Racial Disparities in Youth and Young Adults with AML | Erin Feliciano, MD | #ASH24

Okay, so my name is Erin Feliciano. I'm a second year internal medicine resident at, Elmhurst Hospital Center, that's affiliated with the Icahn School of Medicine at Mount Sinai, where we have a partnership with the Mount Sinai Hospital in Manhattan, New York. Like I said, I'm an internal medicine resident, so I'm still in my clinical training, but I do hem. onc. research, I would say there are two sides of my research.

My clinical research focuses on AYAs particularly with AML. I started doing that when I was doing a six month rotation at Roswell Park with Doctor Wang. She got me started on my AYAs AML research, and on my other side of research, I actually do global oncology hematology oncology research. So we do a lot of disparities work as well.

So a little background about myself. I'm from the Philippines, so I did my medical school in the Philippines. I did definitely get a perspective of health care in that setting. And coming here also gives me a new perspective on that. But yeah, so I do that kind of research. AYAs with AML, hematologic, global oncology research as well.

But really focusing on disparities and really trying to translate that policy and systems change. I presented an oral abstract on or oral presentation rather on the survival disparities in adolescents and young adults with AML. This study was inspired by a study I'm going to mention doctor names, Doctor Durani and Doctor Go, who published a paper that looked at racial disparities in adolescents, young adults with AML from the time period of 2001 to 2011.

And they did find, like, pretty, you know, stark disparities. Black patients had poor outcomes compared to white patients. They saw that across the the outcome of ten years. They, white patients continued to have improved outcomes. No other races did. So we thought to ourselves, you know, it's been, what, ten years since 2011? Let's try to see if there have been changes in outcomes because AML, the landscape has changed.

There's so many new treatments. Maybe something's changed, right. So we did the same analysis. You wanted to look at the outcomes from 2000- basically 2011 to what we have now. And we saw that all well, we tried to look at race first and we saw that white patients versus black patients. So disparities they both improved overall outcomes.

Like when you see the figures they both improved. But the disparities didn’t change, unfortunately. The difference in disparities didn’t significantly change. So even if you can say like oh they both improved. You're like right. But the disparities like black patients continued to perform poorly compared to white patients despite improvement, which makes you think did we distribute this equitably at all to patients like race wise, that everyone get the same fair chance.

So that's the first thing we found. The second thing we found was males and females both improved. Historically. Males have poorer outcomes compared to females, so they usually chalk that to genetic mutations and all of that. But like I said, both sexes improved, but females significantly improved more than males. Which makes you think what gave the females the edge and was it treatment?

Was it socioeconomic? Was it behavioral? That was interesting to us because if we can leverage that improvement in females and kind of distribute that in different ways, could we have everyone improve as well? So the final line our team wanted to write was we hope to improve disparities, not just have them evolve, but transform for the better. Yeah.

If you want everything to be equitably distributed. So so our team really wants to dig further into, like I said, why did the females perform better? Why did black patients not perform any better despite overall survival outcomes improving for everyone? We want to look into the more granular details like data wise, you want to look at biological determinants further and kind of adjust for that.

But our team and I were very interested in figuring out the qualitative side of this. You know, numbers or databases only show you. Right. Like this is the where the needle went period. But in between there's just so much I mean, I'm a resident, so I speak to these patients and they tell me stories, right? I've when I speak to the team in my hospital, they're like, yeah, this guy didn't show up for treatment because he has to go to work.

He's a 30 year old guy trying to build his career for his family, and if he doesn't show up to work, then he can't pay for treatment. So he has a hard decision. And I was thinking about, well, if there was a female patient who had children, you know, how would her experience be any different, right? So because she's an AYA, she's trying to build her life.

She has a young family, she has young kids. Her experience would be different. So it's those little like, not sorry, not little like nuances that I feel people don't really realize. And you want to look further into. And we hope by really looking straight or looking at the root of these changes, we can try to really make real change.