A paucity of data exists on racial and ethnic disparities in patients with acute myeloid leukemia, acute lymphocytic leukemia, multiple myeloma, non-Hodgkin lymphoma, Hodgkin lymphoma, myeloproliferative neoplasms, and myelodysplastic syndromes.
This review focuses on a critical appraisal of the empirical research on racial and ethnic disparities in incidence, survival, outcomes, and enrollment in clinical trials. Reviewers discuss in detail four potential causes for disparities: biologic factors, health behaviors, individual factors, and structural barriers.
Structural barriers can lead to lack of equal access to novel therapies, and as a result, recruitment and enrollment of minorities in research studies is low overall compared with that for whites. For example, in multiple myeloma trials, minorities are known to be underrepresented, which may in turn challenge the generalizability of the results of these clinical trials to minority patients.
In addition, because non-white populations tend to participate less in pharmacogenomics studies than their white counterparts, it is difficult to determine whether a particular drug has similar metabolism across all racial and ethnic populations.
Regarding survival disparities, the authors note that the National Cancer Institute SEER database shows an excess risk of dying among black (12%) and Hispanic (6%) patients with AML compared with non-Hispanic white counterparts. An important topic for further research, according to the authors, is to determine why these disparities exist despite an increased prevalence of favorable cytogenetics and a younger age at diagnosis in these non-white groups.
The authors conclude by noting that “future public health endeavors should focus on increasing clinical trial participation of minorities with hematologic malignancies and refining the SEER data on race, ethnicity, and socioeconomic status.”