POPULARITY
3 episodes with cancer disparities
3 episodes with cancer disparities
3 episodes with cancer disparities
3 episodes with cancer disparities
4 episodes with cancer disparities
3 episodes with cancer disparities
2 episodes with cancer disparities
2 episodes with cancer disparities
2 episodes with cancer disparities
In today's episode, Dr. Mitchell Posner, Dr. Sarah Shubeck, and Dr. Jelani Williams on the University of Chicago Medicine's new Comprehensive Cancer Center. Scheduled to open in 2027, the new center is a seven-floor, 575,000-square-foot building planned to have 80 private beds and 90 consultation and outpatient rooms. At the moment, the center is anticipated to see 200,000 outpatient visits and 5000 inpatient admissions annually. This would be the city of Chicago's first freestanding cancer pavilion.How will we ensure that this new center prioritizes the community's needs? In Chicago's South Side, cancer death rates are twice the national average, and cancer is also the second-leading cause of death on the South Side behind heart disease. In this conversation, you'll hear about the center's development, what patients can expect, and most importantly, the Department of Surgery's commitment to ensure the cancer center supports those who are most vulnerable. Dr. Mitchell Posner is the Thomas D. Jones Distinguished Service Professor of Surgery, Chief of the Section of General Surgery, and the Chief Clinical Officer of the University of Chicago Medicine Comprehensive Cancer Center. From clinical trials for cancer treatment to his more than 250 articles, abstracts, and book chapters, Dr. Posner is a leading authority in the management of upper gastrointestinal cancers. He is frequently voted among the country's best doctors. He is the past president of the Society of Surgical Oncology. He is deputy editor of the Annals of Surgical Oncology and section editor for the gastrointestinal cancer section of the journal Cancer. He served as chairman of the Gastrointestinal Committee of the American College of Surgeons Oncology Group (ACOSOG).Dr. Sarah Shubeck is an Assistant Professor in the Department of General Surgery. She is a Breast Surgical oncologist specializing in breast surgery, cancer, and benign disease treatment. In addition to her clinical practice, Dr. Shubeck's research has been published in many journals including Cancer, JAMA Surgery, and Annals of Surgical Oncology.Dr. Jelani Williams is a 5th-year general surgery resident at the University of Chicago. He is an aspiring surgical oncologist and attended the Eastern Virginia Medical School. He has published research on predictive models and surgery for metastatic pancreatic neuroendocrine tumors as well as the use of machine learning to distinguish benign and malignant thyroid nodules amongst other topics. Deep Cuts: Exploring Equity in Surgery comes to you from the Department of Surgery at the University of Chicago, which is located on Ojibwe, Odawa and Potawatomi land.Our executive producer is Tony Liu. Our senior producers are Alia Abiad, Caroline Montag, and Chuka Onuh. Our production team includes Megan Teramoto, Ria Sood, Ishaan Kumar, and Daniel Correa Bucio. Our senior editor and production coordinator is Nihar Rama. Our editorial team also includes Beryl Zhou and Julianna Kenny-Serrano. The intro song you hear at the beginning of our show is “Love, Money Part 2” from Chicago's own Sen Morimoto off of Sooper Records. Our cover art is from Leia Chen.A special thanks this week to Dr. Jeffrey Matthews — for his leadership, vision, and commitment to caring for the most vulnerable in our communities. Let us know — what have you most enjoyed about our podcast. Where do you see room for improvement? You can reach out to us on Instagram @deepcutssurgery. Find out more about our work at deepcuts.surgery.uchicago.edu.
In this episode of the Bench to Bedside podcast, Dr. Roy Jensen, vice chancellor and director of The University of Kansas Cancer Center, engages in an insightful conversation with Dr. Robert Winn, Director and Lippman Chair in Oncology at Massey Comprehensive Cancer Center at Virginia Commonwealth University. They discuss Dr. Winn's pioneering work in cancer research and health equity, especially focusing on underserved communities. The episode highlights the significance of the Inclusive Excellence initiative Dr. Winn is leading as president of the American Association of Cancer Institutes (AACI), as well as disparities in cancer care in rural areas, the exciting advancements in immunotherapy and molecular therapies, and the essential role of trust and communication in healthcare. The dialogue underscores the critical need for appropriate investment in cancer research to continue making significant strides in reducing cancer mortality and improving patient outcomes. Do you have questions about cancer? Call our Bench to Bedside Hotline at (913) 588-3880 or email us at benchtobedside@kumc.edu, and your comment or question may be shared on an upcoming episode! If you appreciated this episode, please share, rate, subscribe and leave a review. To ensure you get our latest updates, For the latest updates, follow us on the social media channel of your choice by searching for KU Cancer Center. Links from this Episode: Learn more about Dr. Robert Winn Read about the AACI Inclusive Excellence initiative Learn about the National Cancer Institute and the designated cancer centers program
On this episode of EquiTEA, Dorothy and Lupita had a chance to connect with breast cancer survivor, Kara Adams and Pink Ribbon Place Health Educator, Davi Wilson. This conversation explores how breast cancer disproportionately affects communities of color and highlights the importance of early detection and preventative measures, including self-exams, mammograms and regular check ups. Listen as Kara shares her personal journey with breast cancer and Davi shares available resources and support Pink Ribbon Place offers to those impacted by cancer and their families. To find out more about Pink Ribbon Place and how to get involved, please visit: https://pink.rchf.org/
Today, we're joined by Bada Pharasi, CEO of IPASA, who will share how IPASA aims to bridge these critical gaps. With a focus on policy reform, strategic partnerships, and increased advocacy, IPASA is not only raising awareness but pushing for actionable change to ensure that every woman, regardless of background, has access to life-saving cancer care. Let's delve into how these initiatives aim to transform breast cancer care in South Africa.See omnystudio.com/listener for privacy information.
Dr. Bersu Ozcan and Dr. Jessica Porembka dive into the critical issue of breast cancer disparities among underserved women in the U.S. Breast Cancer Disparity and Outcomes in Underserved Women. Ozcan et al. RadioGraphics 2024; 44(1):e230090.
Dr. Erin Kobetz is Vice Provost for Research and Tenured Professor in the Departments of Medicine, Public Health Sciences, and Obstetrics and Gynecology at the University of Miami, Miller School of Medicine. Additionally, she is Associate Director of Population Science and Cancer Disparities at UM's Sylvester Comprehensive Cancer Center (SCCC), as well as, the Chief of Population Health and Cancer Disparities for UHealth Oncology Service line. Dr. Kobetz also serves as Program Director for the Community Engagement and Multidisciplinary Team Science Components of UM's Clinical Translational Science Institute (CTSA). She earned a Master's in Public Health from Rollins School of Public Health at Emory University in 1999, and joined the University of Miami in September of 2004, after completing her Ph.D. at the University of North Carolina at Chapel Hill, Gillings School of Public Health. Soon after, Dr. Kobetz established Patnè en Aksyon (Partners in Action), Sylvester's first ever campus community partnership in Little Haiti, the largest enclave of Haitian settlement, and remains committed to integrating diverse stakeholders into the translational research continuum.
Dr. Erin Kobetz is Vice Provost for Research and Tenured Professor in the Departments of Medicine, Public Health Sciences, and Obstetrics and Gynecology at the University of Miami, Miller School of Medicine. Additionally, she is Associate Director of Population Science and Cancer Disparities at UM's Sylvester Comprehensive Cancer Center (SCCC), as well as, the Chief of Population Health and Cancer Disparities for UHealth Oncology Service line. Dr. Kobetz also serves as Program Director for the Community Engagement and Multidisciplinary Team Science Components of UM's Clinical Translational Science Institute (CTSA). She earned a Master's in Public Health from Rollins School of Public Health at Emory University in 1999, and joined the University of Miami in September of 2004, after completing her Ph.D. at the University of North Carolina at Chapel Hill, Gillings School of Public Health. Soon after, Dr. Kobetz established Patnè en Aksyon (Partners in Action), Sylvester's first ever campus community partnership in Little Haiti, the largest enclave of Haitian settlement, and remains committed to integrating diverse stakeholders into the translational research continuum.
Lung cancer is the largest cancer contributor to the life expectancy gaps between Māori and non-māori, being the leading cause of death for Māori women and the second leading cause of death for Māori and non-māori men. In spite of this, Aotearoa has no national lung cancer screening program at all, even though similar programs exist for Breast, cervical and bowel cancer. To address this, a team of researchers at the University of Otago started a series of projects in collaboration with Te Whatu Ora to help develop a lung cancer screening pathway in Aotearoa, which they've called Te Oranga Pūkahukahu. Oto spoke to study lead Sue Crengle, Senior Māori Health Researcher at the University of Otago of Kāi Tahu, Kāti Māmoe and Waitaha descent, to discuss the project and the impacts of lung cancer on Māori.
On this episode of EquiTEA, we are celebrating Black History Month and highlighting National Cancer Prevention Month. Greg and Lupita had the opportunity to meet with Dr. Steve Serrao Chief of Gastroenterology at Riverside University Health System- Medical Center to discuss how the Black/African-American community is disproportionately impacted by Colorectal Cancer and amplify the importance of early screening. To schedule an appointment for screening at RUHS, please visit www.ruhealth.org or call (800) 720- 9553
What disparities exist in cancer screening and how does this impact patient outcomes? Listen to our latest podcast episode with Kilan Ashad-Bishop (American Cancer Society) to find out about the intersection between science, health, and society.
Carol and Dr. Lannis Hall unpack Cancer disparities in the St. Louis Black Community, causes and prevention, and the need for research participation. To experience more from Listen, St. Louis visit ninepbs.org/listenstlouis.
In this weekend health update, Fred Bodimer discusses the crucial need for COVID vaccination, highlighting a study suggesting that a universal vaccine could save lives and prevent infections. The episode also covers a UK study examining healthcare disparities in breast cancer treatments, shedding light on the challenges faced by elderly patients and people of color. Another segment explores the surprising findings of a study on microplastics in water bottles, emphasizing potential health implications.
In this episode, Anousha invited Beatrice Zovich, program manager at the Hepatitis B Foundation along with Rensely and Kenson, who are members of the Micronesian community and reside in Hawaii. As part of the Liver Cancer Disparities Project, Rensely and Kenson shared details about their experience with participating in the focus group discussions of the project.Support the showOur website: www.hepb.orgSupport B Heppy!Social Media: Instagram - Twitter - Facebook
On the CBS News Weekend Roundup with Stacy Lyn, Holly Williams reports from Tel Aviv on the turmoil in Israel and Gaza. And who will be the next Speaker of the House? Our Nikole Killion reports. It's Breast Cancer Awareness month. In the Kaleidoscope, we learn about the disparities between black and white women when it comes to this disease. We with Dr. Vivian Bea, the Section Chief of Breast Surgical Oncology at NewYork- Presbyterian Brooklyn Methodist Hospital and a breast surgeon at Weill Cornell Medicine.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.
Better Edge : A Northwestern Medicine podcast for physicians
In this Better Edge podcast episode, Adam Murphy, MD, delves into a critical and often overlooked aspect of healthcare—prostate cancer disparities among minority populations, particularly Black men. Dr. Murphy's pioneering research has uncovered new ways to address disparities, from refining cancer nomograms to integrating advanced genomics into patient care. He also discusses his impactful online workshop that enhances urologists' shared decision-making skills, fostering equitable healthcare for all.
Dr Ashwani Rajput speaks with Maureen Umeh, a reporter and anchor for FOX 5 in Washington DC, about her career in news, serving as a voice for immigrant communities, and tackling health disparities in the nation's capital.
