WHITE SUPREMACIST MEDICINE
Stress from living in violent neighborhoods tied to aggressive lung cancer in Black men
BOSTON—Exposure to increased neighborhood violence has the power to change the glucocorticoid receptor (GR) for the stress hormone, cortisol, which may influence the aggressiveness of lung cancer, according to data presented Sunday at ENDO 2024, the Endocrine Society’s annual meeting in Boston, Mass.
“This research uncovers a previously unknown link between exposure to neighborhood violence, GR and lung tumor aggressiveness that can help us understand and fix the lung cancer health disparity seen in Black men” said Hannah Heath, B.S., a graduate research assistant at the University of Illinois at Urbana-Champaign in Urbana, Ill.
For this study conducted in Chicago, Heath and the research team found that Black men were more likely to live in neighborhoods with high levels of violent crime and have greater cortisol levels in their hair. This chronic stress, Heath explained, compelled the researchers to investigate how the GR impacted gene expression that regulates how aggressive a tumor will grow.
They collected lung tumor and healthy lung tissue samples from 15 Black and non-Black patients living in Chicago. Residential zip codes and police record data were used to determine which patients were living in neighborhoods with high, mid and low levels of violent crime.
Among the tests performed, Heath and colleagues performed Cleavage Under Targets & Release Using Nuclease (CUT&RUN), a new technology that can be used to pinpoint regions of DNA that GR binds to.
“We found that genes correlated with exposure to neighborhood violence were associated with pathways involved in cortisol signaling and increased tumor aggressiveness,” Heath said. “When we looked at the spatial expression of these cortisol-signaling and tumor aggressiveness genes, we found regions within tumor samples from high-violence neighborhoods that had elevated expression of these genes.”
They did not find these regions among patients with tumors who lived in low-violence neighborhoods. Furthermore, exposure to neighborhood violence led to the GR binding in regions of DNA that promotes a more aggressive lung tumor–an area it does not typically bind to.
“We hope this research will lead to larger studies that will ultimately be used to guide the addition of the neighborhood environment as a lung cancer screening eligibility parameter,” Heath said. “Currently, these parameters heavily focus on smoking habits. However, because Black men smoke less, they are often not eligible for screening, resulting in Black men being screened less and diagnosed later than white men.”
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Endocrinologists are at the core of solving the most pressing health problems of our time, from diabetes and obesity to infertility, bone health, and hormone-related cancers. The Endocrine Society is the world’s oldest and largest organization of scientists devoted to hormone research and physicians who care for people with hormone-related conditions.
The Society has more than 18,000 members, including scientists, physicians, educators, nurses and students in 122 countries. To learn more about the Society and the field of endocrinology, visit our site at www.endocrine.org. Follow us on Twitter at @TheEndoSociety and @EndoMedia.
BOSTON—Exposure to increased neighborhood violence has the power to change the glucocorticoid receptor (GR) for the stress hormone, cortisol, which may influence the aggressiveness of lung cancer, according to data presented Sunday at ENDO 2024, the Endocrine Society’s annual meeting in Boston, Mass.
“This research uncovers a previously unknown link between exposure to neighborhood violence, GR and lung tumor aggressiveness that can help us understand and fix the lung cancer health disparity seen in Black men” said Hannah Heath, B.S., a graduate research assistant at the University of Illinois at Urbana-Champaign in Urbana, Ill.
For this study conducted in Chicago, Heath and the research team found that Black men were more likely to live in neighborhoods with high levels of violent crime and have greater cortisol levels in their hair. This chronic stress, Heath explained, compelled the researchers to investigate how the GR impacted gene expression that regulates how aggressive a tumor will grow.
They collected lung tumor and healthy lung tissue samples from 15 Black and non-Black patients living in Chicago. Residential zip codes and police record data were used to determine which patients were living in neighborhoods with high, mid and low levels of violent crime.
Among the tests performed, Heath and colleagues performed Cleavage Under Targets & Release Using Nuclease (CUT&RUN), a new technology that can be used to pinpoint regions of DNA that GR binds to.
