“Building Bridges to Conquer Cancer” was the theme of the 2013 Annual Meeting of the American Society of Clinical Oncology (ASCO), as well as the address of ASCO president Sandra M. Swain, MD.
Her address focused on 3 pillars of the theme: 1) ensuring global health equity, 2) the need to strengthen future generations of leaders and practitioners, and 3) the vision for a rapid learning system in oncology. These 3 issues “belong squarely on our personal and professional radar screens,” she said.
Global Health Equity
Gaps in connecting proven treatments and preventive measures with underserved populations are linked to higher mortality from cancer and more suffering due to later stages of presentation.
These gaps occur in different parts of the United States, and not just in low- and middle-income countries, said Swain. Forty-eight million uninsured Americans – and those joining the Medicaid rolls – are all part of this picture. One area of concern is the wide variability in Medicaid programs.
“On the plus side, a recent study showed that in states where Medicaid programs have been expanded to cover more individuals, there has been a reduction in overall mortality,” she said. “While this is an encouraging sign for the general population, cancer-specific outcomes for patients covered by Medicaid have been associated with no better outcomes than for those who are uninsured.”
A key predictor of whether an adult will survive cancer is income. This outcome gap is largely a result of differences in access to care. One innovative effort to bridge equity gaps is a screening program for colon cancer that is available to every citizen in Delaware. The program’s success is exemplified by screening rates in African Americans that rose from 48% to 74%. The number of African Americans presenting with regional and distant colorectal cancer was reduced by 39%. The decline in mortality rates for African Americans was 42%, bringing it closer to that of whites.
“Not only did the program help patients avoid the pain and suffering associated with aggressive treatment of late-stage illness, it saved millions of dollars in treatment costs,” said Swain.
Although advances have been made in vaccines and the screening of large populations for breast and cervical cancers, many of these methods are not available globally. And even if the cancer is diagnosed, there are wide gaps in the availability of affordable treatments.
In response to the global cancer crisis, ASCO has started a program called ASCO International, which aims to increase support for existing programs and invest in new programs targeted at global cancer control. One important strategy will be to use digital resources (ie, virtual meetings and mentoring) “to knit the world closer together.”
Supporting the Next Generation of Leaders and Practitioners
Supporting the next generation of clinical cancer researchers is a priority, said Swain. Although 98% of past winners of the Young Investigator Award and Career Development Awards programs are still involved in cancer research, donations to support the programs are declining, an unwelcome occurrence at a time when federal research dollars are dwindling.
ASCO is continuing its successful and popular Leadership Development Program in an effort to develop the next generation of leaders, but potential shortfalls in practicing oncologists is a concern. “Will we be able to meet the projected increase in cancer cases? To better understand and monitor these trends, ASCO has established a Workforce Information System,” she said.
At present, the number of oncologists 64 years and older is growing rapidly and outnumbers those younger than 40 years. Further, only 3% of oncology fellows are African American, and 8% are Hispanic. In order to address the disparities in access to cancer care, a diverse professional workforce is necessary.
Accelerated Learning for a Data-Driven Era
“To create a world free from the fear of cancer, we must accelerate our knowledge about the disease, its biology, and its treatment,” said Swain.
To this end, ASCO has launched CancerLinQ, a rapid learning system that aims to use real-time information from every patient experience both to guide day-to-day care and inform clinical guidelines on a real-time basis. “A rapid learning system will transform information that is now locked away in filing cabinets, patient records, lab reports, journals, disconnected electronic records, and inside our overloaded brains into real insight,” she said. “We need to be able to use the 97% of patient information that is currently lost.”
A physician can query a CancerLinQ database to discover current practices in the management of a particular cancer and the outcomes obtained. “By stitching together many stories, we can gain understanding of what worked and didn’t for thousands of patients – not just the 3% who may have been in a clinical trial,” she said.
Ultimately, understanding patient experiences can guide research questions, bridge gaps in knowledge, and provide critical information for situations in which randomized controlled trials are not feasible or possible.
CancerLinQ has been advanced with the development of a prototype that contains de-identified data on more than 130,000 patients with breast cancer “By using a combination of open source and other software, we have shown it’s possible to obtain and aggregate information from different electronic health records,” she said.