Maintaining momentum in cancer health equity: Examining Native Hawaiian and Pacific Islander US cancer mortality trends (1999-2024) and mechanisms for enhancing representation in oncology clinical trials.

Abstract

e23327 Background: Native Hawaiian and Pacific Islanders (NHPI) face higher cancer mortality rates compared to White people, with a 75% increased likelihood of dying from liver cancer and 2-3 fold higher risk of mortality from cervical, stomach, and endometrial cancers. 1 Approximately 1.7 million NHPI people live in the U.S., facing health disparities due to socioeconomic and cultural challenges. 2 Cancer ranks as a leading cause of death among NHPI individuals, surpassed only by COVID-19 and heart disease. 3 Despite suffering disproportionately from cancer and often being diagnosed at late stages, NHPI patients are underrepresented in cancer clinical trials. 4 To address these disparities, Roche-Genentech's Advancing Inclusive Research (AIR) initiative focuses on understanding and improving barriers to diverse patient representation. Genentech sponsored studies like CATORI (Study to Characterize Access to Specialty Care R eceived by American I ndian and Alaska Natives), which includes Indigenous populations, investigate cancer health equity factors such as barriers to oncology care and clinical trials. 5 Methods: A secondary analysis utilizing national cancer databases was conducted to assess cancer impact on NHPI populations from 1999-2024. Data sourced from the NCI SEER, CDC, and insights from 12 internal experts (e.g., HCPs, NHPI leaders, clinical study managers) revealed clinical presentation differences and subgroup outcomes. Results: Findings show NHPIs are underrepresented in clinical trials. 6 A study of 139 062 subjects indicated clinical trials for 60% of drug products did not report NHPI participation. 7 Collaborative efforts with the Genentech External Council for AIR have fostered innovative strategies to enhance clinical trial recruitment diversity, as exemplified by the CATORI study. This study aims to characterize barriers AI/AN communities face when accessing specialty care and leverages a virtual engagement model to reach diffuse populations. 8 Three key themes from CATORI and the qualitative expert insights emerged: (1) patient level support: overcoming barriers to healthcare and study participation. (2) study levelstrategies: improving patient experiences and operational efficiency. (3)system level commitment:partnerships, infrastructure investment, and policy reform. Conclusions: Advancing research for NHPI populations is crucial to reducing health disparities. Addressing factors like mistrust and access is essential for improved healthcare and inclusive trials. 9 Disaggregating NHPI data from Asian patients enhances cancer care access and understanding of the disease differences among NHPIs. 10,11 Study teams can use these recommendations for future research to provide equitable care for NHPI patients and address cancer burden disparities.