Hope for a Future Free of Unconscious Biases and Racial Anxiety in Cancer Care
Authors: Elliot A. Asare, Oluwadamilola M. Fayanju
Journal: Journal of the National Comprehensive Cancer Network (2024)

A lthough a social construct and, in modern times, based on self-identification, race and its concomitant legacy of racism continue to exert a significant influence on almost every aspect of the lives of people in diverse countries such as the United States.Although race serves as only a poor proxy for genetic ancestry, the deleterious effects of structural racism, including poverty, differential exposure to environmental carcinogens, and unequal access to resources for screening, prevention, and treatment of cancer contribute to the uneven burden of cancer incidence and mortality in the United States.The study elsewhere in this issue by Balanean et al 1 titled "Oncologists' Perceptions of Racial Disparity, Racial Anxiety, and Unconscious Bias in Clinical Interactions, Treatment, and Outcomes" elucidates 2 root causes of racial disparity in oncology-racial anxiety and unconscious bias in interracial clinical interactions and treatment decision-making.Every year, significant racial disparities in cancer outcomes persist despite continued advances in oncology.Per the latest report on Cancer Statistics from the American Cancer Society (ACS), 4 million deaths from cancer have been averted since 1991. 2 However, although this is excellent news to be celebrated, it is also the case that Black people with prostate, gastric, and uterine corpus cancer have 2-fold higher mortality compared with White people, as do Native Americans with liver, gastric, and kidney cancer. 2s oncologists (medical, radiation, and surgical), we meet and take care of people at the most vulnerable moments in their lives, with the goal of providing cure whenever possible or palliating their symptoms when cure is not possible.Effective engagement in shared decision-making and personalized care for our patients requires that we engage them in discussion and build trust.However, this trust is harder to build when opportunities to interact with people unlike oneself are rare both within and outside a medical context.Historic redlining as a legacy of structural racism, in which neighborhoods with Black individuals were given the worst appraisal rating with regard to risks for housing loans, led to racial segregation that remains a problem across many cities today. 3Without organic, cross-racial interactions, some patients and providers may experience racial anxiety, which is defined as "discomfort with experience or consequences of interracial interactions," 1 on the rare occasions when it becomes necessary for them to engage with people of a different race.The feeling of anxiety during these encounters may be felt by patients, providers, or both, and is detrimental to all parties involved.Racial anxiety has been associated with decreased information-sharing, shorter interaction time, and decreased perception of empathy. 4ue to the lack of opportunity for cross-racial interactions, which may be the legacy of structural, self-imposed, or socioeconomic segregation, stereotypes and biases borne out of a few negative encounters or negative role models may emerge to perpetuate a vicious cycle in which minoritized patients may not be offered many potentially beneficial clinical opportunities, including the chance to enroll in clinical trials, receive palliative care consultation, or be referred for genetic counseling. 5Although we can actively mitigate our conscious biases, our unconscious or implicit biases, defined as "attitudes and beliefs about race, ethnicity, age, ability,