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ASCO 2021 Presidential Address: Eliminating Disparities in Cancer Care

August 2021, Vol 12, No 4

The theme for the American Society of Clinical Oncology (ASCO) 2021 virtual annual meeting was “Equity: Every Patient. Every Day. Everywhere.” As ASCO President Lori J. Pierce, MD, FASTRO, FASCO, explained during her opening address, there is an urgent need to focus on effective ways to eliminate racial and socioeconomic disparities so that every patient can receive care that results in the best possible outcome.

“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,” she said. “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.’”

Dr Pierce highlighted the progress that ASCO has made toward promoting equity in cancer care through initiatives to increase diversity in clinical trials and educate physicians on how social determinants of health and modifiable risk factors affect patient experiences and outcomes. She discussed how the organization’s 3 mission pillars (research, education, and quality care) are being applied to achieve these goals.

Mission Pillar: Research

Dr Pierce explained that people of color account for only 5% or less of cancer clinical trial participants. “We have to increase those numbers. One way to do so is to eliminate potential barriers, such as cost,” she said.

Although Medicaid covers the costs of cancer care for uninsured patients, it has not paid for the routine costs associated with participation in clinical trials (eg, laboratory tests, X-rays, medication needed to manage adverse events). To this end, ASCO’s advocacy arm, the Association for Clinical Oncology, pushed hard for a law requiring Medicaid to cover these costs.

“I am 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,” Dr Pierce said.

ASCO and the Association of Community Cancer Centers have formed an ongoing collaboration to increase diversity in clinical trial populations. In May 2021, recruiting began at more than 40 clinical trial sites to test practical strategies designed to increase screening and participation of African-American and Latino patients.

Mission Pillar: Education

Dr Pierce said that in line with recommendations from ASCO’s Health Equity and Cancer Prevention committees, ASCO is now educating clinicians on social determinants of health and modifiable risk factors for cancer. In October 2020, the organization launched a monthly podcast series designed to educate oncology trainees and early-career oncologists about these issues and their impact on patient outcomes.

Mission Pillar: Quality Care

Dr Pierce said that ASCO believes 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,” she explained. “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.”

Dr Pierce also called for improved access to cancer screening, pointing to an innovative program in Delaware that 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,” she said. “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.”

Dr Pierce said that ASCO is not aiming to return to the cancer screening levels that existed before the COVID-19 pandemic, but to exceed those levels. “We believe the Delaware initiative can be a model for nations and regions to follow around the world,” she added.

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