“We found that genes correlated with exposure to neighborhood violence were associated with pathways involved in cortisol signaling and increased tumor aggressiveness,” Heath said. “When we looked at the spatial expression of these cortisol-signaling and tumor aggressiveness genes, we found regions within tumor samples from high-violence neighborhoods that had elevated expression of these genes.”
They did not find these regions among patients with tumors who lived in low-violence neighborhoods. Furthermore, exposure to neighborhood violence led to the GR binding in regions of DNA that promotes a more aggressive lung tumor–an area it does not typically bind to.
“We hope this research will lead to larger studies that will ultimately be used to guide the addition of the neighborhood environment as a lung cancer screening eligibility parameter,” Heath said. “Currently, these parameters heavily focus on smoking habits. However, because Black men smoke less, they are often not eligible for screening, resulting in Black men being screened less and diagnosed later than white men.”
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Endocrinologists are at the core of solving the most pressing health problems of our time, from diabetes and obesity to infertility, bone health, and hormone-related cancers. The Endocrine Society is the world’s oldest and largest organization of scientists devoted to hormone research and physicians who care for people with hormone-related conditions.
The Society has more than 18,000 members, including scientists, physicians, educators, nurses and students in 122 countries. To learn more about the Society and the field of endocrinology, visit our site at www.endocrine.org. Follow us on Twitter at @TheEndoSociety and @EndoMedia.
Are there racial inequities in naloxone administration during fatal overdoses?
Pennsylvania has been disproportionately affected by the opioid epidemic, having the fourth highest number of overdose deaths in the country in 2020. Also, the rate of overdose deaths among Black persons is significantly higher than that of white persons in the state. A recent analysis published in Addiction reveals that compared with white people in Pennsylvania, Black individuals are less likely to receive naloxone—a medication that rapidly reverses an opioid overdose.
In the analysis of 2019–2021 data collected from death certificates and the State Unintentional Drug Overdose Reporting System, investigators found that overdose death rates in Pennsylvania were the highest among Black persons in the study population and increased over time (rates per 10,000 population were 4.3 in 2019, 6.1 in 2020, and 6.5 in 2021); rates were lowest among white persons and stayed constant over time (approximately 2.6 per 10,000 population).
Across all years, Black people who died from an overdose had 40–50% lower odds of naloxone administration compared with white people who died. Hispanic decedents had similar odds of naloxone administration to that of white decedents.
“The disparity in overdose rates and differences in naloxone administration emphasize the urgent and continued need for equitable distribution of naloxone and other harm reduction services throughout Pennsylvania, especially among communities of color who are already disproportionately affected by systemic inequalities,” said corresponding author Erin Takemoto, PhD, MPH, of the Pennsylvania Department of Health.
URL upon publication: https://onlinelibrary.wiley.com/doi/10.1111/add.16478
Additional Information
NOTE: The information contained in this release is protected by copyright. Please include journal attribution in all coverage. For more information or to obtain a PDF of any study, please contact: Sara Henning-Stout, newsroom@wiley.com.
About the Journal
Addiction publishes peer-reviewed research reports on pharmalogical and behavioural addictions, bringing together research conducted within many different disciplines. The publication is an official journal of the Society for the Study of Addiction, and has been in publication since 1884.
About Wiley
Wiley is a knowledge company and a global leader in research, publishing, and knowledge solutions. Dedicated to the creation and application of knowledge, Wiley serves the world’s researchers, learners, innovators, and leaders, helping them achieve their goals and solve the world's most important challenges. For more than two centuries, Wiley has been delivering on its timeless mission to unlock human potential. Visit us at Wiley.com. Follow us on Facebook, Twitter, LinkedIn and Instagram.
