Oct 29, 2020
By Melanie Farrell, ASCO Communications
In August 2020, ASCO president Lori J. Pierce, MD, FASTRO, FASCO, and Stand Up To Cancer (SU2C) Health Equity Committee chair Edith A. Perez, MD, participated in a Facebook Live streamed event to discuss the importance of health equity in cancer care and the work ASCO and SU2C are doing to increase diversity in cancer research and treatment.
Dr. Pierce and Dr. Perez have collaborated throughout their careers, and their paths are crossing again with the two organizations’ continued efforts surrounding health equity. With ASCO’s recently published “Cancer Disparities and Health Equity: A Policy Statement from the American Society of Clinical Oncology” and Dr. Pierce’s accompanying editorial “A Time to Dig Deeper and Take Meaningful Action,” the Facebook live provided an important opportunity to dive into ASCO and SU2C’s health equity priorities.
During the discussion, Dr. Pierce and Dr. Perez expanded on the concept of health equity and shared what steps need to be in place for cancer care providers and their patients to see improvements on this issue.
“Health equity is having the right to be as healthy as you can be,” said Dr. Pierce. “Equity is such a simple concept, but it’s become so complicated because there’s so many different layers and so many different factors that you have to consider when you consider health equity. In my mind, you have to break those issues apart and address them individually if you want to make real change in terms of health equity.”
Stand Up To Cancer Health Equity Initiative
Much of this virtual conversation highlighted the need to identify barriers in health equity and eliminate them. On both an individual and a collaborative level, organizations and institutions are amplifying their efforts to combat this issue. Dr. Perez spoke specifically of SU2C’s Health Equity Initiative and its aim to increase diversity in cancer clinical trials and address persistent disparities in cancer research and treatment.
“There is data from many sources showing that only approximately 4% of cancer clinical trial participants are Black, and approximately 5% are Hispanic, despite the fact that these two groups combined account for almost 35% of the U.S. population,” said Dr. Perez. “People of color have had the highest mortality rate and shorter survival rate for a lot of cancers over the years. It’s an issue that we know deserves attention.”
Dr. Perez also spoke about SU2C’s Health Equity Breakthroughs Research Team, supported by a transformational grant from Genentech, a member of the Roche Group. The team will focus on cancers affecting underrepresented populations.
“We’ve thought a lot about the structure that we’re going to put into this program before making it available,” said Dr. Perez. “We decided to try to have one very comprehensive program that will be collaborative, including community academics, social determinants of health with molecular biology of cancer, [and] to consider prevention [and treatment] strategies. We’re focusing on our approach, while at the same time providing some leeway for investigators to work amongst themselves to have a fantastic breakthrough team that encompasses the different areas of expertise.”
With the implementation of this team, SU2C is working to diminish barriers to health equity in cancer research and treatment. Dr. Perez noted that this unique opportunity would help bring together key stakeholders who are deeply connected to impacted communities.
“We feel that this Health Equity Breakthroughs Research Team is a cornerstone of Stand Up To Cancer’s Health Equity Initiative,” Dr. Perez said.
ASCO’s Health Equity Priorities
ASCO is also striving to increase racial and ethnic diversity in cancer research and treatment through its own initiatives.
“Equity of care is at the foundation for everything ASCO does,” said Dr. Pierce. “If you look at our strategic plan, it is all predicated on the fact that every patient with cancer deserves high-quality care. Our health equity committee published an updated policy statement regarding health equity—and this was an update compared to the 2009 statement. The 2020 [statement] really emphasizes that aggressive steps are needed to achieve equity in cancer care.”
Dr. Pierce went on to discuss ASCO’s four main recommendations for clinicians outlined in the updated policy statement, which include ensuring equitable access to high-quality care, ensuring equitable access to research, addressing structural barriers to equitable care, and increasing awareness and action.
“This is an all-hands-on-deck kind of thing, [and] I feel very passionate about it,” said Dr. Pierce. “This is not an African American and Hispanic thing. This is not a rural population thing. This is not a financially challenged thing. This is something that we all need to do.”
Collaboration Is Key
While both organizations have to take responsibility for improving health equity individually, Dr. Pierce and Dr. Perez also stressed the importance of collaboration to address this issue.
Dr. Pierce spoke of ASCO’s collaboration with the Association of Community Cancer Centers, which is aimed at increasing racial and ethnic diversity in clinical trials conducted by community practices. ASCO and ACCC issued a nationwide call for novel and practical ideas from the cancer community, and the organizations are currently reviewing submitted ideas to determine which might be piloted or executed in some fashion.
One possible approach might be a toolkit, said Dr. Pierce, “so that we’ll see where different practices are, and they may have an infrastructure that misses perhaps one of two pieces, and hopefully by suggestions of our toolkit they can actually further improve their enrollment in clinical trials.”
Dr. Perez shared her appreciation for collaboration, and noted that in addition to SU2C’s efforts to fund research, including a recently announced grant opportunity from Bristol Myers Squibb focused on lung cancer health equity, SU2C is very intent in collaborating with advocacy organizations and community-based organizations when exploring health equity.
“We are collaborating with the Black Women's Health Imperative and Friends Of Cancer Research on a program called Project TEACH, which stands for Trained Empowered Advocates for Community Health/Healing, which is funded by the Patient-Centered Outcomes Research Institute (PCORI),” said Dr. Perez. “This nation-wide project will empower Black women to effectively engage with researchers and clinicians and will further increase participation of Black women in cancer clinical trials.”
Taking a Stand
As the conversation came to a close, Dr. Pierce and Dr. Perez shared some final thoughts regarding health equity, as well as their hopes for the future of cancer research and treatment.
“I want to remind everybody that health equity is attainable and will be getting better by all of us doing our part,” said Dr. Perez. “I am inspired by the great work of ASCO, the work of Stand Up To Cancer, and what we’re doing together. I think we have a responsibility to really work together so that we can help decrease the risk of cancer and offer the best treatment opportunities for those affected by this disease… regardless of the type of cancer, regardless of race or ethnicity.”
This discussion demonstrated that achieving health equity in cancer care will require a sustained effort, and only through collaboration between organizations like ASCO and SU2C will cancer care providers and their patients see improvements.
“We are at a crossroads,” said Dr. Pierce. “The world has awakened. And that is the silver lining to where we are. I do indeed have hope. I think that everyone realizes that we each have to step up. This is our time. This is our time to make a difference.”