Improving Health Equity Together: A Conversation with Maria Rubinstein, Sameek Roychowdhury, and Mary Lou Smith

Improving Health Equity Together: A Conversation with Maria Rubinstein, Sameek Roychowdhury, and Mary Lou Smith

Guest Commentary

Mar 25, 2021

By Michael Burton, President and CEO, Gateway for Cancer Research

Last year, Gateway for Cancer Research℠ announced its $1.5 million dollar investment in the second biennial Gateway Discovery Grant, administered by Conquer Cancer®, the ASCO Foundation. The grant will provide three to five years of funding to catalyze innovative clinical research with a strong potential impact on mitigating health disparities.

 At Gateway, we believe that all segments of the cancer research community—nonprofit organizations, industry, academia, government, and philanthropists—have a role to play in eliminating cancer disparities. Our approach to this important work must be intentional, not passive. As a funder of early phase clinical trials, Gateway is in a unique position to contribute to the body of work that extends the benefits of progress in oncology to all. It is important that health foundations and funders of research continue to seek out innovative opportunities to make a difference. Afterall, a breakthrough in cancer research and care means nothing to an individual who cannot access it, who cannot benefit from it.

I first gained insight into the challenges of cancer health disparities while serving as the chief development officer of the American Association for Cancer Research, an organization that, like ASCO, has played a leadership role in shedding light on disparities in cancer research and care. It is my hope that 10 years from now we will look back on this time—one in which the pandemic laid bare glaring inequities in health care—as an inflection point. I believe this will be seen as a period when we created inexorable momentum toward more equitable access to cancer care and vastly improved outcomes for all who face this disease. It is my expectation that this Gateway Discovery Grant will be one of many bricks in the foundation of that progress.

As Gateway joins ASCO, Conquer Cancer, and others in the cancer community to expand health equity, I asked Conquer Cancer-Gateway grant recipient Maria Rubinstein, MD, and my Gateway colleagues Sameek Roychowdhury, MD, PhD, and Mary Lou Smith, JD, MBA, to share their experiences and perspectives on how we can address the many challenges of cancer disparities.

Why is it so important to include a racially and ethnically diverse patient population in clinical cancer trials?

MR: Many oncology clinical trials now integrate sophisticated tumor molecular genetics which provides the rationale on how to exploit cancer mechanisms and how to molecularly target cancer growth. By failing to represent some populations in these trials, we are missing critical opportunities required to advance the treatment options for all patients. As a result, we run the risk of not being able to fully generalize the efficacy and safety of newer treatments in patients of all ethnic backgrounds. Lifting the barriers to clinical trial participation and increasing access to clinical trials in the community are necessary to improve outcomes and to expand treatment options for all patients with cancer.

SR: These factors certainly influence the natural history of a cancer diagnosis with different genetics and environmental factors. Clinical trial results that lack diversity may not be applicable for all patients.

MLS: If we do not have diverse populations well represented in our clinical trials, we will not be able to treat them effectively because we will not know if the results of those clinical trials apply to these populations.

What inequities do you see in cancer care?

MR: Health inequities are unfortunately pervasive in many aspects of cancer care, including timely cancer diagnosis and access to treatment. The financial burdens of time away from work and monetary cost are additional major hurdles to overcome in receiving cancer treatment. As a gynecologic medical oncologist, I treat people with ovarian, endometrial, and cervical cancers. Endometrial cancer is rising in incidence and mortality and is a disease that demonstrates huge health disparities. These outcome disparities are rooted in a mix of factors, including diminished access to care and socioeconomic constraints in seeking appropriate care.

SR: In my academic medical oncology practice, I have observed how access to health care and subspecialty cancer care can be limited by multiple factors including geography, insurance (or lack of insurance), state boundaries, and socio-economic factors. It is heartbreaking to see missed opportunities to help someone with their cancer care.

MLS: COVID-19 has exposed many of the inequities in access to care and the unequal prioritization of therapeutics to marginalized populations.

What can oncologists and other clinicians do to mitigate disparities in cancer care?