In this inspiring video, Elena Martinez, Ph.D., shares her journey as a first-generation student from Mexico who dedicated herself to a career in cancer epidemiology, prevention, and disparities. Dr. Martinez emphasizes the transformative power of education as a means of empowerment and opportunity. She candidly discusses the cultural and societal barriers she faced and the unwavering support from her family that fueled her determination to succeed. Dr. Martinez also underscores the significance of representation and diversity in the scientific community, emphasizing the need to break down barriers and create more opportunities for underrepresented individuals in STEM fields. Series: "Education Channel" [Health and Medicine] [Education] [Show ID: 38746]
In this inspiring video, Elena Martinez, Ph.D., shares her journey as a first-generation student from Mexico who dedicated herself to a career in cancer epidemiology, prevention, and disparities. Dr. Martinez emphasizes the transformative power of education as a means of empowerment and opportunity. She candidly discusses the cultural and societal barriers she faced and the unwavering support from her family that fueled her determination to succeed. Dr. Martinez also underscores the significance of representation and diversity in the scientific community, emphasizing the need to break down barriers and create more opportunities for underrepresented individuals in STEM fields. Series: "Education Channel" [Health and Medicine] [Education] [Show ID: 38746]
In this inspiring video, Elena Martinez, Ph.D., shares her journey as a first-generation student from Mexico who dedicated herself to a career in cancer epidemiology, prevention, and disparities. Dr. Martinez emphasizes the transformative power of education as a means of empowerment and opportunity. She candidly discusses the cultural and societal barriers she faced and the unwavering support from her family that fueled her determination to succeed. Dr. Martinez also underscores the significance of representation and diversity in the scientific community, emphasizing the need to break down barriers and create more opportunities for underrepresented individuals in STEM fields. Series: "Education Channel" [Health and Medicine] [Education] [Show ID: 38746]
In this inspiring video, Elena Martinez, Ph.D., shares her journey as a first-generation student from Mexico who dedicated herself to a career in cancer epidemiology, prevention, and disparities. Dr. Martinez emphasizes the transformative power of education as a means of empowerment and opportunity. She candidly discusses the cultural and societal barriers she faced and the unwavering support from her family that fueled her determination to succeed. Dr. Martinez also underscores the significance of representation and diversity in the scientific community, emphasizing the need to break down barriers and create more opportunities for underrepresented individuals in STEM fields. Series: "Education Channel" [Health and Medicine] [Education] [Show ID: 38746]
In this inspiring video, Elena Martinez, Ph.D., shares her journey as a first-generation student from Mexico who dedicated herself to a career in cancer epidemiology, prevention, and disparities. Dr. Martinez emphasizes the transformative power of education as a means of empowerment and opportunity. She candidly discusses the cultural and societal barriers she faced and the unwavering support from her family that fueled her determination to succeed. Dr. Martinez also underscores the significance of representation and diversity in the scientific community, emphasizing the need to break down barriers and create more opportunities for underrepresented individuals in STEM fields. Series: "Education Channel" [Health and Medicine] [Education] [Show ID: 38746]
In this inspiring video, Elena Martinez, Ph.D., shares her journey as a first-generation student from Mexico who dedicated herself to a career in cancer epidemiology, prevention, and disparities. Dr. Martinez emphasizes the transformative power of education as a means of empowerment and opportunity. She candidly discusses the cultural and societal barriers she faced and the unwavering support from her family that fueled her determination to succeed. Dr. Martinez also underscores the significance of representation and diversity in the scientific community, emphasizing the need to break down barriers and create more opportunities for underrepresented individuals in STEM fields. Series: "Education Channel" [Health and Medicine] [Education] [Show ID: 38746]
In this inspiring video, Elena Martinez, Ph.D., shares her journey as a first-generation student from Mexico who dedicated herself to a career in cancer epidemiology, prevention, and disparities. Dr. Martinez emphasizes the transformative power of education as a means of empowerment and opportunity. She candidly discusses the cultural and societal barriers she faced and the unwavering support from her family that fueled her determination to succeed. Dr. Martinez also underscores the significance of representation and diversity in the scientific community, emphasizing the need to break down barriers and create more opportunities for underrepresented individuals in STEM fields. Series: "Education Channel" [Health and Medicine] [Education] [Show ID: 38746]
In this inspiring video, Elena Martinez, Ph.D., shares her journey as a first-generation student from Mexico who dedicated herself to a career in cancer epidemiology, prevention, and disparities. Dr. Martinez emphasizes the transformative power of education as a means of empowerment and opportunity. She candidly discusses the cultural and societal barriers she faced and the unwavering support from her family that fueled her determination to succeed. Dr. Martinez also underscores the significance of representation and diversity in the scientific community, emphasizing the need to break down barriers and create more opportunities for underrepresented individuals in STEM fields. Series: "Education Channel" [Health and Medicine] [Education] [Show ID: 38746]
Increasing diversity in the field of oncology is an ongoing task. Our next guest has made it her mission to increase those ranks as well as becoming the first African American woman to be a Brigadier General in the US Air Force. Dr. Edith Mitchell describes her early years growing up in rural Tennessee (2:52), the motivation for joining the Air Force in the 70's (7:33) and strategizing to increase ethnic diversity in medicine and oncology (16:53). Speaker Disclosures Dr. David Johnson: Consulting or Advisory Role – Merck, Pfizer, Aileron Therapeutics, Boston University Dr. Patrick Loehrer: Research Funding – Novartis, Lilly Foundation, Taiho Pharmaceutical Dr. Edith Mitchell: Leadership – Corvus; Honoraria - Sanofi, Exelixis; Consulting or Advisory Role Company - Genentech, Novartis, Merck, Bristol Myers Squib; Speakers' Bureau – Ipsen; Research Funding Company - Genentech, Sanofi Resources (related podcasts, courses or articles) If you liked this episode, please follow the show. To explore other educational content, including courses, visit education.asco.org. Contact us at education@asco.org. TRANSCRIPT Disclosures for this podcast are listed on the podcast page. Pat Loehrer: Welcome to Oncology, Etc., an ASCO Education Podcast. I'm Pat Loehrer, Director of Global Oncology and Health Equity at Indiana University. Dave Johnson: And I'm Dave Johnson, a Medical Oncologist at the University of Texas Southwestern in Dallas. If you're a regular listener to our podcast, welcome back. If you're new to Oncology, Etc., the purpose of the podcast is to introduce our listeners to interesting and inspirational people and topics in and outside the world of oncology. Pat Loehrer: Imagine knowing in your heart what you wanted to be in life. It usually takes people decades to figure that out, but our next guest knew at age three that she wanted to be a doctor and, later in high school, to be an oncologist. She's achieved much in her lifetime and has incorporated the "pay it forward" by mentoring many others. Dave Johnson: Our guest today is Dr. Edith Mitchell. I first met Edith over 40 years ago when we were both starting out our careers as junior faculty. She grew up in rural Tennessee, and as Pat mentioned, remarkably, she chose a career in oncology at a very early age in high school, despite the fact that oncology was barely a specialty at that time and the lack of role models, particularly role models of color, and women in particular. She received a Bachelor of Science degree in Biochemistry with distinction from Tennessee State University and a medical degree from the Medical College of Virginia and Richmond. In 1973, while still attending medical school, Edith joined the Air Force, receiving a commission through the Health Profession Scholarship Program, and eventually rose to the rank of Brigadier General. She completed a residency in internal medicine at Meharry Medical College in Nashville and a fellowship at Medical Oncology at Georgetown University. Her research interests are broad and involve new drug evaluation, development of new therapeutic regimens, combined modality therapy strategies, patient selection criteria, and supportive care for patients with gastrointestinal malignancies. She is the leader of the GI oncology program at Jefferson Medical College, Director of the Center to Eliminate Cancer Disparities, and Enterprise Vice President for Cancer Disparities at Jefferson's Sidney Kimmel Cancer Center. She's held a number of leadership positions, including those in ASCO, and she's a former president of the National Medical Association. I could go on forever. So, Edith, welcome, and thanks for joining us on Oncology, Etc. Dr. Edith Mitchell: And thank you so much for the invitation, Dave and Pat, it is a pleasure. Dave Johnson: You grew up on a farm, as I recall, in Tennessee. Perhaps you could tell us a little about your early life. Dr. Edith Mitchell: I grew up on a farm that my great grandfather's mother received about 1863 when the Emancipation Proclamation was made. I was the fifth child in my family. My parents were working, my older siblings were in school, so my great-grandparents were my babysitters, so I spent a lot of time with them. He was 89 at the time, became ill, and I overheard family members and neighbors say that they couldn't take him to the hospital because Blacks were not treated properly in the hospital, so they were going to take care of him at home. A physician made a house call. When he left, I told my great-grandfather, “Pa, when I grow up, I'll be a doctor just like Dr. Logan and I'll make sure you get good health care.” So, at three years, I decided I would become a doctor and I would make sure that Blacks received good health care. My work in disparity started when I was three. So, after my sophomore year in high school, there was a National Science Foundation program in Memphis at LeMoyne-Owen College. So, I applied and was accepted. And part of the time in Memphis that year, we were given opportunities to go to St. Jude. So my time at St. Jude made the decision that I would become an oncologist. I became really fascinated by cancers and in pathology, use of the microscope, and how cancers were all different, how they varied from the normal tissue for areas such as the colon or the stomach or the pancreas. Dave Johnson: It's amazing that that early in your life you made that kind of decision. Can I back up just one moment? I want to ask you briefly about the doctor that visited your great-grandfather, Dr. Logan. Dr. Edith Mitchell: Dr. Logan was a family physician, African American, and he had a great interest in Blacks being healthy. In fact, when the polio vaccine was made public, Blacks could only go one day per week because you couldn't go the times when whites were there. Dr. Logan obtained the vaccine and he would line the children up at his office. He gave me my first polio vaccine. He was a very handsome man. And, you know, Dave, I found out later that the medical school that he attended in Memphis was one of the ones closed as a result of the 1910 Flexner Report. So he had to go to Meharry in Nashville and take other courses to maintain his license to practice medicine. Pat Loehrer: Were you the first one to go into medicine? Tell me about that background and how your family influenced you personally. Dr. Edith Mitchell: Neither of my parents finished 8th grade, but they were very smart. They pushed their seven children to do well. They provided educational materials in our home and encouraged us to work and to take advantage of opportunities. Dave Johnson: Let's move forward a little bit. I thought I knew a lot about you, Edith, but I didn't realize that you were a Brigadier General. What was the motivation for joining the service in the ‘70s when you were at med school? Was it scholarship funding, or was there just patriotic zeal or a little of both? Dr. Edith Mitchell: My main objective was, for financial reasons - a scholarship covering all expenses of medical school, plus a monthly stipend. When I was in medical school, one of my laboratory instructors told me about this new scholarship program, and I said, "Okay, I just want to graduate from medical school." So he says, "Well, I know people in the surgeon general's office. I'll have them send you the information." He did, and I looked at it and didn't remember David, that my husband filled out the application. After my neurosciences final exam, I came home, and he says, "Your commission came in the mail today." So I said, "Okay." He says, "Well, I can swear you in. We can't do it at home because you have to have a witness. You take a nap, and then we're going out to job control, which was where all the aircraft controlled, the control room." We went there. We've got a picture of the swearing-in, and we then went to the officers club. It was Friday, and there were lots of people in his group from the Air Force Academy, from Citadel, Virginia Tech, and others. And they were all talking. "Yeah, Edith got a mail-order commission.” So I owed the Air Force two years, and I practiced at Andrews Air Force Base, which was the presidential squadron. You hear the president always leaving Andrews Air Force Base. So I think I was 29 maybe, but I was young, and here I was taking care of senators and other important people in government, and these are people I'd only seen on TV before. So I had a really good experience. I received many accolades, but also many letters from people for whom I cared for. And I was therefore invited to stay on in the Air Force, either go to Walter Reed or to San Antonio. I said, "No, I'm going to Georgetown." So one of the VIPs, if I mentioned his name, you would know, said and wrote a letter for me that the Air Force should give me whatever I wanted and whatever I needed to continue in the Air Force. So I received my Air Force pay while I was a fellow at Georgetown. So I stayed on. I got promoted early and engaged in Air Force work. I loved it, and I did well in that atmosphere and stayed on. After my second child was born, I decided I could not continue active duty and take care of two kids. So I left the Air Force, went to the University of Missouri, and someone called me one day and said, "You know, I hear you are at the University of Missouri now. Would you consider joining the National Guard?" I went, “ Joining the National Guard? Why would the National Guard want an oncologist?” And the information was, the Air National Guard wants good doctors, and you've got a great record. They invited me to St. Louis to just see the National Guard squadron there. I filled out the application while I was there and in a few days was appointed to the National Guard. So after being there for a few years, I was discussing with one of the higher-ranking people in the National Guard who was in Washington, but visiting St. Louis. He said to me, "You know, you've done great work." He had gone through my record, and he said, "And you know, you're one of the people being considered to be in a group for promotion. Promotion at that time meant that it was a higher rank." So he said, "There's one thing you don't have in your records, however, and other competitors in your group have." I said, "What's that?" “You haven't been to flight school.” I said, "Okay." He said, "And everybody who is going to be competing with you will have gone to flight school, and having a flight record will be an important part." So I was in my 40s. My oldest child was 14. I went to flight school and I got my certification, and obviously, I got promoted. And I am the first woman doctor to become a General in the history of the Air Force. And it was really interesting. I'm a Brigadier General. I'm invited to give a talk someplace, and there were lots of people there. So the person introducing me said, "And she is the first African American woman to become a General in the history of the United States Air Force." So I get up to speak and I thank him for this introduction. And I said, "Yes, I was the first Black woman physician to become a General. I said, but, you know, my ancestry says that I'm 30% something white. So I guess I was the first white woman, too." There was a big roar. But I loved every opportunity, and I worked hard at every opportunity. So when I was in the active duty Air Force, I was chief of the cancer center at Travis Air Force Base. So I made my application for research with the Northern California Oncology group, got, they said, one of the highest ratings of the applicants at that time. And I received a phone call from Air Force administration saying “Congratulations, but the Air Force cannot accept this funding from the National Cancer Institute.” There is a law saying you can't transfer money from one area of the government to the other, as they called it, a "gift," but it was a grant. So I call Phil Schein and I tell him about the situation. And he already knew that I had received a top report, and he knew that I had the grant before I knew. So he says, "Well, let's see what we can do.” Now, remember, Vince DeVita was the NCI Chair at that time and Dr. Rosenberg. At every ASCO meeting Phil, Vince, and Dr. Rosenberg would get together and they would bring their fellows. And Bill said, “Let me see what I can do.'" So somebody at NCI made some things happen. And I got this call from Saul Rosenberg. "Edith, congratulations." So I said, "Well, thank you, but I didn't expect a phone call from you." And he says, "Well, there have been some changes. Your grant, the face sheet has been changed." I said, "Oh.” Pat Loehrer: Your husband again. Dr. Edith Mitchell: I can't say who or what, but it had Stanford on it. So my grant went to Stanford. I'm sure they appreciated the kick you get. But Dr. Rosenberg said, "Your grant is now Stanford. We're setting up an account for you at Stanford, and the funding goes to Stanford.” So I had people working for me at the Air Force Cancer Center who were Stanford employees. Dave Johnson: Edith, there are still too few African American and particularly African American men in medicine. What's your perspective on that? Dr. Edith Mitchell: I think that many people are not given opportunities, and I've been concerned about Blacks and other racial and ethnic minorities not entering medicine, and particularly regarding oncology. So fewer than 5% of all practicing physicians in this country identify as Black. Little more than 5% identify as Hispanic. And I've been trying to do something about that. So ECOG-ACRIN has been very good about allowing me, and I set up with others, but I was the lead, a program for individuals - they could either be medical students, residents, fellows, or early faculty - to attend ECOG-ACRIN. And as a result of that program, we identified 12 individuals for each of the two ECOG-ACRIN annual meetings. We bring people in, and that has been a success. There's one person I introduced when she was a resident, she then did a fellowship in oncology, and it is now in her first year as faculty. And we have students mainly from Tennessee State. I do maintain very close relationships with Tennessee State, and I have the first Tennessee State student who has just been admitted to medical school at Jefferson. So trying to work with them. As a result of my work with the National Medical Association and the International Myeloma Foundation, we have a group of medical students that have been mentored for oncology. Whether they will become oncologists, I don't know, but they all 12 are doing well in medical school, and with some anticipation they might select oncology as their area of specialty. We set them up with an individual mentor, various oncologists around the country, and they have conducted research with their mentor. So I'm doing things that I think will be helpful to individuals. And I think we're not giving Blacks enough opportunities. Even in entering medical school, the number of Blacks entering most majority medical schools is still very low. Somewhere nine or ten students per year, Blacks entering medical schools. And also there has been a study conducted by the ACGME, which is the Accreditation Council for Graduate Medical Education, looking at graduate studies in oncology. Do you know that most of the oncologists have been trained at a few medical schools? And there are, I think it was 109 programs did not have a single minority student in the fellowship program. And that's terrible. I think that all fellowship programs should have some racial or ethnic fellows in their programs. Dave Johnson: Yeah. One of the disturbing statistics that I've read from the AAMC is that the number of African American men applying to medical school in 2023 and 2022 is actually less than the number that applied in the ‘70s. It's puzzling to me why we've not been able to attract young men into the medical profession, and perhaps it's because there's a sense of not being wanted or encouraged into the profession. More African American women are applying, but even that number is small, at least in terms of the increase in what we've seen. Pat Loehrer: Edith. You're also the Associate Director of Diversity Affairs at the Sidney Kimmel Cancer Center. What does the recent Supreme Court decision against Harvard in terms of admissions policy, how are you viewing that now at Jefferson? Dr. Edith Mitchell: So I think that the Supreme Court decision certainly was disappointing, but it is what it is, and we've got to deal with it. That is the Supreme Court. So my suggestion and what I am telling students that they have to do, you do have the essay. So when I applied to medical school, I did not talk about Dr. Logan, my growing up on the farm, or my parents not finishing 8th grade. But if I were applying to medical school now, I would use all of that background to include in my essay. And the Supreme Court didn't say that you couldn't include that information in your essay. It said the schools could not use your racial background as a part of the equation, but your letter is still there, and therefore, I would include all of that in the essay, so that you do have an advantage. We've just got to be able to do what we've got to do, not put the university or the medical school at risk because of the Supreme Court decision. But there's nothing in that decision that says you can't include that information in your letter. Dave Johnson: I have one question. What career advice would you offer your younger self? If you could speak to your 30-year-old self based on your knowledge, experience, what career advice would you give yourself? Dr. Edith Mitchell: So the one thing that I did not do when I was about 30 years old and I'm not sure I even knew about it, I think I could have done more in health policy, and the one thing that I have not done is become a White House fellow. And that's usually early in your career plan. But I think my research would have suffered had I done that. And I still say I don't know that I made bad choices. Dave Johnson: No, you didn't make bad choices. Knowing you, you could have been a White House fellow and done everything else you did. Pat Loehrer: And your husband did not make a bad choice either. Dave Johnson: Evidently not. Pat Loehrer: Edith, thank you so much for joining us. You've had such an incredible life, and it's so rich, and we deeply appreciate your spending time with us. I want to also thank all our listeners of Oncology, Etc, which is an ASCO Education Podcast. This is as you know, where we talk about oncology medicine and everything else. If you have an idea for a topic or guest you'd like to see on the show, please email us at education@asco.org. To stay up to date with the latest episodes and explore other educational content, visit education.asco.org. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.
