Jun 07, 2021
Excerpt From the 2021 ASCO Annual Meeting Opening Session
By 2020-2021 ASCO President Lori J. Pierce, MD, FASTRO, FASCO
I’m standing in the Michigan League, which is one of the most historic and culturally significant buildings at the University of Michigan in Ann Arbor, where I serve as a professor of radiation oncology and vice provost for academic and faculty affairs.
The League was created in 1929 for women and by women as a place where they could congregate. That was necessary because, up until 1956, women were not allowed in the main student union. It was exclusive to men unless women were escorted by a man, and even then, they had to use the side door. I thought the League would be a perfect location for me to open our Annual Meeting and to deliver my Presidential Address, which will focus on equity.
What a year it’s been! I am so grateful to have served as your 57th ASCO president during the unprecedented challenge of COVID-19. I have seen our Society and our members respond with strength and resilience, pushing the boundaries of research, taking our treatments to the next levels, and providing excellent patient care, despite the obvious hurdles we’ve all had to overcome. This virtual meeting is additional evidence that not even a global pandemic can deter us from ASCO’s mission, “Conquering cancer through research, education, and promotion of the highest quality, equitable patient care.” In 2020, we added the word “equitable” to our mission statement to formally reflect our long-time commitment to equity.
This brings me to my presidential theme, “Equity: Every Patient. Every Day. Everywhere.” Eliminating racial and socioeconomic disparities in cancer outcomes has been a personal long-term commitment, and I decided on this theme before my presidential year. But clearly today it is even more relevant than ever—since the pandemic has disproportionately affected people of color and institutional racism is finally being recognized as a societal plague that is devastating to all of us.
The events of the past year have galvanized ASCO to explicitly condemn racism, acknowledge its profound impact on public health, and commit significant new volunteer and staff resources to confront it. ASCO's new statement on addressing racism spells out racism's undermining effect on all of our efforts against cancer, and states, “We must pour the same energy and focus into confronting racism as we pour into conquering cancer itself.”
Indeed, racism and health care inequality are global challenges. During my term as your president, it has been my privilege to discuss these issues with ASCO’s international members as well as with domestic members and partners. Just as countries and communities around the world share common challenges, we can collaborate to share common solutions.
I am proud to say that ASCO is 100% committed to combatting cancer care inequities. I will share with you some recent achievements—but first, I want to go back 57 years to how ASCO began.
On April 9, 1964, seven esteemed oncologists met during an American Association for Cancer Research (AACR) meeting with a shared purpose: to form a society that would improve the care of people with cancer through the power of shared knowledge. At that time, there was a great need for improvements in cancer care and treatment. Systemic therapies were limited; the ones that existed were actually relatively ineffective and were associated with significant toxicities. The group of seven imagined a society where information could be shared across clinicians, to benefit all patients with all types of cancers. It was a unique and timely idea.
What made that gathering even more distinctive was the composition of the group of those seven esteemed oncologists. There were six white men—and there was one Black woman.
The woman was Dr. Jane C. Wright. She was the daughter and granddaughter of cancer doctors, and a highly accomplished oncologist. She would go on to win many awards and to conduct research on chemotherapeutic agents, many of which are still used today. She served on President Lyndon B. Johnson’s Commission on Heart Diseases, Cancer, and Stroke, and as an associate dean at the New York Medical College, which was her alma mater. In 1971, she was the first woman elected president of the New York Cancer Society.
Dr. Wright passed away in 2013 at the age of 93 and I regret that I never had the opportunity to meet her. But I did have the great fortune to speak with her two daughters on a Zoom call recently. I asked them how Dr. Wright dealt with racial and/or gender prejudice, since in those days, I suspect, she was the only woman and only African American in nearly every professional room she entered.
Her daughters told me their mother had a deep-rooted belief that everyone deserved equal treatment, but she never mentioned experiencing discrimination herself. Rather, she saw all obstacles as challenges, and she refused to let anything stand in the way of her singular focus, which was to save the lives of people with cancer.
And yet, while Dr. Wright and her colleagues were fighting to improve cancer care, I’m certain she was well aware of the battles of civil rights that were going on all around her. 1964, the year Dr. Wright helped to create ASCO, was a tumultuous year for civil rights in the U.S. and around the world. The Black and white Freedom Riders—including John Lewis, the Congressman and civil rights icon who died last year—were thrown in jail for leading peaceful marches against segregation in the southern United States. In Mississippi, the Ku Klux Klan abducted and killed three civil rights workers who were simply trying to register Black voters. Race riots broke out in New York City and Rochester, New York, reflecting the need for change in the north as well. Meanwhile, in South Africa, Nelson Mandela and his colleagues were sentenced to life in prison for protesting the inhumane yet lawful practice of apartheid.
