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Bridging the Gap Between Populations
prostate cancer by 60 and 30%, respectively, but only a large clinical trial other racial/ethnic groups. Williams
30
provides five principles for reducing
such as SELECT could confirm those initial findings.
29
the disparity gap among African-Americans: provide insurance coverage
and access to high-quality care for all; provide a diverse healthcare
The SELECT study began enrolling patients in August 2001. The workforce to ensure culturally competent care; deliver patient-centered
recruitment of Caucasians to the clinical trial was rapidly outpacing that care; maintain accurate and complete race/ethnicity data to monitor
of African-Americans. The rapid recruitment of Caucasians in proportion to disparities in care; and set measurable goals for improving quality and
African-Americans persisted despite literature that cited African-American ensure that goals are achieved equitably for all racial and ethnic minorities.
prostate cancer incidence rates being on average 60% higher than in
Caucasian men.
1
These individual-level principles can be implemented throughout the US
healthcare system, by federal and state governments, health plans, hospitals,
The inclusion criteria were broadened to enhance the recruitment of high-risk medical groups, and healthcare professionals.
30
However, to aggressively
African-American men into this important cancer prevention clinical trial. reduce the cancer gap, individual-level principles will have to be
Researchers also elected to reduce the minimum age eligibility from 55 to 50 implemented alongside societal-level principles that address the social,
years for African-American men because these men have a higher incidence economic, and political determinants of racial/ethnic cancer disparities.
of prostate cancer at a younger age compared with all other groups. The Societal-level principles include providing universal healthcare that does not
SELECT eligibility criteria also allowed men with controlled comorbidities. deliver unequal treatment based on race/ethnicity and SES; investing in
Lowering the minimum age requirement to 50 years for all African-Americans education and job opportunities for racial/ethnic minorities; and improving
resulted in the accrual of 1,723 men (33% of the total African-American residential and social environments.
accrual), which would not have been possible if the 55-year age limit (for
Caucasians) had been a uniform requirement.
29
When enrollment closed in Conclusion
June 2004, approximately 15% of the participants were African-American. Despite the advances in cancer detection and treatment, racial/ethnic
This targeted strategy was effective not only for enhancing enrollment of an minority populations continue to experience poorer cancer-related
under-represented at-risk minority subpopulation, but also for improving the outcomes. This article has provided a brief discussion of the challenges
generalizability of the cancer clinical trial results.
29
of reducing and ultimately eliminating cancer disparities among
African-Americans and other racial/ethnic populations. The conceptual
To effectively reduce the cancer disparity gap among African-Americans, the challenges of disentangling the multiple factors that contribute to our
challenge will be to focus our efforts on how to equitably distribute understanding of the root causes of health disparities and issues
resources in such a way as to improve the cancer outcomes of surrounding targeting racial/ethnic minorities will have to be addressed to
African-Americans without impeding the improvement of Caucasians and close the cancer gap. ■
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