On today’s episode, I am speaking with Dr. Narjust Florez, a thoracic medical oncologist and…
Dr. John Sweetenham and Dr. Neeraj Agarwal discuss advances across the spectrum of malignancies, including key studies in precision oncology and disparities in cancer care in advance of the 2023 ASCO Annual Meeting. TRANSCRIPT Dr. John Sweetenham: Hello, I'm Dr. John Sweetenham, now the associate director for cancer network clinical affairs at UT Southwestern's Harold C. Simmons Comprehensive Cancer Center, and host of the ASCO Daily News Podcast. I'm delighted to welcome Dr. Neeraj Agarwal, director of the Genitourinary Oncology Program and a professor of medicine at the University of Utah Huntsman Cancer Institute, who is editor-in-chief of the ASCO Daily News. Today we'll be discussing some key advances across the spectrum of malignancies, as well as novel approaches in precision medicine and cancer disparities that will be featured at the 2023 ASCO Annual Meeting. Our full disclosures are available in the transcript of this episode, and disclosures of all guests on the podcast can be found on our transcripts at asco.org/DNpod. Neeraj, it's great to have you back on the podcast today. Dr. Neeraj Agarwal: Thank you so much, John, for having me. Dr. John Sweetenham: Neeraj, let's begin by discussing some practice-changing phase 3 trials, starting with Abstract 5500, the KEYNOTE-826 study. This study reports the final overall survival results from a randomized, double-blind, phase 3 study of pembrolizumab plus chemotherapy versus placebo plus chemotherapy for first-line treatment of persistent, recurrent, or metastatic cervical cancer, which will be presented by Dr. Bradley Monk. Dr. Neeraj Agarwal: I'd be happy to. The initial analysis of the KEYNOTE-826 study revealed that first-line pembrolizumab plus chemotherapy provided significant improvements in the overall survival and progression-free survival compared to placebo plus chemotherapy in patients with metastatic, persistent, or recurrent cervical cancer who had not previously received systemic chemotherapy and were not candidates for curative treatments such as surgery or radiation. In this study, patients were randomly assigned in a 1:1 ratio to receive pembrolizumab or placebo at 200 milligrams every three weeks for up to 35 cycles, along with chemotherapy with paclitaxel, plus a platinum therapy with or without bevacizumab. From November 2018 to January 2020, 617 patients were enrolled with 308 receiving pembrolizumab plus chemotherapy and 309 patients receiving placebo plus chemotherapy. At the data cutoff of October 3, 2022, the median follow-up was 39 months. At this protocol-specified final overall survival analysis, pembrolizumab plus chemotherapy treatment continues to show a significant improvement in overall survival and progression-free survival, regardless of whether patients receive bevacizumab or not. The incidence of grade 3 or more adverse events was higher in the pembrolizumab plus chemotherapy arm than the placebo plus chemotherapy arm, with the most common adverse event being anemia, neutropenia, and hypertension. Dr. John Sweetenham: These are exciting data, Neeraj. So the main message from this trial is that pembrolizumab plus chemotherapy, with or without bevacizumab, can now be considered as standard of care for first-line treatment of persistent, recurrent, or metastatic cervical cancer. Dr. Neeraj Agarwal: Yes, I agree, John. Now, moving on to a different common type of cancer, let's discuss Abstract 1001, titled “Second-Line Endocrine Therapy with or without Palbociclib Maintenance in Patients with Hormone Receptor-Positive/HER2-Negative Advanced Breast Cancer: Results from the PALMIRA Trial,” which will be discussed by Dr. Antonio Llombart-Cussac. So, John, based on this abstract, can you please tell us about the role of palbociclib after prior progression on this drug? Dr. John Sweetenham: Yes. In this study, the authors aimed to determine if palbociclib maintenance with an alternative endocrine therapy improves the anti-tumor activity of second-line treatment in patients with endocrine-sensitive hormone receptor-positive and HER2-negative advanced breast cancer who had disease progression to first-line treatment with palbociclib in combination with endocrine therapy. After including 198 patients in the trial with a 2:1 randomization, 136 patients received palbociclib with endocrine therapy and 62 patients received endocrine therapy alone. And at a median follow-up of 8.7 months, the primary endpoint of progression-free survival was not met with a median progression-free survival of 4.2 months in the palbociclib-containing combination versus 3.6 months in the control arm. Also, higher grade 3 to 4 adverse events were reported in patients treated in the palbociclib arm. Dr. Neeraj Agarwal: Thanks, John. So you are saying that continuing the CDK4/6 inhibitor palbociclib after prior disease progression on palbociclib, even when the primary endocrine therapy has been changed, doesn't seem to be beneficial, therefore, this practice may be discouraged in the clinical setting? Dr. John Sweetenham: Yes, that's correct. Neeraj, I think that's the conclusion from this study. Dr. Neeraj Agarwal: So, John, now let's switch gears and highlight some precision oncology studies. Dr. John Sweetenham: Well, Abstract 3602, titled “Real World Rates of FDA-Approved Targeted Therapy and Immunotherapy Prescriptions for Metastatic Colorectal Cancer Patients in the VA's National Precision Oncology Program” will be presented by Dr. Alice Nono Djosta. Can you tell us more about this abstract, Neeraj? Dr. Neeraj Agarwal: Well, comprehensive genomic profiling has the potential to guide the administration of FDA-approved biomarker-directed therapies and improve outcomes among patients with metastatic colorectal cancer. So, in this study, Abstract 3602, investigators sought to determine the rates of actionable biomarkers and prescription of associated FDA-approved therapies among veterans in the National Precision Oncology Program. Patients with metastatic colorectal cancer who had undergone comprehensive genomic profiling via tissue or liquid biopsy were included between 2019 and 2022 and had 1 of the following 5 actionable biomarker profiles including: NRAS, KRAS, BRAF wild-type, BRAF V600E mutation, MSI-high, TMB-high, NTRK fusion or rearrangements. Prescription data for seven FDA-approved biomarker-directed therapies were extracted and rates of comprehensive genomic profiling (CGP)-directed therapy prescriptions were assessed by the investigators. A total of 908 patients with metastatic colorectal cancer underwent comprehensive genomic profiling, with 80% patients having colon adenocarcinoma and 20% with rectal adenocarcinoma. The combined rates of any actionable variants were 47% in patients with colon adenocarcinoma and 45% in patients with rectal adenocarcinoma. After including 424 eligible patients for FDA-approved biomarker therapy, only 70% patients with MSI-high, 48% patients with TMB-high, 38% patients with NRAS, KRAS, and BRAF wild-type, and only 17% of patients with BRAF V600E mutation received FDA-approved CGP-directed therapies. Dr. John Sweetenham: Very important data, Neeraj. What's the main conclusion of this study? Dr. Neeraj Agarwal: So, in conclusion, this study found that almost 30% of patients with MSI-high metastatic colorectal cancer did not receive effective immune checkpoint inhibitors. And overall, a significant number of eligible patients did not receive FDA-approved biomarker-directed therapies. So, it is crucial that we evaluate the barriers to prescribing comprehensive genomic profiling-directed therapies in our patients with metastatic colorectal cancers. So, John, let's move on to lung cancer, where the use of single-gene testing is still common in the community practice. Can you please tell us about Abstract 6506, titled “The Impact of Single-Gene Testing on Subsequent Comprehensive Genomic Profiling Success in Community Oncology Practice for Advanced Non–small Cell Lung Cancer”? These are results from a prospective observational reference laboratory testing program and these results will be presented by Dr. Mary Nesline. Dr. John Sweetenham: Yes, definitely. In this study, researchers aim to investigate the impact of prior single-gene testing on comprehensive genomic profiling success and therapeutic opportunities for patients with non–small cell lung cancer in community settings. They included patients who underwent at least 1 single gene testing for guideline recommending genomic variants in non–small cell lung cancer such as BRAF, EGFR, KRAS, MET exon 14 skipping mutations, ALK, RET, and ROS1 rearrangements as well as PD-L1 immunohistochemistry. And they offered comprehensive genomic profiling either before or after receipt of a negative single gene test. Of 580 patients with non–small cell lung cancer with the comprehensive genomic profiling ordered between 2021 and 2022, around 30% of the patients had at least 1 single-gene testing ordered prior to the comprehensive testing, with a median of 5 prior single-gene tests. Compared to CGP-only cases. CGP per cases with prior negative single gene testing was canceled twice as often at tissue review, had a higher DNA extraction failure, and a lower DNA sequencing success. CGP also identified guideline-recommended variants in genes with no single-gene testing offered during the study period, such as ERBB2 mutations, or NTRK2/3 fusions, as well as variants targeted in ongoing clinical trials in 28% of patients. Dr. Neeraj Agarwal: Very interesting. So John, what is your key takeaway message from this? Dr. John Sweetenham: The main message is that in a community oncology setting, the practice of ordering single gene testing prior to comprehensive genomic profiling for patients with non–small cell lung cancer is common. Prior negative single-gene testing led to a higher rate of CGP test cancellation due to tissue insufficiency and increased CGP DNA extraction failures. The practice of single-gene testing does not align with practice guideline recommendations and may negatively impact the potential benefits of CGP testing for patients with non–small cell lung cancer. Now, let's move on to another important abstract that our fellow clinicians should hear about. This is Abstract 1534 titled “Real-World Experience of an In-House Dihydropyrimidine Dehydrogenase Genotype Test to Guide Fluoropyrimidine Dosing at a Multi-Site Cancer Hospital” that will be presented by Dr. Jai Patel. Can you tell us more about this abstract, Neeraj? Dr. Neeraj Agarwal: Sure. Fluoropyrimidines, such as 5-fluorouracil and capecitabine, are commonly used to treat solid tumor cancers such as gastrointestinal and breast cancers. We know that severe toxicity occurs in one-third of patients, which delays the timely completion of treatments and result in prolonged hospitalization of these patients. These toxicities may be due in part to genetic variation in the DPYD gene. Five variants are known to have moderate to strong evidence according to the Clinical Pharmacogenetics Implementation Consortium. So, in this observational study, the authors describe the implementation of an in-house DPYD test and its impact on the dosing of these fluoropyrimidines, which include capecitabine and 5-fluorouracil. From March 2020 to December 2022, 491 patients received DPYD genotyping testing, and 90% of them had gastrointestinal cancers. The median lab turnaround time was only 3 days. Pre-treatment testing was ordered in 80% of patients, and 93% of patients had results before starting cycle 1. Overall, 6% of patients were heterozygous carriers. Fluoropyrimidine dose was reduced, avoided, or discontinued in 90% of these patients. Moreover, in pre-treatment carriers, 90% of patients received an upfront dose reduction, avoidance, or they even declined chemotherapy. Dr. John Sweetenham: Thanks, Neeraj. So what do you think is the key takeaway message here? Dr. Neeraj Agarwal: So, DPYD genotype-guided dosing of fluoropyrimidine, including 5-fluorouracil and capecitabine, is logistically feasible with a rapid turnaround time and can result in treatment dose modifications for most carriers, potentially avoiding or mitigating severe toxicities, especially in those patients who received pre-treatment testing. Dr. John Sweetenham: Thanks again. Now let's transition to studies that focus on disparities in cancer care. Dr. Neeraj Agarwal: Definitely. Let's discuss Abstract 6530, titled “Impact of Free Hospital-Provided Rideshare Service on Radiation Therapy Completion Rates: A Matched Cohort Analysis.” In this study, Dr. Eric Chen and colleagues assess the potential of rideshare services in facilitating timely radiation therapy for patients facing barriers, such as limited transportation, financial constraints, and lack of adequate social support. So the authors analyzed data from about 2,900 patients who underwent radiation therapy and found that 58 of them utilized a free hospital-provided rideshare service. These free hospital-provided rideshare service utilizers had a lower median age and were more likely to identify as Black or African American compared to those who did not utilize these services. They also had higher socioeconomic disadvantages and traveled shorter distances for treatment. Interestingly, more rideshare utilizers underwent radiation therapy with curative intent, had longer treatment course duration, and a higher number of fractions prescribed. In the matched-cohort analysis, the study found that radiation therapy completion rates were significantly higher for rideshare utilizers compared to non-rideshare utilizers, especially for patients who were undergoing radiation therapy with curative intent. Dr. John Sweetenham: So what's the key take-home message from this abstract? Dr. Neeraj Agarwal: This study highlights the potential benefit of utilizing hospital-provided free ride-share services, particularly for patients facing barriers to timely treatment. So, using these services were associated with higher radiation therapy completion rates, especially in the curative setting. So, John, there is another study, Abstract 1606, titled “Trends and Disparities in Oncology Telehealth after the Initial Pandemic Era” that will be presented by Dr. Michael Lee and colleagues. They evaluated whether telehealth utilization continued after the pandemic and if demographic differences in its users persist. So John, please tell us more about this abstract. Dr. John Sweetenham: Yes, the authors conducted a retrospective cohort study in 22 Kaiser Permanente Northern California hematology and oncology clinics between October 1, 2020, and June 1, 2022. The study investigated the use of office, video, and telephone visits, analyzing more than 340,000 hematology oncology visits with MD or DO providers. Of these visits, 25% were in-office, 37% were video visits, and 39% were telephone visits. Monthly telehealth visits peaked in January 2021, representing around 86% of total visits, and decreased to 69% of the total visits by June 2022. Video visits were more common for new appointments, whereas telephone visits were more common for return appointments. Moving to the post-pandemic period, telehealth visits remained popular, with video visits being the most commonly utilized. However, telehealth use varied among demographic populations. Video visits were a significantly higher proportion of all visits among individuals less than 45 years old, primary English speakers, patients with commercial insurance, non-Hispanic Whites and Asians, compared with Hispanic, Whites, and Blacks, and patients living in the deprived neighborhoods. Dr. Neeraj Agarwal: Interesting data, John. So what is the key takeaway message from this abstract? Dr. John Sweetenham: Well, overall, it's encouraging to see that even after the pandemic, telehealth continued to be widely used. However, the concerning issue is that telehealth is less utilized in patients who may need it most. The next step, in my view, will be to work on barriers to access telehealth by underprivileged populations. And that brings our discussion to a close today. Before we wrap up the podcast, Neeraj, do you have any final thoughts to share? Dr. Neeraj Agarwal: Yes, thanks, John. I would urge our listeners to come and join us at the ASCO Annual Meeting, not only to celebrate these successes but also to help disseminate these cutting-edge data to practitioners and patients across the world. Dr. John Sweetenham: Absolutely. I'd like to thank our listeners for joining us today, and thank you, Neeraj, for sharing your insights with us as well. You will find links to the abstracts discussed today on the transcripts of this episode. Finally, if you value the insights that you hear on ASCO Daily News Podcast, please take a moment to rate, review, and subscribe wherever you get your podcasts. Disclaimer: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Find out more about today's speakers: Dr. John Sweetenham Dr. Neeraj Agarwal @neerajaiims Follow ASCO on social media: @ASCO on Twitter ASCO on Facebook ASCO on LinkedIn Disclosures: Dr. John Sweetenham: Consulting or Advisory Role: EMA Wellness Dr. Neeraj Agarwal: Consulting or Advisory Role: Pfizer, Bristol-Myers Squibb, AstraZeneca, Nektar, Lilly, Bayer, Pharmacyclics, Foundation Medicine, Astellas Pharma, Lilly, Exelixis, AstraZeneca, Pfizer, Merck, Novartis, Eisai, Seattle Genetics, EMD Serono, Janssen Oncology, AVEO, Calithera Biosciences, MEI Pharma, Genentech, Astellas Pharma, Foundation Medicine, and Gilead Sciences Research Funding (Institution): Bayer, Bristol-Myers Squibb, Takeda, Pfizer, Exelixis, Amgen, AstraZeneca, Calithera Biosciences, Celldex, Eisai, Genentech, Immunomedics, Janssen, Merck, Lilly, Nektar, ORIC Pharmaceuticals, Crispr Therapeutics, Arvinas
As part of the 2022 Prostate Cancer Patient Conference, Dr. Samuel Washington discusses disparities regarding race and prostate cancer. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Education] [Show ID: 38557]
As part of the 2022 Prostate Cancer Patient Conference, Dr. Samuel Washington discusses disparities regarding race and prostate cancer. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Education] [Show ID: 38557]
As part of the 2022 Prostate Cancer Patient Conference, Dr. Samuel Washington discusses disparities regarding race and prostate cancer. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Education] [Show ID: 38557]
As part of the 2022 Prostate Cancer Patient Conference, Dr. Samuel Washington discusses disparities regarding race and prostate cancer. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Education] [Show ID: 38557]
As part of the 2022 Prostate Cancer Patient Conference, Dr. Samuel Washington discusses disparities regarding race and prostate cancer. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Education] [Show ID: 38557]
As part of the 2022 Prostate Cancer Patient Conference, Dr. Samuel Washington discusses disparities regarding race and prostate cancer. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Education] [Show ID: 38557]
This week Bobbi Conner talks with Dr. Marvella Ford about efforts to address disparities in lung cancer screening in S.C. Dr. Ford is a Professor in the Department of Public Health Sciences and she's Associate Director of Population Sciences and Cancer Disparities at Hollings Cancer Center at MUSC.