But 1964 was also a year of hope. President Johnson signed the Civil Rights Bill into law, marking the end to lawful racial segregation and discrimination, and the Reverend Dr. Martin Luther King Jr. became the youngest recipient of the Nobel Peace Prize for his efforts to bring equality and justice to all.
When I was a young child growing up in the nation’s capital, Washington, DC, during the early 1960s, I couldn’t help but be aware of the racial turmoil that was happening during that time; it was on the news every night. And, although I didn’t realize it at that time, I was observing segregation’s impact on health care when I would visit my father’s family in the small town of Ahoskie, North Carolina. While white residents in Ahoskie had access to many high-quality health care options, Black people were largely treated by a single African American doctor. Looking back, no matter how skilled he was, he was still one doctor treating an entire community—every person, every age, every condition—and that, by definition, is limited.
As I got older, attending college and then medical school, I became more aware that while the legal segregation I saw in North Carolina in the 1960s was over, health care inequality remained firmly entrenched in the U.S. and worldwide. As a resident in radiation oncology and then as a breast cancer physician and researcher, I became increasingly committed to improving outcomes for all people with cancer.
That’s one reason why I’m so proud to be a part of ASCO.
Health equity has always been at the heart of ASCO. Our mission pillars reflect this: research, education, and quality care are the guiding lights to our North Star, which is that every patient, everywhere should receive cancer care that results in the best possible outcome. We’ve made substantial progress in all three pillars this year.
Beginning with research, people of color account for only 5% or less of cancer clinical trial participants, and we have to increase those numbers. One way to do so is to eliminate potential barriers, such as cost. The Affordable Care Act significantly increased the number of insured Americans, but Black patients are still 1.5 times more likely to lack health insurance than white patients. And while the U.S. government through Medicaid has long covered cancer care costs for the uninsured, it did not pay the routine care costs of being in a clinical trial.
That’s why ASCO’s advocacy arm, the Association for Clinical Oncology, pushed hard last year for a law requiring Medicaid to cover the costs of care in cancer clinical trials, such as lab tests, X-rays, doctor’s appointments, and drugs needed to manage side effects. I am so happy to say that the CLINICAL TREATMENT Act was passed into law in December. That is a huge victory for our patients and for diversity in cancer research.
Also this year, ASCO and the Association of Community Cancer Centers (ACCC) have formed an ongoing collaboration to increase diversity in our clinical trial populations. In May, we began recruiting over 40 clinical trial sites to test practical strategies designed to increase screening and participation of Black and Latinx patients. The strategies include a clinical trial site assessment tool and education to mitigate biases. I hope you will contact ASCO if your research site would like to participate in this important pilot. Next year, we will publish the results of the study, along with practical solutions and guidance to ensure racial and ethnic diversity among clinical trial participants.
CancerLinQ, as you know, is ASCO’s real-world oncology data subsidiary. It has had a mission since its inception to advance quality of care by capturing and analyzing experiential data on diverse populations with cancer. This year, CancerLinQ is working to further leverage its technological capabilities and growing network to help offer access to clinical trials equitably.
Meanwhile, Conquer Cancer, the ASCO Foundation, which funds ASCO’s research priorities, is scaling and growing funding for diversity and inclusion. Specifically, the foundation is ramping up support for research on cancer health disparities, as well as oncology research conducted by underrepresented populations.
The new ASCO CONQUERS CANCER Fund is helping us achieve these goals. It’s a special fund because it is supported by ASCO Annual Meeting attendees. Please give to ASCO CONQUERS CANCER to support research funding for scientists at every career stage who explore treatments for every type of cancer. I support our foundation and its continued commitment to equity, and I hope you will, too.
ASCO’s second pillar is education. We all know that “Knowledge Conquers Cancer,” and while we’ve made a great deal of progress in understanding cancer biology, we also know biology cannot provide all the answers to cancer disparities. That’s why this year, in line with recommendations from ASCO’s Health Equity and Cancer Prevention Committees, we began educating clinicians on the social determinants of health and modifiable risk factors for cancer.
Social determinants of health are defined by the World Health Organization as conditions in which people are born, grow, live, work, and age. The three most important modifiable risk factors for cancer are smoking, obesity, and alcohol. In the U.S. alone, they are associated with four out of every 10 cancer cases diagnosed and almost half of cancer deaths.
In October, ASCO launched a monthly podcast series designed to educate oncology trainees and early-career oncologists about the social determinants of health and modifiable risk factors and their impact on patients’ care and outcomes.
With respect to modifiable risk factors, we conducted a survey of oncology providers which found that attention to weight management, physical activity, and diet was high during and after cancer treatment. The survey also showed that changes in diet and exercise behavior observed in patients were related to the attention and advice given by their provider. However, this provider survey also showed that providers were failing to refer patients for ongoing lifestyle modification changes. These findings from the provider survey are in agreement with results from a first-of-its-kind patient survey deployed early last spring, which is being presented in poster form at this meeting (Abstract 10549). The results from both the provider and the patient surveys will help guide ASCO in designing energy balance interventions going forward.
