These researchers have dedicated their careers to finding new treatments and cures for people with cancer.
“I noticed many older patients presenting with an advanced-stage cancer diagnosis,” said Dr. Diaz, who’s currently doing a fellowship in geriatric oncology and geriatric medicine at the University of North Carolina (UNC) at Chapel Hill. “The overwhelming majority of these patients were Spanish-speaking, foreign-born, and uninsured.”
It struck a chord with Dr. Diaz, the child of parents who immigrated to the United States from Mexico, in search of the American Dream. “I think, in a lot of ways, I saw my family in those patients,” shares Dr. Diaz.
Now, with an endowed grant from Conquer Cancer, the ASCO Foundation, Dr. Diaz is working to address those disparities by broadening and enriching patient data for older Hispanic and Latino populations and exploring social determinants of health (SDOH), i.e., the social, economic, and physical circumstances affecting people’s health—and he’s doing so in a way that has never been done before.
Here, Dr. Diaz shares more about his work, his background, and the impact of his Conquer Cancer funding.
What was it about older Hispanic and Latino patients that resonated with you and made you want to dedicate your career to helping them?
FD: Initially, I struggled to find my niche within cancer disparities research. So, I spoke to one of my mentors regarding a concern I had about foreign-born Hispanic individuals with cancer: How much influence did the culture they were raised in—and the years that followed while living in the U.S.—affect their understanding and decision-making regarding a cancer diagnosis?
I think, in a lot of ways, I saw my family in those patients. Many of these patients’ stories, the difficulties they endured, it all resonated with me, because that’s what my family and I experienced when I was younger. The barriers and inequities they faced really fostered my interest in cancer disparities.
What is the current reality for these patients, and how does this inform your research approach?
FD: One thing that bothers a lot of Hispanic and Latino communities is how we’re often all just grouped together. To understand how Hispanic and Latino patients age, and how best to improve cancer outcomes in these communities, we must consider integrating geriatric assessment together with Hispanic and Latino-focused SDOH into daily practice and work to disaggregate the data on these populations. Finding the right treatment for an individual requires more time and effort, but we have the tools to do so.
To help address these problems, my research team and I are developing the North Carolina Hispanic Cancer Registry. The database records information on Hispanic and Latino adults receiving care at North Carolina Basnight Cancer Hospital, which serves each of the state’s 100 counties. Having access to such a broad patient population us to gather data on a diverse range of patients, including the uninsured, underinsured, and undocumented. Additionally, geriatric assessments can provide a lot of the information needed to personalize care for patients, so we’re integrating this approach into our research as well.
You've launched a comprehensive study collecting data across four components: SDOH; geriatric assessment; patient-reported outcomes; and cancer-related information from the electronic medical record. What kinds of information are you collecting from patients?
FD: Participants answer questions about where they were born, how long they’ve lived in the U.S. (to gauge acculturation, if applicable), where their parents were born, language proficiency, the highest level of education they’ve received, literacy, diet, exercise, and citizenship status, among other criteria. The geriatric assessment tool is designed to give providers greater insight into patients’ physical abilities, cognitive status, and psychosocial well-being, among other domains. It also allows us to evaluate the patients’ physiological health through more meaningful and telling factors than numerical age.
We’re also surveying participants about their financial security, social support, and mental health to better understand how these factors can shape patients’ perception of their care. Moreover, the study aims to profile the unique circumstances of each individual patient, including cancer type and stage, course of care, treatment toxicity, emergency visits, and appointment attendance, among other factors.
What makes your research unique, and what are the potential benefits for patients?
FD: By asking patients a range of intentional, substantive questions, we've really expanded upon the SDOH in a way that's never been done before. We hope to better segment and categorize the data pertaining to Hispanic and Latino populations so that researchers can more accurately identify the highest-risk subgroups, including patients with cancer who may need additional support. Over time, this database will give us a better idea of how cancer can affect these subgroups and provide insight into how the Hispanic and Latino populations are aging in the U.S., based on where they were born and the influence of acculturation, among various other factors.
What outcomes do you hope to see from your ongoing Conquer Cancer-funded research?
FD: I predict one of the most important takeaways being that older Hispanic and Latino patients will want to know more about their cancer diagnosis and what steps they can take. I hope that a significant percentage of these patients (including people who are undocumented) will express greater interest in sharing more about their cancer journeys, feel encouraged to participate in clinical trials, and express a greater interest in patient education. I also hope to leverage this study as a steppingstone for future research to diversify and enrich Hispanic and Latino cancer data.