On today's episode, we catch up with thoracic oncologist Dr. Narjust Florez. Since the last time we spoke to her she has moved to Boston to assume the role of Associate Director, Cancer Care Equity Program at Dana-Farber Cancer Institute. Apart from her clinical interests in lung cancer, she is also a leading researcher in cancer health disparities, gender and racial discrimination in medical education and medicine. Listen to our previous conversation with Dr. Florez here.
Dr Otis Brawley speaks with Dr Qasim Hussaini, a Fellow in the Hematology and Medical Oncology Fellowship Program, about a study he recently presented on the impact of historical housing discrimination on present-day colon cancer outcomes.
At the recent International Myeloma Society (IMS) Annual Meeting, Dr. Kashyap Patel, CEO of Carolina Blood and Cancer Care Associates and President of the Community Oncology Alliance, spoke about practical solutions for addressing disparities in multiple myeloma in the United States. In this follow-up interview with Oncology Data Advisor, Dr. Patel digs deep into the multifaceted factors that contribute to cancer disparities and shares his pioneering work that aims to ensure that every patient with cancer receives equitable access to care.
SURVEY LINK: https://bit.ly/feedback_UltraSounds SUMMARY: Rachel and Sanaya discuss 3 clinical vignettes regarding cancer genetics with Dr. Versha Pleasant, MD, MPH. TIMESTAMPS: 00:41 Dr. Versha Pleasant Biography 02:18 Case 1: 42-year-old woman presents to establishcare 11:01 Case 2: 34-year-old woman presents to discuss risk reducing surgery for breast cancer. 07:35 Case 3: 47-year-old patient with abnormal uterine bleeding on Tamoxifen. 24:12 Wrap-up LINKS: Practice Bulletin No 182: Hereditary Breast and Ovarian Cancer Syndrome, Obstetrics & Gynecology: September 2017 - Volume 130 - Issue 3 - p e110-e126 doi: 10.1097/AOG.0000000000002296 Daly MB, Pal T, Berry MP, et al. Genetic/Familial High-Risk Assessment: Breast, Ovarian, and Pancreatic, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2021;19(1):77-102. doi:10.6004/jnccn.2021.0001 Pleasant VA, Griggs JJ. Contemporary Residential Segregation and Cancer Disparities. J Clin Oncol. 2021 Sept;39(25):2739-2741. DOI: 10.1200/JCO.21.01328 Schneider K, Zelley K, Nichols KE, et al. Li-Fraumeni Syndrome. 1999 Jan 19 [Updated 2019 Nov 21]. In: Adam MP, Mirzaa GM, Pagon RA, et al., editors. GeneReviews® [Internet]. Seattle (WA): University of Washington, Seattle; 1993-2022. Available from: https://www.ncbi.nlm.nih.gov/books/NBK1311/ Kumamoto T, Yamazaki F, Nakano Y, et al. Correction to: Medical guidelines for Li-Fraumeni syndrome 2019, version 1.1. Int J Clin Oncol. 2022;27(1):262-263. doi:10.1007/s10147-021-02086-5 Idos G, Valle L. Lynch Syndrome. In: Adam MP, Mirzaa GM, Pagon RA, et al., eds. GeneReviews®. Seattle (WA): University of Washington, Seattle; February 5, 2004. McGarrity TJ, Amos CI, Baker MJ. Peutz-Jeghers Syndrome. In: Adam MP, MirzaaGM, Pagon RA, et al., eds. GeneReviews®. Seattle (WA): University of Washington, Seattle; February 23, 2001. TRANSCRIPT: https://bit.ly/ultrasounds_CancerGenetics DISCLOSURES/DISCLAIMERS: The OBGYN Delivered student team has no relevant financial disclosures. The Ultrasounds podcast is for educational and informational purposes only and should not be considered medical advice. Please do not use any of the information presented to treat, diagnose, or prevent real life medical concerns. The statements made on this podcast are solely those of the OB/GYN Delivered hosts and guests and do not reflect the views of any specific institution or organization.
Shannon Westin, Francesca Gany, and Theresa Hastert discuss the topic of food insecurity among patients with cancer. TRANSCRIPT Dr. Shannon Westin: The guest on this podcast episode has no disclosures to declare. Hello friends and welcome to another episode of JCO After Hours, your podcast to get more in-depth on some of the amazing work that has been published in the Journal of Clinical Oncology. I am thrilled to be here today with two fantastic investigators and researchers who are going to discuss a paper that is titled “Food to Overcome Outcomes Disparities – A Randomized Control Trial of Food Insecurity Interventions to Improve Cancer Outcomes.” This was published online in the JCO on June 16, 2022. We're joined by the principal investigator Dr. Francesca Gany, who is the Chief of Immigrant Health and Cancer Disparities service at the Memorial Sloan Kettering Cancer Center in New York City. In addition to Dr. Gany, we're also joined by Dr. Theresa Hastert, who's an associate professor in Population Science in the School of Medicine at Wayne State University in Detroit. And she published an editorial that went along with this article named “The Potential of Cancer Care Settings to Address Food Insecurity.” This was published in the JCO on July 1st, 2022. Welcome, ladies. So excited to hear about this work. Dr. Francesca Gany: Thank you! It's great to be here. Dr. Theresa Hastert: Thanks so much for having me. Dr. Shannon Westin: So, what we're seeing more and more of is oncologists getting into other areas of expertise. For a long time, we've all been involved with treatment trials, and we've started getting into survivorship and health services. But I think that we really are realizing there are other issues for our patients that affect their cancer care and outcomes. So, first, I just wanted to level set and see if maybe Dr. Gany, you can kick us off, can you define food insecurity and just kind of briefly discuss the prevalence patterns in women and men that are diagnosed with cancer? Dr. Francesca Gany: Sure! So, food insecurity is essentially not enough access to food to help you maintain your health. And that could come from a variety of reasons, including not having enough money to buy food, living in a food desert, where there's not availability of food and other factors that could make food inaccessible to you. This potentially has a tremendous impact on health. We see that with folks with cancer and folks who don't have cancer. We know with cancer patients, it's a particularly difficult issue because of the increased nutritional demands that come with a cancer diagnosis, the need for special diets, and decreased absorption of nutrients for certain folks. So, it's especially important that our cancer patients have access to enough healthy food, so they can have the best cancer treatment outcomes possible. Dr. Theresa Hastert: I can add a little bit about the prevalence of food insecurity more broadly. So, in the US population, about 4% of Americans have what's called very low food security. So, that's where people actually reduce the amount of food they eat because they have a lack of money for food. And by contrast, in previous work among cancer survivors, that number is closer to about 15% in sort of population-based studies and much higher in certain select patient populations. So, if you're in an under-resourced population, and as some of Dr. Gany's previous work has cited figures of more like 55 to 70% of cancer patients and survivors with low resources can be food insecure and not have enough money for food. Dr. Francesca Gany: All of this has, of course, worsened with a COVID pandemic because just food insecurity rates have gone up overall and we have certainly seen an impact on our patients in the cancer centers in which we work. Dr. Shannon Westin: And you can imagine with the high costs of drug pricing and all of the other issues around coverage of cancer care that people are having to make those types of decisions between food and shelter and basics and getting their treatment for their cancer, their treatment for their other related comorbidities. Am I on the right track? Dr. Francesca Gany: Absolutely! In fact, we did a study that specifically asked patients whether they were not purchasing medications in order to be able to feed their families. And a very high percentage of them, up to a third of patients, said that they were foregoing some of their cancer meds in order to be able to feed their family. We asked it the opposite way as well, whether purchasing their cancer meds meant that they were unable to feed their families and unfortunately, it was a similar percentage for those food insecure patients. So, it has a tremendous impact on fully engaging in cancer treatment, and also being able to take care of one's family which of course is so important to our patients. Dr. Theresa Hastert: So, in Detroit, we're in Michigan, which expanded Medicaid. So, in the work that we do predominantly among African-American cancer survivors, we find that most Americans are able to access care, like with the expansion of Medicaid, people are able to get treated for cancer. Paying for drugs is another thing but we still have a lot of food insecurity among this population. About 15% of our cancer survivors, African-American cancer survivors in Detroit are food insecure. So, it's not an insurance issue in the sense. They have Medicaid coverage and they're able to get cancer care, it might not cover every out-of-pocket expense, they still have food insecurity. So, broadening insurance is not necessarily enough to help people avoid some of these follow-on impacts. Dr. Francesca Gany: Yes! One very important issue is that looking at food insecurity at a moment in time with our patients is not enough because we know that as treatment progresses, financial hardship also progresses – financial toxicity of the cancer treatment. So, it's really important not to do just an initial screen for food insecurity and for other social determinants of health because food insecurity is certainly a window into other essential needs that have to be met, but it's really important that we don't just ask once, but that we ask in an ongoing way because we know that as time goes on, it only gets worse. Dr. Theresa Hastert: That's so important. I've talked to several providers who have these issues with patients, where it's the people who are sort of more middle class who are going into cancer and be like, ‘I'm fine, I'm fine, I'm fine” when first asked if they need assistance. And it's not for several weeks or months when they start racking up out-of-pocket costs, and then suddenly, they realize they're not fine. It can become very delicate also because people are used to being self-sustaining, and financially independent, and they're used to being able to maybe help other people who have financial needs to donate to charities and things like that. And there can be a shift for people when they realize, ‘'Oh, no, now I need assistance.' That can be difficult for people to grapple with. And it's so important to keep checking in with patients throughout their treatment experience to see how they're doing. Dr. Shannon Westin: I think this is really a great segue into kind of getting into the nitty-gritty of the publication. I would love for you, Dr. Gany, to give our listeners a little bit of information around the trial, the patient population that you chose, and the intervention arms. Dr. Francesca Gany: Sure, I'm happy to do that! So, we started when we first saw the high prevalence of food insecurity among the patients, we were working with that are partnering with safety net institutions, we knew that we needed to do something. And so, we did a study and we looked at emergency food resources in the top 50 zip codes that our patients lived in and then we did site visits, etc, to these emergency food resources and saw how inadequate they were for our cancer patients. They were inadequate because they didn't have medically tailored foods. Often, they didn't have culturally tailored food choices. Their hours of operation were very short and with all of the appointments that our patients had to keep, it made it really hard for them to reach the pantries. They weren't that geographically accessible so that was a deterrent to patients. So, we realized that we have to do something that was much more convenient for our patients that would address their medically tailored food needs. And also, the difficulties they might have traveling to another site to get food. So, we started a medically tailored food pantry of one initially, in which we partnered with a local food bank for New York pantry site that was close by to the hospital and worked with them around food choices for our patients, etc. And would work with them to pack the bags at their site and then we would bring the bags over to the hospital. We found with our patients that there was tremendous uptake of this service, and tremendous appreciation and they reported improved quality of life and improved ability to get on with their cancer care. This grew to now 15 pantries in both safety net facilities and also Comprehensive Cancer Centers because there are a sizable number of people in Comprehensive Cancer Centers, as you know we've been discussing that are also food insecure. So, we had 15 pantries, but pantries - they're a great piece of the solution - but we didn't feel that they were enough of the solution because even though they were medically tailored and patients had some choice, they didn't have total choice in what they were getting. And especially with cancer care, people's food preferences shift, etc. And what they need to be healthy shifts. So, we explored two other options of home grocery delivery service where they would get to pick what groceries came to their home, and having the groceries come to their home eliminated the issues that come up certainly with having to carry heavy bags, etc. It was some choice that this gave them but the windows of delivery were a little bit of a problem for the patients because sometimes the food delivery services would be coming at a time that didn't work for the patients. And then, the third option was a voucher system, where people get basically a debit card, and they can buy whatever they want within, no alcoholic beverages, etc, but whenever they want to purchase with that voucher card. And we accompanied that with education around healthful food choices, nutrition during cancer, etc, which was