MR: It is necessary to address these challenges to narrow the health disparities gap. We must recognize that socioeconomic factors such as job security and medical insurance coverage contribute to a patient’s reluctance to seek timely care and participate in comprehensive treatment. As part of medical professionals’ responsibilities in cancer care, we must advocate not only personally for our patients, but also to local communities, health foundations, and legislative bodies to ensure equal access to high-quality health care, and further development of novel treatments. We must be aware of the prevalent disparities and challenges our patients face and continue to confront and correct our implicit biases.

SR: Facilitating access to subspecialty cancer care for patients and supporting means to overcome barriers is critical. And, through the pandemic, telemedicine has emerged as a tool that could potentially help to create access to subspecialty cancer care consultations and opinions.

MLS: Use their professional organizations to exert pressure on health systems to reach out into poorer, under-resourced neighborhoods and rural America. Volunteer their time and the time of their staff to bring prevention and screening to these neighborhoods.

What disparities have you witnessed or experienced in your career? How have they shaped how you approach your work?

MR: Throughout my training, I have had the privilege of caring for patients from all diverse backgrounds, including rural communities in Ohio and urban communities in the Bronx and New York City. In many instances, patients face many challenges in seeking appropriate and timely medical care even prior to a cancer diagnosis. Cancer care can be complicated and frightening. It is my goal is to guide patients through all available treatment options and to take continuing assessments of what the largest and most prevalent challenges are. A better understanding of these challenges is important to work towards a more equitable approach to cancer treatment for all of my patients.

SR: Whenever we receive referrals or queries from patients too far away to travel or unable to get insurance coverage, I always try to review medical records and speak with their local oncologist in case there is something we can help with and recommend.

MLS: My organization, Research Advocacy Network, has dedicated some of its time and resources to educating research advocates about health equity, understanding their own biases, and using their newly gained insights to make the system work for the disadvantaged. Patient advocates are typically white, well-educated, and in a higher socio-economic bracket. They see the need for change from their own experience with cancer, be it as patient or caregiver, and they have the resources to be able to give their time and energy to making the system work better for the patient. They know how to work the system, or they learn how to influence it.

Gateway for Cancer Research is very pleased to be in partnership with Conquer Cancer, the ASCO Foundation, to launch this new and exciting funding opportunity. Our two organizations share a deep commitment to addressing the many challenges of cancer disparities and I am confident that our collaboration will yield meaningful results for the patients we serve.

Learn more and apply for the Gateway Discovery Grant.

Mr. Burton is the president and CEO of Gateway for Cancer Research. A nonprofit leader with over twenty-five years of experience in the philanthropic sector, Michael Burton honed his leadership skills at some of the nation’s most highly regarded institutions, including Princeton University, The Pew Charitable Trusts, and the American Association for Cancer Research. Disclosure.

Ms. Smith is a member of the Board of Directors at Gateway for Cancer Research, co-founder of the Research Advocacy Network, co-chair of the ECOG-ACRIN Cancer Research Advocate Committee, and co-chair of the Translational Breast Cancer Research Consortium Patient Advocate Working Group. She sees the value of bringing advocates and researchers together to ensure the patient voice is integrated into clinical research. Disclosure.

Dr. Roychowdhury in an associate professor of translational therapeutics at The James Comprehensive Cancer Center of The Ohio State University, and serves on the Research and Grants Committee at Gateway for Cancer Research. Additionally, he serves as an assistant professor in the Department of Internal Medicine and the Department of Pharmacology at The Ohio State University. Dr. Roychowdhury is a medical oncologist who specializes in treating patients with advanced prostate and colorectal cancers, including soft tissue sarcoma. Two major areas of research for his lab are the use of smart drugs to target cancers driven by FGFR gene mutations and using a cellular mechanism called hypermutation with immunotherapies to boost the immune system. Disclosure.

Dr. Rubinstein is an assistant attending in the gynecologic medical oncology service at Memorial Sloan Kettering Cancer Center. Her main research efforts are focused on improving outcomes for patients through enhancing PI3K pathway targets, optimizing immunotherapeutic approaches for endometrial cancer, and identifying modifiable metabolomic interventions that contribute to disease development, disease progression, responses to treatment. Dr. Rubinstein is a 2019 Conquer Cancer – Gateway for Cancer Research Young Investigator Award recipient for her phase Ib trial which will investigate copanlisib (pan-PI3K) in combination with ketogenic diet in advanced endometrial cancer. Disclosure.

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