distress and unplanned hospitalizations but lack focus on minority patients. Studies of telehealth aiming to address disparities have not focused on patients with cancer. In this pilot study, we evaluated the feasibility of RPM among patients with cancer at a large urban medical center serving a racially and socioeconomically diverse population. Methods: We partnered with Current Health to provide an FDA-approved RPM wearable device, which included a secure HIPAA-compliant platform, to collect heart rate, temperature, respiration, oxygen saturation, and blood pressure. The kit included broadband access and a tablet to provide telehealth services. Oncology coordinators determined clinical inclusion and exclusion criteria of RPM initiation for patients. A centralized team of Nurse Practitioners (NPs) monitored alarms. Clinical alarms indicated abnormal vital signs; technical alarms indicated no data transmission for a 12-hour period. We measured feasibility by recruitment and retention, and used descriptive statistics to describe the study population, time enrolled on RPM, and alarms. Results: To date, we enrolled 39 patients on the RPM platform over a 14-month period with a weekly census of 10 patients undergoing RPM monitoring. Of the 39 patients, 19 (49%) were white, 10 (26%) Black, and 5 (13%) Asian; 3 (8%) patients identified as Hispanic. Nine (23%) patients had either primary or secondary Medicaid insurance. The average age was 57.9 years. The majority of patients (95%) had hematologic malignancies, all of whom were enrolled on hospital discharge. The mean length of time per patient enrolled with the device was 21.7 days. Over 14 months, there were 607 technical and 118 clinical alarms with an average of 2 clinical alarms per week addressed by NPs by phone, indicating low clinician burden. Conclusions: This pilot study demonstrated the feasibility of RPM in patients with cancer at home. Future studies should focus on equity-driven implementation of RPM in patients with cancer, as well as patient-reported and healthcare utilization outcomes to identify best practices in telemedicine implementation. RPM has promise to deliver high quality and equitable cancer care.

Association of area-level mortgage discrimination and guideline-concordant non–small cell lung cancer care in the United States.

3 Background: Disparities in receipt of care for non-small cell lung cancer (NSCLC) are well described. Discriminatory mortgage lending, which limits access to home ownership in specific neighborhoods overall and disproportionately for racialized groups, is a marker of systemic racism and lower levels of neighborhood investment. This may, in turn, decrease access to high quality care. We used the mortgage denial rate as a measure of housing discrimination and investigated its association with guideline-concordant NSCLC care. Methods: Mortgage denial rates were estimated at the zip code tabulation areas (ZCTAs) level using the Home Mortgage Disclosure Act (HMDA) database (2014-2019). Mortgage denial rates represent the proportion of denied home loans to total loans and were categorized into quartiles. Individuals ≥ 18 years diagnosed with NSCLC 2014-2019 were identified from the National Cancer Database and combined with HMDA. Multivariable logistic regression models examined associations between mortgage discrimination and receipt of guideline-concordant care, including surgery, chemotherapy, and chemoradiation. A multivariable Cox proportional hazard model examined the association between mortgage discrimination and time to chemotherapy initiation. Results: Cohort included 450,614 patients newly diagnosed with NSCLC resided in 33,120 ZCTAs. Individuals residing in ZCTAs with higher mortgage denial rates were more likely to be aged 45-64 years, male, non-Hispanic White, with private health insurance coverage and income &lt; $40,000/year. 69% of all patients received guideline-concordant care. Likelihood of guideline-concordant care was lower in neighborhoods with higher mortgage denial rates, adjusting for age and sex (Table). This disparity was present in all care subgroups. Time to chemotherapy initiation was longer for patients in neighborhoods with higher mortgage denial rates. Conclusions: Mortgage discrimination is adversely associated with receipt of guideline-concordant NSCLC care. Our examination of institutional practices leading to barriers in access to resources highlights the critical need to understand the pathways through which area-level mortgage denials impact receipt of equitable cancer care.[Table: see text]

The Road Less Traveled: Transportation Barriers to Cancer Care Delivery in the Rural Patient Population.