translated into a number of different languages. So, those ended up being three pieces of the arms of the study. The pantry had become pretty much the standard of care in all of the facilities we were working in. So, that was one arm. So usual, customary care. And then, we added to that because it was in the sites that we were at, we added a voucher arm as well. And in the third arm, it was a home grocery delivery arm. Those were the three arms of this randomized control trial. All of the monetary amounts were the same for the three arms. So, the grocery bag cost the same as the amount they were given in the debit card, which costs the same as the home grocery delivery pretty much, or it was at least equivalent nutritional content and food content. So, those are the three arms of the study. Dr. Shannon Westin: Great! Well, just cut to the chase and let the group know what did you find? Dr. Francesca Gany: So, we found that after six months of participation, the voucher plus pantry arm had the greatest treatment completion rates, 94%, versus the home grocery delivery, 82.5%, versus the pantry alone, which was 77 and a half percent. So, tremendous differences between these three arms. All three arms saw a significant improvement in food security status but those were the treatment completion rates across the arm. We also looked at quality of life and depression symptoms across the arms at 6 months, and across all arms, patients had fewer depression symptoms in follow-up. And improved FACT-G quality of life scores. But the statistically significant differences were actually found in the pantry and the delivery plus pantry arm for both of those measures. Dr. Shannon Westin: That is so interesting and so exciting to see this type of intervention making a difference for our patients. Was there anything that surprised you about your results? Dr. Francesca Gany: So, the one that was a little surprising was why the quality-of-life results did not exactly mirror the treatment completion rates. And we are assuming that that has to do with the fact that with the pantry, there's a lot of in-person interaction with staff and with the home grocery delivery, actually, because many of the patients found it a little bit tricky to order the grocery deliveries online, they also had a fair amount of staff interaction. Whereas with the voucher, there was less of that. So, perhaps that explains that we're not sure and we're doing a much larger randomized control trial now in which we're going to look at that. One really great finding was that around food choices and healthy food choices with the voucher because we wanted to look at that, we were controlling what we gave to patients with the pantry arm, and we were controlling that to some extent with the grocery delivery, especially because we were ordering with them. But we were very interested for the voucher arm and across the board, people made very healthful choices with the voucher. Again, they all were accompanied by nutrition education, etc. And interestingly, limited English proficient patients and patients who were born abroad had the healthiest food choices. So, this was a great way to intervene with all patients who were food insecure. And we saw that it had a tremendous impact equally regardless of country of birth, language, etc. And great extra finding that there were healthful food choices and that was especially true in immigrants and in folks who have limited English proficiency. Dr. Shannon Westin: Great. It's so exciting. I think though, it brings up the obvious question that seems like a ton of work. So, how do we operationalize this in our clinic? How do we screen patients? How do we work with our cancer center directors or our clinic directors to be able to provide these types of interventions? Sorry, I know it sounds like it's a million-dollar question. Dr. Francesca Gany: This screening is simple. For these studies, we use the 18-item USDA Food Security screener. That's a longer instrument but we wanted to make sure we use that for this study. But in actual clinical practice, the two item screener works. And we are working now on one question specifically for cancer patients that we're finding is also quite sensitive and quite specific, and that does not take a long time at all. We should be screening everyone. We should be screening in an ongoing way. We should be tracking this as a very important patient outcome. What does take longer and which is a little bit daunting to folks is that once you find food insecurity, you need to treat it. And so, we do a lot of work around how to treat food insecurity and how to treat it efficiently. In the end, I actually think that the food voucher is going to be the way to go because it requires less staff time. And people are used to paying for groceries with debit cards, and with cards, and that has not been an issue at all for our patients. And I do think from a clinical operations perspective, from a policy perspective, and from an insurer's perspective, this should be part of the workflow. The vouchers are a really easy way to do it. We'll of course have more data when the larger trial is done. Dr. Shannon Westin: These points are so important around needing to be able to address food insecurity when you find it. The screening is very simple and providing food to somebody else is much less so. And it can actually be harmful to screen for something and then not do anything about it like that could actually increase patient's distress if you're making moves like you're going to help them and then don't, it can actually be harmful. But I was wondering, Dr. Gany, if you could talk a little bit about how you got this off the ground, functionally speaking, at the beginning. Like, if somebody wanted to do something similar for their own cancer survivor, with their patient population, what kinds of steps can people be taking? Who did you work with? Did you get any pushback? Are there any lessons learned that you could share with people? Dr. Francesca Gany: Yes, so I think there are more and more pantries actually now that are being implemented at cancer sites. So, I think that there is broader buy-in now on the systems part. So, I think that's a little bit less of a heavy lift than it might have been a few years ago. We were in a very receptive place. They were really happy that we wanted to help the patients this way and were very facilitative. And so, we partnered with a food bank for New York Food Pantry at our initial site, and we partnered at other sites, and then we became a food pantry site ourselves so that we could have access to as many varied products as possible, so that we could put together bags that were tailored, etc. And so, then patients could pick the items in the pantry that were tailored. The couple of issues that arose was this one was a space issue, especially in New York City spaces at such a premium and the clinics were really worried about even giving over a closet. So, in one pantry, we have a few drawers in the conference room, and we pull everything out when we get there. We have a cart and we wheel it around, and we wheel to a spot, etc. So, we take care of it that way. At another site, we keep everything in the basement. When we came to where there was more space, we wheel it up to the cancer clinic. Some sites had more space and that was great, we could set up the pantry to be permanently there and displayed. The other issue that concerns sites was food safety, food management, vermin, etc. So, all of our folks are trained in food safety, food handling, and food storage, so that we store it in the safest way possible. And so, that there were no issues around that. So, that has really worked out. One other thing is we've also introduced an intervention at some of the sites of food navigators. So, not only do they help patients with the pantries, etc., but they also work with folks around what are some of the other resources they can access that'll work for them in their communities near their home that have the right foods for them, etc. And that's helped. This was not in the study, but this is just in our clinical operation for this. That has helped as well. Dr. Shannon Westin: It's so great. It's such a lot of work and it seems so essential. I think it's really going to be on us to take it back to our institutions and determine what works. I loved your line about it seems like the vouchers might be our best. I think we really need those kinds of real-world solutions that we can actually bring back to implement. I guess my other question is, is there a role for policy change here? Is there something we can do kind of on a more national level to address these things rather than it being at the individual practice and institution levels? Dr. Francesca Gany: Oh, my God, yes! That is our hope from these studies that at the healthcare system level, the insurer level, and then the broader policy level in New York. For instance, some of our patients are undocumented immigrants. So, they have less access to food programs that others might have access to such as SNAP. By the way, we saw the same food insecurity rates in SNAP participants as we saw in non-SNAP participants because the benefits are not that hefty in SNAP, but that is an aside. But for undocumented immigrants, let's say, when in New York when they are diagnosed with cancer, they are eligible for Medicaid for the treatment of emergency conditions. So, such an easy thing to do would be to do a food insecurity screener when you were doing the emergency Medicaid eligibility, and then help people right into a food program, a voucher program. When we think of the costs of the vouchers, in this study, the costs were a little bit more than $200 a month. For the vouchers, the staff time does not cost that much. And when one thinks about the cost of cancer treatment, of cancer care, and what a teeny drop in the bucket this is compared to the cost of cancer treatment. This should be a no-brainer for policy folks because it is so little money compared to the bigger outlay with so much impact. So, that's one example of how we see it rolling out in a policy arena. When you're screening for Medicaid, for the treatment of emergency eligibility, you ask a couple of food insecurity questions or the one we're hoping to roll out and if somebody's food insecure, it's just they automatically got the food voucher. Dr. Theresa Hastert: I think, well, ultimately, being able to have people in with policy-level solutions for this would be amazing, it would be a huge step. In the meantime, I really think it is going to be a lot of individual people and individual cancer centers trying to connect the people in front of them with the resources that they need. And in order to do that, I think we'll really make the biggest progress when we do get buy-in, we get champions higher up in the cancer centers. When cancer center leadership takes it up and helps smooth paths, and when funders put efforts behind it, and I think they're doing this increasingly, put efforts behind addressing social needs among cancer patients and survivors, and also our accrediting agencies in terms of tracking, ‘Are you not only screening people? Are you hooking people up with resources?' And of course, there's a balance between cancer centers that are set up to diagnose and treat cancer but if our patients are dealing with all these other issues, we need to be doing what we can to help address those issues so people can recover from cancer, can go on to live healthy, happy lives, could have the best outcomes. Dr. Francesca Gany: Definitely. And some natural allies, the cancer centers, our folks in nutrition services, because they totally know how important it is for people to have access to nutritious food during their treatment. So, they're great allies, social work depending navigators, and community helpers depending on how the institution is structured. But it has not been hard for us to find champions at any of the sites that we've been at despite the space issues, etc. But we're super flexible. We make it work however we have to so that the site feels that it's value-added and that it's not interrupting their clinical flow. Dr. Shannon Westin: This was great. Ladies, thank you so much for your expertise and for giving us some really, I think, concrete things that we could potentially do back in our institutions. And thank you to all of our listeners. Again, we were discussing ‘Food to Overcome Outcomes Disparities – A Randomized Control Trial of Food Insecurity Interventions to Improve Cancer Outcomes.' published online in the Journal of Clinical Oncology on June 16th, 2022. We're so excited that you took the time to listen, please check out our other episodes and check back soon for a new episode of the podcast. Have a great one, y'all. Dr. Francesca Gany: Thank you! Dr. Theresa Hastert: Thank you. The purpose of this podcast is to educate and inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity or therapy should not be construed as an ASCO endorsement.
This week Bobbi Conner talks with Dr. Marvella Ford about a statewide project to increase HPV vaccination in children in underserved communities of South Carolina. Dr. Ford is a Professor in the Department of Public Health Sciences and she's the Associate Director of Population Sciences and Cancer Disparities at Hollings Cancer Center at MUSC.
Addressing Cancer Disparities at the Community Level with guests Dr. Beth Jones and Monique Stefanou July 3, 2022 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095
Addressing Cancer Disparities at the Community Level with guests Dr. Beth Jones and Monique Stefanou July 3, 2022 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095
Addressing Cancer Disparities at the Community Level with guests Dr. Beth Jones and Monique Stefanou July 3, 2022 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095
Dr Ashwani Rajput talks with Dina Lansey, Associate Deputy Director of Community Outreach and Engagement, about the Kimmel Cancer Center's efforts to partner with our communities to address cancer disparities and improve healthcare outcomes.
