Lessons from the past shape a better future in cancer care at Karmanos
Since 1976, February has been designated Black History Month in the United States. The month provides an opportunity to celebrate African Americans' many contributions to the country's history while recognizing inequities and struggles that have divided the nation over time.
Inequality has spanned every inch and industry in America, from voting rights to equal pay, and the field of medicine is no exception. At the Barbara Ann Karmanos Cancer Institute, we acknowledge the disparities and inequities that Black cancer patients face. Since our founding, we have been committed to understanding these issues and leading changes that can shape a better future for underserved populations and all individuals fighting cancer.
The cancer burden facing the African American population is undoubtedly significant.
- According to the American Cancer Society, African Americans have the highest death rate and shortest survival of any racial and ethnic group in the United States for most cancers.
- A report by the U.S. Department of Health and Human Services Office of Minority Health showed that from 2012-2016, Black women were 40 percent more likely to die from breast cancer than non-Hispanic white women, despite similar diagnosis rates.
- In men, African Americans have lower five-year survival rates for most cancers compared to non-Hispanic white men.
- Additionally, fewer Black patients participate in clinical trials than other groups. A ProPublica analysis of data from the FDA found that in 2015, fewer than five percent of patients participating in 24 of 31 clinical trials for cancer drugs were African American.
SEER
Gathering and understanding data is critical in addressing the inequities faced by ethnic minorities. To capture critical data, Karmanos began working with the Surveillance, Epidemiology and End Results Program (SEER) in 1973 as one of the original nine registries. Karmanos contributes approximately 38 percent of the national cancer incidence and survival data for African Americans. The SEER registry is not only used for descriptive studies; it provides a population-based source of cases for case-control and case-case comparisons.
Community Engagement
Karmanos also engages with diverse communities through the Office of Cancer Health Equity and Community Engagement (OCHECE), whose mission is to eliminate cancer health disparities in Michigan by promoting community-engaged research and evidence-based strategies throughout Karmanos' 46-county catchment area. OCHECE programs include Michigan Cancer HealthLink, an academic-community partnership created to build community capacity to collaborate in cancer-related research. Michigan Cancer HealthLink has 11 Cancer Action Councils in six cities throughout the Karmanos catchment area. Five CACs represent neighborhoods or regions — three are predominantly African American — while other councils represent populations, specifically LGBTQ adults, Arab Americans and African American men. Through these councils, Karmanos researchers can hear the voices of those in various populations, so they may collaborate with the councils on research and solutions to suit the needs of cancer patients.
OCHECE also oversees a Research and Advocacy Consortium (RAC). This growing network includes more than 50 faith-based, social service and public health organizations. The RAC works with OCHECE to support evidence-based interventions to improve cancer outcomes; inform diverse communities about clinical trials, cancer control, prevention, screening, and treatment; aid in disseminating and implementing research discoveries; and advance health policy recommendations.
Karmanos Research
In addition to the work of the OCHECE, many individual researchers at Karmanos study disparities in health care and propose novel solutions.
Susan Eggly, Ph.D., professor and a Population Studies and Disparities Research (PSDR) Program member at Karmanos and Wayne State University (WSU) School of Medicine, focuses her research on the ways that patients and providers communicate, particularly around clinical trials. She leads the Partnering Around Cancer Clinical Trials (PACCT) study, which encourages physicians to offer trials to all eligible patients using high-quality, patient-centered communication. The study's overall goal is to test two communication interventions, one for patients and another for physicians, to increase the rates of Black and White men with prostate cancer participating in clinical trials based on informed decisions.
During the study, clinical interactions are recorded and reviewed with permission from patients, family members and providers to understand better and improve patient-physician communication. In addition, videos from these interactions are re-enacted and used to provide evidence-based instruction to providers and patients. These videos are utilized in training modules, which include techniques and education for better care. As a result, Dr. Eggly received the Anthony and Joyce Danielski Kales Endowed Faculty Award for Innovative Cancer Researcher for her work. Thus far, 16 Karmanos network locations in Michigan have benefited from using these videos and reported positive results. These latest training modules will soon be available nationwide. Dr. Eggly and her team's latest research, "Addressing multilevel barriers to clinical trial participation among Black and White men with prostate cancer through the PACCT study," published in Cancer Medicine, can be reviewed here.
