Widespread disparities exist in treating advanced cancers

DALLAS – Sept. 04, 2024 – A study led by researchers at UT Southwestern Medical Center reveals significant disparities across the country in the use of immunotherapy for patients with advanced kidney and bladder cancers. The findings, published in Urologic Oncology: Seminars and Original Investigations, suggest that factors such as race, socioeconomic status, and the type of health care facility influence whether patients will receive these effective therapies.

“With the rapidly changing pace of innovation in cancer therapeutics, it is important that all patients have access to novel, potentially lifesaving medications,” said study leader Solomon Woldu, M.D., Associate Professor of Urology and a member of the Harold C. Simmons Comprehensive Cancer Center at UT Southwestern. “Our study highlights critical gaps in health care equity when it comes to treatments that have been shown effective in prolonging survival.” 

Using data from the National Cancer Database, researchers investigated the influence of a patient’s socioeconomic and demographic factors on the use of immunotherapies approved by the U.S. Food and Drug Administration to treat stage 4 clear cell renal cell carcinoma (ccRCC) and urothelial carcinoma of the bladder (UC).

Although the use of immunotherapies for these advanced cancers increased throughout the study period, persistent disparities remained. Between 2015 and 2020, for example, 34% of 15,926 patients diagnosed with advanced ccRCC received immunotherapy treatment. Among 10,380 patients diagnosed with advanced UC between 2017 and 2020, about 21% were treated with immunotherapy.

However, Black and Hispanic patients with ccRCC were about 25% less likely to receive approved treatment compared with other groups, researchers found. A similar trend persisted among lower income and education statuses. And while the data showed that those without insurance were less likely to receive treatment than those with private insurance or Medicare, the study noted that having health insurance didn’t necessarily offer “affordable coverage for expensive and novel therapies.” 

In addition, patients at nonacademic facilities were less likely to receive immunotherapy, underscoring the benefits of being treated at academic medical centers like UT Southwestern. Dr. Woldu said the study serves as a key step toward ensuring that all patients, regardless of background, have access to the most advanced and effective cancer treatments.

“Our mission at UT Southwestern is to provide cutting-edge care to all of our patients, and I believe we do so,” Dr. Woldu noted.

These findings build upon a growing body of research that reveals enduring inequities in medical care across the United States for various types of cancers and set a foundation for potential changes in clinical practice and policy.

“It should encourage doctors counseling patients with kidney and bladder cancers to spend extra time discussing the potential benefits of novel therapies,” Dr. Woldu said.

Other UTSW researchers who contributed to this study are first author Levi Holland, M.D., fourth-year Urology resident; Neil Desai, M.D., M.H.S., Associate Professor and Director of Clinical Research in Radiation Oncology; Kris Gaston, M.D., Associate Professor of Urology; Yair Lotan, M.D., Professor of Urology, Chief of Urologic Oncology, and Medical Director of the Urology Clinic at UT Southwestern and Parkland Health; Vitaly Margulis, M.D., Professor of Urology; Tian Zhang, M.D., M.H.S., Associate Professor of Internal Medicine in the Division of Hematology and Oncology and Associate Director of Clinical Research in the Simmons Cancer Center; Suzanne Cole, M.D., Associate Professor of Internal Medicine in the Division of Hematology and Oncology, Medical Director of the University Hospital Simmons Cancer Center at the UT Southwestern Medical Center at Richardson/Plano, and Medical Director of the Community Oncology Program at Simmons Cancer Center; Raj Bhanvadia, M.D., Assistant Instructor of Urology; Nathanaelle Ibeziako, M.D., third-year Urology resident; Jacob Taylor, M.D., fellow in Urologic Oncology; and Iftach Chaplin, M.S., researcher.

Drs. Cole, Desai, Lotan, Margulis, and Zhang are also members of the Simmons Cancer Center.

Dr. Desai is a Dedman Family Scholar in Clinical Care. Dr. Lotan holds the Jane and John Justin Distinguished Chair in Urology, in Honor of Claus G. Roehrborn, M.D. Dr. Margulis holds the Paul C. Peters, M.D. Chair in Urology.

About UT Southwestern Medical Center  

UT Southwestern, one of the nation’s premier academic medical centers, integrates pioneering biomedical research with exceptional clinical care and education. The institution’s faculty members have received six Nobel Prizes and include 25 members of the National Academy of Sciences, 22 members of the National Academy of Medicine, and 14 Howard Hughes Medical Institute Investigators. The full-time faculty of more than 3,200 is responsible for groundbreaking medical advances and is committed to translating science-driven research quickly to new clinical treatments. UT Southwestern physicians provide care in more than 80 specialties to more than 120,000 hospitalized patients, more than 360,000 emergency room cases, and oversee nearly 5 million outpatient visits a year.