Health Disparities: Impact of Health Disparities and Treatment Decision-Making Biases on Cancer Adverse Effects Among Black Cancer Survivors

BACKGROUND

Health disparities affect cancer incidence, treatment decisions, and adverse effects. Oncology providers may hold biases in the decision-making process, which can perpetuate health disparities.

OBJECTIVES

The purpose of this article is to describe health disparities across treatment decisions and adverse effects, describe decision-making biases, and provide suggestions for nurses to mitigate adverse outcomes.

METHODS

A scoping review of the literature was conducted.

FINDINGS

Factors affecting health disparities stem, in part, from structural racism and decision-making biases, such as implicit bias, which occurs when individuals have unconscious negative thoughts or feelings toward a particular group. Other decision-making biases, seemingly unrelated to race, include default bias, delay discounting bias, and availability bias. Nurses and nurse navigators can mitigate health disparities by providing culturally appropriate care, assessing health literacy, providing education regarding adverse effects, serving as patient advocates, empowering patients, evaluating personal level of disease knowledge, and monitoring and managing cancer treatment adverse effects.

Selective treatment de-escalation in advanced prostate cancer: have we come full circle?

Compelling evidence has solidified the notion of early treatment intensification in managing patients with metastatic hormone-sensitive prostate cancer (mHSPC). Landmark trials have provided Level 1 evidence for the survival benefits achieved by combining multiple agents. The efficacy of combined therapy relies not only on how treatment is intensified but also on how it is de-escalated. This underscores the importance of tailored treatment approaches, potentially involving a reduction in therapy for specific patients, to strike a balance between the benefits of hormonal treatment and its associated adverse effects. While de-escalation of therapy in mHSPC remains challenging due to limited evidence, it is recommended for elderly or frail patients, those with poor performance status, or experiencing significant toxicity. However, for patients with excellent prostate-specific antigen responses or favourable biomarkers, decisions should be personalised, weighing the potential benefits of continued treatment against the risk of long-term side effects, using risk stratification tools where appropriate.

Iatrogenic myelodysplastic syndrome complicating multiple sclerosis: A case report

After 1.5 years of treatment with dimethyl fumarate (DMF) for multiple sclerosis, preceded 8 years earlier by intravenous (IV) cladribine and 1 year earlier by natalizumab, our patient developed myelodysplastic syndrome (MDS). The initial manifestation was a severe drop in absolute neutrophil and lymphocyte counts. Repeat bone marrow biopsy demonstrated a new unbalanced translocation (between the chromosome 1 long arm and chromosome 7 short arm). This case report, to our knowledge, is the first linking iatrogenic MDS to DMF and cladribine, while also suggesting caution with immunosuppressants in multiple sclerosis patients.