Racial and ethnic disparities in genomic testing among lung cancer patients: a systematic review.
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2024-06
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Abstract
Background
Racial and ethnic disparities in genomic testing could exacerbate disparities in access to precision cancer therapies and survival-particularly in the context of lung cancer where genomic testing has been recommended for the past decade. However, prior studies assessing disparities in genomic testing have yielded mixed results.Methods
We conducted a systemic review to examine racial and ethnic disparities in the use of genomic testing among lung cancer patients in the United States. Two comprehensive searches in PubMed, Embase, and Scopus were conducted (September 2022, May 2023). Original studies that assessed rates of genomic testing by race or ethnicity were included. Findings were narratively synthesized by outcome.Results
The search yielded 2739 unique records, resulting in 18 included studies. All but 1 study were limited to patients diagnosed with non-small cell lung cancer. Diagnosis years ranged from 2007 to 2022. Of the 18 studies, 11 found statistically significant differences in the likelihood of genomic testing by race or ethnicity; in 7 of these studies, testing was lower among Black patients compared with White or Asian patients. However, many studies lacked adjustment for key covariates and included patients with unclear eligibility for testing.Conclusions
A majority of studies, though not all, observed racial and ethnic disparities in the use of genomic testing among patients with lung cancer. Heterogeneity of study results throughout a period of changing clinical guidelines suggests that minoritized populations-Black patients in particular-have faced additional barriers to genomic testing, even if not universally observed at all institutions.Type
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Meernik, Clare, Yadurshini Raveendran, Michaela Kolarova, Fariha Rahman, Ebunoluwa Olunuga, Emmery Hammond, Akhilesh Shivaramakrishnan, Steph Hendren, et al. (2024). Racial and ethnic disparities in genomic testing among lung cancer patients: a systematic review. Journal of the National Cancer Institute, 116(6). pp. 812–828. 10.1093/jnci/djae026 Retrieved from https://hdl.handle.net/10161/31215.
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Scholars@Duke
Clare Meernik
Clare Meernik, PhD, MPH is an Assistant Investigator at The Cooper Institute and holds an adjunct Assistant Professor appointment at Duke University School of Medicine. Previously, she was a Postdoctoral Associate at Duke University in the Department of Population Health Sciences. Dr. Meernik completed her PhD in Epidemiology from the University of North Carolina (UNC) at Chapel Hill Gillings School of Global Public Health, and her MPH in Epidemiology from the University of Michigan School of Public Health. She was also previously a Research Specialist with the Tobacco Prevention and Evaluation Program at the UNC Department of Family Medicine.
Prior to joining The Cooper Institute, Dr. Meernik’s research focused on tobacco control, cancer epidemiology, and cancer survivorship, with a particular focus on improving quality of life after cancer. She has extensive experience in epidemiologic study design, quantitative and qualitative data analysis, and program evaluation.
At The Cooper Institute, she leads research related to healthy living, including investigating relationships between healthy living and the prevention of long-term adverse effects of cancer and its treatment (e.g., cardiovascular disease, cognitive decline). To date, she has published more than 40 peer-reviewed studies in journals including JAMA, BMJ, Pediatrics, Human Reproduction, and Tobacco Control.
Hayden Barry Bosworth
Dr. Bosworth is a health services researcher and Deputy Director of the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) at the Durham VA Medical Center. He is also Vice Chair of Education and Professor of Population Health Sciences. He is also a Professor of Medicine, Psychiatry, and Nursing at Duke University Medical Center and Adjunct Professor in Health Policy and Administration at the School of Public Health at the University of North Carolina at Chapel Hill. His research interests comprise three overarching areas of research: 1) clinical research that provides knowledge for improving patients’ treatment adherence and self-management in chronic care; 2) translation research to improve access to quality of care; and 3) eliminate health care disparities.
Dr. Bosworth is the recipient of an American Heart Association established investigator award, the 2013 VA Undersecretary Award for Outstanding Achievement in Health Services Research (The annual award is the highest honor for VA health services researchers), and a VA Senior Career Scientist Award. In terms of self-management, Dr. Bosworth has expertise developing interventions to improve health behaviors related to hypertension, coronary artery disease, and depression, and has been developing and implementing tailored patient interventions to reduce the burden of other chronic diseases. These trials focus on motivating individuals to initiate health behaviors and sustaining them long term and use members of the healthcare team, particularly pharmacists and nurses. He has been the Principal Investigator of over 30 trials resulting in over 400 peer reviewed publications and four books. This work has been or is being implemented in multiple arenas including Medicaid of North Carolina, private payers, The United Kingdom National Health System Direct, Kaiser Health care system, and the Veterans Affairs.
