ASCO’s President-Elect Aims to Ensure Equitable Cancer Care for Every Patient
A Conversation With Lori J. Pierce, MD, FASTRO, FASCO
The desire to pursue a career in medicine took root when Lori J. Pierce, MD, FASTRO, FASCO, was a young child visiting family in segregated Ahoskie, North Carolina. She witnessed firsthand the impact the town’s lone African American family physician had on the community.
Lori J. Pierce, MD, FASTRO, FASCO
When it came time to choose a medical specialty, while attending Duke University School of Medicine, Dr. Pierce was drawn to radiation oncology; it combined her dual interests in physics and biology and would give her the opportunity to spend time in the clinic treating patients with cancer. The experience led her to complete her residency and chief residency in radiation oncology at the Hospital of the University of Pennsylvania, where she subsequently made the decision to specialize in the treatment of breast cancer.
After completing her chief residency at the University of Pennsylvania in 1989, Dr. Pierce was appointed as a senior investigator at the National Cancer Institute, and, 2 years later, she joined the faculty of the University of Michigan. Today, Dr. Pierce is Professor of Radiation Oncology and Vice Provost for Academic and Faculty Affairs at the University of Michigan and Director of the Michigan Radiation Oncology Quality Consortium.
Focus of Breast Cancer Research
In 1992, Dr. Pierce published a study comparing the effectiveness of breast-conserving surgery and radiation therapy among black women compared with white women who had early-stage breast cancer. Although her study found that the combined local therapy was comparable in controlling local tumor growth in patients, overall survival was worse among black patients, suggesting a more aggressive cancer phenotype.1 Although breast cancer is less common in black women, they are 41% more likely to die of the disease than white women; the reason is the result of several factors, including ethnic/racial differences in tumor characteristics, the dissemination of mammographic screenings, and access to oncology care.2
That early career experience solidified Dr. Pierce’s dedication to the pursuit of equitable care for all patients with cancer and to the development of more effective therapies for breast cancer. Her research is now focused on the use of radiotherapy in the multimodality treatment of breast cancer, whether specific agents can radiosensitize breast cancer, and the outcomes of carriers of a BRCA1/2 breast cancer susceptibility gene treated with radiation therapy.
In 2018, in acknowledgment of her “research in developing radiation treatments for breast cancer that leverage advances in medical physics and laboratory science and for [her] national efforts to draw women and people of color into medicine,” Dr. Pierce was elected to the National Academy of Medicine, considered among the highest honors in the fields of health and medicine.
A Lifelong Career Commitment
An ASCO volunteer since 1992, Dr. Pierce has served on ASCO’s Board of Directors, ASCO’s Special Awards Selection Committee, the Government Relations Committee, the Scientific Program Committee, and Chair of the Conquer Cancer Nominating Committee. She also served as a mentor for the Leadership Development Program from 2015 to 2018. In recognition of her extensive volunteer service to ASCO, in 2015, Dr. Pierce was named a Fellow of ASCO and, in 2018, was elected to serve as ASCO President. Dr. Pierce began her 4-year term in June 2019 as President-Elect and will start her tenure as ASCO’s 57th President during the 2020 ASCO Annual Meeting, followed by her third year as Chair of the Board and fourth year as Past President.
In a wide-ranging interview with The ASCO Post, Dr. Pierce discussed her goals and challenges as she contemplates her presidential term and the lasting legacy she would like to leave on ASCO.
Shining a Spotlight on Health-Care Equity
What is the theme of your presidential term?
My theme is “Equity: Every patient. Every day. Everywhere.” Equity in cancer care has been a focus of mine for a very long time, and it is a major part of ASCO’s focus as well, in terms of its mission to conquer cancer through research, education, and the promotion of the highest quality patient care. We haven’t had a focus specifically on equity of care as a presidential theme before, and I wanted to highlight this because health-care equity is at the forefront of everything we do at ASCO.
What are the major goals you hope to accomplish during your presidential term?
I hope to take the year to move the needle in patient-care equity and, by doing so, enable ASCO to be an even stronger Society than it is now. In 2018, the ASCO Board approved the name change of the Health Disparities Committee to the Health Equity Committee, signaling a move beyond reporting the disparities in cancer incidence, prevalence, mortality, and disease burden to increasing health-care equity for all patients with cancer.
