African American and Hispanic patients with clear cell renal cell carcinoma may be less likely to receive treatment with immune checkpoint inhibitors than White patients, says Solomon Woldu, MD.
In a conversation with CancerNetwork® during the 2023 Society of Urologic Oncology (SUO) Annual Meeting,Solomon Woldu, MD, discussed findings from his presentation on disparities in treatment access and outcomes among patients with high-risk clear cell renal cell carcinoma (RCC).
In particular, he emphasized that several factors may contribute to these disparities, including education, race, and language barriers. Moreover, Woldu, an assistant professor in the Department of Urology at the University of Texas Southwestern Medical Center, said that after analyzing findings from databases including the National Cancer Database (NCDB), investigators found that Hispanic and African American patients were less likely to have access to treatment with immune checkpoint inhibitors, and that they generally had shorter overall survival. He suggested that these data may inspire action among urologists and other frontline providers to counsel underserved patients and direct them towards adjuvant immunotherapy when applicable.
When we think of disparities, our minds naturally gravitate towards the role of race and ethnicity and their [impact] on health care results in kidney cancer, other cancers, or even other medical conditions. But the reality is that the causes of disparity can be many different things including economics, education, religion, language barriers, and of course payer mix, especially in the United States. There are numerous disparities with regard to outcomes in RCC and kidney cancer.
Some of the most prominent disparities are findings that suggest that African American and Hispanic patients have worse overall survival in a general aggregate kind of way. That has certainly been borne out in the evidence using large national level databases, such as the NCDB and SEER. But in some ways, there’s a problem with these large aggregate generalizations in the sense that we may sort of lose the ability to have some action upon that. Instead, I think there’s some value to focusing on discrete things that we can control as urologists and frontline workers.
One of the [aspects] of our study that we presented at this SUO meeting was to look at the NCDB since the approval of immune checkpoint inhibition. And in the study, when taking into account other factors such as the socioeconomic factors that are available to us in the NCDB, we found that African American and Hispanic patients were about 20% less likely to receive immune checkpoint inhibition for advanced RCC. This type of information could be very actionable to any frontline worker and provider, especially a group of urologists who are seeing patients postoperatively and may be able to spend the extra time to counsel patients towards adjuvant immunotherapy for high-risk clear cell RCC.
Woldu SL. Disparities in kidney cancer care/outcomes. 2023 Society of Urologic Oncology (SUO) Annual Meeting; November 28-December 1, 2023; Washington, DC.