CLINICAL NEWS
Slowly But Surely No Milestone Unturned
In 2009, the Liaison Committee on Medical Education (the body that accredits medical schools) issued a
requirement for medical schools to implement policies to attract and retain more diverse students. Ten
years later, the effort seems to be paying off, according to a research letter published in JAMA. This year, the U.S. marks a milestone in improving out-
comes for patients with cancer: a 25-year-long decline in
cancer mortality.
Between 2002 and 2017, percentages of matriculants changed as follows: A report from the American Cancer Society found that,
between 1991 and 2016, deaths from cancer dropped by 27%:
80% —
250
70% —
1991
60% —
215.1 deaths
■ 2002
■ 2017
50% —
40% —
30% —
20% —
200
150
2016
156.0 deaths
100
50
10% —
0
0% —
White
67.9% to 58.9%
Female
49% to 50.4%
Black
6.8% to 7.3%
Hispanic
5.4% to 8.9%
Asian
20.8% to 24.6%
“I think there’s a strong incentive now to have at least some kind of benchmark to promote diversity,”
said lead author Dowin Boatright, MD, adding, “We see the trend going up, but it’s going up very
slowly.”
Source: Boatright DH, Samuels EA, Cramer L, et al. Association between the Liaison Committee on Medical Education’s diversity
standards and changes in percentage of medical student sex, race, and ethnicity. JAMA. 2018;320:2267-9.
Researchers applauded the narrowing of the racial gap
in cancer mortality, with the disparity between black and
white patients declining from 33% to 14%, but warned that
the socioeconomic gap is widening, with residents of the
poorest counties experiencing an increasingly dispropor-
tionate burden of the most preventable cancers.
Source: Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin.
2019 January 8. [Epub ahead of print]
No Guts, No Glory
For patients planning to undergo hematopoietic
cell transplantation (HCT), disruptions in the gut
microbiota (which led to lower diversity of intestinal
bacteria) predict worse outcomes post-transplant.
Results from an observational study at Memorial
Sloan Kettering Cancer Center demonstrated that
patients with lower-diversity
microbiota had a 24-month overall
survival rate that was 31% lower
than patients with high-diversity microbiota (p=0.002).
Transplant-related mortality and relapse rates also were
higher as diversity of microbiota dropped.
“In the future, we envision that the health of the gut
microbiota – which some have called the ‘forgotten organ’
– may become part of this whole-body evaluation [before
transplant],” said lead study author Jonathan U. Peled, MD,
PhD. “It might also be possible to intervene and repair the
microbiota in the pre-transplantation period.”
Source: Peled JU, Gomes ALC, Stein-Thoeringer CK, et al. Multicenter
microbiota analysis indicates that pre-HCT microbiota injury is prevalent
across geography and predicts poor overall survival. Abstract #811. Presented
at the 2018 ASH Annual Meeting, December 3, 2018; San Diego, CA.
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