Innovation Can Advance Equitable Cancer Care
The North Star of an organization is its mission statement. At ASCO, no initiative gets the green light unless it can fulfill the Society’s mission. ASCO updated its mission statement in 2020 specifically to reinforce our goal of reducing disparities, changing it to read: “Conquering cancer through research, education, and promotion of the highest quality and equitable patient care.” Although equity has been a focus of ASCO from its beginnings, this update committed us to weave equity into every one of our initiatives.
All President-Elects of ASCO are tasked with choosing a theme for their presidency. The theme not only shapes the course of a presidency but of the Society as well. The ASCO team works with President-Elects to develop a theme that both reflects the needs of the cancer community and their passion. ASCO’s Immediate Past-President Lori J. Pierce, MD, FASTRO, FASCO, chose as her theme, “Equity: Every patient. Every day. Everywhere,” because it reflected her vision for equal access to equitable cancer care. I chose “Advancing Equitable Cancer Care Through Innovation,” because I believe innovation is a key path to reducing disparities in cancer care across the world.
Everett Vokes, MD, FASCO
Transforming Treatment and Patient Care
I have been committed to advancing innovations in oncologic care throughout my entire career. During my fellowship training and subsequent faculty appointment at the University of Chicago, I began exploring the hypothesis that combining radiation therapy and systemically dosed chemotherapy might lead to higher cure rates and allow for organ preservation in patients with some advanced cancers. Through sequential clinical trials, my team and I found that certain induction chemotherapies integrating novel drugs and regimens of concurrent radiotherapy could increase cure rates in advanced head and neck cancers and non–small cell lung cancer, and the principles have since been applied to esophageal cancer and other solid tumors.
The past 50 years of cancer research have transformed treatment and patient care with innovations like this one. Unfortunately, progress is uneven, and deep-seated disparities remain in limiting access to the best prevention, detection, and treatment approaches. In the next decade, we need to focus our efforts and innovation on ensuring equity for patients across the spectrum of diagnosis, care, and survivorship.
This process starts with connecting the oncology community worldwide. In some ways, I experienced this connectivity before technology made it truly possible. I was born in New York City but moved with my mother to Bonn, West Germany, as a child. I received my medical degree at the University of Bonn Medical School before returning to the United States to complete my residency. Although I have since practiced in the United States, I have always felt a kinship with European oncology as well.
By expanding innovations that cross boundaries, we can bring down barriers to access and make care more equitable, convenient, and efficient for patients worldwide. ASCO is working toward this goal in many ways.
By expanding innovations that cross boundaries, we can bring down barriers to access and make care more equitable, convenient, and efficient for patients worldwide.— Everett Vokes, MD, FASCO
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Making Advancements Available Globally in Real Time
When I started my career as an oncologist, scientific advances were shared in two ways: through studies published in print journals and abstracts presented at scientific meetings. These processes were lengthy, and the time required to disseminate information was substantial. Furthermore, access to the information was dependent on access to journals and/or meeting proceedings, and one can understand the significant lag time in this information being disseminated to underserved communities in the United States and in developing countries. Thanks to online publications and innovations in the conduction of virtual meetings, especially enhanced over the past 2 years of the COVID-19 pandemic, we do not have to wait to share novel discoveries and can have a global conversation about their implementation, taking regional differences into account.
The impact of COVID-19 also crystallized that today’s science simply can’t wait for the cycle of medical meetings. To meet this need, ASCO launched a monthly Plenary Series, a new educational program that allows researchers and clinicians to stay current on cutting-edge research in oncology in between meetings. Each month, up to two practice-changing and clinically relevant abstracts that impact the global oncology community are presented in a 1-hour online session. Each abstract presentation is accompanied by a discussant presentation and followed by a live question-and-answer session. ASCO’s Monthly Plenary Series was held monthly from November 2021 through April 2022 and will resume in July, following the 2022 ASCO Annual Meeting, being held on June 3 to 7.
It is also critical we share and shape advances that meet physicians and patients where they are. For example, an advancement based on next-generation mutation detection or novel cellular therapies may not be accessible in a country where the median monthly income is less than $300 a month. ASCO recognized that clinical practice guidelines for care in developed countries such as the United States and in Europe may not be applicable in developing countries. These latter countries need resource-stratified guidelines, which provide a practical framework for managing each individual patient, based on the level of health-care resources available in the country, region, or practice area where the care is being administered.
In addition, ASCO is working to fill this void with JCO Global Oncology, which provides a home for high-quality literature covering the wide array of challenges health-care professionals face in underserved settings. JCO Global Oncology is an online-only, open-access journal with articles that include resource-stratified guidelines, original reports, review articles, commentaries, correspondence/replies, special articles, and editorials.
