A Conversation With Dr. Lori J. Pierce on Her Plans to Improve Cancer Care Equity During Her ASCO Presidential Year

A Conversation With Dr. Lori J. Pierce on Her Plans to Improve Cancer Care Equity During Her ASCO Presidential Year

Clifford A. Hudis, MD, FACP, FASCO

@CliffordHudis
Aug 18, 2020

Editor’s note: Dr. Hudis hosts the ASCO in Action Podcast, which focuses on policy and practice issues affecting providers and patients. An excerpt of a recent episode is shared below; it has been edited for length and clarity. Listen to the full podcast online or through iTunes or Google Play

I'm pleased to be joined by 2020-2021 ASCO president Lori J. Pierce, MD, FASTRO, FASCO. Dr. Pierce is a practicing radiation oncologist, a professor and vice provost for academic and faculty affairs at the University of Michigan, and the director of the Michigan Radiation Oncology Quality Consortium. 

CH: My hope is that our conversation will give our readers a better idea of who you are and what has had an important impact over your life and career. I also hope to highlight what you hope to accomplish during your presidential year. I think people will be interested to learn how your childhood inspired you to become a radiation oncologist. Can you talk a little bit about your childhood summers in North Carolina, how they were informative for you, and how they inspired your career?

LP: I'm happy to. I'm originally from Washington, DC, but my father's family, which is quite large, is from a small town in North Carolina called Ahoskie. That was in the south in the '60s and in retrospect there was significant segregation there.

I would have a great time going to visit my family, but I noticed that when there were health care issues, there was only one doctor that my family and the town could see. He was great, Doc Weaver, he did it all. People just revered him because he always seemed to help everyone and that was one of the first times that I thought about possibly becoming a physician.

As I got older, though, that experience made me acutely aware that there was inequity in care. Even though Doc Weaver was a great doctor, there clearly weren't choices in terms of care and that was my first exposure to health care inequity.

CH: For me personally, one of the highlights of the year is when our president comes on board and begins to present their vision for their theme and what they hope to see ASCO achieve during their presidential year. You certainly came into this with a very clear vision: Equity: Every Patient. Every Day. Everywhere. Can you expand on what you hope to see accomplished through this theme and what motivated you to focus on it specifically in your role as ASCO president?

LP: A multitude of things. It's hard to really pick out one, but certainly I think we’re all acutely aware of how different the outcomes are for people of color—how they are often less favorable in terms of receiving health care—and there are reasons to explain this. Quite often it's not biology at all, but rather these patients have a lower socioeconomic status, a late diagnosis, an inability to receive treatment, or transportation issues. There is a myriad of reasons as to why the outcomes are different. We need to get to the root causes to understand the barriers that patients face if we're going to really make a difference. So, it's important to me that equity be front and center in everything that we do. ASCO has done so much to make sure that the message is there, that every patient deserves high-quality care, but I wanted to actually make equity our theme this year since it has never been highlighted in this way before.

CH: In early 2020, nobody could have anticipated that we would be facing a global pandemic that would so disproportionately impact people of color, or that there would be a tipping point through yet another brutal crime against an African American and that this would so completely capture the nation's attention. Can you speak a little bit more about the timing of these events and your theme, and why this is so important for us to act at this point?

LP: The theme was chosen before the pandemic because I felt it was appropriate at this point in time for ASCO. Then the pandemic happened, and we saw how it disproportionately affected those who had comorbidities, or those who were the essential workers and didn't have the luxury to work from home.

I take a little bit of pride being from the state of Michigan because it was actually one of the first states that started reporting COVID data by race and ethnicity, which made the observation that there were cohorts of patients that had a significantly worse outcome. So, the country and the world learned that people of color did more poorly with COVID.

Then we saw more of the senseless deaths that we've seen in the past, but we've seen even more of as of late. We have to acknowledge there's structural racism, and once we acknowledge that, the next thing we have to do is initiate steps that eradicate it. 

I am cautiously optimistic that this time is different, that the world is in a different place and this is no longer acceptable. That people are not going to look away, that they are going to stare this down and create change. I'm optimistic that this will not just be another set of deaths of poor people at the hands of police, that the world is awake now, and change will come. So, the theme of equity is perhaps more impactful now than it ever would have been in the past.

CH: There is one area of progress that's already taking shape: an exciting new collaboration between ASCO and the Association of Community Cancer Centers (ACCC). This is focusing on increasing participation of both racial and ethnic minority populations in cancer research, which to your point, is something that we have been focusing on for years, but we really need somebody to move the needle. Can you talk a little bit about this initiative and what you hope to see formed and accomplished through this?

LP: I am very happy—largely thanks to you, for putting Randy Oyer, who is the president of ACCC, and I in contact with one another—to set up this collaboration. We all know that if you look at people of color—let's say African Americans and Hispanics—and look at their participation in clinical trials, it is much lower than their representation as patients with cancer. Around 3% to 5% of patients in clinical trials are Hispanic or African American, whereas those two groups make up about roughly 15% of patients with cancer. There's clearly a disconnect in the representation of those ethnicities and races in our clinical trials.

And so many have tried to come up with strategies to improve the enrollment. We are working together to create a robust steering committee of individuals who have thought long and hard about accrual of minorities in clinical trials. We are also sending out an RFI to request ideas from people associated with ASCO and ACCC for their strategies on how to improve accrual. The steering committee will review the ideas and try some of these strategies within ASCO’s Targeted Agent and Profiling Utilization Registry Study (TAPUR). It's almost a laboratory, if you will, for new ideas.

If we see that there are one or two strategies that appear to be successful in terms of increasing the uptake of minorities, then we can suggest them to some of the cooperative groups to employ in their trial. It's an exciting time for us to use TAPUR for this collaboration. I am very grateful for the opportunity to be able to work with Randy and all the infrastructure that ASCO has to make this a reality.

CH: That's great. Thank you, Dr. Pierce, for taking the time to speak with me. I'm excited for the year ahead, both for you and for all of us at ASCO. 

Learn more about the ASCO-ACCC initiative and submit ideas that will help address the issues related to longstanding barriers to diversity in cancer clinical trials.

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