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Review
. 2024 Feb;13(3):e6790.
doi: 10.1002/cam4.6790. Epub 2024 Jan 17.

Disparities in care of older adults of color with cancer: A narrative review

Efrat Dotan  1 , Shannon M Lynch  2 , Joanne C Ryan  3 , Edith P Mitchell  4
Affiliations
Review

Disparities in care of older adults of color with cancer: A narrative review

Efrat Dotan et al. Cancer Med. 2024 Feb.

Abstract

This review describes the barriers and challenges faced by older adults of color with cancer and highlights methods to improve their overall care. In the next decade, cancer incidence rates are expected to increase in the United States for people aged ≥65 years. A large proportion will be older adults of color who often have worse outcomes than older White patients. Many issues contribute to racial disparities in older adults, including biological factors and social determinants of health (SDOH) related to healthcare access, socioeconomic concerns, systemic racism, mistrust, and the neighborhood where a person lives. These disparities are exacerbated by age-related challenges often experienced by older adults, such as decreased functional status, impaired cognition, high rates of comorbidities and polypharmacy, poor nutrition, and limited social support. Additionally, underrepresentation of both patients of color and older adults in cancer clinical research results in a lack of adequate data to guide the management of these patients. Use of geriatric assessments (GA) can aid providers in uncovering age-related concerns and personalizing interventions for older patients. Research demonstrates the ability of GA-directed care to result in fewer treatment-related toxicities and improved quality of life, thus supporting the routine incorporation of validated GA into these patients' care. GA can be enhanced by including evaluation of SDOH, which can help healthcare providers understand and address the needs of older adults of color with cancer who face disparities related to their age and race.

Keywords: geriatric assessment; geriatric oncology; healthcare disparities; minorities; older adults; oncology.

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Conflict of interest statement

Shannon M. Lynch has received fees as a consultant with Beautycounter. Efrat Dotan has received grants or contracts from Incyte, Ipsen, Lilly, MedImmune, NGM Biopharmaceuticals, Relay Therapeutics, Lutris, Kinate, and Zymeworks; she has received consulting fees from Incyte, Helsinn, G1 therapeutics, Taiho, Olympus, and Amgen; and payment or honoraria from Pfizer. Joanne C. Ryan is an employee and shareholder of Pfizer, which provided funding for editorial support for the manuscript and is acknowledged above. Edith P. Mitchell has received grants or contracts from Bristol Myers Squibb, Exelixis, Genentech, GlaxoSmithKline, Pfizer, and Regeneron; she has received consulting fees from Astellas, Bristol Myers Squibb, Corvus, Genentech, and Janssen.

Figures

FIGURE 1
FIGURE 1
Overall cancer incidence (2015–2019) and mortality (2016–2020) rates (per 100,000) by race and ethnicity in the US for all ages and older adults (≥65 years). Abbreviations: AI/AN, American Indian/Alaskan Native; API, Asian/Pacific Islander; NH, Non‐Hispanic. Source: National Cancer Institute Surveillance Epidemiology, and End Results program SEER*Stat Database. Rates are per 100,000 and are age‐adjusted to the 2000 US standard population (19 age groups—Census P25‐1130). Rates for American Indians/Alaskan Natives only include cases that are in a purchased/referred care delivery area. Incidence data for Hispanics and non‐Hispanics are based on the North American Association of Central Cancer Registries Hispanic Latino Identification Algorithm.
FIGURE 2
FIGURE 2
Multifactorial contributors to cancer disparities in older people of color.
See this image and copyright information in PMC

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Publication types

Grants and funding