CONTEXT: Numerous reports demonstrate disparities in access to care, clinical trial enrollment, and survival outcomes in various hematologic malignancies based on race/ethnicity. Based on 2020 US Census data, the Stanford Cancer Institute catchment area includes a population of 32% Non-Hispanic White (NHW), 32% Hispanic, 25% Asian, and 5% Non-Hispanic Black (NHB).OBJECTIVE: To examine reporting of race/ethnicity and disparities in referral for, and receipt of, cellular therapies based on race/ethnicity in our region.METHODS: In this retrospective review of patient electronic medical records, we assessed race and ethnicity among adults referred to Stanford for hematopoietic cell transplantation (HCT) and chimeric antigen receptor T-cell (CAR-T) between 2018 and 2022. Race/ethnicity data were evaluated as was receipt of cellular therapy.RESULTS: For the 3,532 referred patients identified, 49% (N=1,743) were NHW compared to 17% (N=599) Hispanic, 15% (N=522) Asian and 5% (N=104) NHB patients; 19% (N=672) of referred patients had unknown race/ethnicity. Among those referred, 48% (N=1,695) actually received HCT and 9% (N=333) received CAR-T. The racial/ethnic distribution of HCT recipients were proportional to the referral population: 49% (N=836) NHW, 18% (N=312) Hispanic, 16% (N=273) Asian, 6% (N=95) NHB, and 25% (N=418) unknown, while CAR-T recipients were somewhat less likely to be NHB than the referral population: 54% (N=181) NHW, 17% (N=59) Hispanic, 13% (N=42) Asian, 3% (N=10) NHB, and 25% (N=82) unknown. Social determinants of health were not routinely captured among referred or treated patients.CONCLUSIONS: Approximately 20% of adult patients referred and receiving cellular therapies have unknown race/ethnicity. Referred patients did not match our catchment area, with Hispanic patients comprising 50% fewer referrals than anticipated. The race/ethnicity of patients treated was overall consistent with the distribution of patients referred, suggesting that disparities are occurring more at the referral level. These data have prompted an interventional project aimed at better capturing race/ethnicity and social determinants of health among all adults referred for HCT and CAR-T cell therapy at Stanford.
View details for DOI 10.1016/S2152-2650(22)01645-7
View details for PubMedID 36164197