Structural racism persists in radiotherapy

Everyone should get quality care, no matter the color of their skin. However, implicit bias, micro-aggressions, and a lack of cultural understanding persist, leading to oppression and unequal treatment in healthcare. An insightful article opens in new tab/window in the new themed issue of the Journal of Medical Imaging and Radiation Sciences opens in new tab/window on specialized populations, published by Elsevier, highlights this serious problem, specifically addressing the assessment and treatment of radiation-induced skin reactions (RISR) in patients across the world undergoing external beam radiotherapy.

The article provides a stark example of how outdated perceptions and racialized myths have resulted in inadequate care for people of color globally. It discusses widely used assessment tools originally designed for white skin, which do not account for the diverse skin tones of patients. As a result, patients of color often face delayed recognition and management of adverse reactions, causing significant distress and burden on healthcare systems.

The article presents a historic clinical case from a Society of Radiographers special interest group in which a black patient with head and neck cancer was advised that their skin should be more resistant to radiation damage. The patient described the subsequent reaction to radiotherapy as their skin “was on fire,” causing them significant distress. The incident led to the patient seeking psychological support and reporting they felt “helpless.”

Radiation can harm anyone's skin, no matter its color. The way we check for skin problems during treatment doesn't always work for everyone.To address this issue, the author calls for a more inclusive and ethnically conscious approach in medical education and clinical practice. He emphasizes the importance of understanding and acknowledging the unique characteristics of brown and black skin, including the visual and tactile differences in how RISR presents.

The healthcare industry is urged to adopt new, more inclusive medical terminology and grading tools to ensure that patient-centered care is provided to individuals of all racial backgrounds. The article underscores the critical need for education and collaboration to mitigate implicit biases and improve care for people of color.

Author Naman Julka-Anderson, Research Radiographer at The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, explains, “It is essential that new and more inclusive guidance is developed for clinicians who deliver radiotherapy, ensuring that treatment and care are appropriately tailored to people of color. Understanding the diverse skin tones of patients and addressing the structural racism that exists within healthcare are imperative steps to ensure equitable care for all individuals.”

The article concludes with a call for a more inclusive and ethnically conscious approach in medical education and clinical practice, emphasizing the importance of understanding the diverse skin tones of patients. The author suggests that addressing these issues is crucial to reducing racial bias, racial health disparities, and structural racism within healthcare services and ensuring patient-centered care for everyone.

Notes for editors

The article is “Structural racism in radiation induced skin reaction toxicity scoring,” by Naman Julka-Anderson (https://doi.org/10.1016/j.jmir.2023.09.021 opens in new tab/window). It appears in the Journal of Medical Imaging and Radiation Sciences, volume 54, issue 4 (December 2023), published by Elsevier.

This article is openly available for 30 days at https://www.jmirs.org/article/S1939-8654(23)01872-6/fulltext opens in new tab/window.

Full text of the article is also available to credentialed journalists upon request; contact Eileen Leahy at +1 732 238 3628 or [email protected] opens in new tab/window. Naman Julka-Andersonmay be reached for comment at [email protected] opens in new tab/window.

About the author

Naman Julka-Anderson is an advanced therapeutic radiographer who co-founded the multi-award-winning podcast Rad Chat opens in new tab/window, and is an Allied Health Professional Clinical Advisor for Macmillan Cancer Support. He is passionate about equity, diversity, and inclusion, as well as health inequalities, radiotherapy, Indian food, and long-distance events such as Ironman triathlons.

About the Journal of Medical Imaging and Radiation Sciences (JMIRS)

The Journal of Medical Imaging and Radiation Sciences opens in new tab/window (JMIRS) is the official bilingual, peer-reviewed journal of the Canadian Association of Medical Radiation Technologists (CAMRT) opens in new tab/window. We aim to influence practice within the rapidly evolving fields of radiological, nuclear medicine, MRI, and ultrasound technologists and radiation therapists, grounded in our circular tagline "research informing practice - informing research.” JMIRS provides an essential platform for Canadian and international medical radiation technologists and therapists to publish and discover their own body of knowledge to define and inform their practice, enabling translation to a global audience. Published by Elsevier, JMIRS is included in MEDLINE and CINAHL. www.jmirs.org opens in new tab/window

About the Canadian Association of Medical Radiation Technologists (CAMRT)

The Canadian Association of Medical Radiation Technologists opens in new tab/window (CAMRT) is the national professional association and certifying body for radiological, nuclear medicine and magnetic resonance imaging technologists and radiation therapists. Recognized at home and internationally as a leading advocate for the profession of medical radiation technology, the CAMRT is an authoritative voice on the critical issues that affect its members and their practice. Established in 1942, the CAMRT today represents over 11,000 members. www.camrt.ca opens in new tab/window

About Elsevier

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