Addressing Ovarian Cancer Outcome Disparities With Cultural Understanding, Disaggregated Research

In the final part of our interview with Alice W. Lee, PhD, MPH, of California State University, Fullerton, she emphasizes that addressing health disparities in cancer care, particularly among Hawaiian/Pacific Islanders with ovarian cancer, requires understanding cultural and behavioral factors.

Lee concludes that a more disaggregated approach to cancer research is necessary overall to ensure interventions are culturally relevant and effective for diverse subgroups within broader racial categories. To learn more, watch parts 1 and 2 of our interview.

This transcript has been lightly edited for clarity.

Transcript

How can health care interventions or policies address the disparities you’ve identified?

One of the goals when we're doing disparities work is to really highlight where the burden is the greatest. With that information, we can explore why there is that higher burden. We found that Hawaiian/Pacific Islander patients with ovarian cancer are at higher risk of death.

Before we start thinking about what you were saying, health care interventions and policies, I think we need to take a step back and think about what's happening within that ethnic population that puts them at higher risk. Like what I was saying earlier about that next step. Some of that may be health care related, but some of it may also be culturally related. Maybe it's behaviorally related, maybe it has to do with their beliefs.

So, I'm thinking that we want to first dig a little deeper into this population because I think only with that information can we then develop the appropriate public health interventions and efforts to address these disparities. I think the end goal is to improve ovarian cancer care, so what I'd like to do first is figure out the important aspects that may be associated with that care that we should be focusing on. Then, take that information to develop the right interventions and disseminate that.

What steps should be taken to promote a more disaggregated approach in cancer research beyond ovarian cancer?

That's like preaching to the choir here, because I'm so excited about looking at data disaggregation. I think, really, just this action of collecting detailed race and ethnicity information, making sure that that information is collected in national population surveys, and making sure that's collected in research studies, I think that has to be the norm.

The US is becoming more and more diverse. It's become so diverse that when you think about these general racial categories like White, Black, Hispanic, or Asian, it really does not capture the diversity that exists within those categories. When we do cancer research and we're looking at these overarching racial categories, we are really missing those subgroups that may be disproportionately burdened by cancer.

I also think cancer researchers themselves need to be aware of these ethnic-specific differences in larger racial groups. If you're planning to implement an intervention to address cancer in Asians, I don't think you can use that intervention for all Asians you recruit. There's bound to be differences in the language, there's differences in the culture, all of that really needs to be considered.

I think another step to really promoting a more disaggregated approach is just being cognizant of this diversity. When I say this, I'm not even just talking about for Asians, I'm talking about for a lot of these major racial groups, but I really think that would be the first step.