Patients with cancer residing in geographically rural areas experience lower rates of preventative screening, more advanced disease at presentation, and higher mortality rates compared with urban populations. Although multiple factors contribute, access to transportation has been proposed as a critical barrier affecting timeliness and quality of health care delivery in rural populations. Patients from geographically rural regions may face a variety of transportation barriers, including lack of public transportation, limited access to private vehicles, and increased travel distance to specialized oncologic care. A search using PubMed was conducted to identify articles pertaining to transportation barriers to cancer care and tested interventions in rural patient populations. Studies demonstrate that transportation barriers are associated with delayed follow-up after abnormal screening test results, decreased access to specialized oncology care, and lower rates of receipt of guideline-concordant treatment. Low clinical trial enrollment and variability in survivorship care are also linked to transportation barriers in rural patient populations. Given the demonstrated impact of transportation access on equitable cancer care delivery, several interventions have been tested. Telehealth visits and outreach clinics appear to reduce patient travel burden and increase access to specialized care, and patient navigation programs are effective in connecting patients with local resources, such as free or subsidized nonemergency medical transportation. To ensure equal access to high-quality cancer care and reduce geographic disparities, the design and implementation of tailored, multilevel interventions to address transportation barriers affecting rural communities is critical.

2022 Presidential Address: Advancing Equitable Cancer Care Through Innovation.

2022 Presidential Address: Advancing Equitable Cancer Care Through Innovation.

Assessing research methodologies used to evaluate inequalities in end-of-life cancer care research: a scoping review protocol

IntroductionTo provide equitable cancer care at the end of life, it is essential to first understand the evidence underpinning the existence of unequal cancer outcomes. Study design, measurement and analytical...

A feasibility study of remote patient monitoring among vulnerable patients with cancer.

e13652 Background: Patients with cancer have high rates of healthcare utilization due to complications of disease and treatment. Early identification of patient illness may help reduce acute care use and improve quality of care. Remote patient monitoring (RPM), a type of telemedicine involving collection and transmission of health data from a patient’s home to clinicians, has promise to alleviate disparities by providing timely access and early intervention, particularly during the COVID-19 pandemic. Studies of digital interventions in oncology have demonstrated reduction in symptom distress and unplanned hospitalizations but lack focus on minority patients whereas studies of telehealth aiming to address disparities have not focused on patients with cancer. In this pilot study, we aimed to evaluate the feasibility of RPM among patients with cancer at a large urban medical center serving a racially and socioeconomically diverse population. Methods: We partnered with a secure HIPAA-compliant platform and FDA-approved RPM device, Current Health, which monitored heart rate, temperature, respiration, oxygen saturation, and blood pressure. The kit included broadband access and a tablet to provide telehealth services. Oncology Clinicians determined clinical inclusion and exclusion criteria of RPM initiation for patients on the bone marrow transplant service and patients with myeloma and lung cancer. A centralized team of Nurse Practitioners (NPs) monitored alarms. Clinical alarms indicated abnormal vital signs; technical alarms indicated no data transmission for a 12-hour period. We measured feasibility by recruitment and retention, and used descriptive statistics to describe the study population, time enrolled on RPM, and alarms. Results: To date, we enrolled 30 patients on the RPM platform over a 10-month period with a weekly census of 9-10 patients undergoing RPM monitoring. Of the 30 patients, 17 (57%) were white, 7 (23%) Black, and 2 (7%) Asian; 2 patients (7%) identified as Hispanic. The average age was 57.4 years. The majority of patients (93%) had hematologic malignancies, all of whom were enrolled on hospital discharge. Of the 2 patients with lung cancer, 1 patient was enrolled from the outpatient setting and 1 following hospital discharge. The mean length of time per patient enrolled with the device was 21.7 days. Over 10 months, there were 393 technical and 62 clinical alarms with an average of 3 clinical alarms per week addressed by NPs by phone, indicating low clinician burden. Conclusions: This pilot study demonstrated the feasibility of RPM monitoring in patients with cancer. Future studies should evaluate patient-reported and healthcare utilization outcomes, as well as barriers to reimbursement. The identification of best practices in telemedicine implementation can accelerate adoption and increase high quality, timely, and equitable cancer care.

Association of modifiable factors with financial burden and health literacy among patients with cancer.

