Nina Niu Sanford, M.D.  Assistant Professor Dedman Family Scholar in Clinical Care UT Southwestern Department of Radiation Oncology Dallas TX

Racial & Ethnic Cancer Survivors Less Able to See Health Care Providers Who Share Their Culture Interview with:

Nina Niu Sanford, M.D.  Assistant Professor Dedman Family Scholar in Clinical Care UT Southwestern Department of Radiation Oncology Dallas TX

Dr. Nina Niu Sanford

Nina Niu Sanford, M.D.
Assistant Professor
Dedman Family Scholar in Clinical Care
UT Southwestern Department of Radiation Oncology
Dallas TX What is the background for this study?

Response: Minority racial/ethnic groups present at later stages of cancer and have worse stage-specific survival rates.  Cultural competency represents a single element within the dynamic and trans-disciplinary field of health disparities, but is an important modifiable factor for both providers and health organizations that could be associated with disparities in cancer outcomes.

There have been longstanding initiatives and training requirements in medical education specifically designed to improve provider cultural competency over the past couple of decades, and the American Society of Clinical Oncology (ASCO) has recently outlined goals for improving cultural competency within its policy statement on cancer disparities.

Moreover, ASCO health disparity policies have recently highlighted the association between racial/ethnic disparities in cancer outcomes and a “lack of access to high-quality care that is understanding and respectful of diverse traditions and cultures plays a significant role.”  Given the above, we wished to assess access to culturally competent providers among patients with cancer by race/ethnicity. What are the main findings?

Response: The main findings of our study is that cancer survivors who identify as racial/ethnic minorities were 18% more likely than non-minorities to believe that it was at least somewhat important for their health care providers to share or understand their culture. However, racial/ethnic minorities were almost 15% less likely to be able to see health care providers who actually shared or understood their culture, and nearly 13% of minority cancer survivors reported that they were never able to see these types of providers. What should readers take away from your report? 

Response: This is, to our knowledge, the first nationally-representative study to demonstrate patient-reported ratings of provider cultural competency among cancer survivors: Although racial/ethnic minorities seemed to place more value on the cultural competency of their health care providers, they were significantly less likely to be cared for by such providers. So, despite policy and medical education efforts aimed at improving patient-centered and culturally competent care over the past several decades, there remains an apparent racial disparity in the access to or receipt of this care at the national level.

Our study highlights the need for further increases in both culturally competent and culturally diverse oncology providers throughout the United States. What recommendations do you have for future research as a result of this work?

Response: Future work will be needed to determine to what degree these disparities are driven by lack of patient-provider racial concordance versus insufficient training in patient-centered practices.  Also, future studies should assess whether provider cultural competence is associated with receipt of guideline-concordant care, enrollment onto clinical trials, better quality of life, among other measures.


Butler SS, Winkfield KM, Ahn C, et al. Racial Disparities in Patient-Reported Measures of Physician Cultural Competency Among Cancer Survivors in the United States. JAMA Oncol. Published online October 31, 2019. doi:10.1001/jamaoncol.2019.4720


Last Modified: Nov 2, 2019 @ 12:41 pm



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