Dr Manana on How Systemic Racism Appears in Oncology

Ana I. Velazquez Manana, MD, MSc, assistant director, Diversity, Equity, Inclusion, and Accessibility (DEIA) for Trainees, Department of Medicine, assistant clinical professor, Medicine, Division of Hematology/Oncology, University of California San Francisco (UCSF), UCSF Helen Diller Family Comprehensive Cancer Center, discusses how systemic racism appears in oncology.

At the 2023 ASCO Annual Meeting, Manana presented information on the role of oncologists in ending systemic racism in oncology. Manana says there are many ways in which systemic racism appears in oncology. As individuals, everyone has certain implicit biases about how certain people should be treated or how they believe a certain person or group of people behaves, she explains. Awareness of those implicit biases is key to ensuring physicians do not harm patients. For example, if an oncologist has a specific idea or prejudice about how certain groups of people may tolerate pain or are more likely to abuse substances, it is possible that they may then treat patients from these groups differently than they treat other patients, including not managing their pain adequately, leading to suffering for those patients with cancer, Manana explains. Additionally, if an oncologist believes that certain groups of people are not going to agree to participate in a clinical trial, they may not offer that trial to patients from these groups, she adds. These are all reflections of individualbiases, Manana notes.

During this presentation at the 2023 ASCO Annual Meeting, Manana highlighted how people can take implicit bias tests to try to analyze their environment, their behaviors, and the reasons for their implicant biases. Additionally, she aimed to help participants better understand what drives these biases.

Systemic or institutionalized racism can also arise in areas of oncology such as policies that drive differences in access to insurance, Manana expands. It is known that people who don't have insurance cannot access cancer care equitably and have different mortality rates, she says. Some communities also have less access to food and a lower average socioeconomic status, and patients in these communities therefore may not have access to high-quality hospitals for their cancer care, Manana emphasizes. These are examples of ways in which systemic racism is part of the cancer care spectrum, Manana concludes.