I want to add to those efforts by incorporating the concept of cancer-care equity into the fabric of every session during the ASCO Annual Meeting by looking at the content of each session. I want to see how research findings can be translated into improving care for all patients, so everyone, everywhere, has equal access to high-quality cancer care.
“I would like to see more funding go toward health-services research to analyze how health-care changes impact cancer outcomes.”— Lori J. Pierce, MD, FASTRO, FASCO
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Regarding ASCO’s research efforts, I would like to see more funding go toward health-services research to analyze how health-care changes impact cancer outcomes. And so, much of what we do at ASCO is to develop educational programs through the Annual Meeting Education Committee, which seeks to meet the needs of our diverse caregiver membership. But we have to go further, to educate our patients as well.
One statistic from the American Cancer Society I find very disturbing: About 42% of cancer cases—and 45% of cancer deaths—in the United States are linked to modifiable risk factors, including smoking, excess body weight, physical inactivity, and alcohol abuse.3 These factors are well under our control to address and ASCO can help change. There are some things we can’t do, such as affect people’s income, but we can help them reduce their risk for cancer by making lifestyle changes.
ASCO’s Cancer Prevention Committee is currently studying how well health-care providers are advising their patients on the benefits of energy balance, ie, maintaining a healthy weight and increasing levels of physical activity, in reducing their risk of cancer and what tools physicians need to be more successful. The committee is currently developing a patient survey to better understand how to help patients achieve improved exercise and diet strategies. What these patients tell us will inform future ASCO patient and caregiver educational programs.
All these plans we hope to put in place during my presidential term. However, accomplishing this goal is difficult because measuring its success is challenging. Furthermore, it may take time to perceive real change. These current efforts are, however, an important first step.
Understanding the Barriers to Equitable Care
What do you anticipate will be your greatest challenges to accomplishing those goals?
It depends on how you look at the endpoints that I’m hoping to accomplish during my presidential year. Equity is a simple concept to grasp but very complicated to execute and measure for success. As I mentioned, we have a survey underway to better understand caregivers’ and patients’ interactions regarding weight loss and physical activity. Before we can act to improve patient outcomes, we need to better understand the barriers that currently exist. A survey of health-care providers of underserved communities is also planned to better understand their needs for delivering optimal care to their patients.
The biggest challenge for success in accomplishing my goals is going to be time. My presidential year will pass quickly, so I’ve been working with members of the Cancer Prevention Committee and the Health Equity Committee during my first year as President-Elect to support these surveys in the hope of reviewing the data generated next year and planning next steps.
Expanding ASCO’s Role in Patient Advocacy
Despite many advances in the treatment of cancer and improved survival outcomes for millions of patients, many obstacles still remain. What ASCO initiatives do you hope to launch or expand that will contribute to the development of solutions and policies to improve care for all patients with cancer?
One area we plan to expand is our role in patient advocacy. For example, currently, ASCO is part of a broad coalition of 106 organizations representing health-care providers, patients, researchers, survivors, and patient advocates urging Congress to pass the CLINICAL TREATMENT Act (H.R. 913) to improve access to life-saving therapies for patients on Medicaid by covering routine costs incurred while participating in clinical trials. There is bipartisan support for this legislation, and I am working closely with ASCO’s Government Relations Committee to lobby Congress to pass this bill. Passage of this legislation would be a big step forward to providing equitable care for poor and underserved patients, and I am very committed to its passage.
We are also working with the U.S. Food and Drug Administration and the patient advocacy organization Friends of Cancer Research to develop recommendations to broaden the eligibility criteria for participation in clinical trials. Although expanding eligibility criteria will help all patients have greater access to new therapies, it may be especially beneficial to underserved populations, who may have concerns about out-of-pocket costs not covered by a clinical trial. Ending restrictive eligibility criteria for patients with cancer will also increase their participation in clinical trials and provide real-world study data that could lead to more equitable outcomes.
Another area I hope to influence during my time as ASCO President is increasing our workforce diversity and ASCO membership. I’m fortunate to embody three groups: I am a woman, I am African American, and I am a radiation oncologist. This collectively gives me a unique perspective on the field of oncology and of ASCO. I hope it gives other women and people of color the perspective that ASCO is an extremely welcoming organization for all cancer caregivers. I want to use that acceptance to increase our membership; with increased membership comes increased representation and the power to challenge the status quo to potentially improve patient outcomes. We also need a more diverse workforce to mirror the patients we serve.
