Cancer Care in 2024: Striving to Overcome the Challenges

Manmeet S. Ahluwalia, MD, MBA, FASCO

Ongoing advances in immunotherapies and increasingly precise targeted therapies have shaped an optimistic and encouraging outlook for cancer care in 2024. Yet for the first time in history, the US is predicted to hit a new, sobering cancer milestone: More than 2 million people are estimated to be diagnosed with cancer in 2024 (nearly 5500 new cases per day), according to the American Cancer Society’s annual outlook report.¹

The number gives rise to concern because, despite innovations in care, significant challenges remain, partic- ularly in overcoming long-established health disparities that prevent equal access to diagnostic care, standard-of- care therapies, and novel treatments. For example, more than 90% of drug trial participants identify as White. It is a statistic that is of deep concern to clinicians every- where, but it is especially concerning to those in South Florida, where most of the population has origins in Latin America and the Caribbean.

The problem has garnered widespread attention, and the FDA’s latest guidance documents recommend that study designers and investigators discuss plans for increasing diversity early in the process.² Without adequate representation of underrepresented populations in a clinical trial, the postapproval requirements of a drug may be affected, the FDA reports.

Baptist Health Miami Cancer Institute launched the Center for Equity in Cancer Care & Research to address this issue. Its mission is to identify and decrease disparities in cancer care and improve participation of underrepresented populations in clinical trials. With approximately 200 trials open at the institute, part of the center’s goal is to ensure that the latest advances are reaching all patients with cancer.³

However, we know cancer incidence is not the same across all ethnicities; consider the following:

• The incidence of major cancers (eg, lung, colorectal, kidney) among Black men is higher than for White men.
• Black women have a higher incidence of cancers with low survival, such as stomach and pancreatic cancer.
• Black women are nearly twice as likely to die of uterine cancer as White women.

The incidence of prostate cancer is 70% higher in Black men than in White men, and mortality rates in Black individuals are twice as high compared with those of White individuals.

In general, Hispanic individuals are less likely to be diagnosed with cancer than White individuals but have a higher incidence of specific types of cancer. For example, Hispanic men and women have nearly double the incidence and mortality rates of liver and stomach cancers compared with White individuals.³

In terms of clinical trial participation, Miami Cancer Institute is working closely with patient navigators, community health workers, and local faith-based organi- zations to educate people and reduce some of the cultural mistrust that exists among underrepresented populations.

In addition to boosting diverse participation in clinical trials by 50% over the next 2 to 3 years and increasing numbers in cancer screenings, the Center for Equity in Cancer Care & Research is taking a close look at the many social determinants of health that can negatively affect outcomes. One area we are continuing to develop is our Spanish-language materials because approximately 20% of the institute’s patients indicate that they do not read English well enough to understand consent forms.

The institute is also working on increasing screening numbers of cancer detection in alignment with President Joe Biden’s Cancer Moonshot program, which aims to decrease the age-adjusted cancer death rate by 50% in the next 25 years.⁴ The American Lung Association’s State of Lung Cancer 2023 report stated that Florida’s lung cancer screening rate of 2.4% was far below the national average of 4.5%.⁵

To build awareness and encourage those at highest risk to undergo lung cancer screenings, Baptist Health and the American Lung Association joined forces in 2021 as part of the Saved by the Scan campaign.³ The partnership was the first between a large health care organization and the American Lung Association, and it produced encouraging results. The campaign resulted in a 55% increase in lung cancer screenings, using low-dose CT scans. Additionally, Baptist Health has partnered with the LUNGevity Foundation, the nation’s leading lung cancer–focused nonprofit organization, to set up a screening program centered on the Hispanic/Latino community.

As we work together to focus our efforts to provide equal access to high-quality care for all, the cancer community pushes forward on cutting-edge trials and advances that are leading to longer survival, improved quality of life, and cures. There is every reason to have an optimistic outlook for cancer care in 2024.

References

1. Siegel RL, Giaquinto AN, Jemal A. Cancer statistics, 2024. CA Cancer J Clin. 2024;74(1):12-49. doi:10.3322/caac.21820
2. Diversity plans to improve enrollment of participants from underrepresented racial and ethnic populations in clinical trials; draft guidance for industry; availability. FDA. April 13, 2022. Accessed March 5, 2024. bit.ly/3LznYiE
3. Fernandez J. Cancer care outlook 2024: more treatment advances and more minority involvement in clinical trials. Baptist Health South Florida blog. February 5, 2024. Accessed March 5, 2024. bit.ly/4cK4Vy
4. NIH study outlines opportunities to achieve President Biden’s Cancer Moonshot goal of reducing cancer death rates in the United States. News release. National Institutes of Health. April 17, 2023. Accessed March 5, 2024. bit.ly/4cCyrG9
5. American Lung Association. State of Lung Cancer 2023. Accessed March 5, 2024. bit.ly/4cLDZhE