By Brandon J. Blue, MD
Saint Louis University School of Medicine

When the word diversity is uttered, the immediate picture in the minds of most people is one of race, separated by color lines of black and white. However, diversity in the workforce, especially in a complex specialty of medicine such as oncology, surpasses racial lines.

Oncology, more than other specialties, is well known for affecting patients from all walks of life. Cancer is an equal opportunity disease: from the multimillionaire CEO to the unemployed, all are susceptible to this diagnosis. This places the medical provider in a unique role to provide care for patients from various economic backgrounds. In addition to racial and economic differences, as oncologists, we see patients across numerous religious and linguistic backgrounds; it is our duty to be on the forefront of cultural competency. Research demonstrates that patients respond better to medical providers with similar backgrounds, which puts pressure on the oncology community to have our workforce reflect the patient population we serve.¹

ASCO has been one of the pioneers in the area of diversity in oncology, beginning with the creation of the ASCO Task Force on Health Disparities in 2003. Since that time, and with the addition of the Diversity in Oncology Initiative in 2008, ASCO has provided funding through the Conquer Cancer Foundation (CCF) to increase diversity in the oncology workforce. ASCO provides awards to underrepresented medical students, residents, and fellows with the goal of retaining these bright young minds in careers in clinical oncology and research to improve care in underserved communities. These efforts have begun to pay dividends for our field. As of the last ASCO workforce survey, 28.4% of practicing oncologists are women, and women make up 45% of oncology fellows.²

While oncology has made strides in the gender disparity, the racial disparity in our specialty has room for improvement. Recent reports suggest 17% of medical students are from underrepresented minority backgrounds, but African Americans only represent 3.1% of oncology fellows, and Hispanics represent only 7.5%.²

But does diversity in the oncology workforce and in oncology training truly matter? It is our goal as physicians to treat our patients to the best of our ability. Such high-quality treatment has necessarily evolved beyond the pen and prescription pad. Adept oncologists must treat the mental, social, and spiritual needs of our patients, as well as their physical disease, to fully encompass the complexities of their care. Understanding patients’ cultural norms and social standards helps establish rapport and strengthen patient-doctor relationships. In oncology, we often discuss matters of end-of-life care, and social beliefs dictate patients’ views on the death and dying process. In the age of personalized medicine, oncologists from diverse backgrounds can uniquely aid the field by providing equitable and culturally sensitive care for all our patients.

Mirroring the rich history of the United States, the history of advancements in oncology is rooted in the fertile soil of diverse scientific minds working toward a common goal. The work of Jane Cooke Wright, MD, comes to mind—one of ASCO’s founders and responsible for numerous medical breakthroughs in her research, including chemotherapeutics still in use today, such as methotrexate.³ Without contributions from doctors such as Olufunmilayo I. Olopade, MBBS, FACP, FASCO, we would not know as much as we do about breast cancer biology and BRCA mutations.⁴ In addition, Harold P. Freeman, MD, has been a champion for resource-poor patients with cancer, and has developed a national patient navigation system which seeks to narrow disparities in cancer outcomes.⁵ The impressive work of this diverse group of oncologists represents just a sample of the contributions that women and minorities have made to our field. Without an intentional effort to develop a workforce of oncologists from diverse backgrounds, our profession would not be as we know it today.

To ensure that we continue to have innovative approaches and fresh ideas in oncology, many organizations have developed pipeline programs which aim to increase the interest in oncology, and ultimately the number of oncologists, through early exposure and mentorship. ASCO and CCF are starting as early as medical school with the Medical Student Rotation for Underrepresented Populations. This award gives funding for medical students to work closely with giants in oncology to pique their interest and build experience.

ASCO and CCF also award trainees from minority populations with the Resident Travel Award (RTA) to defray costs associated with attending the ASCO Annual Meeting. As a 2014 RTA recipient, I know personally that the networking opportunities and career advice gained by attending the national ASCO meeting have been priceless. The RTA was a major talking point while on my oncology fellowship interview trail—had it not been for ASCO and CCF, my career path may have turned out differently.