JOURNAL
Addiction
ARTICLE TITLE
Inequities in Naloxone Administration Among Fatal Overdose Decedents by Race and Ethnicity in Pennsylvania, 2019-2021
ARTICLE PUBLICATION DATE
29-May-2024
Dana-Farber researchers uncover disparities in lived experiences for patients and physicians
DANA-FARBER CANCER INSTITUTE
IMAGE:
FOUR TEAMS OF Dana-Farber Cancer Institute INVESTIGATORS HAVE FOUND THAT PEOPLE EXPERIENCE DISCRIMINATION AND BIAS IN DIFFERENT WAYS AND IN MORE REALMS OF CANCER CARE THAN PREVIOUSLY UNDERSTOOD.
view moreCREDIT: DANA-FARBER CANCER INSTITUTE
Boston – Four teams of Dana-Farber Cancer Institute investigators have found that people experience discrimination and bias in different ways and in more realms of cancer care than previously understood.
The findings, in different studies, suggest that oncology professionals and the systems they work in have more work to do to adapt to the realities of increasing diversity and inclusion, not only in the patient population but also in the oncology workforce. The research teams will present their findings at the 2024 Annual Meeting of the American Society of Clinical Oncology (ASCO) in Chicago. ASCO is the world’s largest clinical cancer research meeting, attracting more than 30,000 global oncology professionals.
“We need to transform our health systems so that they work for everybody,” says presenter Shail Maingi, MD, a member of Dana-Farber’s Cancer Care Equity Program and a physician at the Dana-Farber Brigham Cancer Center at South Shore Health. “These findings bring to light disparities and interpersonal dynamics that are surprising and important for us to pay attention to as we strive to build medical systems that see and take care of everyone.”
LGBTQ+: Patient and physician experiences
Maingi is presenting two abstracts and reporting data from a survey of 817 LGBTQ+ cancer patients and 115 oncology professionals from a wide range of treatment centers in the U.S. The survey revealed that while 84% of physicians reported feeling comfortable treating LGBTQ+ patients, only 24% of patients felt comfortable disclosing their LGBTQ+ status. In addition, a scant 4% of patients felt that their care team treated their partner with respect. At least 30% of physicians reported being unsure how LGBTQ+ status affected treatment considerations or how to discuss LGBTQ+ status with their patients.
Maingi’s team used the survey responses to develop a toolkit to improve LGBTQ+ patient experiences. Her team shared that toolkit with several community sites and discussed initiatives the sites could implement rapidly, within 30 days.
Many of these initiatives are already in place at Dana-Farber. “Dana-Farber is becoming more approachable and diverse, so we are starting to understand the lived experiences of our patients. This knowledge is making the Institute stronger,” says Maingi. “But we don’t have this solved.”
- Study Title: Disparities uncovered: LGBTQ+ patients report on their cancer care journey Abstract Number: 1516 Session: Rapid Oral Abstract Session - Care Delivery/Models of Care; June 3, 2024, 7:00am ET Presenting Author: Shail Maingi, MD
- Study Title: Beyond the binary: A transformative implementation science initiative to improve LGBTQ+ cancer care Abstract Number: 11010 Session: Rapid Oral Abstract Session - Quality Care/Health Services Research; June 3, 2024, 12:21pm ET Presenting Author: Shail Maingi, MD
International medical graduates face unconscious bias and limited opportunities
Three other abstracts will be presented during the conference that focus on oncology professionals who are international medical graduates, meaning they attended medical school outside of the U.S. or Canada but completed residency and fellowships and are now practicing in the U.S. Approximately 30% of U.S. oncology professionals are international medical graduates.
International medical graduates, like author Narjust Florez, MD, Associate Director of the Cancer Care Equity Program and a thoracic medical oncologist at Dana-Farber, help diversify the oncology workforce so that it more closely mirrors the populations of patients it serves. Florez, however, will report that being an international medical graduate in the U.S. is difficult.
Her team’s survey of 97 oncologists who are international, or Puerto Rican medical graduates revealed that over half experienced racial or ethnic discrimination during training and independent practice. In addition, women were more likely to face racial or ethnic discrimination during training than men and were more likely to experience gender discrimination during training and clinical practice, demonstrating the power of intersectionality between different types of biases, including gender bias.
“Unconscious bias is an extra thing that international medical graduates need to deal with,” says Florez, who has personal experience with bias. “My race and my accent come through the door before any of my credentials, titles, and publications.”
