Recent events of systemic discrimination have led to national introspection on the importance of tolerance and diversity. The tragic killing of George Floyd in May 2020 was a sentinel event that raised awareness of the pervasive nature of systemic discrimination and served as a significant impetus for positive change. This was a clear reminder that we still face substantial challenges to tolerance and equal treatment for all as a society. It is also a unique opportunity to reflect on our common purpose as humanity.
In the immediate aftermath of Mr. Floyd’s death, many organizations issued statements reaffirming their commitments to promoting and advancing diversity through anti-discriminatory policies and initiatives. On their part, the American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS) released the following joint statement:
As a profession, we in neurosurgery aim to promote the highest quality of patient care and advance the specialty of neurosurgery and neurosurgical education while espousing the values of integrity, leadership, excellence, and professionalism. As organizations and as a profession, we are committed to inclusion and diversity within our neurosurgical community. As neurosurgeons, we are committed to providing the highest quality of care to all segments of our society. Indeed, our principles are only relevant to the extent they apply to the most disadvantaged in our society.
The Society of Surgical Oncologists (SSO) also released a similar statement:
The Society of Surgical Oncology condemns racism and violence in all forms. We recognize racism as an underpinning to health disparities, and recent events serve as a clarion call to all of us that there is a need to do more than what we do on a daily basis — provide the best cancer care to individual patients regardless of race, ethnicity, gender, sexual orientation, or socioeconomic status.
Diversity requires the core elements of equity and inclusion. Equity requires deliberate, fair and just treatment of our patients and colleagues irrespective of their background. Inclusion requires a conscious effort in thoroughly engaging diverse patients and colleagues in all aspects of the care we deliver and the decisions that govern our care through tolerance. Through equity and inclusion, our colleagues and patients feel respected and valued.
A firm commitment to the core elements of diversity is critical to the impactful delivery of neurosurgical care to society’s most vulnerable members. In treating life-threatening disorders of the nervous system, neurosurgeons can positively impact patients from all works of life. To render the best possible care, neurosurgeons should understand the diverse patient population they serve in the context of race, gender and ethnicity. When we deliver neurosurgical care in an atmosphere of tolerance and understanding, we serve as role models to those who look up to us.
Neurosurgical oncologists are integral to cancer care in the central nervous system, one of the most critical battle lines in the fight against systemic cancer-related morbidity and mortality. Despite advances in oncology, there is still a considerable disparity in cancer care. Racial and ethnic minorities and lower socioeconomic patients are disproportionately impacted by cancer. As part of the multidisciplinary management of diverse patients with central nervous system tumors, neurosurgical oncologists perform surgeries, stereotactic radiosurgery and clinical trials. Therefore, it is imperative for neurosurgical oncologists to incorporate diversity-informed clinical decision-making approaches to positively impact cancer patients who are affected by health disparities. Moreover, neurosurgical oncologists should be mindful of the barriers and challenges to recruiting underrepresented minorities into clinical trials, given historical precedence of mistrust. Identifying, acknowledging and addressing such barriers would undoubtedly enhance participation.
From a workforce perspective, organized neurosurgical oncology should strive to reflect the diverse cancer patient population they serve. Concerted efforts are needed to diversify the pool of neurosurgeons. We should strive to attract, train and mentor neurosurgeons from under-represented groups into the subspecialty of neurosurgical oncology. If we embrace diversity efforts, we should also establish benchmarks to assess progress in this journey. Beyond diversity in its members’ composition in general, neurosurgical oncology should strive to include diverse membership and leadership in committees. Such diversity efforts will strategically position us to address the neurosurgical oncologic needs of a multifaceted society uniformly.
As a profession, we should strive for the ideals of diversity and its associated tenets of equity and inclusion. Neurosurgical oncologists are in a unique position to understand and reduce health disparities. Our patients deserve that from us. We should never forget that our future is only as bright as the future of the patients whom we serve.
Editor’s Note: We hope that you will share what you learn from our posts. We invite you to join the conversation on Twitter by following @Neurosurgery, @AANSDiversity and @NSTumorSection and using the hashtag #TumorSeries.
Arnold B. Etame, MD, PhD, FAANS