H. Lee Moffitt Cancer Center and Research Institute, Department of Malignant Hematology, Tampa, FL.
Memorial Sloan Kettering Cancer Center, Division of Multiple Myeloma and Lymphoma, Montvale, NJ; Flatiron Health, Division of Research Oncology and Real World Evidence, New York, NY.
Clin Lymphoma Myeloma Leuk. 2023 Sep;23(9):651-659. doi: 10.1016/j.clml.2023.05.005. Epub 2023 May 6.
Multiple myeloma (MM) represents ∼1% of all cancers and is the second most common hematologic malignancy worldwide. The incidence of MM is at least two times higher in Blacks/African Americans compared with their White counterparts, and Hispanics/Latinxs are among the youngest patients diagnosed with the disease. Recent advances in available treatments for MM have demonstrated significant improvement in survival outcomes; however, patients from non-White racial/ethnic groups clinically benefit less due to multiple factors including access to care, socioeconomic status, medical mistrust, underutilization of novel therapies, and exclusion from clinical trials. Health inequities in disease characteristics and risk factors based on race also contribute to inequities in outcomes. In this review, we highlight racial/ethnic factors as well as structural barriers attributed to variations in MM epidemiology and management. We focus on three populations-Black/African American, Hispanic/Latinx, and American Indian/Alaska Native-and review factors that healthcare professionals may consider when treating patients of color. We offer tangible advice for healthcare professionals on how to incorporate cultural humility into their practice by following the five key steps: establishing trust, respecting cultural diversity, undergoing cross-cultural training, counseling patients on appropriate available clinical trial options, and connecting patients to community resources. The outlined recommendations will help the medical community to better understand and apply the important concept of cultural humility into their practice to provide the best care for all their patients, regardless of race/ethnicity.
多发性骨髓瘤(MM)占所有癌症的 1%左右,是全球第二大常见的血液系统恶性肿瘤。与白种人相比,黑种人/非裔美国人患 MM 的发病率至少高出两倍,而西班牙裔/拉丁裔是确诊该病的最年轻患者之一。目前 MM 治疗方法的进展显著提高了生存结果;然而,由于多种因素,包括获得医疗服务的机会、社会经济地位、医疗不信任、新型疗法的利用不足以及被排除在临床试验之外,非白人群体的患者从临床获益较少。基于种族的疾病特征和风险因素的健康不平等也导致了结果的不平等。在这篇综述中,我们强调了种族/民族因素以及结构障碍,这些因素归因于 MM 流行病学和管理的差异。我们关注三个群体——黑种人/非裔美国人、西班牙裔/拉丁裔和美洲印第安人/阿拉斯加原住民,并回顾了医疗保健专业人员在治疗有色人种患者时可能考虑的因素。我们为医疗保健专业人员提供了切实可行的建议,介绍了如何通过遵循五个关键步骤将文化谦逊纳入实践:建立信任、尊重文化多样性、进行跨文化培训、就合适的临床试验选择为患者提供咨询,以及将患者与社区资源联系起来。所概述的建议将帮助医学界更好地理解和应用文化谦逊的重要概念,为所有患者提供最佳护理,无论其种族/民族如何。