Miami’s Diversity Provides Greater Research in Health Care
Sylvester Comprehensive Cancer Center works to navigate diversity in culture, language, history and social communities.
Health care disparities are not the result of one universal problem. Along those lines, patients sometimes face what feels like insurmountable barriers to accessing care. It is also well documented that research and clinical trials have traditionally included white patients while they often leave out both the genetic makeup and lived experiences of the rest of the world. Just one example: In 2020, 75% of trial participants were white, according to the Food and Drug Administration.
Sylvester Comprehensive Cancer Center, part of the University of Miami Miller School of Medicine, continues to be a leader in changing who can access world-class care, and who is considered vital to advancing scientific research. Sylvester works for and with a population that represents what the rest of the U.S. may look like in the next 20 to 30 years.
Miami Melting Pot
The 10,000 square miles of Southeast Florida Sylvester services is “the melting pot of the 21st century,” said Erin Kobetz, Ph.D., M.P.H., associate director, Community Outreach and Engagement at Sylvester, co-director, Clinical Translational Research Institute, the John K. and Judy H. Schulte Senior Endowed Chair in Cancer Research and vice provost for research and scholarship.
Nearly 70% of residents of Miami-Dade County identify as Hispanic or Latino, according to the U.S. Census Bureau, and 17.1% as Black or African American. More than 50% of residents surveyed by the Census Bureau from 2017 to 2021 are also foreign-born. Just one example of the uniqueness of the patient population in Miami: More than 120,000 residents of Haitian descent live in the county, making up the largest Haitian community outside of Haiti.
Because of this makeup, Sylvester works to navigate diversity in culture, language, politics, history and social communities. Instead of seeing this as a challenge to overcome, Dr. Kobetz calls Sylvester’s community “extraordinary” and a driver of exponential opportunity and change.
“To effectively engage with these diverse communities, with outreach and research, really requires a robust community infrastructure, which provides opportunities for the bidirectional exchange of ideas between community stakeholders and the cancer center, and commitment on behalf of the cancer center’s leadership,” she said. “That ensures that ideas nominated by the community actually translate into the center’s strategic planning and investment.”
Location, Location, Location
While research centers around the country are doing critical cancer research, high-performing academic institutions with access to cutting-edge treatments and clinical trials are not often located in places with diverse patient populations, said Brandon Mahal, M.D., radiation and oncology vice chair of research and director of community outreach and engagement. He came to Sylvester because he wanted to work in an area with a diverse patient population, to provide world-class cancer care to those living in South Florida and make sure that all patients including those historically underserved have the opportunity to participate in clinical trials and studies.
Research disparities cause real harm. According to an analysis by the Food and Drug Administration of drug approvals between 2014 and 2021, fewer than 20% of trials for those drugs had clinical trial data regarding treatment benefits or side effects for Black patients.
If trials don’t include people of different identities, and from different racial, ethnic and socioeconomic backgrounds, those results won’t reflect the efficacy of that treatment or drug in the real-world population they are designed to serve.
“At Sylvester, we have the opportunity to include very diverse patient populations so we can better understand the risk factors that drive cancer,” said Mahal. “We can look at our neighbors and plot the burden of disease across different cancers, and can better understand what factors may drive the excess burden of those cancers in different populations.”
Game Changer Outreach, Research
In order to make sure residents in the entire surrounding community can avail themselves of Sylvester’s cancer care and are presented with opportunities to participate in research and clinical trials, Sylvester continues to work on ways “to make sure we’re able to provide care in a culturally and linguistically appropriate manner,” said Valerie Bethel, Ph.D., M.B.A./HCM, B.S.W., director of research support, Sylvester Office of Outreach and Engagement. That includes Sylvester’s Game Changer vehicles, which are RVs that have been transformed into mobile medical units. The mobile units provide cancer screenings for groups in communities.
The Game Changers, which launched in 2018, reach people in traditionally marginalized populations, who may not think that Sylvester’s services are for them, or who may face hurdles in traveling to receive medical care. Everything about the way the mobile units work, from including practitioners who speak languages common to areas serviced to featuring a wrap design by local artist Peter Tunney, make the Game Changers part of the community rather than interlopers into it.
“We try to think about everything we do from a holistic, sociodemographic, orientation and then the intersectionality that occurs between and within varying ages, races, ethnicities and sexual identities,” Kobetz said. “If we do not address that intersectionality, we run the risk that our work does not achieve its intended impact.”