By Brian Reid and Lauren Oubre
Grizzled veterans of the American Society of Clinical Oncology (ASCO) Annual Meeting often scoff at their peers who hustle through the cavernous McCormick Place in Chicago, bumping from hall to hall, from presentation to presentation, like khaki-clad Roombas.
Instead, the old pros take a more leisurely approach, strolling through acres of lower-profile — but often more thought-provoking — posters. These summaries of research, condensed to a single piece of paper, often give a glimpse of what’s next.
And though this year’s ASCO will again be virtual, sparing attendees the annual “blister walk” from the front door to Lake Michigan, the story of the meeting will again be told through posters, conveniently housed online.
The story of 2021? A far more nuanced understanding of the health inequities that riddle cancer care, as well as the seeds of the solutions to America’s most pressing public health crisis.
Hidden in the online poster hall this year:
- A database scan of 73 million Americans that found cancer prevalence rates for Black Americans were significantly lower than expected, especially for Americans not yet on Medicare, underscoring the reality of underdiagnoses and shorter survival rates for this patient population.
- A study that found 42% of Caucasian women with triple-negative breast cancer received genetic testing compared with only 23.8% of Black women.
- An assessment of enrollment in more than 150 precision oncology trials, likewise, showed significant racial disparities in representation.
- As assessment of leukemia trial enrollment found that, between 2011 and 2014, enrollment of Black and Latinx patients fell by around 20%.
- Telehealth services – an important tool for ensuring care during the pandemic — also showed our health equity failings: between March and December of last year, the odds of a Black patient using telehealth services at the University of Minnesota’s cancer center was less than half that of White patients.
This is by no means a comprehensive list. And while not all the action is confined to the poster sessions — we’re also interested in an oral presentation on the largest-ever study on the impact of race and socio-economic status on pediatric cancer hospitalization and mortality in the United States — the topic of health equity is absent from the formal ASCO press schedule and the late-breaking research being presented.
To be sure, ASCO has set “Equity: Every Patient. Every Day. Everywhere” as the theme of the conference and held a pre-meeting virtual roundtable on the topic, but the issue is otherwise not front-and-center.
Using the flexibility of ASCO’s virtual format to dive as deep as possible into research on health equity is just the first step to better understand and address the scope of the problem prior to fashioning solutions. We need to go further, and we can start with the following actions:
- Find the Blind Spots: If those of us who work in health care are going to solve these issues, we need to take a hard look and identify our shortcomings. We must be willing to step up in new ways so that we no longer allow racism to drive poor health outcomes. By confronting, addressing, and dismantling the discriminatory structures, policies and norms within organizations, we can start to chip away at some of the problems that cause health disparities.
- Customize Your Approach: Covid-19 exposed the elements of equitable care that have been shrugged off as someone else’s responsibility to fix. Those days are over. Organizations must not just learn about the disparities that exist, as we’re seeing at ASCO this year, but develop concrete approaches to address those disparities, in partnership with trusted community leaders and gatekeepers.
- Prioritize Health Equity as a Key Business Objective: The old business school cliché dictates that what gets measured get managed, and the time has come to formalize how we assess health equity. Centering on the patient is where this effort must start, with special attention on solidifying ties with underserved communities and reigniting engagement from stakeholders. This is critical in ensuring our commitment is woven into the fabric of who we are as an industry.
Those actions aren’t necessarily simple, but the first step in the work ahead is understanding the issues around health equity, in all of their complexity. That’s why Real Chemistry will be in the poster section, unearthing those foundational insights to start us down the path of addressing the root causes of this most pressing and debilitating issue.
Real Chemistry is a global health innovation company with an alchemic mix of 1,800 people and hundreds of clients and partners working from bench to bedside, making the world a healthier place. To learn more, visit the company’s website.