Most cases of oropharyngeal cancer are positive for the human papillomavirus, but among Blacks, 55.3% of cases are HPV-negative, and HPV-negative cases are, to say the least, understudied, said Babak Givi, MD, associate professor of otolaryngology–head and neck surgery at New York University Grossman School of Medicine, in a virtual session at the Combined Otolaryngology Spring Meetings (COSM) in April (Otolaryngol Head Neck Surg. 2021;164:131-138).
Explore This IssueJune 2021
“How many clinical trials are ongoing for HPV-negative oropharyngeal cancer?” he said. “The answer is zero. We had one trial that was closed. We aren’t even looking at the problem.”
The example was one among many described in a session on inequities in head and neck cancer, a series of talks that was a drumbeat of issues facing minority populations, but with suggestions on ways to improve.
Dr. Givi presented two graphs—one showing the diverging survival outcomes between HPV-positive and HPV-negative oropharyngeal cancers and one showing the diverging survival outcomes between Blacks and Whites. Both graphs looked practically the same. “If this isn’t an example of disparity, I don’t know what is,” he said.
Gaining Cultural Competency
Loren Saulsberry, PhD, assistant professor of health policy and politics at the University of Chicago, said shifting demographics in the U.S. will heighten the need for cultural competency. For instance, the backgrounds and experiences of physicians and their patients frequently differ, which could have an effect on health equity, she said.
Clinicians, she said, should keep a careful eye on who’s coming in for care and take into account their life situations so that their care is “truly personalized.” “What’s the patient experience when they visit these health encounters?” Dr. Saulsberry asked. “What are patient values, beliefs, and preferences regarding specific types of care? Where might opportunities exist for clinicians to align the care delivered with patient values?”
Sidharth Puram, MD, PhD, assistant professor of otolaryngology–head and neck surgery at Washington University in St. Louis, said understanding health inequities isn’t as simple as considering one race or another at higher or lower risk for a disease. Rather, it’s thinking carefully about how demographic characteristics and their interaction are vital.
For instance, he said, males are more likely than their female counterparts within a matched racial cohort to have a higher risk of oral cavity cancer, Black males are more likely to have cancers of the larynx compared to other racial and gender subgroups, and Hispanic females have a very high percentage of oral cavity cancers compared to other subsets of cancer (Oral Oncol. 2020;104:104609).
“We can’t take a broad, categorial approach to these issues,” said Dr. Puram. “There’s actually a lot of nuance related to the pathology and adjuvant treatment that might be involved.”
Cultural variation in healthcare is more than the immutable traits of a patient, Dr. Puram added. It also involves diversity in beliefs. For instance, one person’s idea of palliative care —say, medical treatment of symptoms—might be very different than someone else’s—say, leaving everything in God’s hands. Physicians need to be aware of how their own beliefs and values differ from those of their patients, honestly assess their own willingness to accept these differences, and make adjustments in how they think and behave, Dr. Puram said.