I’m hoping that as oncologists see that ASCO clearly embraces diversity, it will have a positive effect on increasing a diverse membership.
Increasing Diversity in the Oncology Workforce
In oncology, just 2.3% of the physician workforce self-identifies as black/African American and 5.8%, as Hispanic/Latino.4 Please talk more about how you plan to increase diversity in the oncology workforce.
First, we need to understand why the oncology profession is not viewed more favorably by minority internal medicine residents; when you look at the subspecialties they pursue, oncology is at the very bottom. The focus needs to be on having more underrepresented medical students and residents exposed to oncology to encourage them to consider a career in the field.
“When you look at the subspecialties pursued by minority internal medicine residents, oncology is at the very bottom.”— Lori J. Pierce, MD, FASTRO, FASCO
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In 2008, ASCO launched its Diversity in Oncology Initiative to help achieve that goal. The initiative is designed to support and promote diversity in the oncology workforce through award opportunities for medical students and residents who self-identify as underrepresented minorities. For example, the ASCO Medical Student Rotation award supports 4-week clinical or cancer clinical research rotations and pairs underrepresented minority medical students with a clinical oncologist who can provide ongoing academic and career development guidance, learning opportunities, and personal advice. The ASCO Resident Travel Award supports residents wishing to attend the ASCO Annual Meeting to build interest in the field.
We are also reaching out to historically black medical schools, as well as medical schools with high minority enrollment, to raise awareness of the career opportunities in oncology and the impact they could make on patients of color.
In my capacity as Vice Provost of the University of Michigan, I help junior faculty, including underrepresented minorities, achieve success in their academic career. As President of ASCO, I want to use that experience to help junior faculty, including underrepresented minorities, to navigate their careers in oncology.
Leaving a Lasting Legacy
Approximately one-third of ASCO members practice outside the United States, and, of these members, one-quarter practice in low- and middle-income countries. Do you have plans to expand ASCO’s global cancer programs, especially in resource-limited countries?
I don’t have plans specifically to expand these programs, but I do plan to focus on some aspects of our current programs. For example, ASCO’s International Cancer Corps, which is designed to improve the quality of cancer care at medical institutions in low- and middle-income countries through oncology training by ASCO member volunteers, has developed the ASCO Asia-Pacific Regional Council. Our goal is to set up similar regional councils in other parts of the world, where we can engage in bidirectional efforts to improve cancer care in areas where resources are limited. Hopefully, we can use the information we gain in areas in the United States, such as in inner-city clinics and rural communities.
During my term as ASCO President, I want to gain a better understanding of how to improve cancer care for more patients, wherever they are. Many of the pieces are already in place for success. We need, however, to connect the pieces and promote our thoughts to the next level. Everything that ASCO does is with the intent to improve equitable care for all patients with cancer. Part of my strategy for my presidential year is to strategically put steps in place that will have a long-lasting impact and will be woven into the fabric of ASCO.
Is that the enduring legacy you would like to leave on the Society?
If, during my time as President of ASCO, I can set up the metrics needed to inform how we can achieve equitable patient care that can be followed over time, it will be a significant step forward for the Society and for the patients we serve.
DISCLOSURE: Dr. Pierce owns stock or other ownership interests in PFS Genomics and holds intellectual property in PFS Genomics and UpToDate.
1. Pierce L, Fowble B, Solin LJ, et al: Conservative surgery and radiation therapy in black women with early stage breast cancer: Patterns of failure and analysis of outcome. Cancer 69:2831-2841, 1992.
2. Jemal A, Robbins AS, Lin CC, et al: Factors that contributed to black-white disparities in survival among nonelderly women with breast cancer between 2004 and 2013. J Clin Oncol 36:14-24, 2018.
3. Mendes E: More than 4 in 10 cancers and cancer deaths linked to modifiable risk factors. Available at www.cancer.org/latest-news/more-than-4-in-10-cancers-and-cancer-deaths-linked-to-modifiable-risk-factors.html. Accessed March 24, 2020.
4. ASCO: Facts & figures: Diversity in oncology. Available at www.asco.org/practice-policy/cancer-care-initiatives/diversity-oncology-initiative/facts-figures-diversity. Presented March 24, 2020.