Expert: Pharmacists Play Key Role in Culturally Competent Care for Racially Diverse Patients


Mara Hofherr, PharmD, a clinical oncology pharmacist at Washington University, highlights key findings of the KEYNOTE-522 trial in comparison of outcomes between Black and White patients with triple-negative breast cancer.

Mara Hofherr, PharmD, a clinical oncology pharmacist at Washington University, highlights key findings of the KEYNOTE-522 trial in comparison of outcomes between Black and White patients with triple-negative breast cancer.

Breast cancer with lymphatics, medically 3D illustration | Image Credit: Axel Kock -

Axel Kock -

Q: In the real-world analysis of KEYNOTE-522, what were the key findings in the comparison of outcomes between Black and White patients with triple-negative breast cancer receiving therapy?

Mara Hofherr: In KEYNOTE-522, we were lucky enough to have more of a real world comparison. We had 74% White patients and 16% Black patients, and when we looked at the 2 with the PCR rates, we found no difference. We also found no difference with our safety measures, our utilization, our acute care utilization, and our hospitalizations were the same. What we did find, which was really unique, was that our White women had more grade 3 toxicities and our immune-related adverse events than our Black woman. And that was statistically significant with a P-value. That's really interesting. We don't really know why if that's underreporting, or if that's biological. Yeah, very excited to continue to look at it.

Q: Were there any results from the trial that were surprising or unexpected?

Mara Hofherr: I think the most surprising thing, and most unexpected was that the grade 3 immune-related adverse events in our Black woman were lower than in our White limit statistically. Then we were really relieved to see that our acute care utilization and hospitalization rate was the same, and then our pathologic complete response at surgery was the same. We were surprised by all those results, but we were really happy about a lot of them.

Q: Were there any differences in adverse events for Black and White patients?

Mara Hofherr: The white patients had more grade 3 immune-related adverse events, but when we're just looking at total immune-related adverse events, there was no statistical difference. Then if we're thinking about nonimmune-related adverse events, we're also not seeing anything huge. We are seeing what I would say are like weird, immune-related adverse events in both categories, like we saw on the full cohort.

Q: How can demographics and socioeconomic factors contribute to disparities in care for those with triple-negative breast cancer?

Mara Hofherr: The socio-economic factors are huge, right? So for this chemo-regimen, you're coming once every 3 weeks at minimum, and then with the CarboTaxol, you're coming once a week for 12 weeks, and this is going to go on for a year. You have to go through surgery, you have to go through the mental burden of losing your hair, and all the other side effects. If you don't have a job or you can't pay your mortgage, [its] really, really tough. If you look at in St. Louis, specifically, in patients with different and lower socio-economic zip codes are 6 times more likely to die of cancer than patients in affluent zip codes. I feel really lucky that our cohort doesn't show that our outcomes will be any differently in either race group, but we still have to work harder for socio-economic patients as well.

Q: What should pharmacists consider when considering therapy options for Black patients diagnosed with triple-negative breast cancer?

Mara Hofherr: When we're looking at our Black patients diagnosed with triple negative breast cancer, we can be confident that this regimen is going to be as effective for them with, especially with our immune-related side effects, we're going to see a little bit less right. When considering it, as a pharmacist when you're counseling patients, I think the biggest thing to keep in mind is identity around hair and a lot of those emotional factors and trust within the system have been proven time and time again to be something that we all need to work on and improve.

Q:P How can pharmacists collaborate with health care teams to ensure culturally competent and patient-centered care for Black individuals with triple-negative breast cancer based on the findings from the trial?

Mara Hofherr: I think the biggest step one is just acknowledging that they're Black, and that they may have, as we know, Black patients may come from different socio-economic backgrounds, a lot of our care team will most likely be white facing. So just acknowledging that they're Black, and they may have different struggles than their White counterparts. I think it's important. I think a lot of times in health care, we try to just pretend like it's not happening, or we don't see race, and I don't think that that's an effective strategy. Improving their care by acknowledging it will be helpful.

Q: There has been a recent push to move beyond simply understanding SDOH and make actual steps to address or improve these. How could these findings help do that?

Mara Hofherr: When given the appropriate tools, we're going to see the same exact results in our in our efficacy, right? It's possible that we can get these women to have a complete pathologic complete response, which is a surrogate marker for efficacy and these trials. What our study can really exemplify is just giving these patients enough support, whether it be mortgage or their car payment, or whatever. Then emotional support as well, to improve their quality of care and to really get those outcomes.

Q: Why are pharmacists well-positioned to address these types of issues?

Mara Hofherr:I actually think pharmacists are the most poised to address these issues. I feel like we get really, really lucky in the fact that, especially in regimens like these, that are really complicated and really hard that we get a lot of face time with our patients, for the unfortunate fact that they have side effects. I think just acknowledging what's going on, identifying the side effects, identify and looking out for the signs and believing these women is going to be a huge, a huge thing.

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