Sybil R. Green, JD, RPh, MHA
Ensuring equitable cancer care for every patient, everywhere has been embedded into ASCO’s mission statement since the Society’s inception nearly 60 years ago. Nevertheless, events of the past year, including the ongoing COVID-19 pandemic, which has disproportionally impacted minority communities, and numerous high-profiled incidents of racial injustice, have reinforced that commitment.
This year, ASCO has put plans in place to strengthen its existing initiatives for equity in cancer care and is rolling out new programs and resources that aim to help members and the larger cancer community better understand and address health equity issues in all aspects of care. For example, ASCO’s programmatic work in antiracism and equity, diversity, and inclusion now encompasses new and expanded initiatives in research, professional development, public policy, membership, publishing, education, and care delivery.
To coordinate these initiatives, ASCO created a new position, Chief Diversity and Inclusion Officer, and named Sybil R. Green, JD, RPh, MHA, formerly ASCO’s Director of Strategic Initiatives in Policy and Advocacy, to lead this ambitious effort within both the cancer community and the Society.
Tackling Disparities in Cancer Care
In 2009, ASCO issued its first Policy Statement on Cancer Care Disparities, which affirmed the Society’s commitment to addressing disparities in cancer care and presented a comprehensive set of strategic commitments across three broad areas: enhancing awareness, improving access to care, and supporting research on health disparities. That statement guided ASCO’s work for a decade, leading to progress on Medicaid expansion, access to the 340B Drug Program, and initiatives related to addressing health disparities among sexual and gender minorities, among others.
“There is no way we can truly talk about cancer care without first thinking about how to ensure that every patient can benefit from the latest advances.”— Sybil R. Green, JD, RPh, MHA
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In August 2020, ASCO updated its policy statement on cancer disparities and health equity to focus on four key areas: ensuring equitable access to high-quality care; ensuring equitable research; addressing structural barriers; and increasing awareness and action.1 In addition to addressing these issues in the larger cancer community, ASCO has established an internal Equity, Diversity, and Inclusion Task Force, which is co-chaired by Ms. Green, to examine potential inequities within ASCO’s workforce and to promote a culture of inclusion.
“ASCO is an employer, and we owe it to our staff to provide an environment in which everyone has equitable opportunities and career success,” said Ms. Green.
In a wide-ranging interview with The ASCO Post, Ms. Green discussed ASCO’s bold initiatives to advance health equity in cancer care, increase oncology workforce diversity, and improve clinical trial participation among underrepresented minority patients with cancer.
Ensuring Every Patient Benefits From Advances in Treatment
As ASCO’s new Chief Diversity and Inclusion Officer, how are you planning on meeting the Society’s goals to accelerate its programmatic work in antiracism and equity, diversity, and inclusion in cancer care? Are there initiatives to help improve patient health literacy?
This is an exciting time for ASCO. Advancing health equity isn’t a new area for us, but one that has been pushed to the forefront due to the events of the past year, including the onset of the COVID-19 pandemic and frequent episodes of racial injustice we have witnessed. I’m proud that health equity has been part of our mission from day one, and it lies at the heart of everything we do.
There is no way we can truly talk about cancer care without first thinking about how to ensure that every patient can benefit from the latest advances. Despite all the progress that has been made in cancer care over the past 50 years, we recognize that there is still inequity in how that care is delivered.
We need to work on how to focus our efforts to accomplish the goal of conquering cancer through the highest-quality equitable care, including ensuring that more minority patients are represented in clinical trials. Through our website, asco.org, and our meetings, we aim to empower our members to become engaged in efforts to improve health equity. For example, we provide members with the tools and resources they need to address the specific concerns of their patients, including health equity issues in cancer research and care. We also have a dedicated Web page (asco.org/equity) that includes a wide range of information and resources to help ASCO members and the larger cancer community better understand and address equity issues in cancer research and care.
We are working very closely with patient advocacy organizations to make sure that we are doing what is necessary to help our members communicate effectively with their patients regarding their rights in taking an active role in their care and in dealing with insurance companies and other situations related to health coverage. In addition, our patient information website, Cancer.Net, is dedicated to providing evidence-based information to people with cancer and their families and caregivers.
