Five Ways Sylvester Creates Health Equity in Gynecological Care
South Florida’s only NCI-designated cancer center helps to close health equity gaps in gynecologic cancer care locally and globally.
Every five minutes, a woman is diagnosed with one of the five gynecologic cancers—cervical, ovarian, uterine/endometrial, vaginal or vulvar—according to the Foundation for Women’s Cancer.
Despite advances in the prevention, detection and treatment of these cancers, health disparities that disproportionately impact underserved populations persist. Education and access to screenings, research trials and care continue to be challenging for many women.
Sylvester Comprehensive Cancer Center, part of the University of Miami Miller School of Medicine, has five initiatives to improve access to gynecologic care.
1. Multipronged Approach to Cervical Cancer Prevention, Care
Cervical cancer is preventable and curable, if caught early. The World Health Organization (WHO) partnered with Sylvester in a first-of-its-kind collaboration to eliminate cervical cancer in 2021.
“Eliminating cervical cancer globally is a realistic goal, but women must have equitable access to care to achieve it,” said Erin Kobetz, Ph.D., M.P.H., associate director of community outreach and engagement at Sylvester and the John K. and Judy H. Schulte Senior Endowed Chair in Cancer Research.
One approach is to disseminate cervical screening self-sample tests. The FDA-approved at-home screening is easy to use and indicates a positive or negative result for the human papillomavirus (HPV), which causes nearly all cervical cancers.
While a positive result would still require that women visit their doctors, the test provides HPV screening without the stigma and other barriers associated with a speculum-based exam, Dr. Kobetz said.
“Sylvester was the first to study self-sampling by U.S. mail. In underserved communities, upwards of 90% of women returned the tests,” Dr. Kobetz said.
Women who meet the eligibility criteria for HPV screening are offered the self-sample kit from Sylvester’s Game Changer mobile cancer screening vehicles. On a more global scale, Sylvester, along with the Pan American Health Organization, recently hosted a two-day workshop to talk about the development of national plans to distribute self-sampling HPV infection screenings in Latin America and the Caribbean.
2. Global Health Equity Through Education
Fueled by a $1.65 million grant from the Chan Zuckerberg Foundation to support the African-Caribbean Single Cell Network in 2022, Sylvester physician-scientists Sophia George, Ph.D., an associate professor of gynecological oncology and associate director of diversity, equity and inclusion at the Miller School, and Matthew Schlumbrecht, M.D., M.P.H., an associate professor of gynecological oncology at the Miller School, visited hospitals and clinics in Nigeria. One of their goals was to provide in-depth training and mentoring for Nigerian gynecologic-oncology fellows.
The next year, Sylvester hosted a 25-person university delegation from northeast Nigeria to increase global health equity and accelerate medical research and education.
“We are learning from one another about the challenges regions and countries face in providing equitable care for gynecologic and other cancer types,” Dr. Schlumbrecht said. “Our goal is to maintain the dialogue and share best practices in order to broaden our global impact.”
3. Mapping Cancer Genes
Funding from the Chan Zuckerberg Foundation also created an international effort to investigate the genetic drivers behind breast, ovarian and prostate cancer in Black people.
Dr. George’s trip to Nigeria involved setting up collection sites for the African-Caribbean Single Cell Network to gather genetic samples from people of African descent.
“Black people are at higher risk for aggressive cancers and often develop them at younger ages,” Dr. George said. “From a health equity standpoint, it is vital that we understand how factors like genetics might play a role and how we can use that information to develop targeted prevention and treatment strategies.”
4. Clinical Trial Access
One of the most important ways to improve equity in cancer care is to enroll patients in clinical trials. The problem is minority and underserved women usually don’t have clinical trial access, according to Abdulrahman Sinno, M.D., chief of gynecologic oncology and director of surgical research and education at Sylvester.
“Seventy percent of the women in Sylvester’s gynecological cancer clinical trials are minority or underserved women,” Dr. Sinno said. “We’re also conducting research in genetic ancestry to determine how races and ethnicities react differently to cancer drugs. Finally, we focus on trials that identify risk factors for poor outcomes in minority groups, so we can target interventions to tackle them directly.”
Among the many studies she oversees, Tracy Crane, Ph.D., RDN, co-lead of the Cancer Control Program and director of lifestyle medicine, prevention and digital health at Sylvester, is investigating ways to integrate lifestyle medicine, including nutrition and exercise, into clinical practice so every patient receives this support as part of their cancer care.
In ovarian cancer, for example, Sylvester and Yale Cancer Center are leading one of four grants that make up the National Cancer Institute-funded Exercise and Nutrition Interventions to Improve Cancer Treatment-related Outcomes (ENICTO) in Cancer Survivors study. The Trial of Exercise and Lifestyle in Women With Ovarian Cancer (TEAL) looks at the impact of nutrition and exercise on ovarian cancer outcomes.
Yet another recently completed study, Lifestyle Intervention for Ovarian Cancer Enhanced Survival (LIVES), a national trial of a combined diet and physical activity intervention for stage II to stage IV ovarian cancer survival, is the largest behavior-based lifestyle intervention trial conducted among ovarian cancer survivors.
To create equitable access to these trials, Dr. Crane and her team design interventions that are culturally adapted to meet the needs of South Florida’s diverse population, including offering trials in Spanish.
“Educating women about the importance of clinical trial participation is crucial,” Dr. Crane said. “But all the educating in the world will not move the needle of participation if we do not also address cultural needs and hurdles as a result of social determinants of health faced by underserved populations.”
5. Cancer Hotspots
Big data-powered technology is transforming health care delivery by targeting disease burden.
“Sylvester’s proprietary SCAN 360 web-based platform informs all that we do at Sylvester to promote health equity in gynecologic and other cancers,” Dr. Kobetz said. “The technology allows us to target who needs what and where. We can then efficiently and effectively deliver education and screenings, step up recruitment for clinical trials and more to change cancer trajectories.”
Tags: African-Caribbean scNetwork, African-Caribbean Single Cell Network, cancer genetics, cancer research, Cervical cancer, Dr. Erin Kobetz, Dr. Matthew Schlumbrecht, Dr. Sophia George, endometrial cancer, Game Changer, ovarian cancer, Sylvester Comprehensive Cancer Center, vaginal cancer, vulvar cancer