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What’s New in Oncology Disparities! ASCO GI San Francisco, California
Conference Coverage

January 30, 2023
Chicago, IL - 2016 ASCO Annual Meeting - General Views During Gastrointestinal (Colorectal) Cancer Poster Session

January 21, 2023

Irby Hunter, Jr., MD Medical Director Oncology Independent Medical Education Inc & Executive Publisher Oncology Disparities Peer Reviewed Scientific Journal

Participants from across the globe gathered in San Franciso, California, and online for the 2023 ASCO Gastrointestinal (GI) Cancer Symposium on January 19-21, 2023. The theme for this year’s symposium was “Applying Innovation, Transforming Care, Advancing Equity.” This year’s conference was a celebration of 20 years of transformative care in GI cancers. The conference proved to be an impactful gathering for the sharing of new information about disparities in oncology. Conference attendees were well informed with respect to inconsistency in cancer screening, Hispanic patient outcomes, health insurance coverage, and access to systemic treatment. Trained data sets, genomic sequencing, and diversity and inclusion plans were a few of the many solutions proposed by investigators during the conference.

Rafaella Litvin, MD, presented an abstract titled “Disparities and outcomes in young adults admitted for gastric cancer in the US.” The investigative team led by Dr. Litvin used the National Inpatient Sample (NIS) database to identify adult patients primarily admitted to hospitals for gastric cancer from 2016 to 2019. The team analyzed demographic data on young adults (defined as those aged between 20 and 49 years of age) and older patients (aged 50 and above). The following variables were studied: hospital mortality, payer mix, total hospital length of charges, and length of stay. Thirty-three percent of the population studied were White patients, while 31% and 16% of the patients were identified as Hispanic and Black, respectively. Interestingly only 5% of the patients were Medicare beneficiaries; 35% of the patients were enrolled in Medicaid. The largest payer primary payer was revealed to be private insurance, comprising 51% of the studied population. A figure that is a catalyst for future studies is the finding that approximately 10% of the population under study were uninsured. (1)

During the study period, 77,720 patients were admitted with gastric cancer, of which 12.4% were defined as young, and 87.5% were old patients.1 Majority of the young patients were female. Hispanics comprised 30.9% of the young patients were Hispanic compared to 15% of older individuals.1 Young adults were over 3 times more likely to be uninsured than older adults.1 The work completed by Dr. Litvin et all is applauded. The cancer disparities community offers its gratitude to the research team. Additional analysis of the potential correlation between a patient’s ethnicity, age, cancer risks, and insurance coverage uninsured needs to be performed to advance our understanding of cancer disparities. Their findings demonstrate the need to address inequities found in social determinants of health as a significant solution to disparities.

Dina Ioffe, MD et all; offered additional insight into the well-known occurrence of hepatocellular carcinoma (HCC) disproportionately affecting minorities, particularly Black and Hispanic patients. Not only are these populations expected to have the highest rate of HCC over the next ten years, patients representing these minorities are known to be drastically underrepresented in clinical trials. Furthermore, patients from these populations are more likely to be diagnosed with advanced diseases. Ioffe et all; studied 1283 patients diagnosed with metastatic HCC from 2011 to 2021 from a nationwide Flatiron Health electronic health record (EHR)- derived database for the purpose of exploring differences in patient characteristics and patterns of systemic treatment in disadvantaged groups.2 Several variables were studied: race/ethnicity, insurance type, and lines of systemic therapy after metastatic diagnosis.2 The database included 750 White, 175 Black, 122 Hispanic, and 69 Asian patients.2 Most patients received systemic treatment for metastatic HCC within 2 months without a significant difference based on race/ethnicity. There was no difference in unadjusted time to systemic treatment based on insurance.2 Dr. Ioffe’s findings are appreciated and need to be benchmarked against similar large-scale analysis.

Despite being the second largest racial/ethnic group in the US behind Whites, Hispanics have the largest rates of liver cancer. Cecilia Monge, MD, led a team of researchers from the National Institute of Health (NIH) seeking to answer the question, “are Hispanic Individuals proportionately represented in clinical trials for liver cancer?” Clinical trials housed in several national databases were filtered by unique search terms related to liver cancer. The liver as a cancer site was revealed to have the highest incidence rate-ratio (IRR) in Hispanic individuals relative to non-Hispanic White individuals. The incidence rate per 100,000 grew steadily between the years 2000 to 2010. Investigators revealed data indicating that between the years 2000 to 2019, the mortality rate for Hispanic individuals was, on average, 84% higher than non-Hispanic White individuals. During the same time period, Hispanic individuals comprised, on average, 31% of the total number of liver cancer cases while representing 2.4% of the participants enrolled in clinical trials for liver cancer. (3)

Monge et all, are to be commended for their investigative findings. The group of talented researchers clearly highlighted that non-Hispanic Black, and Hispanic patients are underrepresented in multinational phase III trials for liver cancer relative to their representation in the US population. Further highlighting the need for clinical trials gaining FDA approval to require mandatory racial/ethnic inclusion that is reflective of the US population.