Areas of Expertise: Health Behavior, Health Services Research, Implementation Science, Health Measurement, and Health Policy
Devon Karnes Check
Devon Check, PhD is a health services and implementation researcher whose primary research interests include quality of care and the implementation of evidence-based and guideline-recommended practices in oncology. Her projects use large secondary data analysis as well as qualitative and mixed methods to investigate variation and inequities in cancer care, the experiences of patients and clinicians, and multi-level factors that impact cancer treatment and outcomes. She has a specific interest in supportive cancer care, and within that area, she has a growing portfolio of research projects focused on pain and symptom management in cancer.
Dr. Check also has methodological expertise in implementation science. She has served as the implementation research methods expert on several behavioral intervention trials that use a hybrid effectiveness-implementation design. She also co-leads the Implementation Science Core Working Group as part of the Coordinating Center for the NIH Pragmatic Trials Collaboratory and the NIH HEAL Collaboratory.
Dr. Check received her PhD in Health Policy and Management from the Gillings School of Global Public Health at UNC-Chapel Hill. Prior to joining the Department of Population Health Sciences at Duke, she completed a postdoctoral fellowship in Delivery Science at Kaiser Permanente Northern California's Division of Research.
Areas of Expertise: Implementation Science and Health Services Research
John Strickler
John Strickler, MD is a Professor of Medicine in the Division of Medical Oncology, where he is Co-Leader for the Precision Cancer Medicine and Investigational Therapeutics Program at the Duke Cancer Institute, Leader of the Molecular Tumor Board, and Associate Director of Clinical Research – GI Oncology. Dr. Strickler’s clinic specializes on the treatment of gastrointestinal malignancies, with a particular emphasis on gastroesophageal, pancreatic, and colorectal cancers. His research focuses on precision cancer medicine: identification of biomarkers that predict sensitivity or resistance to targeted therapies and immunotherapy. He has designed and executed clinical trials that test novel therapies and innovative therapeutic strategies. He was Principal Investigator on an investigator sponsored trial that led to the first FDA-approved therapy for HER2+ metastatic colorectal cancer. He has first-author publications in several high impact factor medical journals, including the New England Journal of Medicine, Clinical Cancer Research, Cancer Discovery, Journal of Clinical Oncology, and Lancet Oncology. Nationally, he has served as a member of the American Society of Clinical Oncology (ASCO) Treatment Guidelines Committee for Advanced Colon Cancer.
Tomi Akinyemiju
Area of Expertise: Epidemiology
Dr. Akinyemiju is a Professor of Population Health Sciences, Global Health and Ob/Gyn with expertise in cancer epidemiology, cancer biology, global health, and health disparities. Her research expertise and accomplishments have focused on articulating and innovating conceptual and empirical approaches for cancer health disparities research, specifically, disentangling the role of race as a social construct and race-associated biological mechanisms that contribute to cancer disparities. Dr. Akinyemiju also serves as the Vice-Chair for Diversity, Equity, and Inclusion at the Department of Population Health Sciences, and Associate Director for Community Outreach, Engagement, and Equity at the Duke Cancer Institute. Dr. Akinyemiju’s leadership centers around building cross-enterprise, multi-stakeholder coalitions to advance health equity, promote inclusion and diversity, and mentor the next generation of diverse, talented clinical research scholars. Dr. Akinyemiju has received numerous awards, including the 2023 Michelle Winn Inclusive Excellence Award
Dr. Akinyemiju has published over 150 peer-reviewed publications, and her research program has been continuously funded by the National Institutes of Health, Susan G. Komen and the V Foundation. She has mentored (formally and informally) at least 50 trainees and junior faculty, over 50% of whom are URM. Dr. Akinyemiju works extensively with diverse stakeholders, including community-based organizations, policy makers, providers, health system leadership, and leaders from diverse communities to develop impactful, evidence-based interventions to advance health equity
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