The impact of COVID-19 crystallized that today’s science simply can’t wait for the cycle of medical meetings. To meet this need, ASCO launched a monthly Plenary Series....— Everett Vokes, MD, FASCO
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Advancing Equitable Care at the Practice Level
Sharing innovations faster and more broadly is one step, but supporting providers at the practice level is another. The pandemic demonstrated to the world that telemedicine provided opportunities to facilitate patient contact with reduced travel and wait times, especially from more remote areas. Even though the COVID-19 pandemic is receding, we should not let up on this progress and need to look at partnership opportunities with local providers to explore ways to improve patient care.
This also includes bringing the benefits of precision medicine into new areas, adopting innovative models for patient care, and using health information technology, and other innovations to improve long-term survivorship care. Accomplishing this task requires supporting oncology professionals at the individual practice level.
In the United States, ASCO and the Community Oncology Alliance (COA) have launched the Patient-Centered Cancer Care Certification program to help oncology group practices and health systems ensure they are meeting comprehensive, expert-backed standards for patient-centered care delivery. This pilot program, which is based on published oncology medical home standards, assesses practices and certifies they are meeting ASCO’s and COA’s oncology medical home standards; the program aims to reduce administrative burden for practices, provide an objective measurement for high-quality cancer care, and prepare practices to manage a rapidly changing environment.
At the global level, connecting oncologists is vital to facilitate global communication of best practices. ASCO is working toward making this happen with the hybrid format of in-person and virtual access for all its scientific meetings. In addition, the Society is working to reschedule its next Breakthrough meeting, which will bring together global leaders in oncology medicine, research, and technology with the goal of transforming cancer care. Unfortunately, ASCO had to cancel this year’s Breakthrough meeting because of the COVID-19 pandemic but is planning to hold the meeting in August 2023.
Thanks to technology and a greater commitment to equity, ASCO’s nearly 45,000 members in more than 150 countries—one-third of whom practice outside the United States—can experience an even greater level of connectivity, especially in the developing world. We are working to make this happen by convening global experts to spark new ideas and collaborations as well as fostering the research and exchange of ideas in cancer care delivery and prevention. These efforts can range from an eCourse on palliative care connecting Malaysian health professionals with others across the world to $20,000 grants to stimulate innovative cancer control solutions for low-resource practice environments.
We should be just as innovative about the ways we serve our patients as we are about developing new therapies.— Everett Vokes, MD, FASCO
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Making Clinical Trials More Accessible
The COVID-19 pandemic necessitated and accelerated the transition of clinical trials from being site-centered to patient-centered, and we should build on that progress even as the world continues to reopen. To lay out a path for doing this, ASCO put together a Road to Recovery Report1 to create a more equitable, accessible, and efficient clinical research system, which is supported by other oncology societies. Core components are continuing to bring innovatively designed clinical trials to patients everywhere, including in smaller urban and rural oncology practices, and to pioneer new ways to engage and enroll minority patients, so they can benefit fully from research. Regarding the latter, ASCO and the Association of Community Cancer Centers are working on a research site assessment tool and implicit bias training program to address why trials are not routinely being offered by clinicians to eligible patients, a major barrier to participation.
The past 2 years laid bare long-standing inequities across the world. As a global community of innovators, oncology professionals have unmatched potential to improve care for all patients, everywhere in the world. With that mindset, we should be just as innovative about the ways we serve our patients as we are about developing new therapies. ASCO is looking forward to participating in that discussion in collaboration with our partners in the United States and internationally.
Dr. Vokes is President of ASCO and John E. Ultmann Professor, Chair of the Department of Medicine, and Physician-in-Chief at the University of Chicago Medicine and Biological Sciences.
Disclaimer: This commentary represents the views of the author and may not necessarily reflect the views of ASCO or The ASCO Post.
DISCLOSURE: Dr. Vokes owns stock in Coordination Pharmaceuticals; has received honoria from AstraZeneca, Lilly, EMD Serono, Genentech, GlaxoSmithKline, Novartis, BeiGene, and BioNTech AG; has served as a consultant or advisor to AstraZeneca, Lilly, Novartis, EMD Serono, Genentech, GlaxoSmithKline, BeiGene, and BioNTech AG; has received research funding from AbbVie, Bristol Myers Squibb, Celgene, and Novartis; has received institutional research funding from Lilly; and has received reimbursement for travel, accommodations, and expenses from AstraZeneca, Lilly, EMD Serono, Genentech, GlaxoSmithKline, Novartis, BeiGene, and BioNTech AG. An immediate family member has served as a consultant or advisor to and received honoraria from Takeda, Radius Health, and Ascendis Pharma.
1. Pennell NA, Dillmon M, Levit LA, et al: American Society of Clinical Oncology Road to Recovery Report: Learning from the COVID-19 experience to improve clinical research and cancer care. J Clin Oncol 39:155-169, 2021.