Guest host Dr. Fumiko Chino, a radiation oncologist at Memorial Sloan Kettering Cancer Center, leads a discussion on how the continual improper aggregation of Asian American (AA) and Native Hawaiian and other Pacific Islander (NHPI) populations downplays cancer disparities with Dr. Scarlett Lin Gomez, a professor in the Department of Epidemiology and Biostats at UCSF Helen Diller Family Comprehensive Cancer Center, and Dr. Kekoa Taparra, a radiation oncology resident at Stanford University. Transcript Dr. Fumiko Chino: Hello, I'm Dr. Fumiko Chino, a radiation oncologist and Health Equity researcher at Memorial Sloan Kettering Cancer Center, and the guest host of the ASCO Daily News Podcast today. In today's episode, we'll explore the unequal burden of cancer across diverse communities, specifically looking at how the continual improper aggregation of Asian American, Native Hawaiian, and other Pacific Islander populations mask cancer disparities. Joining me for this discussion are Dr. Scarlett Lin Gomez, a professor in the Department of Epidemiology and Biostats at the UCSF, Helen Diller Family Comprehensive Cancer Center, and Dr. Kekoa Taparra, a radiation oncology resident at Stanford University. My guest and I have no conflicts related to our topic today. Our full disclosures are available in the show notes and disclosures for all guests on the podcast can be found on our transcripts at ASCO.orgpodcasts. We've all agreed to go by our first names. Scarlett and Kekoa, it's great to have you on the podcast today. Dr. Scarlett Lin Gomez: Thank you so much. Great to be here. Dr. Kekoa Taparra: Thank you. Dr. Fumiko Chino: I'm so excited to start. My first question is just really general, which is can you describe your background, how you got into this research and why it's really meaningful for you and your community. I can start just a little bit with myself. I'm Japanese American, my grandfather came to the United States before World War II and was actually excluded from coming into the United States under the Asian Exclusion Act. He managed to come into the country walking up from Chile, ultimately started a farm in the United States, but was interned during World War II under Executive Order Act 9066. And he and my father and the family suffered some hardships from that but managed to rebuild. I think kind of overall, I've been interested in how Asian communities and groups within Asian America and other race and ethnicity groups have had differing experiences within the American history and within American health, and specifically within cancer. Scarlett, can you go ahead and tell me just a little bit about yourself? Dr. Scarlett Lin Gomez: Absolutely. I think that we find amongst ourselves who identify as Asian-American, Native Hawaiian Pacific Islander, that many of our unique experiences, life experiences, do have an impact on the cancer research that we do today. I am a first-generation Taiwanese American. My family came over after the repeal of the Asian Exclusion Act in the early-mid-70s. Like many Asian American families, we settled where we already had some family here in the United States, and so that happened for us to be in central Washington state. I grew up in central Washington, a very largely rural homogeneously non-Hispanic White population, and went to school largely in Spokane, Washington. So, eastern Washington. During my time growing up there, I certainly, and my family had experiences with structural racism. I definitely saw firsthand among my family and our social networks cancer as a very strong cultural stigma. For example, my grandmother's colorectal cancer diagnosis was actually never disclosed to her. In fact, this is very common among many Asian cultural populations. I also observed firsthand the relevance of our neighborhoods, our neighborhood environments, our social environments, and the structural context within which we live, work, and play, and how that really has a strong impact, not only on our access to health care but health behaviors and degree of social connections. I then moved to the San Francisco Bay Area. You can certainly imagine the vastly different cultural and structural and neighborhood environments of that in the Bay Area compared to growing up in central and eastern Washington. This is in fact—little to my knowledge—actually largely shaped the area of research that I chose to go into. In my doctoral dissertation, I had the opportunity to be introduced to and become involved with working with cancer registry data. I was actually surprised to learn that in fact, within Cancer Registry data, there were some several dozen codes for distinct Asian American, Native Hawaiian, [and] Pacific Islander ethnic groups, yet for me, it was surprising: why don't we see any statistics by these specific ethnic codes? In fact, we continue to see statistics for the Asian American population, Asian American Pacific Islander population aggregated as a whole. So, I set out for my dissertation to understand a very non-sexy doctoral dissertation topic to understand the quality of that data and how can we get the data to a point where we could start to report on statistics for disaggregated populations. That has really become a whole research program for my group today. Dr. Fumiko Chino: It's so nice to hear the history of how you got into that and even just if you had happened to end up in New York City, maybe your research could have gone a different direction. Kekoa, can you tell me a little bit about your history and what brought you to do the research that you do today? Dr. Kekoa Taparra: Yeah, absolutely. I am part Native Hawaiian from both my mom's and my dad's side. And just as a note, when we say Native Hawaiian, it's not the same as saying, native Californian or native Texan. That's not what I'm talking about. I'm indigenous Native Hawaiian, from both my mom's and my dad's side. I actually had the good fortune to attend the Kamehameha schools. That's a school for indigenous Native Hawaiian youth in Hawaii. And so, I grew up learning a lot about our history or culture throughout the Pacific, from Melanesia to Micronesia, and Polynesia. And so, with that kind of sense of identity, I really got a grasp of our community and our community's needs. And within my own family, I've had 10 family members, all of whom were Native Hawaiian, all die from cancer. That was something that I grew up with just thinking that cancer was just something that people couldn't overcome. It wasn't really until college that I got really interested in research, and that led to my eventual attending of Johns Hopkins. I was in the lab of Dr. Phuoc Tran, who was an MD, PhD, radiation oncologist, and he was really the first to bring me into the clinic and I'll never forget, the first time he ever told the patient, “Let's cure your cancer.” That was just something that I'd never heard before, given all my family members really struggled with different types of cancer diagnoses, none of them had the same thing. And so, really, from that point on, that's what inspired me to go to medical school. And towards the end of my medical school years, when I was actually applying for radiation oncology, I was a true bench scientist, and I'm a lab rat—that's where I've always belonged and felt like I belonged. But towards the end of medical school, when I was interviewing for radiation oncology, I met one of my mentors, Dr. Curtiland Deville Jr., at [Johns] Hopkins. He was really the first to, at least through my application, recognize the kind of cultural and historical context of what I've been through, what my family and my community in Hawaii, we call lāhui, what our lāhui has gone through. And so, he really encouraged me to write about it. That's kind of how I've ended up in this niche of speaking on Pacific Islander health. Again, just full disclosure, as a part Native Hawaiian, I can't even speak for the whole lāhui. I'll speak for myself and what I know. Again, the Native Hawaiian lāhui is very different from the rest of the Pacific Islands. But overall, I do research Pacific Islander health. Dr. Fumiko Chino: I love having both of you on this podcast because I feel your voices are so unique, but again, you also represent sort of different ends of the spectrum in terms of your research career, someone who's a little bit more senior and someone who's more junior. I think that really gives us a well-rounded perspective. Scarlett, can you tell me just a little bit about the history of Asian American, Native Hawaiian, and Pacific Islander aggregation and why it might be a problem? Dr. Scarlett Lin Gomez: I honestly don't know why the data are aggregated for. We're talking about people who come from 30 different countries and speak more than 100 different languages. My guess is that historically, we have tended to aggregate because of convenience, but potentially also just lack of knowledge about the vast heterogeneity among these populations. And so, I think for us who do research in this field, our hope is that by continually putting out the data that we can start to educate folks about why it is harmful, in fact, to aggregate. Why is this a problem? I think that we hide disparities. In fact, if you look, I think part of the reason why the practice of aggregation has continued is because when you look at the aggregated statistics, with regards to cancer, it actually paints a very rosy picture for the most part, for most cancer statistics that we look at. That's because the data are largely based on the largest groups, statistically the largest groups of those who potentially have been here the longest, but in fact, when we disaggregate, we know dramatic heterogeneity, as we would expect, because we know socio-demographically and based on immigration patterns and language patterns, these populations are really different. So, we would expect, in fact, we do see that translate into differences in cancer outcomes. I will give a direct answer to your question about why this is a problem. I like to note the very poignant story of Susan Shinagawa, who is a Japanese American woman who was diagnosed with breast cancer. She's also my friend and colleague, and she was one of the first advocates who really inspired me in doing this research. And so, her story is that she had to go to 3 different surgical oncologists to finally have her very prominent breast lump biopsied and looked at. She will recall that the reasons why she had to go to all these different surgeons was because they continuously told her, “You can't have breast cancer. You're Asian, and you're too young. Asian women don't get breast cancer." Her story isn't unusual. I think the other harm in aggregation is that the community then thinks that our risks of cancer are low and that this doesn't affect us, and in some of the first publications we put out, there was a paper where we documented both high survival rates among Asian immigrant women, as well as high rates among young Asian American women for breast cancer. This was published in the American Journal of Public Health in 2011. I actually received personally several emails from Asian women out in the community saying, because we had received quite a bit of press, this was reported out in the media, and they noted to me that they themselves were shocked when they were diagnosed with the disease because they thought that this was a “white old woman disease.” But in fact, it's not. I have a strong family history of breast cancer, as many of us do, and other cancer sites. And so, I think that perpetuates not only the model minority myth but the cultural stigma of cancer as a disease. Dr. Fumiko Chino: I can't wait until those oncologists that passed her by find out about the history of lung cancer in young Asian American women. Scarlett, can you talk a little bit and I know you had mentioned this before, in terms of when you first started digging into some of the data, how challenging this research can be in terms of, for example, do every databases have granular data in terms of the Asian races and countries of origin, ethnicities? Dr. Scarlett Lin Gomez: I think it's incredibly challenging and as an epidemiologist, we need the data. That's if we don't have the data, we don't even have a place to start. I think we've been fortunate to some extent within the cancer space in that the major databases that we really rely on to report the burden of cancer among our various groups do, in fact, have a fairly good capture of detailed Asian American, Native Hawaiian, and Pacific Islander codes, yet there is much that can be improved. The information on place of birth, for example, is really incomplete. Also, our group has really started working with data from electronic health records. And that is highly variable in terms of data capture availability, the granularity of codes, and the availability of the relevant variables like birthplace and language across the different groups. So, I do firmly believe, and I would call to action that I think we need to make a concerted effort to improve the granularity of data that are being collected. I think the other challenge that has really come about is the small data problem. I think that our epidemiologic and clinical toolbox is very limited in terms of what we can do, analytically with small populations. But I would put forth that just because a population is small in numbers doesn't mean that they're any less important. And so, I think that we need to do better in terms of developing better methodological and statistical approaches to being able to not only quantify but understand the burden of cancer in all of our populations. We also need better approaches to begin to study the intersectionality of multiple marginalized social determinants, statuses, language, and ensure language inclusion in terms of really being able to adequately study and incorporate and include these populations. Dr. Fumiko Chino: Can you talk specifically about some of the disparities that you've actually uncovered with your research? What are we talking about when we say that aggregation masks disparities? If I just say, Asian Americans are doing great from a cancer standpoint, what am I missing? Dr. Scarlett Lin Gomez: One particular disparity I can certainly highlight is the high burden that we recently documented in a publication last year in the Journal of National Cancer Institute that documented the high rates of lung cancer among certain groups of Asian-American, Native Hawaiian, and Pacific Islander females who have no history of smoking. Ours was the first study to actually show what the rates of lung cancer are in these particular groups. And it's particularly high—1.5 to 2 times higher among some of the Asian American, Native Hawaiian, and Pacific Islander groups compared to non-Hispanic White female never smokers. When we look across the Asian American, Native Hawaiian, and Pacific Islander ethnic groups, we note that there are differences in that risk. One example is that among Chinese American females 80% who have been diagnosed with lung cancer have no history of smoking, the vast majority, 80% have never smoked, in contrast to smaller percentages among, for example, Native Hawaiian and some Pacific Islander groups. Another pattern in terms of heterogeneity is that we actually did not notice the higher rates of lung cancer among Japanese American female never smokers. And this is an interesting observation, we actually note similar patterns for Japanese American women for breast cancer as an example, and this is something that definitely needs further follow-up. In fact, we're conducting a study right now called “FANS: Female Patient Never Smokers,” which is the first study to try to identify genetic and epidemiological risk factors for lung cancer among Asian-American females who have never smoked. Dr. Fumiko Chino: Kekoa, can you speak about what your research has shown? Dr. Kekoa Taparra: Yeah, definitely. From the perspective of a recent paper that we published in the JAMA Network Open, we looked specifically at the Hawaii Tumor Registry looking at patients in Hawaii, who were treated for premalignancy, the DCIS (ductal carcinoma in situ). What we found were the patients who ended up developing a second breast cancer after being treated for that first DCIS [that] the rates of the second malignancies both from ipsilateral and contralateral breast cancer were primarily seen in Native Hawaiians. Also, to some extent, Filipinos as well compared to other Asian ethnic groups. I think that there are definitely some trends that we continue to see in terms of who might potentially be at higher risk, but in other work that we have presented at [2021] ASCO Quality Care Symposium (Abstract 80) with yourself, we found that in terms of it in things like overall survival, there are potential differences in terms of Native Hawaiian and other Pacific Islanders as well as even Southeast and East Asian groups. And so, I think there's a lot of work to be done in terms of what are the kind of implications for disaggregation? What are appropriate techniques for data disaggregation? What is too much to disaggregate because we can disaggregate for a Native Hawaiian female who is from a specific zip code and who never smoked, and like, is that kind of the data disaggregation that we end up wanting, or is there something a little bit broader, that still tells us the same story of who should we be paying attention to? And so, I think there are a lot of unanswered questions. I think that Scarlett is doing amazing, amazing work that I continually follow. So, I think there's a lot to be done still. Dr. Fumiko Chino: So, I guess that leads to my next question, which is the concluding question, which is, what is the next step? So, how do we either: get better data or how do we actually intervene? So, Scarlett, I know you had talked a little bit about the FANS study. Can you talk a little bit about your breast cancer cohort study in terms of really thinking about getting together diverse data sets and making sure that it's powerful enough to actually draw some conclusions? Dr. Scarlett Lin Gomez: Absolutely. Breast cancer is actually a really interesting disease that I think we are in the midst of seeing a very interesting and dynamic pattern of breast cancer. We actually noted recently, in a small study in the Bay Area, that we may be seeing a reversal of higher rates among Asian American immigrant women compared to those who were born here. I think actually, this makes sense. If we think about, especially in the San Francisco Bay Area, who were the immigrants over the past 10, 20, and 30 years. And in fact, we are seeing very high, rapidly increasing rates of breast cancer within many of the East Asian countries. And so, I think we are really undertaking work to try to understand what some of these patterns are, but I think we are really well-positioned to invest in cancer research among Asian Americans, Native Hawaiian, and Pacific Islanders, because of these dynamic patterns, and the vast heterogeneity that we know exist within these groups. I think that investing in research among these groups can really tell us a lot in terms of the discovery of novel risk factors. My last final thought would be to the funders out there to really think about what we can learn by focusing on these populations, but also being able to study the disparities that really have gone ignored for a long time. Dr. Fumiko Chino: Kekoa, can you talk about some research that you have coming up that may or may not have recently been funded? Dr. Kekoa Taparra: Absolutely. One of the things I definitely have to appreciate from ASCO is having the opportunity to kind of publish our work in JCO Oncology Practice on a paper with the historical context of Native Hawaiian and other Pacific Islanders with cancer. Actually, a recent project that I have had, and I've been working on for the past year, really came about from a physician out actually in Micronesia, who read the paper and then contacted me, and this is a project specifically on betel nut induced oral cavity cancer. Betel nut is something that is consumed throughout the Pacific Islands as well as Southeast Asia, but something specific to islands in Micronesia is that according to the WHO (World Health Organization), they have the highest rates of elementary and middle school students who consume betel nuts. So, they had a very, very concerning epidemic right now of betel nut-induced oral cavity cancer. And so, one of the projects that I've been working on is a clinical trial, which we're calling NEO-CORAL. But the trial is specifically looking at a neoadjuvant immunotherapy approach to local or regionally advanced betel nut-induced oral cavity cancer. We're really excited to be working with teams from Guam, which is in Micronesia, as well as Queen's Medical Center in Hawaii, where I'm from, and at Stanford as well. And this tri-site approach we're hoping to kind of conduct a culturally careful and culturally aware clinical trial so that we can really try and make a difference in these patients' lives because the biology and just the aggressiveness are nothing like we've ever seen with tobacco-induced oral cavity cancer alone. I'm really grateful for certain funders that we've had recently who have funded this grant. I think it really just goes to show the kind of excitement around really helping a very marginalized community. Dr. Fumiko Chino: I think that that study and I think putting in the context of what Scarlett just said in terms of, we need this data, we need granular data, we need funding so that we can actually design interventions that are really tailored to unique, vulnerable communities to really provide the resources, education, and culturally competent care that actually gets people the best outcome so that there are not haves and have-nots in terms of health care, and that's really again everyone's goal. I'm wrapping up now. I really like to thank Dr. Scarlett Gomez and Dr. Kekoa Taparra for sharing your really valuable insights with us today and for your dedication to addressing the unequal burden of cancer across diverse communities. Dr. Kekoa Taparra: Thank you. Dr. Scarlett Lin Gomez: Thank you. Dr. Fumiko Chino: Thanks to our listeners for your time today; you will find links to all of the studies and presentations discussed today in the transcript of this episode. And, if you're enjoying the content of the ASCO Daily News podcast, please take a moment to rate, review, and subscribe. Disclosures: Dr. Fumiko Chino: None disclosed. Dr. Scarlett Lin Gomez: Employment: Bioinspire (Immediate Family Member), Valentia Bioanalytics (Immediate Family Member) Stock and Other Ownership Interests: Amgen (Immediate Family Member), Bioinspire (Immediate Family Member) Consulting or Advisory Role: GRAIL Page Break Dr. Kekoa Taparra: None disclosed. Disclaimers: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product service organization, activity or therapy should not be construed as an ASCO endorsement.
