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Oncologist Perceptions of Racial Disparity, Racial Anxiety, and Unconscious Bias in Clinical Interactions, Treatment, and Outcomes

Alexandrina Balanean, Emily Bland, Ajeet Gajra, Yolaine Jeune-Smith, Andrew J. Klink, Harlen Hays, and Bruce A. Feinberg

Background: Cancer spares no demographic or socioeconomic group; it is indeed the great equalizer. But its distribution is not equal; when structural discrimination concentrates poverty and race, zip code surpasses genetic code in predicting outcomes. Compared with White patients in the United States, Black patients are less likely to receive appropriate treatment and referral to clinical trials, genetic testing, or palliative care/hospice. Methods: In 2021, we administered a survey to 369 oncologists measuring differences in perceptions surrounding racial disparity, racial anxiety, and unconscious bias and adverse influence on clinical interactions, treatment, and outcomes for non-White patients. We analyzed responses by generational age group, sex/gender, race/ethnicity, US region, and selection of “decline to respond.” Results: The most significant differences occurred by age group followed by race/ethnicity. Racial disparity was perceived as moderate to very high by 84% of millennial, 69% of Generation X, and 57% of baby boomer oncologists, who were also 86% more likely than millennials and 63% more likely than Generation Xers to perceive low/nonexistent levels of racial anxiety/unconscious bias. Conclusions: Most oncologists rarely or never perceived racial anxiety/unconscious bias as adversely influencing clinical treatment or survival outcomes in non-White patients, and White oncologists were 85% more likely than non-White oncologists to perceive rare/nonexistent influence on referral of non-White patients to palliative care/hospice. The discrepancy between 62% of oncologists perceiving moderate to very high levels of racial anxiety/unconscious bias and 37% associating them with adverse influence on non-White patients shows a disconnect, especially among older oncologists (baby boomers), who were also least likely to select the decline option. Together, these factors hinder effective patient–provider communication and result in differential care and outcomes. Oncologists should uncover their own perceptions surrounding racial disparity, racial anxiety, and unconscious bias and modify their behaviors accordingly. It is this simple—and this complicated. Cancer does not discriminate, and neither should cancer care.

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Pediatric Hodgkin Lymphoma, Version 3.2021

Jamie E. Flerlage, Susan M. Hiniker, Saro Armenian, Ellen C. Benya, Adam J. Bobbey, Vivian Chang, Stacy Cooper, Don W. Coulter, Branko Cuglievan, Bradford S. Hoppe, Leidy Isenalumhe, Kara Kelly, Leslie Kersun, Adam J. Lamble, Nicole A. Larrier, Jeffrey Magee, Kwadwo Oduro, Martha Pacheco, Anita P. Price, Kenneth B. Roberts, Christine M. Smith, Aliyah R. Sohani, Erin M. Trovillion, Emily Walling, Ana C. Xavier, Jennifer L. Burns, and Mallory Campbell

Hodgkin lymphoma (HL) is a highly curable form of cancer, and current treatment regimens are focused on improving treatment efficacy while decreasing the risk of late effects of treatment. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for pediatric HL provide recommendations on the workup, diagnostic evaluation, and treatment of classic HL, including principles of pathology, imaging, staging, systemic therapy, and radiation therapy. This portion of the NCCN Guidelines focuses on the management of pediatric classic HL in the upfront and relapsed/refractory settings.

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NCCN Guidelines® Insights: Melanoma: Cutaneous, Version 2.2024

Featured Updates to the NCCN Guidelines

Susan M. Swetter, Douglas Johnson, Mark R. Albertini, Christopher A. Barker, Sarah Bateni, Joel Baumgartner, Shailender Bhatia, Christopher Bichakjian, Genevieve Boland, Sunandana Chandra, Bartosz Chmielowski, Dominick DiMaio, Roxana Dronca, Ryan C. Fields, Martin D. Fleming, Anjela Galan, Samantha Guild, John Hyngstrom, Giorgos Karakousis, Kari Kendra, Maija Kiuru, Julie R. Lange, Ryan Lanning, Theodore Logan, Daniel Olson, Anthony J. Olszanski, Patrick A. Ott, Merrick I. Ross, Luke Rothermel, April K. Salama, Rohit Sharma, Joseph Skitzki, Emily Smith, Katy Tsai, Evan Wuthrick, Yan Xing, Nicole McMillian, and Sara Espinosa

The NCCN Guidelines for Cutaneous Melanoma (termed Melanoma: Cutaneous) provide multidisciplinary recommendations for diagnostic workup, staging, and treatment of patients. These NCCN Guidelines Insights focus on the update to neoadjuvant systemic therapy options and summarize the new clinical data evaluated by the NCCN panel for the recommended therapies in Version 2.2024 of the NCCN Guidelines for Cutaneous Melanoma.

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NCCN Guidelines® Insights: Breast Cancer Screening and Diagnosis, Version 1.2023

Featured Updates to the NCCN Guidelines

Therese B. Bevers, Bethany L. Niell, Jennifer L. Baker, Debbie L. Bennett, Ermelinda Bonaccio, Melissa S. Camp, Sona Chikarmane, Emily F. Conant, Mohammad Eghtedari, Meghan R. Flanagan, Jeffrey Hawley, Mark Helvie, Linda Hodgkiss, Tamarya L. Hoyt, Jennifer Ivanovich, Maxine S. Jochelson, Swati Kulkarni, Rachael B. Lancaster, Caitlin Mauer, Jessica Maxwell, Bhavika K. Patel, Mark Pearlman, Liane Philpotts, Donna Plecha, Jennifer K. Plichta, Shadi Shakeri, Mary Lou Smith, Clarie L. Streibert, Roberta M. Strigel, Lusine Tumyan, Nicole S. Winkler, Dulcy E. Wolverton, Mary Anne Bergman, Rashmi Kumar, and Katie Stehman

The NCCN Guidelines for Breast Cancer Screening and Diagnosis provide health care providers with a practical, consistent framework for screening and evaluating a spectrum of clinical presentations and breast lesions. The NCCN Breast Cancer Screening and Diagnosis Panel is composed of a multidisciplinary team of experts in the field, including representation from medical oncology, gynecologic oncology, surgical oncology, internal medicine, family practice, preventive medicine, pathology, diagnostic and interventional radiology, as well as patient advocacy. The NCCN Breast Cancer Screening and Diagnosis Panel meets at least annually to review emerging data and comments from reviewers within their institutions to guide updates to existing recommendations. These NCCN Guidelines Insights summarize the panel’s decision-making and discussion surrounding the most recent updates to the guideline’s screening recommendations.