6573 Background: Cancer patients are at a higher risk of financial burden compared to those with other chronic illnesses and those without cancer. Additionally, cancer patients with low health literacy are at risk for poor health outcomes and poor self-management. Aside from factors such as education and insurance, there is limited information on the role of modifiable factors in predicting financial burden and health literacy. The aim of this study was to identify risk factors associated with financial burden and health literacy among cancer patients. Methods: Participants were 2,260 adult, English- or Spanish-speaking patients who were recruited from an NCI-designated cancer center in the Chicagoland area as part of a trial on symptom management. Participants completed measures on depressive symptoms and anxiety using the Patient-Reported Outcomes Measurement Information System (PROMIS). Financial burden was assessed using a Comprehensive Score for Financial Toxicity (COST FACIT) item (FT12) and health literacy was assessed by the Single Item Literacy Screener (SILS). Additional information on insurance and cancer diagnosis were extracted from medical records. The area deprivation index (ADI) was calculated using national percentile rankings for the patient’s block group. All patient-reported outcomes were assessed at study baseline. Cross-sectional logistic regression models were fit with the FT12 item [dichotomized as high (somewhat/quite a bit/very much) vs. low (not at all/a little bit) financial burden] and SILS [dichotomized as high (quite a bit/extremely) vs. low (not at all/a little bit/somewhat) health literacy] as separate outcomes. The primary covariates of interest were anxiety and depressive symptoms T-scores (dichotomized reflect normal limits vs. elevated distress). Analyses were adjusted for socio-demographic and clinical characteristics. Results: After adjusting for covariates, significant associations of greater financial burden were PROMIS depression [odds ratio (OR): 1.63 (95% CI: 1.22-2.19)] and PROMIS anxiety (OR: 1.60; 95% CI: 1.22-2.10). In addition, higher ADI score, lower education, unemployment, and low health literacy were significantly associated with greater financial burden. PROMIS depression (OR: 2.15; 95% CI: 1.38-3.40) was associated with low heath literacy, along with disability/leave of absence, Medicare/Medicaid/uninsured and lower education. Conclusions: Modifiable factors are associated with financial burden and health literacy. These results support the systematic screening for financial burden and health literacy in addition emotional well-being. Interventions targeting the modifiable factors elucidated in this study may further efforts to provide quality and equitable comprehensive cancer care. Future work should evaluate the potential causal pathways between depression, health literacy, and financial burden.

Evaluating efficacy on tumor biopsy tissue ex vivo before treatment for equitable cancer care.

e13502 Background: Nearly half the world will be diagnosed with cancer. Each year, &gt; 1.7 million new cancers are diagnosed in the US. Worse, systemic therapy turns out to be ineffective in 70% of patients because those drugs do not match the patient’s tumor, imposing a substantial physical, emotional, and financial burden. Each tumor’s distinct composition and heterogeneity can result in diverse responses to the same treatment. There is a critical and urgent need to develop ex vivo personalized cancer models that match patients with the right treatment – before treatment. Here we present a low-cost ex vivo personalized cancer model to rapidly evaluate effectiveness of various therapeutics on intact core biopsy tissue obtained from a patient’s tumor. Objective: The goal of this study is to deliver multiple isolated fluid streams to spatially distinct regions (SDRs) of intact core biopsy specimens for evaluating efficacy of multiple anticancer agents simultaneously. Methods: Core biopsies were generated from xenograft and resected human tumor tissue using 18-gauge and 20-gauge spring-loaded biopsy systems. Xenografts were established using cell lines with known sensitivity and resistance profiles. Fluid streams with anticancer agents, nucleic acid stains, and mock drugs were delivered to spatially distinct regions (SDRs) on intact core biopsy specimens in our patented Personalized Oncology Efficacy Test (POET) lab-chip bioreactors. High content imaging and custom image processing algorithms were used to measure differential activity. Results: No lateral fluid surface conduction, and only minimal lateral diffusion, was observed up to 200 μm deep in tissue. Extent of observed lateral diffusion was within operational parameters of the bioreactor. Integrity of spatially distinct regions on intact core tissue was maintained. Differential activity from anticancer agents compared to mock drugs was observed and quantitatively measured using custom image processing algorithms. Conclusions: The NCI warns that “current methods to assess potential cancer treatments are cumbersome, expensive, and often inaccurate.” A personalized medicine approach, based on efficacy observed on tissue directly from the patient’s own tumor, is fundamentally better than the current approach. Low-cost next generation ex vivo cancer models that can rapidly match treatments to tumors, such as POET, could transform cancer treatment and make a significant impact on the lives of patients.

A Call to Action: The Role of the Oncology AP in Equitable Cancer Care.

The COVID-19 pandemic has only further brought to light how racism, bias, and lack of equity can result in social injustice, morbidity, and mortality. A panel of four advanced practitioners convened at JADPRO Live Virtual 2021 to examine oncology advanced practitioners’ capacity for enhancing equitable cancer care in the domains of care coordination and communication, clinical trials, and acknowledging and mitigating bias.

