Wakenda Tyler, MD: Bringing Health Equity into Sarcoma Care

Sarcoma is considered a rare cancer, affecting fewer than 1% of people in the United States, but inequities in timely, life-saving care appear to be widespread. 

For Wakenda Tyler, MD, a musculoskeletal oncologist specializing in bone and soft tissue sarcomas, closing those gaps is both a professional endeavor and a personal commitment. Alongside caring for patients with bone cancer, she is helping push orthopedic oncology to reckon with disparities that have long gone unexamined. 

In honor of Black History Month, we spoke with Dr. Tyler about why she thinks disparities research should be a priority in sarcoma care, challenging biases in medicine, and the daily, intentional practices that drive progress in health equity. 

Orthopedic oncology hasn’t traditionally centered disparities research, yet you have been a leader in this space. Why was it important for you to bring this work into orthopedic oncology?

For a long time, health disparities simply weren’t on the radar in orthopedic oncology, not because people didn’t care, but because the field hadn’t reached a critical mass of clinicians asking these questions- and I think we’ve finally arrived at that moment.

Sarcoma care sits within a relatively small and highly specialized corner of cancer medicine. Compared to breast, prostate, or lung cancer, the number of patients diagnosed each year is much smaller, which has historically made it feel like an “orphan” disease - one that doesn’t always receive the same attention or research focus. But when you step back and look at rare cancers collectively, they affect just as many patients.

That realization has helped shift the conversation. As more people in orthopedic oncology begin to think critically about equity and access, the disparities research is no longer invisible. It may not yet be at the top of everyone’s research agenda compared to other cancers, but it’s now firmly on the map, and that’s an important start. 

What factors are you studying that influence outcomes and health disparities in sarcoma? 

The first question we always ask is: Do disparities actually exist in sarcoma care? And unfortunately, we know the answer is yes.

Using large datasets like the SEER database, we found that patients from underrepresented racial and ethnic groups, immigrant populations, and those who are underinsured consistently experience worse outcomes. These patients are more likely to present with larger, more advanced tumors and have higher mortality rates. Once we established that gap, the next question became why, and how we could intervene.

One clear factor is language. Patients facing language barriers tend to enter the healthcare system later, experience delays in diagnosis, and ultimately present with more advanced disease. That directly affects outcomes, including higher rates of amputation and mortality. 

We’ve also looked closely at access to reconstructive care. Working with our plastic surgery colleagues, we found that patients who are more affluent (often non-immigrant and non–underrepresented minorities) are far more likely to receive limb-sparing reconstructions involving plastic surgeons. The data show that having access to these specialists leads to better wound healing, fewer complications, and lower recurrence rates. In many cases, patients don’t know to ask about such specialists because of lack of awareness and access, particularly in smaller or community hospitals.

Another area that’s been eye-opening involves rural patients. When we talk about underserved populations, we often focus on urban communities, but rural Americans -who are more likely to be underinsured and live far from major medical centers- have their own barriers. Distance alone can limit access to specialized sarcoma care, and the farther patients are from large academic centers, the less likely they are to receive optimal treatment.

Have we reached a point where solutions are being introduced yet? 

We’re almost there. One promising solution we’re starting to see is patient navigators. Evidence suggests that when navigators are involved early, especially for patients unfamiliar with the healthcare system, care happens faster and more effectively. Not everyone needs that support, but for patients who don’t know where to begin, it can make a big difference. Expanding these programs is something we’re definitely advocating for.

You’ve spoken about how your own background has shaped your commitment to serving underserved communities. How does that perspective show up in your day-to-day work?

At the most basic level, I try to meet every patient on equal ground. When someone walks into my office with cancer, or the fear that they might have cancer, they’re all scared. My job is to guide them through that process and help them get to the other side, whatever that looks like for them.

Where my background comes into play is understanding that not everyone starts from the same place. If you’ve always had reliable transportation, excellent insurance, and easy access to care, you may not realize how difficult it can be for someone who’s been turned away by multiple providers before ever reaching a sarcoma specialist.

That awareness fosters empathy. It helps me recognize the invisible hurdles patients may be navigating, like insurance limitations, transportation challenges, language barriers, that aren’t immediately obvious in a clinic visit but profoundly shape their experience.

In the exam room, it doesn’t matter who someone is or where they come from, they receive the same time, energy, and concern. And once I’m in the operating room, that commitment translates into the same level of precision, care, and meticulousness for every patient.

What are meaningful ways other clinicians -in any field- can keep that awareness active and translate it into action?

The first step is acknowledging that everyone has biases. It’s not a personal failing; it’s a human condition. But awareness gives you the opportunity to interrupt it.

When you recognize that you might be making assumptions about a patient’s ability to adhere to treatment, to complete rehabilitation, or to understand complex information- you can pause and recalibrate. You can ask: "Am I putting this person into a box based on my own preconceived notions?"

Even taking a minute each week to reflect on that can make a difference. Biases can come from anywhere-media, past experiences, things we absorbed decades ago without realizing it. The key is being willing to examine them. Every patient-facing professional has the capacity to do that if they want to.