International medical graduates may also have fewer opportunities to be invited as faculty. Findings by senior author Toni Choueiri, MD, Director of the Lank Center for Genitourinary Oncology at Dana-Farber, will be presented from an analysis of event programs from the two previous ASCO annual meetings. This team found that international medical graduates who are practicing oncologists in the US are less likely to be invited as faculty presenters at ASCO than their American medical graduate counterparts, even when they produce the same amount of original research.
- Study Title: Going back home: Understanding the challenges of international medical graduates (IMGs) in oncology Abstract Number: 9001 Session: Clinical Science Symposium - Conflicts (of Interest) and Conundrums: Perspectives From the Global Oncology Community; June 1, 2024, 12:39pm ET Senior Author: Narjust Florez, MD
- Study Title: Assessing gender disparities in oncology: Less talk, more action Abstract Number: 9011 Session: Rapid Oral Abstract Session - Medical Education and Professional Development; June 3, 2024, 9:57am ET Senior Author: Narjust Florez, MD
- Study Title: International medical graduates (IMG) representation at international oncology conference meetings Abstract Number: 9000 Session: Clinical Science Symposium - Conflicts (of Interest) and Conundrums: Perspectives From the Global Oncology Community; June 1, 2024, 12:27pm ET Senior Author: Toni Choueiri, MD
Experiences of discrimination and financial stress, not race, associated with mistrust in health care systems
Social determinants of health (the conditions a person is born, lives, and ages in) and not race were associated with a lack of engagement with and trust of health care systems, according to findings reported by Dana-Farber’s Breast Oncology Program. Rachel Freedman, MD, MPH, a clinician-scientist in Dana-Farber’s Breast Oncology Program is the senior author of the study, which is presented and led by Olga Kantor, MD, MS, of Dana-Farber Brigham Cancer Center.
The team surveyed 297 women (a mix of 60% white, 25% Black, and 15% Hispanic people). Analysis associates experiences of discrimination in daily life and in health care, such as being treated with less courtesy or as if dishonest, with avoiding information about cancer, not initiating recommended treatment for cancer, and mistrust of physicians. Financial strain, such as concerns about medical bills or not having insurance, was also associated with these end results. Race and ethnicity were not associated with any of these outcomes.
- Study Title: Associations of social determinants of health with avoidance of information, treatment receipt, and physician mistrust for women with breast cancer Abstract Number: 1507 Session: Oral Abstract Session - Care Delivery/Models of Care; June 4, 2024, 10:57am ET Presenting Author: Olga Kantor, MD Senior Author: Rachel Freedman, MD, MPH
These findings are among more than 80 studies presented at ASCO that are led by Dana-Farber-affiliated researchers.
A full list of Dana-Farber Oral Presentations at the 2024 ASCO Annual Meeting is available here.
A full list of Dana-Farber Poster Discussions at the 2024 ASCO Annual Meeting is available here.
For all ASCO-related media inquiries, call, or email Victoria Warren, 617-939-5531, Victoria_Warren@dfci.harvard.edu. Follow the meeting live on X using the hashtag #ASCO24 and follow Dana-Farber News on X at @DanaFarberNews.
About Dana-Farber Cancer Institute
Dana-Farber Cancer Institute is one of the world’s leading centers of cancer research and treatment. Dana-Farber’s mission is to reduce the burden of cancer through scientific inquiry, clinical care, education, community engagement, and advocacy. We provide the latest treatments in cancer for adults through Dana-Farber Brigham Cancer Center and for children through Dana-Farber/Boston Children’s Cancer and Blood Disorders Center. Dana-Farber is the only hospital nationwide with a top 10 U.S. News & World Report Best Cancer Hospital ranking in both adult and pediatric care.
As a global leader in oncology, Dana-Farber is dedicated to a unique and equal balance between cancer research and care, translating the results of discovery into new treatments for patients locally and around the world, offering more than 1,100 clinical trials.
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Study assesses cancer-related care at US hospitals predominantly serving minority populations compared with non-minority serving hospitals
Analysis reveals systemic disparities in the delivery of definitive cancer treatment.