We’re also developing tobacco cessation resources for providers and patients that will have a meaningful and measurable impact on modifying behaviors that increase the risk of cancer.
ASCO’s third pillar is quality care. All patients with cancer should have equal access to quality cancer prevention, screening, and treatment.
Last year, our Health Equity Committee formed a task force to better understand and serve the needs of oncology providers who care for underserved patients. We identified these providers with the help of our State Affiliates, and then conducted a series of interviews about their challenges, solutions they currently implement, and how ASCO may be able to help. The task force is now working to design and launch a broader survey that will validate and expand on these initial findings, and ultimately, help these providers deliver the best care for their patients.
We must improve global access to cancer screening. A woman living in a village in Malawi should have the same ability to get regular mammograms as a woman living in an affluent area of New York City.
Cancer screening can make a significant difference to patients and families. In the state of Delaware, an innovative program has covered colorectal cancer screening and treatment for uninsured state residents since 2008. It has virtually eliminated colorectal cancer screening disparities, it has improved the rate of African American cancer survival to nearly that of white residents, and it has saved millions of dollars. So, I ask you, what is stopping us from implementing this initiative everywhere? ASCO is now looking at how we can best engage at the state level and with national policymakers to replicate Delaware’s success. And as you all know well, COVID-19 has had a devastating impact on cancer screening worldwide. Our goal is not just to get back to pre-COVID screening; we want to exceed those screening levels. We believe the Delaware initiative can be a model for nations and regions to follow around the world.
Finally, I am especially proud to announce the new Excellence in Equity Award. This recognizes ASCO members who make significant and measurable contributions toward equity, diversity, and inclusion within oncology, or increase access to equitable cancer care. I championed this award because I believe it will motivate and inspire all of us to help every patient, everywhere achieve equal access to quality cancer treatment and care.
I’ve highlighted just a few of the many initiatives throughout ASCO to promote equity in research, education, and high-quality cancer care; I wish I had more time to discuss all of them. I am highly encouraged as there is ongoing meaningful dialogue, throughout the country and throughout the world, about inequity in all aspects of cancer care. This includes those invisible societal factors and structural racism that have long been ignored or underestimated.
While I am encouraged, I realize there’s still so much more to do. Here’s how you can help:
- Give us your thoughts on what else ASCO can do to better promote equitable care in your part of the world.
- Tell us what barriers you and your patients face and what resources ASCO can provide.
- Continue to advocate for your patients in the communities that you serve. That outreach—to government, businesses, and health care institutions—is something we can and should all do on behalf of our patients.
I want us all to imagine what this world could and will be like when we can deliver the right care to every patient, every day, everywhere.
Similar to what the playwright Lin-Manuel Miranda said in his historic musical, Hamilton, history has its eyes on us. We are at a pivotal time in the history of our Society and the social history of the world. We must capitalize on the momentum and hold ourselves accountable. Success is within our reach. I firmly believe success is within our reach. In other words, it is our time.
It’s our time—and it’s our responsibility. In 1965, Dr. Martin Luther King Jr. said, “A man dies when he refuses to stand up for that which is right.” The lives of countless patients with cancer worldwide rest on us speaking out. We must be bold in our commitment and actions for equitable care.
It’s our time, it’s our responsibility, and I firmly believe it’s ASCO’s destiny. When Dr. Jane Wright was asked in a 2010 interview what advice she would give colleagues today, she said, “I would tell ASCO members to work hard, persevere, collaborate with one another, be pioneers in the field, and keep up the good fight.”
Today, ensuring equity of care, that’s our good fight. That is who we are. This is the foundation of ASCO. We must take the vision of our founders into the next 57 years and beyond.
Being your president has been the greatest honor of my career. My gratitude to Dr. Clifford A. Hudis and the ASCO leadership for their unwavering commitment to the Society and to equity of care. A special thank you to Dr. Allen S. Lichter, the previous ASCO CEO, who has been a friend and mentor during many phases of my career and who showed me all that is possible with ASCO. My sincere thanks to many other mentors and colleagues along the way. Please know I will always be grateful for your support.
I wish that my parents were alive today to share in this moment. They had limited educational opportunities and yet were two of the smartest and wisest people I have ever known. I thank my sister, Karen Williams, and my extended family for their steadfast love and support through the years.
Finally, those of you who know me know my family is the absolute key to any professional success I may have had. I am at a loss for how to thank my husband, Tony Denton, and our son, Evan, for always being there to support me, and for taking this momentous journey with me. So, I will simply say a heartfelt thank you to them.
And to all of you: I thank you. I hope you will be enriched and enlightened by the 2021 ASCO Annual Meeting. Thank you.
Editor’s note: Excerpt has been edited for length, style, and clarity.