Cancer detection, diagnosis, and treatment for adults with disabilities

About 15% of the global population-more than 1 billion people-have a disability. People with early-onset disability are now living into middle and older ages and are therefore at risk for adult cancer. Overall, disabled people are more disadvantaged in social determinants of health and are more likely to have risk factors associated with cancer than people without disabilities. People with disabilities often experience disparities in breast and cervical cancer screening compared with people who do not have disabilities, and patterns in colorectal cancer screening disparities are inconsistent. The minimal evidence that exists relating to the timeliness of cancer diagnosis, treatment, and outcomes for people with disabilities suggests differential treatment and higher cancer-related mortality than for people without disabilities. Worldwide, disabled people face barriers to obtaining cancer care, including inaccessible medical diagnostic equipment, ineffective communication accommodations, and potentially biased attitudes among clinicians. Ensuring equitable cancer care for people with disabilities will therefore require eliminating not only physical but also attitude-based barriers to their care.

Understanding Racial and Ethnic Inequities in Uptake and Outcomes Following Multigene Prognostic Testing in Early Breast Cancer: The Promise of Real-World Data

In the past decades, multigene prognostic testing, such as Oncotype DX (ODX), has been increasingly used to inform treatment decisions for patients with early-stage breast cancer. This advance in precision oncology has increased existing concerns about differential access to genomic testing across racial and ethnic groups. The investigation by Moore and colleagues, analyzing real-world data from the National Cancer Database, shows that patients of color with breast cancer were less likely to receive ODX testing and Black patients were more likely to have a high risk Recurrence Score (RS) compared with White patients. This study emphasizes that the appropriate adoption of ODX testing is critical to promote equitable cancer care for patients with breast cancer. The reported associations on overall survival across specific racial and ethnic groups provided here give additional insight to the known associations between the ODX RS and outcomes of distant recurrence and cancer-specific mortality. Analyses of contemporary, real-world data from diverse populations with long-term follow-up should continue to keep pace with the expansion of precision breast cancer care to better understand and mitigate potentially widening inequities in genomic testing. See related article by Moore et al., p. 821.

Representation of Sexual and Gender Minority People in Patient Nondiscrimination Policies of Cancer Centers in the United States.

Sexual and gender minority (SGM) people are an underserved population who face high rates of discrimination in healthcare, including receipt of cancer treatment. Several national organizations have identified the importance of patient nondiscrimination policies that explicitly recognize SGM people in creating safe healthcare environments. We performed a web-based analysis of NCI-designated Cancer Centers to evaluate the landscape of patient nondiscrimination policies in major cancer centers with regard to representation of SGM people. We found that 82% of cancer centers had a patient nondiscrimination policy on their website. The most commonly mentioned SGM-related term was "sex" (n=48; 89%), followed by "sexual orientation" (n=37; 69%) and "gender identity" (n=36; 67%). None of the policies included "sex assigned at birth" or "LGBTQ/SGM identity." Of the policies reviewed, 65% included protections for both sexual orientation and gender identity. Cancer centers with academic affiliations were significantly more likely to have policies that included both of these protections compared with nonacademic institutions (100% vs 79%; P=.005). Our study shows that patient nondiscrimination policies across NCI-designated Cancer Centers are not always accessible to patients and their families online and do not consistently represent SGM people in their content. Because the SGM population is both at higher risk for cancer and for discrimination in the healthcare setting, it is crucial to create inclusive, safe, and equitable cancer care environments for this group. Administrators and clinicians should view the patient nondiscrimination policy as an opportunity to offer expansive protections to SGM people that extend beyond those offered in federal and state laws. Additionally, the patient nondiscrimination policy should be visible and accessible to patients seeking cancer care as a signal of safety and inclusion.

Women with bladder cancer: an underserved population due to a faulty health care system or in a biological disadvantage?

Abstract&#x0D; Although men are four times more frequently diagnosed than women with urothelial bladder cancer, clinical outcomes greatly differ between both genders, as women present a higher lethality rate, as well as a greater loss of life expectancy. At diagnosis, women present more advanced clinical stages, situation which has led to many efforts to elucidate the social determinants of health and the biological factors implied. Women face different challenges associated with a delay in both, diagnosis and treatment, a more limited access to systemic treatment, and lower response rates associated with immunotherapy. Women are underrepresented in the main chemotherapy, immunotherapy, and other systemic treatment trials, as they comprise only 15 to 25% of the overall population, limiting the possibility of drawing any definitive conclusions. Furthermore, through gene expression analysis, women have been linked to a more aggressive biological subtype of bladder cancer (basal), a higher rate of FGFR 1-4 mutated tumors, lower rate of NECTIN-4 expression, and a higher prevalence of germline mutations. Despite the worse prognosis, sex-based recommendations have not been developed. Cancer care teams must not hinder access to treatment options based on sex and should strive for an equitable cancer care.