In Episode 14, I spend the second half of my convo with Dr. Z discussing colorectal cancer disparities among African Americans, what drew him to his subspecialty, and the critical role of mentorship in medicine.
In Episode 13, I chop it up with Colorectal Surgeon Dr. Zuri Murrell about growing up in the Golden State, how attending Morehouse College changed his life, and his journey to becoming one of the nation's leading colorectal surgeons.
In this episode, Dr. Thomas discusses her extensive cancer healthcare access work with the Amish and Mennonite communities.
African Americans have the highest death rate and shortest survival rate of any racial or ethnic group in the U.S. for most cancers. The factors surrounding such gaps in cancer are interconnected and complex. Scientists at The University of Kansas Cancer Center are working hard to overcome these hurdles, and they're doing it in unique ways. Through a consortium called Faith Works, researchers, church leaders and church members come together to spread the word about the importance of prevention and cancer screening.
The Boobie Docs: The Girlfriends' Guide to Breast Cancer, Breast Health, & Beyond
Black women have a 40% higher breast cancer mortality rate than their white counterparts, younger age at diagnosis, and more aggressive disease, just to scratch the surface. Breast cancer disparities have only widened because of the COVID-19 pandemic.We sit down with Roberta “Bobbi” Albany and Jamil Rivers to explore some of the multifactorial causes of breast cancer disparities. They offer advice to black women to improve their breast cancer outcomes and tangible things we can all do to address the problem. Jamil is founder and CEO of the Chrysalis Initiative. Bobbi is founder and CEO of Cancer in the Know and is a contributing author of Bruised, Broken & Blessed. Both women are advisory council members of Knowledge Is Power: Understanding Black Breast Cancer by Living Beyond Breast Cancer. This is a really important episode and we hope you give it a listen. (If you do, please review and share!)
This week Bobbi Conner talks with Dr. Marvella Ford about the SC AMEN program and efforts underway to help reduce prostate cancer mortality in Black men in SC. Dr. Ford is a Professor in the Department of Public Health Sciences and she's the Associate Director of Population Sciences and Cancer Disparities at Hollings Cancer Center at MUSC.
Dr. Shannon Westin, Dr. Kirsten Beyer and Dr. Jennifer Griggs discuss how mortgage lending bias and residential segregation intersect with cancer disparities and survival outcomes. TRANSCRIPT [MUSIC PLAYING] SHANNON WESTIN: Hello, everyone. My name is Shannon Westin, and I'm an Associate Professor at the University of Texas MD Anderson Cancer Center in the Department of Gynecologic Oncology and Reproductive Medicine. And I currently serve as the Social Media Editor for the Journal of Clinical Oncology. And we're starting a brand new podcast series to try to bring really exciting research that's being published in the JCO to you, and I'm so excited to kick off this series with a group of very accomplished women who are covering something that I don't think a lot of us don't know very much about. So I'm really excited to learn a ton over this next few minutes. So it's my pleasure to introduce Dr. Kirsten Beyer, who is an Associate Professor in the Division of Epidemiology in the Institute for Health and Equity as well as the Director of the PhD program in Public and Community Health at the Medical College of Wisconsin. We are also joined by Dr. Jennifer Griggs, who's a Professor the Department of Internal Medicine, Division of Hematology Oncology, as well as a member of the Institute of Health Care Policy and Innovation at the University of Michigan. She does predominantly practice taking care of women with breast cancer. Welcome, doctors. JENNIFER GRIGGS: Thank you. KIRSTEN BEYER: Thank you very much. SHANNON WESTIN: So we're talking today about the manuscript "Mortgage Lending Bias and Breast Cancer Survival Among Older Women in the United States" that Dr. Beyer published just this month in the JCO. In addition, Dr. Griggs and her colleague Dr. Pleasant were invited to participate in an editorial called "Contemporary Residential Segregation and Cancer Disparities." So let's get into to what was covered. So I think for me, the lowest hanging fruit here, Dr. Beyer, is understanding what exactly is redlining, because that was one of the critical exposure that you were assessing amongst these women with breast cancer. KIRSTEN BEYER: Thank you, Dr. Westin. Yes, redlining-- I think most people think about redlining as being a historical practice, where mortgage lenders would essentially draw red lines around particular neighborhoods and then not lend mortgages in those areas, regardless of whether or not the applicant for that mortgage was otherwise qualified. So it's generally thought of as a historical practice. But what we've done in this study is to look at some more contemporary data and create a new measure that we think represents contemporary redlining, maybe not in the legal sense in terms of housing discrimination. But this measure represents essentially the odds ratio of denial of a mortgage application for a property in a local neighborhood as compared to the metropolitan area as a whole. So we're really looking to see which areas of our US cities are systematically denied mortgage applications. By denying those mortgage applications, they are suffering from disinvestment, and I would argue structural racism is guiding a lot of that practice. SHANNON WESTIN: So can you explore that a little bit more with us? And how do you find that type of data? Where do you get this information about these denied mortgages? How do you get into the different covariates like race, ethnicity, things like that? KIRSTEN BEYER: Sure. So I think a little history lesson is important first. Between the historic practice of redlining and today, there have been a number of major laws that have been passed in the United States really to try to overcome housing discrimination. Some of the most important ones are-- in the Civil Rights Act of 1968, there was something called the Fair Housing Act, and that act prohibited discrimination in the sale, rental, and financing of housing based on race, religion, and national origin. And since then, they've added a few more protected categories. And then right after the Civil Rights Act of 1968, there was something passed called the Home Mortgage Disclosure Act. And this act was essentially to bring transparency to mortgage lending in this country. The idea was that we were requiring public disclosure of loan-level information about mortgages that were lent in the country. And the goal was to shed light on lending patterns, including those that could be discriminatory. And so the HMDA data-- it's commonly referred to as "hum-duh." That HMDA data has been collected then since 1975. And that database evolves over time, but we use that data for 2007 to '13 to really try to understand what are the mortgage lending patterns in our US cities in terms of their spatial distribution. And so there are a number of covariates that we were able to control for there. There are some things that we're not able to control for. I'm excited that the HMDA database has recently improved, and there are some new variables that are going to become available in the coming years. So what we did with the HMDA database was to calculate an index of redlining, so an odds ratio of denial of a mortgage application for a property in a specific neighborhood compared to all the properties across the metropolitan area. And so it's an area-level measure, a neighborhood-level measure. And then we put that measure into a statistical model to see what happens to women diagnosed with breast cancer if they live in redlined areas compared to if they live in other areas. And so we were able to control for a number of other factors, including race, including tumor characteristics, age, stage at diagnosis, and then to see what is the added effect of redlining over and above the things that we already know impact survival. So what we found was that women living in redlined areas in the United States were more likely to die faster after breast cancer diagnosis than women living in other areas. We also found that among people living in redlined areas, there was a discrepancy in terms of the race and ethnicity of those women. So 79% of Black women, 57% of Hispanic women, and 34% of white women lived in redlined areas in our sample. SHANNON WESTIN: That's so interesting, because I think we've all read and seen across a number of different cancer types how race and ethnicity can be associated with worse outcomes. So I think you're starting to scratch the surface of why that might be. Now, do we think that is there an association with other factors like socioeconomic status or insurance or anything like that? KIRSTEN BEYER: Yes, I think those are really good questions. Not all databases contain all of the information we would like. But in SEER-Medicare, which is the database we use, we know that all of the women have health insurance because it's a linked database with cancer registry data and then Medicare claims data. So health insurance wasn't a factor here, but we certainly know that it could be a factor in a larger sample of women across the age spectrum. And I think when you get into questions of socioeconomic status, you also have to think about, as opposed to statistically controlling away the effect of socioeconomic status, what is the mediating effect? Or what is the explanation? What factors explain the relationship between redlining and breast cancer survival? So I think that's where we'll see a lot of the important explanations for how does redlining contribute to survival. SHANNON WESTIN: Thank you. I think you nailed it right there, because finding a problem is, of course, important, but then what do we do next? Dr. Griggs, I thought your editorial was just so great at providing context for this issue, and I was wondering if you could expand a little bit more on this idea around residential segregation and how it impacts outcomes for these patients. JENNIFER GRIGGS: Thank you very much, and thanks for including me on this great podcast. It's so important to understand that place matters more than race, and we've known this for quite a while. So that area-level factors are associated with environment-- for example, pollutants, safe water, safe places to play, safe places to exercise, transportation fragility, for example, a robust public transport system. We know that neighborhoods that are in redlined areas are more likely to be policed in different ways, which takes children from school being suspended at higher rates. There's less educational investment, but Dr. Beyer mentioned this disinvestment in neighborhoods basically has shutters all the way down. It shutters from childhood all the way to how we age and access to healthy food. We know redlined areas are associated with poor markers of diabetes control, and if you take somebody from an area that's a poor neighborhood that's segregated and give them a voucher to live in a more affluent area, that markers of diabetes improve and weight goes down. So just to think about this, that the impact of where we live affects things that we think of as personal behavior-- like, what we eat or how we control our diabetes. There are, of course, implications for access to high-quality health centers when we think about people sort of locked into certain neighborhoods, all that goes along with that, including wealth. Wealth is probably one of the biggest predictors of health and not being able to have the wealth associated with home ownership decreases economic stability. And we know these things like allostatic load or stress, sometimes called wear-and-tear effects, are associated with things like tumor biology and breast cancer. We see more triple-negative breast cancers in areas where there's more allostatic load. So imagine, we think about race as this fixed-- sometimes people even construe race as a biologic construct, when really, of course, it's a social construct that has systematically-- our systems have been put in place so that even the legislation, Fair Housing Act, can't be overcome, as shown in Doctor Beyer and colleague's paper. In other words, despite legislation, we continue to see mortgage lending bias, which we've termed contemporary redlining. Yet, we think of race as this fixed, deterministic way of describing people and explaining differences and outcome. So this kind of work is really important when we can show the effect of place independent of race and if we can show that there has been systematic construction of something so important as residential segregation. What this does is it drives us to really a call to action. A lot of ideas in there, but basically, showing where people live being associated with their outcome in breast cancer-- and this has been shown in other cancers, as well-- through pathways like economic stability and wealth, wear and tear on the body, and then to acknowledge the sad truth that things have been intentionally constructed structures. SHANNON WESTIN: I mean, I think this is really in line with a lot of what we're learning about our society and our country, the way we were educated when we were younger was that we did not always hear the truth about what really went down as this country was built. I think that you really touched on a lot of very critical points. And I think for me, a lot of times when we read about these racial and ethnic disparities, I feel like it often comes down to where people are like, oh well, it's just access to care, or lack of insurance, or they're just not focusing on these things. They're not educated. They don't know that these things are important. But what I hear the two of you saying is, it goes much deeper than that. So Dr. Beyer, I'd be interested to hear your thoughts on that with these areas. Should we be working on improving what is available to people in these areas? Or should we work on breaking down or both? KIRSTEN BEYER: Yeah, thanks, Dr. Westin. That's a great question, and it's a complicated one. I think Dr. Griggs mentioned housing vouchers. And so for example, when we are giving someone a housing voucher to move from a more vulnerable neighborhood, let's call it, to a less vulnerable neighborhood, that can improve health outcomes for sure. But we also know that there's a downside to that. Sometimes there are impacts on social support or mental health. And then on the flip side, if we are trying to improve neighborhoods themselves so that the people living in them can benefit from those enhancements, we often see that what happens is gentrification, when people who are living in those neighborhoods get displaced, and newer people, wealthier people, move in and take those amenities. So I think it's something that really requires close management with housing policy. And then I think another thing that I would add is that, as you mentioned, we're really scratching the surface. I think that's an important thing to emphasize. This is one aspect of housing. There are other aspects that are very important, like quality of housing and stability of housing, which is what Dr. Griggs mentioned. And I think it's also important to note that even if a person is denied a mortgage application because of a credit score, that credit scores, wealth, income, and many other things that are considered in the mortgage lending process are also affected by structural racism, as are things like home appraisals, mentorship, and eviction, something that we've certainly seen during the COVID-19 pandemic. SHANNON WESTIN: Wow, so thoughtful. I feel like I'm trying to take notes as fast as I can because I'm learning so much. I think we didn't hear about anything like this in our medical school and your PhD training. I don't know if you all got any type of background in this. Dr. Griggs, did you-- I mean, we never even scratched the surface with the impact of structural racism. And in fact, I think a lot of our medical education was founded in that structural racism. JENNIFER GRIGGS: I couldn't agree more, and I couldn't agree more with what Dr. Beyer said about things like housing vouchers, so I just want to acknowledge that it's not as simple as giving people a voucher, obviously. No, we are calling for structural competence. There are multiple calls that we teach medical students and current practicing clinicians and scientists the structures that have been put into place and that persist. So again, that intentionality that these systems were put in place through deliberate efforts, and it's only going to be through deliberate efforts that they're dismantled. And teaching people that individual behaviors are not predetermined or, frankly, learned. They cross multiple generations, and they reside within a place and the way not just a person, but an entire people, have been treated. And I do just want to say, although this may be new to a lot of us, that the lived experience of people who live in vulnerable neighborhoods and their life experience and their family's experience going back many generations make this not new news, right? This is old news. This is stuff people have known for generations that they're being systematically cut out of opportunities for advancement and for accumulation of wealth. So I think we just want to be-- I just want to be careful when I'm talking with my colleagues, my team, my research colleagues that this is not new knowledge. And we want to also be careful not to be parasites in a way on other people's suffering, that we want to be careful not to glorify our own ideas because number one, they're not our ideas. And number two, this type of work is the lived experience of people for many, many years, not just our neighbors and friends and colleagues. So there's so much harm that's been done, and we can celebrate advances and new knowledge, but I also think we want to focus on cultural humility and do a lot of deep listening and less talking and build trusting relationships with communities that are not about our career advancement but are really about fairness and justice. SHANNON WESTIN: I think that needs