Disparities in care of older adults of color with cancer: A narrative review

This review describes the barriers and challenges faced by older adults of color with cancer and highlights methods to improve their overall care. In the next decade, cancer incidence rates are expected to increase in the United States for people aged >= 65 years. A large proportion will be older adults of color who often have worse outcomes than older White patients. Many issues contribute to racial disparities in older adults, including biological factors and social determinants of health (SDOH) related to healthcare access, socioeconomic concerns, systemic racism, mistrust, and the neighborhood where a person lives. These disparities are exacerbated by age-related challenges often experienced by older adults, such as decreased functional status, impaired cognition, high rates of comorbidities and polypharmacy, poor nutrition, and limited social support. Additionally, underrepresentation of both patients of color and older adults in cancer clinical research results in a lack of adequate data to guide the management of these patients. Use of geriatric assessments (GA) can aid providers in uncovering age-related concerns and personalizing interventions for older patients. Research demonstrates the ability of GA-directed care to result in fewer treatment-related toxicities and improved quality of life, thus supporting the routine incorporation of validated GA into these patients' care. GA can be enhanced by including evaluation of SDOH, which can help healthcare providers understand and address the needs of older adults of color with cancer who face disparities related to their age and race. Older adults of color with cancer face healthcare disparities related to both their race/ethnicity and age. Many interconnected factors contribute to these disparities including clinical, age-related physiologic, and treatment-related factors, as well as the social determinants of health related to healthcare access, socioeconomic concerns, systemic racism, mistrust, and the neighborhood or built environment where a person lives. To allow for early identification of these factors and personalized management for older patients of color with cancer, we advocate for widespread implementation of an enhanced geriatric assessment that includes consideration of a patient's functional, cognitive, psychological, and nutritional status, their comorbidities, polypharmacy, and social determinants of health.image