Diversity extends beyond geographic borders. Given the importance of international partnerships, ASCO and CCF offer various international awards, such as the International Development and Education Award, International Innovation Grant, and the Long-term International Fellowship. These international awards make it possible to support the ideas and careers of oncologists from all over the world.

Funding is also provided for a women’s pipeline program: The Women Who Conquer Cancer Mentorship Award. This award focuses on both women’s mentorship and research, with the hope of honoring the advancement of women and promoting future careers in oncology.

These tremendous workforce investments championed by ASCO and supported by CCF place these organizations among medicine’s leaders in improving diversity and being catalysts for change. However, there is more to be done in this arena, and we remain far from our goals of equality in oncology training and the oncology workforce. The question remains: What are the next steps?

I propose a three-part plan to accelerate diversity in our field:

• Reach trainees earlier in their education pathway. The process of creating an oncologist should start when the interest in science and math starts, and for many students this happens in high school. I recommend that ASCO State/Regional Affiliates adopt high schools in their area that focus on science, technology, engineering, and math (STEM) programming. By inspiring these young minds, we can prepare them for successful college careers to ensure acceptance and matriculation into medical school and oncology training programs.
• Engage current diverse trainees in the decisions made to recruit future oncology trainees. ASCO has done a wonderful job with the creation of the Trainee Council, of which I am currently a member. We discuss issues of interest to young professionals, such as integrating technology and social media into our oncology practice, improvements in transition from trainee to faculty, and creating an educational experience for trainees at the ASCO Annual Meeting. We focus on what trainees need and want from a parent organization such as ASCO. Several ASCO committees have opened new positions to trainee representatives; currently, I sit on the Cancer Survivorship Committee and contribute my thoughts and ideas as a valued member of the group. Including diverse voices at such an early stage of training prepares young oncologists like me to be leaders and ambassadors for our field.
• Provide career guidance and support through all levels of training. For example, those who receive the Medical Student Rotation Award should not only engage with ASCO during the award ceremony and tenure of the award process, mentors and mentees should check in during every phase of training to assess continued progress. Those who have been initially recruited for mentoring programs in STEM high schools should be followed in college and medical school with special programming. Trainees who successfully matriculate should be encouraged to apply for RTAs during residency, and CCF’s Young Investigator and Career Development Awards in the last years of their training and as they secure faculty positions.

In this way, as people from diverse racial, gender, religious, or other backgrounds navigate the complex medical training system, ASCO and similar organizations will be there to offer support at every step.

ASCO Diversity Mentoring Program

The ASCO Diversity Mentoring Program is a yearlong program that encourages medical students and residents from underrepresented populations in medicine to pursue rewarding careers in oncology by pairing each mentee with an experienced oncology professional who can provide career guidance, learning opportunities, and personal advice. The program runs from June 15, 2017, to June 15, 2018.

If you are interested in participating as a mentee or mentor, please email professionaldevelopment@asco.org.

References

1. U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Professions, et al. Changing Demographics: Implications for Physicians, Nurses, and Other Health Workers. 2003. http://old.nachc.com/client/documents/clinical/Clinical_Workforce_Changing_Demographics.pdf. Accessed January 19, 2017.
2. Kirkwood MK, Kosty MP, Bajorin DF, et al.  J Oncol Pract. 2013;9:3-8.
3. Ignotofsky R. Women in Science: 50 Fearless Pioneers Who Changed the World. New York: Ten Speed Press; 2016.
4. Soliman AR, Schottenfeld D, Boffetta P (eds). Cancer Epidemiology: Low- and Middle-Income Countries and Special Populations. New York: Oxford University Press; 2013.
5. Freeman HP, National Cancer Institute (U.S.). Role of government agencies in the research mission of the National Cancer Program. Presented at: President’s Cancer Panel; January 1994; Bethesda, MD.