By Everett E. Vokes, MD, FASCO
The past 50 years of cancer research have transformed treatment and patient care, but progress remains uneven, and deep-rooted disparities still exist. We see this in the United States—especially during COVID-19—as patients struggle with everything from cost of care to commuting several hours to appointments to not having the broadband capacity to utilize telehealth services. On a global level, no country or place is immune from pervasive inequities in cancer care. According to the World Health Organization, half the world’s population does not have access to the full range of essential health services because of differences in income and education levels, geographic location, and discrimination.
This year’s World Cancer Day (February 4, 2022) calls on the oncology community to “Close the Care Gap.” In my view, the way to accomplish this lofty goal is by focusing on innovations that are designed to improve equity for patients in diagnosis, care, and survivorship. By innovating across boundaries in key areas of cancer care and treatment, we can bring down the barriers patients face and make care more equitable, convenient, and efficient worldwide. ASCO can and is playing a key role in making this happen.
The Society’s nearly 45,000 members represent more than 150 countries and have unmatched potential to improve care for all patients, everywhere in the world, through research and a global exchange of ideas on innovative cancer care delivery models. Six years ago, ASCO launched JCO Global Oncology (JCO GO) to offer an open access journal focused on research addressing challenges unique to countries and areas with limited health care resources. JCO GO also publishes resource-stratified guidelines, which optimize patient care based on the level of resources available in the practice setting. Through our International Clinical Research Course and our IDEA mentoring program, we train and support investigators to perform this research, and Conquer Cancer, the ASCO Foundation, funds innovative research in low- and middle-income countries (LMICs) with International Innovation Grants and Young Investigator Awards in Global Oncology. Through ASCO’s International Cancer Corps program, our volunteers are collaborating with colleagues in hospitals in LMICs to improve access to quality care over the long term. And, more recently, ASCO has begun creating Regional Councils to foster the exchange of knowledge and expertise among oncology leaders.
As we make these advancements and innovations in care, it is important to take steps to make sure that this knowledge is shared globally as quickly as possible. Today’s science simply cannot wait on the traditional approach of presenting at meetings and publishing in journals. To that end, we created the monthly ASCO Plenary Series to help clinicians stay up to speed on emerging research in between scientific meetings with abstracts highlighting novel and high-impact research. The virtual format allows for instant global dissemination of new practice-changing information. The series also gives attendees the opportunity to ask questions of the experts after they present their studies.
With these types of advances, far more patients can benefit from personalized care if we are able to truly innovate at the intersection of medicine, technology, and scientific discovery. It is time to harness the power of artificial intelligence to drive cancer research. This could help improve diagnosis, clinical decision-making, and outcomes measurement.
Real-world evidence programs powered by cutting-edge health information technology, like ASCO’s CancerLinQ, also can provide new insights reflecting the diversity of patients, which can ultimately improve care and drive future research. In addition, they can also help us better pinpoint the gaps and inequities in care that needed to be closed.
For example, a retrospective cohort study presented at the 2021 ASCO Quality Care Symposium used a CancerLinQ Discovery data set of women diagnosed with early-stage (I-III) breast cancer between 2005 and 2015. The analysis found that more than half of the patients in this data set would be considered underrepresented or unrepresented in clinical trials due to age, comorbidity, or race/ethnicity. This is a stark reminder why clinical trial participants must reflect the real-world disease population if we are going to improve cancer care for every patient.
To make this possible, we need to bring innovatively designed clinical trials to patients everywhere, including smaller urban and rural oncology practices. COVID-19 brought on regulatory flexibility and virtual approaches to offer trials to more patients in more settings, and we need to sustain and build on that.
We also need to make sure patients from all populations and walks of life are fully represented in clinical trials. ASCO and the Association of Community Cancer Centers (ACCC) are collaborating to make cancer treatment trials better reflect the diversity of cancer populations. The program will establish practical strategies and solutions to help increase participation in trials with a specific focus on increasing participation among people from historically underrepresented racial and ethnic communities.
The pandemic has highlighted the striking disparities in access to healthcare within the United States and in countries around the world and the direct impact that these disparities can have on the outcomes for individual patients. At the same time, the pandemic has brought the world closer and has demonstrated the promise for global innovation to address seemingly insurmountable challenges. In our local and global communities, let us take this lesson to heart, and with renewed purpose work together to discover innovative ways to address the profound inequities in access to cancer care today.