A professor and cancer expert presented a talk on equity in cancer treatment at Georgetown University on Jan. 12.

The Georgetown Survivorship Research Initiative hosted Dr. Cardinale Smith, Chief Medical Officer for the Tisch Cancer Institute in New York City and a professor of medicine, geriatrics and palliative medicine at the Icahn School of Medicine at Mount Sinai, to present a talk entitled “Achieving Health Equity in Cancer and Palliative Care.” Part of the Lombardi Comprehensive Cancer Center, the initiative focuses on promoting survivorship and increasing equity in treatment of cancer patients. 

Smith began by stressing the importance of health equity, the practice of providing health care based on a patient’s individual needs, and how it differs from equality. 

“Equality is when we want to give everybody the same thing, but not everybody comes to the table in the same way,” Smith said at the event. “Equity is really saying that we recognize, particularly in healthcare, that it is multifaceted, and it is really sort of meeting people where they are.” 

Yet Smith noted that socioeconomic disparities mar the possibility of achieving health equity.

“The challenge for us in the healthcare system is that there are these other categories—education, the neighborhood, social community contexts, and finance—things that we in healthcare do not necessarily control,” Smith said.

Smith, a medical oncologist and a physician, practices palliative care, a form of care that aims to provide relief and an improved quality of life through focusing on social and emotional treatment in addition to traditional medical care. Her research highlights where racial and ethnic disparities are apparent throughout different stages of cancer care, including palliative care. 

According to Smith, racial and ethnic minorities are often underrepresented in clinical trials for cancer. 

“While the Hispanic population makes up about 18%, they are represented in about 2% of cancer clinical trials, and that same disparity exists for those who identify as Black,” Smith said. 

According to Smith, an important aspect of palliative care is communication with a patient, especially during serious illness. Yet in a study she led, Smith found a significant difference in the length of oncologists’ conversations with patients depending on the patient’s background, leading to questions about disparities and the role of implicit bias in care. 

“Overall, we found that oncologists spent three minutes less with their minoritized patients in these visits that were set up to be enriched times and conversations about the cancer,” Smith said. 

Despite increasing awareness of disparities in medical care, Smith said medical practitioners often lack confidence in their ability to improve these issues.

“60% of providers feel responsible for addressing health disparities, but only 30% feel prepared to do so,” Smith said. 

Going forward, Smith said improving communication with patients and teaching new doctors to recognize the presence of implicit bias — bias derived automatically from learned stereotypes — will play a key role in her research for improving outcomes. 

“Thinking about serious illness communication and bias is part of the work that is ongoing for us,” Smith said. “We are recording more conversations, asking oncologists to take an implicit association test, and really wanting to look at what role bias may be playing in some of these communication outcomes.”

Along with limiting bias and increasing empathy, Smith emphasized that palliative care is a tool that can be used to move in a positive direction towards limiting disparities in healthcare. 

“I think palliative care is something that can definitely benefit and can help us move toward equity, and it certainly helps us with communication,” Smith said. “Figuring out those key components that get us there is the work that lots of us are doing, and is where we need to move.”