to be shouted from the rooftops, and I think it is a very careful balance, because we want this research to get out. We want to make sure people understand this. You're right. It's not new knowledge, but I think it's something that hasn't necessarily been highlighted in academic fields up until, like, the last few years, where I feel like we've started to see this. But you're exactly right. We can't just do the research and find the association. Now it's time for the next steps. And I'd be interested to hear from both of you, because, to me, there are several levels of steps that we can take. There's the local level, right? So what can we do for the patients in front of us? And then I'd be interested to hear what you all think about what do we do on the more institutional-- and by institutional, I mean, our entire country. Like, what can we do? How do we advocate for policies that will help to reverse these practices? I don't know Dr. Beyer, if you want to start. I know that was a really big question. What can we do when we're seeing patients in the clinic? Are there ways, or are there things we can offer or things that we can do on the local level that could help to address some of these disparities? KIRSTEN BEYER: Yeah, thank you, Dr. Westin. I'm not a medical doctor, but I work a lot with medical students. We have some pathways at the Medical College of Wisconsin, one on urban and community health and one on global health. And in those pathways, we do try to put forth a lot of this type of content and learning. But again, that's just a select number of students who end up getting that training. I think that structural racism is a fundamental force in our society, and therefore, it justifies a position in the core medical curriculum. I think since the murder of George Floyd, there has been a national consciousness that's been raised around this issue, that we should take advantage of that and try to push forward some core learning on structural racism for medical students. And then beyond that, I think as a patient, I can use the patient perspective. As a patient, I would want my physician to take into account my life context when providing clinical care. How hard is it for me to get to my appointment and to get there on time? How hard is it for me to find child care? How hard is it for me to obtain the prescriptions I need and maintain them with any significant cost at hand? So I think that awareness for physicians is really a first step. And then the last thing I would say is that doctors have power, and so I think it's the responsibility of those with power who are in the know about structural racism to leverage and use that power to make social change. JENNIFER GRIGGS: I really appreciate what you said from education to practice. I would add that an integrated health system would be able to think from prevention all the way up to health care. I feel like by the time people are accessing health care, a lot of other things have gotten in the way of their health, right? That's why we talk about social determinants of health. So I think we need to think about elevating the role of other people in the health care system. So even if you're in an individual practice, do you have access to a social worker? Are you including patient and family voices when you build your new office? We have transportation initiatives being made all over this country, and I know in Europe as well. So cities are being designed to undo transportation fragility and vulnerable neighborhoods. I can't emphasize enough the importance of asking communities what they need. It strikes me that the ivory tower is just that, right? It's very rarefied where we work. And to go into a community and say, this is what you need, feels-- which is not what you were suggesting, Dr. Beyer or Dr. Westin, but to start by listening and ask the communities what they need and then to provide it and to listen and not leave once the, quote, "problem is fixed." And I think the same is true nationally. We need to make sure that the administration's priorities actually bear fruit and soon, that we not kick things down the road and make compromises at the level of national policy. And as physician clinicians, those physicians who are listening, we should be going to the city council meetings when a new building is being erected. Is there going to be a consequence for neighborhoods in terms of things like gentrification? Cities have been constructed intentionally to isolate people, and we need to start undoing that, and cities are doing that. They're taking down freeways that divide the rich from the poor. I think we need to make sure as clinicians that we are speaking up about equitable and high-quality education for young people because we know your early life experiences and education are associated with health. Publishing work like Dr. Beyer's work, ASCO has a heavy advocacy arm. And as Dr. Beyer said, we have power. Inequities in power is what got us to where we are. So really, the burden is on those with power to speak on Capitol Hill and other places, local level, statewide level, to make change and to insist on it for the health of our patients and our communities. SHANNON WESTIN: That is so thoughtful and such a great call to action. And I do think there's a huge opportunity for members of ASCO to get involved. The advocacy is extremely strong. There are Capitol Hill days and committees, and now we even have their own political action committee, where we can work to lobby for patients and their health care. So I think that is a perfect place for us to end this conversation. I would like to give Dr. Beyer last opportunity to one-liner to sum up where we are and what we need to do next for those people that tend to fade in and out of these types of things. KIRSTEN BEYER: Sure. Thank you, Dr. Westin. I would say, to summarize, that the housing sector is actively revealing structural racism. This isn't a historic practice only. We are seeing structural racism in housing right now, and it's actively revealing both structural racism and economic disinvestment. And it's a very actionable policy target, so that we can mitigate those upstream determinants of health for the benefit of patients with cancer and with other diseases. And then I think as a final, I would say that there's a great quote from Matthew Desmond, who's a housing equity writer and scholar and activist. And he says, "A stable home functions as a secure foundation on which to build holistic and cost-effective health care." And so I think that's a great way of thinking about it from a practical standpoint. Housing is primary. It's an important foundation on which we build all the other things that we can do to improve people's health. SHANNON WESTIN: Perfect. Thank you both so much. Thank you, Dr. Beyer. Thank you, Dr. Griggs. And thank you, all of the listeners. We'll be back soon with a new podcast coming to a ear near you. JENNIFER GRIGGS: Thank you so much. KIRSTEN BEYER: Yeah, thank you very much. [MUSIC PLAYING] SPEAKER 1: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. For more original research, editorials, and review articles, please visit us online at jco.org. This production is copyrighted to the American Society of Clinical Oncology. Thank you for listening.
Dr. Ford is Associate Director of Population Sciences and Cancer Disparities at the MUSC Hollings Cancer Center and the SmartState endowed chair in prostate cancer disparities for South Carolina State University. In this episode, Dr. Ford describes her experiences as a breast cancer patient not once but twice.
Co-host Natasha Allard interviews First Lady Charmaine Geeter and First Lady Narseary Harris from the National Witness Project, along with Dr. Ermelinda Bonaccio from Roswell Park, on their efforts to overcome breast cancer screening disparities among African American women in Western New York and on racial discrimination in healthcare setting.Ermelinda Bonaccio, MDDr. Bonaccio serves as the Chair of Diagnostic Radiology at Roswell Park Comprehensive Cancer Center and has been a breast imager for 24 years. First Lady Charmaine Geeter and First Lady Narseary HarrisAs first ladies of their church, First Lady Geeter and First Lady Harris are passionate about their advocacy work with The National Witness Project. The goal of the National Witness Project program is to increase cancer awareness and cancer screening uptake in the African American community. Follow us!Official WebpageBuzzsproutSpotifyApple PodcastsYoutubeInstagramFacebookTwitter
Fulton County Registration & Elections Director Richard Barron discusses early voting and the recent firing of two employees accused of shredding 300 paper voter registration applications.Plus, Dr. Lauren McCullough, a breast cancer epidemiologist and assistant professor at Emory's Rollins School of Public Health, discusses her research that focuses on why Black women in Atlanta, who have breast cancer, have worst health outcomes than their white counterparts.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.
While academic and medical research has led to incredible breakthroughs in breast cancer care—including new treatments and screening methods—these advances have not reached every patient in every corner of the globe. With breast cancer now the most commonly diagnosed cancer in the world, it's critical that lifesaving advances are deployed more equitably and universally—especially to women and men in lower-income and -resource countries. Dr. Fadelu discussed his work that lies at the intersection of breast cancer and global health services research Each year, BCRF underwrites several grants to breast cancer researchers in partnership with Conquer Cancer, the ASCO Foundation. Dr. Temidayo Fadelu recently received the Career Development Award for Diversity, Inclusion and Breast Cancer Disparities. His BCRF-supported project aims to improve adherence to endocrine therapies among patients in Rwanda and Haiti.
In the days following Dr. Karen's appointment to the NCI's National Cancer Advisory Board, she reflects on what it took to get here and how attitudes toward disparities research has changed. Dr. Zanetta and Dr. Tiffany discuss their unique pathways to health disparities work, including the ways in which they were deterred or dissuaded from it, and how they were able to include it in their journey. --New Episodes every Tuesday, available wherever you get your podcasts! Rate and Subscribe! Also, join us for our live streams on Facebook and Youtube!Sign Up for our newsletter here or at 3BlackDocs.com Please take a moment to fill out our survey so we can continue to bring you the content you love! Join the Conversation! Follow us on social media!3 Black Docsfacebook.com/3blackdocstwitter.com/3blackdocsinstagram.com/3blackdocsYouTube.com/3blackdocsDr. Karen Winkfieldfacebook.com/drwinkfieldtwitter.com/drwinkfieldinstagram.com/drwinkfieldDr. Zanetta Lamarfacebook.com/drzanettainstagram.com/drzanetta
The Docs celebrate Dr. Karen's appointment to the National Cancer Advisory Board (NCAB) this past week and the impact she hopes to have in this new position. The NCAB advises the director of the National Cancer Institute (NCI) to support research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer, rehabilitation from cancer, and the continuing care of cancer patients and the families of cancer patients. Dr. Karen reflects on the the path that has led her to this appointment and how academia has evolved to consider health disparities work important worthy of a seat at the table. Read the official appointment here!--New Episodes every Tuesday, available wherever you get your podcasts! Rate and Subscribe! Also, join us for our live streams on Facebook and Youtube!Sign Up for our newsletter here or at 3BlackDocs.com Please take a moment to fill out our survey so we can continue to bring you the content you love! Join the Conversation! Follow us on social media!3 Black Docsfacebook.com/3blackdocstwitter.com/3blackdocsinstagram.com/3blackdocsYouTube.com/3blackdocsDr. Karen Winkfieldfacebook.com/drwinkfieldtwitter.com/drwinkfieldinstagram.com/drwinkfieldDr. Zanetta Lamarfacebook.com/drzanettainstagram.com/drzanetta
Continuing with our Pfizer leadership campaign, Zach sits down with Tyrone McClain, Global Director of Public Affairs for Oncology at Pfizer to talk the Delta variant and Pfizer's priorities in this season. Check the show notes to connect with Tyrone and more! Read the American Cancer Society piece, "Cancer Disparities in the Black Community," that Zach mentioned in the interview. https://bit.ly/3kBDDQY Want to know more about our LinkedIn Learning courses? Check them out! https://bit.ly/3k4havy You can connect with Tyrone on LinkedIn. https://bit.ly/3t3wtIJ Interested in working at Pfizer? Check out their Careers page. https://bit.ly/34YmfhM Follow Pfizer on LinkedIn. https://bit.ly/3ptZxHQ Learn more about Pfizer on their website. https://bit.ly/2TTtZiZ Check out Living Corporate's merch! https://bit.ly/375rFbY Interested in supporting Living Corporate? Check out our Support page. https://bit.ly/3egO3Dk
One of the most promising areas of cancer treatment involves identifying the cancer a person has and using therapies targeted at just that cancer. This field of precision medicine or targeted medicine is not well understood by most lawmakers or the general public. On the podcast to discuss this emerging field is Dr. Carl Morrison, a molecular biologist and pathologist who is the senior vice president of Scientific Development and Integrative Medicine at the Roswell Park Comprehensive Cancer Center in Buffalo, N.Y. He is one of the nation’s leading researchers in the field. Our second guest is Karmen Hanson, a policy expert at NCSL. She explains why these new treatments are important for legislators to understand, both so they can aid their constituents and because of the costs to the health care system. Resources Advancing Health Equity, Addressing Cancer Disparities, American Cancer Society/Cancer Action Network Biomarker Testing, LUNGevity Cancer Disparities, National Cancer Institute Cancer in the 21st Century, NCSL Common Cancer Testing Terminology, Consistent Testing Terminology Working Group “Improving Access to Biomarker Testing,” American Cancer Society/Cancer Action Network “Development of an Actionable Framework to Address Cancer Care Disparities in Medically Underserved Populations in the United States,” JCO Oncology Practice “Know Your Biomarker,” Global Colon Cancer Association No One Missed, LUNGevity OAS Episode 138 Transcription “Precision Medicine,” Cancer Support Community
The California Prostate Cancer Coalition (CPCC) and The Helen Family Diller Comprehensive Cancer Center present the 2021 Patient Conference on Prostate Cancer. This session: Mack Roach III, MD, Professor of Radiation Oncology, Medical Oncology and Urology, UCSF. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 37257]
The California Prostate Cancer Coalition (CPCC) and The Helen Family Diller Comprehensive Cancer Center present the 2021 Patient Conference on Prostate Cancer. This session: Mack Roach III, MD, Professor of Radiation Oncology, Medical Oncology and Urology, UCSF. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 37257]
The California Prostate Cancer Coalition (CPCC) and The Helen Family Diller Comprehensive Cancer Center present the 2021 Patient Conference on Prostate Cancer. This session: Mack Roach III, MD, Professor of Radiation Oncology, Medical Oncology and Urology, UCSF. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 37257]
The California Prostate Cancer Coalition (CPCC) and The Helen Family Diller Comprehensive Cancer Center present the 2021 Patient Conference on Prostate Cancer. This session: Mack Roach III, MD, Professor of Radiation Oncology, Medical Oncology and Urology, UCSF. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 37257]
The California Prostate Cancer Coalition (CPCC) and The Helen Family Diller Comprehensive Cancer Center present the 2021 Patient Conference on Prostate Cancer. This session: Mack Roach III, MD, Professor of Radiation Oncology, Medical Oncology and Urology, UCSF. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 37257]
The California Prostate Cancer Coalition (CPCC) and The Helen Family Diller Comprehensive Cancer Center present the 2021 Patient Conference on Prostate Cancer. This session: Mack Roach III, MD, Professor of Radiation Oncology, Medical Oncology and Urology, UCSF. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 37257]
The California Prostate Cancer Coalition (CPCC) and The Helen Family Diller Comprehensive Cancer Center present the 2021 Patient Conference on Prostate Cancer. This session: Mack Roach III, MD, Professor of Radiation Oncology, Medical Oncology and Urology, UCSF. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 37257]
The California Prostate Cancer Coalition (CPCC) and The Helen Family Diller Comprehensive Cancer Center present the 2021 Patient Conference on Prostate Cancer. This session: Mack Roach III, MD, Professor of Radiation Oncology, Medical Oncology and Urology, UCSF. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 37257]
This week Bobbi Conner talks with Dr. Marvella Ford about efforts underway to improve COVID-19 vaccination rates in communities of color in S.C. Dr. Ford is a Professor in the Department of Public Health Sciences and she's the Associate Director of Population Sciences and Cancer Disparities at Hollings Cancer Center at MUSC.
This is the first in the series on uncovering health care disparities in the United States. This week Dr. Hirsch uncovers breast health disparities, including discussing differences in incidence and mortality of breast cancer. She also discuss social factors that play a role into the differences in breast health including genetic factors, poverty, diet, physical inactivity, cultural factors and more. Listen in to this empowering and educational episode and comment along! Follow along side Dr. Hirsch on her youtube channel: https://www.youtube.com/channel/UCrAeWep_qZiP7QeR7ogcCPA/ Follow on Instagram: https://www.instagram.com/hormone.health.doc/ Follow on Twitter: https://twitter.com/heatherhirschMD --- Support this podcast: https://anchor.fm/heather-hirsch/support
Diane Nathaniel
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