Increasing Minority Representation in Clinical Trials
In July 2020, ASCO and the Association of Community Cancer Centers (ACCC) launched a pilot project to recruit more than 40 oncology research sites to participate in a site assessment and implicit bias training program to improve diversity in cancer clinical trials. What is the status of this effort, how many sites have signed on to the program, and are there any results to report so far?
I am thrilled to share with you that when we launched this program, our goal was to enroll 40 investigative sites to identify opportunities to increase clinical trial participation among underserved racial and ethnic patient populations. We received an enthusiastic response to our call for site participation and have expanded the number of trial sites to 75 across the country.
The assessment tool will evaluate structural and procedural considerations that may affect patient screening and participation in clinical trials. Later this fall, we will be launching the implicit bias training program, which will have an institutional component and an individual aspect, and we should have preliminary results very soon.
Addressing Structural Barriers That Increase Health Disparities
In 2020, ASCO also published its policy statement on Cancer Disparities and Health Equity, which expands on ASCO’s recommendations in its first policy statement on Cancer Care Disparities published in 2009. The new policy statement is focused on four key areas: ensuring equitable access to high-quality oncology care, ensuring equitable research, addressing structural barriers, and increasing awareness and action.1What is ASCO’s action plan to accomplish these goals?
What has happened between 2009, when ASCO published its first policy statement on cancer disparities, and now is the recognition that we could no longer just focus on health disparities and needed to find ways to confront the systems that created those disparities in cancer prevention, treatment, and research participation and work to eliminate those disparities. As you mentioned, the statement describes the four very broad buckets where we could have an impact in ensuring equitable access to care and research, focusing on the structural barriers to equitable care, and raising awareness and action through education campaigns; collaborations among oncologists, patients, and advocacy groups to drive action; and engagement with state, local, and national policymakers to drive acceptance of proven solutions.
“Ultimately, our goal is to improve equitable, high-quality cancer care for all patients, no matter their geographic location.”— Sybil R. Green, JD, RPh, MHA
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The work of health equity is happening on the ground where patients live, so part of our strategic plan is making sure that all ASCO members are aware of the health inequities that are happening with their patients. Later this year, we will be announcing additional details of the strategic plan. This is just the beginning of a long, long march forward.
We no longer think of ASCO’s Equity, Diversity, and Inclusion commitment as a separate initiative but are working to integrate its programmatic work in antiracism and equity into everything ASCO does to have the greatest impact.
Advocating for Change
As Chief Diversity and Inclusion Officer, will you be initiating new lobbying efforts on Capitol Hill to improve diversity in health care, especially for underserved populations, to ensure that payment for health care is the same for every patient, and to advocate that health equity become a metric for Medicaid managed-care organizations?
Health equity has always been an advocacy priority for ASCO, including ensuring passage of the Clinical Treatment Act, H.R.913, which Congress passed this past December and that requires Medicaid to cover routine care costs for patients with life-threatening conditions who are enrolled in clinical trials.2 Our next advocacy effort will be to see that the law is implemented in a way that ensures increased access to clinical trials as intended throughout the United States.
In terms of Medicaid managed-care organizations, we will, through our regulatory advance work, continue to weigh in on opportunities to eliminate barriers to care that arise as a result of different policies being moved forward by the various managed-care entities.
With regard to LGBTQ patients, in 2017, ASCO published its position statement on strategies for reducing cancer health disparities among sexual and gender minority populations, which outlined recommendations to address the needs of this patient population affected by cancer, as well as members of the oncology workforce who identify as sexual and gender minorities.3 We have done some work to understand how we can start collecting data on sexual and gender minority patient issues, and once we have the data and understand what those issues are, we will increase our advocacy work in that area.
Growing a Diverse Oncology Workforce
In 2017, ASCO launched its 3-year strategic plan for Increasing Racial and Ethnic Diversity in the Oncology Workforce, which had three primary goals: establish a pathway for increasing workforce diversity, enhance diversity within ASCO leadership, and integrate a focus on diversity across ASCO’s programs and policies.4 Please talk about the results from the strategic plan. Are you seeing more minority physicians entering the oncology workforce; and what education initiatives, such as mentoring, is ASCO launching to increase the diversity of the oncology workforce?
