The 10th annual American Cancer Society Cancer Action Network (ACS CAN) forum on the future of health care, held virtually, stressed the theme of breaking down barriers to care for all American cancer patients. The forum brought together leaders in government, industry, patient care, patient advocacy, research, and development to discuss new approaches to help all Americans overcome persistent inequities in cancer diagnosis, treatment, and clinical research.
Noting that the cancer death rate is 20 percent higher for the poorest U.S. counties compared to the wealthiest, ACS CAN President Lisa A. Lacasse, MBA, said that COVID-19 has exacerbated inequities in cancer care that disproportionately affect people of color and those in poverty. She also noted that cancer patients are among those at highest risk of COVID-19 because of their compromised immune systems, so the pandemic has put patients in underserved populations at even higher risk than they were before the pandemic began.
"We believe that where you live should not determine if you live," said Gary Reedy, outgoing CEO of the ACS and ACS CAN. Reedy stressed that in this, the 50th anniversary year of the National Cancer Act, it is important not to lose the hard-won momentum that has been gained against cancer. ACS CAN is on record in urging President Biden and Congress to make affordable health care a priority in any forthcoming infrastructure legislative package.
Reedy praised passage of the Henrietta Lacks Enhancing Cancer Research Act of 2019, which ACS CAN lobbied for actively and which was signed into law in January 2021. The law is named for a Baltimore County African-American woman whose cancer cells are the source of the HeLa cell line, the first-and one of the most important-of the immortalized human cell lines in cancer research. The law requires the federal government to publish a report on government-funded cancer research trials, including the amount of participation by people from underrepresented populations, and provide recommendations on removing barriers to their participation in such trials.
"Together, we are uniquely positioned to lead the fight for a world without cancer," said incoming ACS and ACS CAN CEO Karen Knudsen, MBA, PhD, Executive Vice President of Oncology Services at Jefferson Health in Pennsylvania and Enterprise Director of the Sidney Kimmel Cancer Center at Jefferson.
Knudsen said there is much work to do, because the pandemic has led thousands of people to skip cancer screenings, and there have been gaps and delays in cancer care. She said the ACS has a major role to play in increasing cancer screening and access to treatments, and the current national discourse on health inequities is "urgently needed."
The health inequities exacerbated by the pandemic would be "shocking if not for the predictability of this pattern," said keynote speaker Marcella Nunez-Smith, MD, MHS, Chair of the U.S. COVID-19 Health Equity Task Force. Health inequities persisted in communities of color long before the pandemic, and COVID-19 has served to show "how deeply embedded they are in our social fabric," noted Nunez-Smith, who is Associate Professor of Medicine at Yale School of Internal Medicine and Associate Dean for Health Equity Research.
Noting that the risk of severe COVID-19 is heightened in patients with cancer and those in underserved populations, Nunez-Smith noted, "Wellness is elusive for far too many." She said the Biden-Harris administration is committed to a multi-pronged response to reduce health inequities, adding that the administration has made access to COVID-19 vaccination "a top priority" for vulnerable populations and has adopted a strategy of targeting underserved communities in its U.S. vaccination campaign. She cited partnerships with community health centers and retail pharmacies, extended hours to receive vaccines, and mobile vaccine delivery efforts. She also said the Biden administration plans to double its mass vaccination sites.
Nunez-Smith stressed the importance of all people, especially cancer patients, receiving accurate information on the vaccine, noting that some cancer patients fear its potential side effects.
Cancer Technology Discoveries
Forum speakers stressed the importance of bringing advances in new cancer technology to all Americans regardless of ethnicity, zip code, or insurance status. As an example, Eric Fung, MD, PhD, Vice President of Clinical Affairs at GRAIL, cited a new multi-cancer early detection blood test, which combines high-intensity sequencing, computer science, and large population-scale clinical studies in order to detect cancer early across many cancer types. He said it is important to educate all Americans in clear language on what the results of a diagnostic cancer test mean and what follow-up tests may be needed.
Fung also urged passage of the Medicare Multi-Cancer Early Detection Screening Coverage Act of 2020 legislation making its way through Congress. To ensure equitable treatment for all cancer patients, he cited the value of the Equity Report Card developed as part of a new Elevating Cancer Equity initiative by ACS CAN, the National Comprehensive Cancer Network, and the National Minority Quality Forum.