Dr. Ricardo Estrada-Mendizabel led a team of investigators from the University of Arizona Cancer Center in conducting a retrospective analysis of genomic testing data collected by the center from 2013 to 2021. The team studied outcomes for Hispanic and non-Hispanic patients suffering from late-stage pancreatic cancer. Data collected included: patient demographics, clinical characteristics, treatment regimens, germline, somatic tissue, somatic liquid genetic testing, and outcomes. Estrada-Mendizabel’s analysis included 198 patients, of which 20.1% of the individuals were Hispanic. Also, 64.1%, 48.9%, and 48.9% of the patients had germline, somatic tissue, and somatic liquid testing, respectively. Study results revealed that Hispanic patients were significantly less likely to receive germline screening and more likely to have potentially actionable pathogenic variants via somatic tissue and liquid biopsy testing. (4)

Investigators are encouraged to take note of Dr. Estrada-Mendizabel’s keen use of the appropriate statistical analysis method, Kaplan Meier and Cox regression, to tease out disparities. His findings highlight the need to advance genomic testing to reveal mutations yielding targeted therapies among minority patients. The use of genomic sequencing to improve outcomes among underrepresented patients diagnosed with late-stage cancers should further be investigated as a potential solution to disparities.

Daniel King offered evidence to support how natural language processing can be used to identify potential minority patients for clinical trial enrollment. King et all; trained a novel language processing engine, RadBERT, to read radiology report texts. Also, RadBERT was used to identify reports which seemed suspicious for pancreatic cancer. Researchers measured accuracy on a retrospective training set and a prospective dataset. Retrospectively, King computed the final classifier performance metric over the test dataset. Training sets results were reported as follows: accuracy 92%, F1 score: 0.943, recall 0.943, and precision 0.930. Investigators are calling for the publishing of an open-source code and training set leading to wide spread use of the tool. Also, they are seeking for the implementation of the tool to identify qualified clinical trial patients for study coordinators. (5)

Mayo Clinic investigator, Dr. Ahmed Ouni, sought to demonstrate the disparities associated with colorectal cancer screening. Ouni et all conducted a retrospective review of over 555,000 patients. The study period was between 2015 to 2021. Patients were seen in primary care physicians and Gastroenterology specialists. Patients were over the age of 45 and self-identified as either being African-American, Asian, Caucasian, and other. African Americans were 38% less likely to have Cologuard testing ordered, while Asians were 1.23 times more like to have Cologuard. Equally alarming, African Americans were half as likely as Caucasians to have a colonoscopy within one year of the patient’s first visit. (6)

A special note of gratitude is due to ASCO GI Symposium leaders and research contributors for continuing to advance the awareness and evidence of disparities as well as for offering innovative solutions to a challenging problem.


  1. Litvin, Rafaella. 2023. Disparities and outcome in young adults admitted for gastric cancer in the US. ASCO. Abstract 298. January 19, 2023. 2023 ASCO Gastrointestinal Cancers Symposium.
  2. Ioffe, Dina. 2023. Investigating disparities in heptatocellular carcinoma and their effect on patterns of systemic care. ASCO. Abstract 96. January 20, 2023. 2023 ASCO Gastrointestinal Cancers Symposium.
  3. Monge, Cecilia. 2023 Racial and Ethnic Disparities in Multinational Phase III in Liver Cancer. ASCO. Abstract 497. January 20, 2023. 2023 ASCO Gastrointestinal Cancers Symposium.
  4. Estrada-Mendizabal, Ricardo. 2023. Disparities in Late-Stage Pancreatic Cancer: Retrospective Analysis of Genomic Testing and Outcomes between Hispanics and Non-Hispanics. ASCO. Abstract 663. 2023 ASCO Gastrointestinal Cancers Symposium.
  5. King, Daniel. 2023. Democratizing Access to Research for Pancreatic Cancer Patients Through Natural Language of Processing Radiology Reports. ASCO. Abstract 666. 2023 ASCO Gastrointestinal Cancer Symposium.
  6. Ouni, Ahmed. 2023. Disparities in Colorectal Cancer: Trends of Reduced Screening Among Minority Populations. ASCO. Abstract 18. 2023 ASCO Gastrointestinal Cancer Symposium.



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