Lauren Hamel, Ph.D., assistant professor and co-program leader of the PSDR Program, also works toward a greater understanding of disparities in cancer care. Along with her team, she identified discernable patterns of behaviors between African American patients with cancer and their oncologists by measuring discrete behaviors like smiling, eye gaze and leaning in that could potentially be modified to help physicians connect with their patients, especially minority patients. One of Dr. Hamel's team's latest research studies, "Nonverbal synchrony: An indicator of clinical communication quality in racially-concordant and racially-discordant oncology interactions," published in Cancer Control, can be read here. In 2022, Dr. Hamel was awarded the Outstanding Diversity, Equity and Inclusion (DEI) Faculty Scholar by the Office of Faculty Affairs and Professional Development at WSU's School of Medicine.
Isaac Powell, M.D., urologic oncologist and member of the Genitourinary Oncology Multidisciplinary Team, is another Karmanos team member who has dedicated his research to understanding disparities. He focuses on how prostate cancer impacts African Americans compared to other ethnic groups. He was the principal investigator of the African American Hereditary Prostate Cancer (AAHPC) study to recruit families to identify genes associated with hereditary prostate cancer. This group continued their study with the International Consortium Prostate Cancer Genetics (ICPCG) group to compare hereditary prostate cancer genetic results among African American men from AAHPC families to other ethnicities and other centers worldwide. He has also collaborated with Harvard University and Cornell University researchers to report the whole exome sequencing of prostate cancer and potential racial differences, which showed that prostate cancer among African American men grew faster than among other ethnicities. His work identified genes associated with advanced prostate cancer that are more expressed among African American men than European American men.
Dr. Powell has been recognized for his expertise and work in his studies. In 2021, he was honored by WDIV and the Today Show as a change maker. In 2022, Dr. Powell continued the public conversation to understand the differences of Black Americans' unique risk of prostate cancer and population hereditary genetics during a discussion on Empowered with Angela T. Moore and in a barbershop with African American men.
Health Equity Book Club
In addition to quantitative data, it is important to acknowledge the nuanced experiences, cultural complexities and individual narratives that African Americans report about their health care. One way that Karmanos is opening a dialogue about these stories is through the quarterly Health Equity Book Club. Through reading and discussing texts that explore a range of topics related to equity in healthcare, this program educates healthcare providers on the history of systemic racism in medicine. It sets the stage for developing strategies and interventions to eliminate the impact of racial inequities in medical practice and society.
The group's first read was a 2007 book by Harriet A. Washington, “Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present.” Washington's text presents a history of the medical industry's shocking mistreatment of African Americans, from slavery to now. Led by a diverse group of leaders from Karmanos and WSU, 115 readers attended this virtual discussion, where emotional and disturbing passages sparked deep conversation. The meeting concluded with a dialogue outlining steps medical providers can take to build trust with the African American community.
The reading community has grown to over 530 people. Many book club participants are physicians and staff members at Karmanos, McLaren Health Care, and other health care systems, physicians pursuing fellowships, professionals in higher education, students in residency and students studying public health, and patients and community members. Learn more about the Health Equity Book Club and the current book selection here.
Diversity and Inclusion Initiatives for Karmanos Employees
In addition to our work to understand and serve our African American patients' needs, Karmanos is committed to providing an inclusive environment for its employees. In 2020, Karmanos formally launched a Diversity and Inclusion Committee. Led by this committee, Karmanos integrates best practices in diversity, inclusion and cultural competence. The committee comprises members from many different areas of the organization, from leadership and administration to clinical staff and researchers. In addition to core members, the committee works with department leaders in identifying staff members to participate in initiatives to broaden the scope of voices and ideas.
While much is being done at Karmanos to remedy the social and medical inequities experienced by African Americans, there is more work ahead. We are proud of our work and will continue to fight against disparities with the same enthusiasm we use to fight against cancer so our impact can grow. Black History Month reminds us to reflect on the past. We must take action in the present to repair broken systems to create a more equitable future. Karmanos will continue its commitment to serving the African American community with outstanding research and care. We will never stop striving for equality.