Researchers from Harvard University and WIPH have proposed policy changes in cancer care to take into account a common genetic variation.
The recommended strategies, published in a New England Journal of Medicine Perspective article, follow earlier research led by Stephen Hibbs (WIPH) in collaboration with Harvard University colleagues, highlighting a source of discrimination in clinical trials and cancer treatment guidelines. The study found that people with the Duffy null phenotype (a trait predominantly found in people of African or Middle Eastern descent) risk exclusion from clinical trials due to eligibility criteria based on absolute neutrophil counts (ANC). In the same paper, a secondary analysis of prescribing guidelines for first-line cancer treatments revealed that Duffy null individuals face increased risks of treatment delays, dose reductions, or therapy discontinuations. Researchers concluded that a lack of acknowledgment of natural variations in ANC levels across populations within treatment guidelines exemplifies structural racism in healthcare.
In their NEJM Perspective piece, Hibbs and his Harvard co-authors propose strategies for addressing the discriminatory practices that have an impact on cancer patients with the Duffy null phenotype. Their suggestions include:
They also recommend expanding collaborations with clinicians and researchers in regions such as sub-Saharan Africa and the Arabian Peninsula, where the Duffy null phenotype is most prevalent, to gain insights on the safety and logistics of implementing specific dose modifications for these patients.
Andrew Hantel, Stephen P. Hibbs, Lauren E. Merz, Gregory A. Abel. The Duffy Null Phenotype - Addressing a Source of Discrimination in Cancer Care. N Engl J Med, 23 November 2024. https://www.nejm.org/doi/abs/10.1056/NEJMp2409329