Having more Latino cancer doctors will improve patient care

From inside her grandmother’s house in the rural outskirts of Hatillo, Puerto Rico, Keishla Arce-Ruiz heard a scream. She and her grandma rushed over to her uncle’s house a few yards away, where they found Arce-Ruiz’s aunt naked and covered in blood, holding her baby in her hands. She had just given birth.

Arce-Ruiz took control. She called an ambulance, described the condition of the baby to the dispatcher, and took care of her aunt while panic and chaos swarmed her. It was in this moment, at the age of 21, that she decided to pursue medicine.

Growing up, Arce-Ruiz never imagined this career path — no one in her family had gone to college. But after volunteering with a local organization that provides medical and quality-of-life care for homeless people, she felt inspired and moved by the compassion and skill of the volunteer nurses and doctors.

In 2021, she enrolled at Ponce Health Sciences University, 50 miles away from her home in Hatillo, and began her studies in medicine. When she discovered a one-year research fellowship in Boston for medical students from underrepresented backgrounds who want to pursue intensive training in cancer population science, she jumped at the chance.

The Cancer Care Delivery and Outcomes Research Fellowship is the brainchild of Dr. Jennifer Mack, director of the Center for Outcomes and Policy Research at Dana-Farber Cancer Institute, a teaching hospital of Harvard Medical School. The idea is to look at oncology and cancer prevention holistically and from a broader perspective, with a focus on patient care and health equity, Mack says.

“It’s a way to try to bring a diverse group of people into the field,” she says. “Research shows that if we include diversity in science, it makes the science better, more innovative, and helps tackle persistent challenges like health disparities.” Such disparities include a lack of biomedical research on racial and ethnic groups including Black or African American, Hispanic or Latino, American Indian or Alaska Native, Native Hawaiian, or other Pacific Islander backgrounds, according to the National Institutes of Health.

Latinos have been historically underrepresented in the medical field in the United States. Hispanic doctors made up 5.8 percent of all active physicians in 2018, according to a report by the Association of American Medical Colleges. The percentage specializing in cancer care is lower still: Only 4.7 percent of practicing oncologists identified as Latinx or Hispanic despite comprising 16.8 percent of the adult US population, according to a 2022 study in the American Society of Clinical Oncology Journal. Considering that cancer is the leading cause of death for Latinos in the United States, that gap is even more concerning.

“Diversity is good for patients,” Mack says. “Doctors from diverse backgrounds are more likely to engage with communities that need their service.” The sense of ease and trust inherent in feeling a closer connection with a doctor can have measurable benefits. For example, visits between patients and doctors from similar backgrounds last 2.2 minutes longer than average, studies show, and patients “are overall more satisfied and the quality of care is rated more highly,” Mack says.

Medical students from underrepresented groups are invited to apply for the Dana-Farber fellowship, though only one is chosen per year. Arce, only the second fellow, began the one-year program in July. For her research project, she’s conducting an observational study on patients who have myeloma, a type of blood cancer, or a risk of developing it.

Hispanic blood cancer patients are more likely to have worse outcomes than non-Hispanic patients and receive their diagnosis at a younger age, according to a 2021 study from Texas Tech University Health Sciences Center. A study by Dana-Farber found that 40 percent more Hispanic or Latino children were diagnosed with acute lymphoblastic leukemia, another kind of blood cancer, than non-Hispanic/Latino children.

Arce-Ruiz hopes her research will shed light on different factors that can lead to blood cancer, including lifestyle, environment, and comorbidities. And she’s examining the risk factors that having blood cancer pose for developing other diseases.

The fellowship encourages students to draw from their own experience. When her mother was diagnosed with breast cancer, Arce Ruíz learned firsthand how difficult managing care was: navigating Medicaid referrals and required lab work meant her mother waited three to four months before her first appointment with an oncologist.

“There was a lack of coordination between her primary doctor and any kind of oncology treatment,” Arce-Ruiz recalls. “We had to find an oncologist on our own. And a lot of oncologists who specialize in breast cancer [were] far from us. We didn’t have a car that could make the trip.”

Arce-Ruiz hopes that experiences like her mother’s long wait to get the medical help she needed will become much more rare as more and more Latino doctors enter specialties such as oncology.

Cancer treatment begins before diagnosis — it includes prevention, which is only possible via a robust system of screening and education that can reach everyone. “We also need to improve on identifying which populations are at risk of developing these diseases. And that’s what this program focuses on — population science,” Arce-Ruiz says. “If we want to stop cancer and end it, we have to prevent it.”

Jazmin Aguilera can be reached at [email protected]. Follow her @jazminaguilerax.