Depoliticizing DEI in Cancer Care

Your vote on November 5 could decide whether you live or die from cancer.

We hear almost weekly about another public figure who has been diagnosed with or died from cancer. The math is not in our favor; four of every ten people in the United States will have cancer in their lifetime. But what you may not know is that quality, effective, and accessible cancer care is on our local and federal ballots this November.

I am a board-certified academic medical oncologist and clinical researcher. Over the past 20 years, I’ve repeatedly observed that a diverse workforce leads to more innovative science and healthier outcomes.

Sadly, our cancer workforce does not reflect the patients we serve. Stark disparities exist in the field of oncology. Over 50% of medical students are women, but only 35% of oncologists are women, and even fewer are in leadership. Only 6% of practicing oncologists in the United States identify as Hispanic or Latinx even though 19% of the US population is Hispanic or Latinx. Only 3% of practicing oncologists identify as Black compared to 13% of the population.

The COVID-19 pandemic shed light on many long-standing race-based disparities in healthcare delivery, access, and outcomes, and this is no different for cancer care. For example, Black Americans are more likely to get and die from colorectal cancer than other racial groups in the United States. Black women have a 40% higher risk of death from breast cancer compared to white women in the United States, due to delays in diagnosis, and later stage at presentation. There are also disparities in the social drivers of health (SDOH), such as social, economic, and environmental conditions, on the cancer continuum – a fact highlighted by the American Society of Clinical Oncology in a recent policy statement.

These disparities are not just a social justice problem; they are a healthcare problem.  We know that a diverse cancer workforce leads to more innovative science and better health outcomes for patients. Research shows that women surgeons may provide better outcomes for women patients. In addition, racial concordance between doctors and patients can improve communication, trust, and adherence to medical advice.

Despite these acknowledged disparities, our goal of equitable cancer care delivery faces headwinds – most notably the erosion of diversity, equity and inclusion (DEI) programs at universities across the United States. These changes are a direct result of the hateful rhetoric started by former President Trump and propagated by many far right-leaning politicians.

Compounding this rhetoric, a 2023 decision by the Supreme Court of the United States (SCOTUS) struck down affirmative action programs in college admissions. This was followed by a proliferation of anti-DEI legislation, with 86 bills introduced since 2023. DEI programs in universities and colleges have come under fire, and over 150 institutions of higher education have eliminated or made restrictive change to DEI programs. Public colleges and universities are especially vulnerable. They have been forced to change offices or departments, eliminate positions, end DEI training or programming, and ax funding.

These changes to DEI university programs may have implications on research areas and funding. Federal agencies, such as the National Institutes of Health and National Cancer Institute, typically require applicants to show they are considering diversity and equity in their work. The future of cancer research funding that includes any element of DEI is uncertain, something that the American Association of Cancer Research has acknowledged could affect scientific integrity.

These changes undermine efforts to diversify the cancer workforce, limit what scientific questions are asked, and curtail research aimed at reducing cancer health disparities. Eliminating these DEI programs means that we will have a less diverse cancer workforce, less innovation, and fewer scientific discoveries. The health disparities for patients with cancer will only widen.

To be sure, some DEI efforts have fallen short, and some have been criticized for being discriminatory and disadvantaging certain groups. For example, the University of Michigan has invested billions of dollars in DEI over the last two decades. They were once considered pioneers in this space, but they now face criticism for what some describe as performative and superficial practices. Legacy DEI offices and programming may in fact no longer meet our evolving needs. But that isn’t an invitation to turn away from these core values. Despite this challenging policy landscape, national organizations are renewing their commitment to inclusive excellence in cancer care.

On November 5, cast your vote for local and federal policy makers who have a track record of supporting legislation that values a diverse cancer workforce, supports freedom of scientific inquiry and innovation, and promotes equitable access to optimal cancer care for all patients.

Politics does not belong in our cancer centers or exam rooms. Vote like your life depends on it – because it does.