As previously reported by Oncology Times, the Equity Report Card makes a number of practice recommendations and policy change recommendations to help ensure that all cancer patients receive equitable care delivery. "These activities actually make a lot of sense," Fung noted.
Agreeing on the need for equitable coverage across the board of cancer screening tests and any needed follow-up tests were Joseph E. Ravenell, MD, Associate Dean for Diversity Affairs and Inclusion at NYU Langone Health and Director of the Cancer Prevention Navigation Program at the Perlmutter Cancer Center, and Dorado Brooks, MD, MPH, Deputy Chief Medical Officer of the Screening Business Unit at Exact Sciences.
Brooks said there needs to be increased use of home screening tests, and urged inclusion of cancer prevention, as well as treatment in telehealth visits. Ravenell has successfully partnered with barbers to increase colorectal cancer screening among black men. "The barber shop is a place that we trust," he said.
"Modern cancer treatment is precision medicine," said Beverly Moy, MD, MPH, Clinical Director of the Gillette Center for Women's Cancers - Center for Breast Cancer at Massachusetts General Hospital. She noted that in many cases the best care option for a cancer patient is a clinical trial. She noted the reality is that U.S. health insurance plans vary widely in coverage, and some are quite limited, thus contributing to inequities in care. She also said biomarker tests often are not covered or it is unclear whether they are covered, adding that germline genetic testing should be done on family members who may be at higher risk, as well as the affected cancer patient. Agreeing was Jerrell Martin, RN, BSN, Clinical Specialist for Clinical Research and development at Bristol Myers Squibb. "An ideal health care system needs to recognize the value of personalized medicine," said Martin.
Also agreeing was John Park, PharmD, Director of U.S. Oncology Marketing at Amgen, who decried the fact that biomarker tests for targetable driver mutations are not being provided to all Americans. He said that fewer than one in four Americans is receiving biomarker testing for actionable and emerging mutations, and this gap is most pronounced in underserved populations. Park praised the cancer advocacy community, which he said "has done a lot to empower patients to seek biomarker testing."
Important Initiatives Needed
Speakers at the ACS CAN Forum also discussed the following issues:
* Reimbursement for patient navigators in cancer care. "When you put trusted people in trusted places," the health care system works better, said Ravenell.
* The need for cancer care providers to take the initiative in recommending a clinical trial to patients. People in underserved populations are not unwilling to participate in a clinical trial, but the system is stacked against their enrollment, said Mark Fleury, PhD, Principal for Policy Development & Emerging Science at ACS CAN. He said 80 percent or more of cancer patients will never be offered an invitation to enroll in a clinical trial. The FDA is actively working to bring more patients from underrepresented populations into clinical trials, and issued a guidance document on this topic in November 2020, said Rear Admiral Richardae Araojo, PharmD, Associate Commissioner for Minority Health and Director of the Office of Minority Health and Health Equity at the FDA.
* The need to take cancer clinical trials into the community. Now there is more of an emphasis on taking trials to the people by including them in non-academic centers, said Gregory J. Dennis, MD, Global Head of Therapeutic Science and Strategy Research and Development Solutions at IQVIA. An immunologist who helped start a community clinic while working at the National Institutes of Health, Dennis advocated for the use of resources for localized clinical trial sites far from the main research site. COVID-19 has taught cancer researchers about flexibilities in doing clinical trials at the local level, such as obtaining virtual remote consent, said Christopher S. Lathan, MD, MS, MPH, Director for Cancer Care Equity and Medical Director of the Dana-Farber Cancer Institute, Brighton.
* The need for continued reimbursement for telehealth treatment pathways. Many patients did not understand telehealth when the pandemic began, and now that it has become more routine, reimbursement for different telehealth applications (including audio-only consultations), should be continued when appropriate, said Mei Wa Kwong, JD, Executive Director of the nonprofit, nonpartisan Center for Connected Health Policy. She also said patients need a strong educational outreach effort in using telehealth, noting that her own father did not have a comfort level with it until she helped him.
Peggy Eastman is a contributing writer.