Patient, Caregiver, and Oncologist Experiences With and Perceptions of Racial Bias and Discrimination in Cancer Care Delivery
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Background: Cancer prevention and treatment systems are significantly impacted by interpersonal, organizational, and structural and systemic racism. A wide body of research has found that racial disparities in access to guideline-adherent cancer care are pervasive throughout the United States and contributing factors include social determinants of health, insurance status, and bias and discrimination in care delivery. Although the existence of racial disparities in cancer care and outcomes is well established, there has been limited research exploring the patient and caregiver experience with bias and discrimination in cancer care. Methods: Two national surveys were conducted, one of patients and caregivers and one of oncologists. The surveys examined patient and caregiver experiences with and oncologist perceptions of racial disparities in cancer care. Results: The surveys found that when patients and caregivers were asked about negative care experiences, differences across race were observed. Patients and caregivers identifying as African American/Black (AA/B) or Hispanic/Latino (H/L) were more likely to report at least one negative care experience than patients and caregivers identifying as White (W). Patients who were AA/B or H/L were also more likely than W patients to report that the healthcare system treats people unfairly based on their racial or ethnic background and that racial bias occurs often or very often when a patient and doctor are of different racial/ethnic background. A slight majority of oncologists reported that the healthcare system treats people unfairly based on their racial or ethnic background. Conclusions: The survey results highlight a need for improved racial representation in the oncology professional workforce, improved implicit bias training, and improved clinical trial recruitment efforts.
Submitted January 21, 2022; final revision received May 27, 2022; accepted for publication June 30, 2022.
Author contributions: Development of survey questions: Schatz, Brooks-Coley. Survey design and launch: Harrington. Analysis of survey results: Harrington. Manuscript writing: Schatz, Stober Murray, Carlson. Manuscript revision: All authors.
Disclosures: The authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.
Funding: Research in this article was supported by AbbVie, Inc., bluebird bio, Inc., Bristol-Myers Squibb Company, Eli Lilly and Company, Merck & Co., Inc., MorphoSys AG, Pfizer Inc., Regeneron Pharmaceuticals, Inc., sanofi-aventis U.S., and Taiho Pharmaceuticals Co., Ltd. (A. Schatz). Research in this article was also supported by Genentech, Inc., GlaxoSmithKline, and Janssen Pharmaceutica Products, LP.
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