It’s important to ensure that care provided at US hospitals that predominantly serve Black and Hispanic populations is as high-quality as the care provided at other US hospitals. New research reveals significant disparities in the delivery of cancer-related care at minority serving hospitals (MSHs) compared with non-MSHs, however. The findings are published by Wiley online in CANCER, a peer-reviewed journal of the American Cancer Society.
For the study, investigators analyzed information from the National Cancer Database (which accrues approximately 70% of US cancer diagnoses) to identify patients eligible for definitive treatment for breast, prostate, non-small cell lung, and colon cancers between 2010 and 2019. Definitive treatment was defined as surgery for breast and colon cancer; surgery, radiation, or ablation for prostate cancer; and surgery or radiation for non-small cell lung cancer.
Of approximately 2.9 million patients who received care at 1,330 hospitals between 2010 and 2019, 9.3% were treated at MSHs. Among patients with breast cancer, those treated at MSHs were 17% less likely to receive definitive cancer treatment. For prostate, lung, and colon cancer, those treated at MSHs were 31%, 27%, and 19% less likely to receive definitive treatment respectively. These disparities persisted even after accounting for various sociodemographic and clinical factors.
The study’s authors calculated that if efforts successfully improved treatment rates at MSHs to match those at non-MSHs, 5,719 additional patients would receive definitive cancer treatment over 10 years. Providing additional funding and targeted improvements to hospitals without adequate resources may be important steps towards reaching this goal and could help to reduce racial and ethnic disparities in cancer outcomes.
“Access to care is a significant factor contributing to racial differences in cancer mortality, alongside biological differences. Therefore, improving services at hospitals that primarily serve minority populations could be a crucial part of a wider effort to achieve healthcare equity,” said lead author Quoc-Dien Trinh, MD, MBA, of Brigham and Women’s Hospital.
Additional information
NOTE: The information contained in this release is protected by copyright. Please include journal attribution in all coverage. A free abstract of this article will be available via the CANCER Newsroom upon online publication. For more information or to obtain a PDF of any study, please contact: Sara Henning-Stout, newsroom@wiley.com
Full Citation:
“Estimating the Impact of Enhanced Care at Minority-Serving Hospitals on Disparities in the Treatment of Breast, Prostate, Lung, and Colon Cancers.” Edoardo Beatrici, Marco Paciotti, David-Dan Nguyen, Dejan K. Filipas, Zhiyu Qian, Giovanni Lughezzani, Danesha Daniels, Stuart R. Lipsitz, Adam S. Kibel, Alexander P. Cole, and Quoc-Dien Trinh. CANCER; Published Online: May 27, 2024 (DOI: 10.1002/cncr.35328).
URL Upon Publication: http://doi.wiley.com/10.1002/cncr.35328
Author Contact: Brigham and Women’s Hospital’s External Communications & Media Relations office, at mediarelations@bwh.harvard.edu
About the Journal
CANCER is a peer-reviewed publication of the American Cancer Society integrating scientific information from worldwide sources for all oncologic specialties. The objective of CANCER is to provide an interdisciplinary forum for the exchange of information among oncologic disciplines concerned with the etiology, course, and treatment of human cancer. CANCER is published on behalf of the American Cancer Society by Wiley and can be accessed online. Follow CANCER on Twitter @JournalCancer and Instagram @ACSJournalCancer, and stay up to date with the American Cancer Society Journals on LinkedIn.
About Wiley
Wiley is a knowledge company and a global leader in research, publishing, and knowledge solutions. Dedicated to the creation and application of knowledge, Wiley serves the world’s researchers, learners, innovators, and leaders, helping them achieve their goals and solve the world's most important challenges. For more than two centuries, Wiley has been delivering on its timeless mission to unlock human potential. Visit us at Wiley.com. Follow us on Facebook, Twitter, LinkedIn and Instagram.
JOURNAL
Cancer
ARTICLE TITLE
Estimating the Impact of Enhanced Care at Minority-Serving Hospitals on Disparities in the Treatment of Breast, Prostate, Lung, and Colon Cancers
ARTICLE PUBLICATION DATE
27-May-2024
