ASCO 2019 Presidential Address: Removing Disparities in Cancer Care
The theme for this year’s meeting—“Caring for Every Patient, Learning from Every Patient”—was meant to convey the message that every patient with cancer deserves equal access to the highest quality care and the opportunity to participate in clinical research. ASCO’s efforts to make these goals a reality was the focus of the presidential address by ASCO President Monica M. Bertagnolli, MD, FACS, FASCO, Chief, Division of Surgical Oncology, Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Boston.
The important word here is “every,” she said. “We know that this is not the case today, that disparities in access to care and clinical research are unfortunately widespread. The very tricky thing about disparities is that their causes are complex. Their roots go deeply into the communities that we serve.”
Dr Bertagnolli highlighted ASCO members’ efforts to improve cancer screening and prevention across economically disadvantaged counties in Appalachian Ohio, and the Walking Forward program, which brings cancer clinical trials to the residents of the Pine Ridge Indian Reservation in South Dakota, where “life expectancy…is the lowest in the nation—just 49 years for men and 52 years for women,” she said.
Patients diagnosed with breast cancer at the Gateway Community Health Center in Laredo, TX, receive much-needed medical care and are also able to participate in clinical trials sponsored by the National Comprehensive Cancer Network thanks to the efforts of ASCO members.
Queens, NY, the fifth-largest city in the United States, is home to underrepresented minority populations, where many people face homelessness and food insecurity, yet they are able to receive cancer care at Mount Sinai’s Icahn School of Medicine and to participate in clinical trials at Queens Hospital Cancer Center as a result of ASCO, Dr Bertagnolli said.
Committees populated by ASCO volunteers are assessing patient needs and barriers to care, as well as developing strategies to achieve ASCO’s vision of caring for every patient, she emphasized.
Using Technology to Improve Patient Care
“How can we use technology to help us be better doctors?” Dr Bertagnolli asked. “Imagine what would happen if we could bring the wisdom of this crowd into the consult room with your patient.”
Functional electronic health records (EHRs) are now used by more than 90% of physicians to facilitate the exchange of information throughout the healthcare system. “Today, all fully functional EHRs allow patients to participate in their healthcare by having direct access to their record,” she said.
However, few physicians are connected in ways that allow data to be shared freely. EHRs need to be linked so that data from the clinical environment can be collected, aggregated, and analyzed. An effort must be made to ensure that these data include underrepresented minorities, patients with rare conditions, and patients who live in rural settings. A common structured language is needed for every EHR, Dr Bertagnolli said, to make data computable for analysis at scale, so that information can be captured routinely and accurately.
Treatment decisions can be improved by having instant access to the most recent patient information available, such as ASCO’s CancerLinQ, which captures information on older adults with cancer who are not typically included in randomized clinical trials.
“All of us can see that our decisions can be better if we have the best available information at our fingertips every time we meet with a patient,” Dr Bertagnolli said. “Think of what CancerLinQ will do when it fully connects all of us and learns from all our patients’ experiences. Artificial intelligence is a tremendous tool that can reveal important new insights from large data sets.”
Connectivity must also flow from the patient to the clinician, Dr Bertagnolli said. “We will all be much better doctors when patients are easily able to access their information, to know how their information is being used, and to give consent for participation in research. ASCO and CancerLinQ are defining a prototype for a patient engagement portal, funded by Conquer Cancer, to achieve this goal,” she concluded.