A lot of work has been done in this area since we published the Increasing Racial and Ethnic Diversity in the Oncology Workforce strategic plan, including programs such as the Medical Student Rotation, the Annual Meeting Research Award, and the Diversity Mentoring Program.
This past summer, ASCO added the Oncology Summer Internship pilot to the strategic plan to further encourage medical students to enter the field of oncology. Much of this strategic plan is focused on underrepresented minorities, including Black, Latinx, Hispanic, Alaska Native, and Native American students.
The Oncology Summer Internship pilot is a 4-week immersive program for approximately 30 second-year medical students annually. Students will participate in daily virtual cancer education seminars created by ASCO while also learning from local leaders in their medical institutions and communities through mentoring; this way, they have the opportunity to understand what the field of oncology is all about. We were successful in partnering with five medical schools in 2021 and hope to ramp up the program next year.
In 2020, we also launched a free Social Determinants of Health educational series, which is geared toward oncology trainees and early-career faculty. However, all members of the oncology community are invited to access the information to increase their knowledge about the social determinants of health. A link to this series can be found at asco.org/equity.
Supporting ASCO Members in Addressing Equity Within Their Practices
According to a survey ASCO conducted this past year to assess members’ awareness about health equity in cancer care, most respondents said they did not feel prepared to address health disparities and would like scripts for addressing equity with their patients, as well as additional training on social determinants of health.5 Is ASCO developing a health equity and action plan that is concordant with ASCO’s equity, diversity, and inclusion strategic priorities for members?
Are we planning to launch an awareness and action campaign? Absolutely, yes. Understanding that our members want the tools, the support, and the guidance in how to address health equities, we are developing a health equity and action plan that will be in sync with ASCO’s equity, diversity, and inclusion strategic priorities and activities.
As you mentioned, the findings from the Perceptions of Health Equity survey suggest that the ASCO action plan include audience segmentation, with tailored messaging or tactics for different cohorts of our membership. We are planning a follow-up survey in 2022 to see how cross-sectional perceptions have changed and to capture trend data.
In the meantime, we have relaunched ASCO’s Health Equity Web page (asco.org/equity), which has information on all the work we have done to date and resources members can access. We are also working with our state affiliates to discuss opportunities for community engagement, so we can understand from the ground up what community members’ needs are and work with them to resolve those needs.
Improving Health Equity Globally
A large percentage of ASCO members come from countries outside the United States. What is ASCO doing to improve health equity for patients with cancer in other countries, especially in low- and middle-income countries?
We recognize that although every country, including the United States, has its unique issues regarding health equity, there are some common problems that pose barriers to care. We have been working with our international members and partners to better understand what those issues are, so we can collaborate on a global scale to address them.
One way we have been working with other countries to improve oncology care for patients globally is through our Quality Oncology Practice Initiative (QOPI®), which is now available in several countries outside of the United States, including Argentina, Australia, Brazil, India, the European Union, Mexico, New Zealand, Pakistan, Philippines, and Saudi Arabia. We also hope to expand the program in low- and lower-middle-income countries with the goal of introducing the concept and value of measuring quality improvement.
Ultimately, our goal is to improve equitable, high-quality cancer care for all patients, no matter their geographic location.
DISCLOSURE: Ms. Green reported no conflicts of interest.
1. Patel MI, Lopez AM, Blackstock W, et al: Cancer disparities and health equity: A policy statement from the American Society of Clinical Oncology. J Clin Oncol 38:3439-3448, 2020.
2. H.R.914—Clinical Treatment Act. Available at www.congress.gov/bill/116th-congress/house-bill/913. Accessed September 23, 2021.
3. Griggs J, Maingi S, Blinder V, et al: American Society of Clinical Oncology position statement: Strategies for reducing cancer health disparities among sexual and gender minority populations. J Clin Oncol 35:2203-2208, 2017.
4. Winkfield KM, Flowers CR, Patel JD, et al: American Society of Clinical Oncology strategic plan for increasing racial and ethnic diversity in the oncology workforce. J Clin Oncol 35:2576-2579, 2017.
5. ASCO: ASCO domestic member survey: Perceptions of health equity (December 2020–February 2021), a summary. Available at www.asco.org/sites/new-www.asco.org/files/content-files/about-asco/documents/2021-ASCO-Domestic-Member-Equity-Survey-Summary.pdf. Accessed September 23, 2021.