How will ASCO combat cancer disparities?

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Published: 21 Jun 2019
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Dr Eduardo Cazap, Dr Richard Schilsky

Eduardo Cazap, MD, PhD speaks to Dr Richard Schilsky at the 2019 American Society of Clinical Oncology (ASCO) Annual Meeting for ecancer's Global Cancer Leaders initiative.

They initially tackle the issue of global cancer care, and how ASCO aims to help equip oncologists worldwide to tackle the rising cancer incidence outside of developed countries.

Dr Cazap probes the issue of access disparities inside and outside the US, and what role ASCO will play in aiding these issues, with a focus on providing information.

The consensus is that cancer care is a global issue, but the solution is often local.

EC: Today we are here at the ASCO meeting 2019 with Dr Richard Schilsky, past President of the organisation and now with the position of Chief Executive.

RS: Chief Medical Officer.

EC: Chief Medical Officer, exactly. Thank you Dr Schilsky. So, Dr Schilsky, you have really your background in research and your background in the domestic situation in the US about cancer oncology. How do you see the ASCO meeting that, of course, convenes more than 50% of the audience is international, but the topics are many situations dominated by therapeutic advances that sometimes are difficult to apply to the world populations. How do you see that ASCO is planning to manage this situation?

RS: It’s a complicated question, of course, because, as you point out, a third of ASCO’s membership are located outside the United States, half of the meeting attendees are located or coming from outside the United States. As we look to the future the greatest incident burden of cancer is going to be outside the United States. Most of the new cancer cases in the world in the coming decades are going to be in China, other Asian countries, Africa, South America and not so much in the US and Western Europe. So one of the things that ASCO has to do is to equip oncologists wherever they are in the world with all of the knowledge and skills that they need to have to deliver the best quality care to the people they serve.

Obviously it’s important that wherever an oncologist practices that they are at least aware of what the most up to date advances and options are for their patients, even if they can’t apply them immediately in their own practice. Because that is still the aspirational goal, is to deliver the best possible, most impactful new therapies to patients in need. What ASCO is doing, at ASCO we have a mandate now from the ASCO Board of Directors to expand our activities internationally. To that end we are beginning to convene what we call regional councils in different regions of the world. The first will be in Asia but there will be others in Africa, in South America, elsewhere around the world, where we will be bringing together the leading oncologists from those regions of the world to sit down and talk with ASCO leaders about what do they need, what are their challenges, their obstacles. How can ASCO help them to overcome those challenges and deliver the best quality of care to the patients they serve? There are things that we can do well with respect to education and helping them build quality clinical practices and even certifying those practices through our QOPI certification programme which is expanding internationally now. There are other things that we perhaps have less capacity to help with like what can their health system afford. That’s a huge problem everywhere in the world and it’s going to have to be solved locally. But, at the very least, we can provide oncologists with the evidence that can help them to advocate to their own governments, to their own health systems, to get the resources that they need for their patients.

EC: First of all I am very happy to know that ASCO has the same vision about integrating more the global community in the ASCO future plans. But I have a doubt because it seems that we have the US oncology and other world. I am not so sure, there are data that in some states of the US or in some communities you have situations that are in cancer incidence or mortality similar to other countries and below the average of the ASCO medium. So how do you see… don’t you think that this is not a question of the US or international, this is a question of everybody and that at certain points some self experiences or international experiences may help the healthcare in the US to be more efficient or lowering the cost?

RS: Well, we certainly need to learn from each other, there’s no doubt about that. We certainly have health disparities in the US, as you point out. In the US, everywhere in the world, I think, a lot of health disparities are driven by access to care. In the US it’s perhaps particularly problematic because we don’t have a single parent healthcare system like many other parts of the world do. So in our country your access to care depends largely on your insurance status. If you don’t have insurance, if you don’t have good insurance, you may not get the access to care that is necessary to be able to see the oncologist and the cancer care team that you need to see.

Now, I’m sure in other parts of the world, even those with single parent systems, there are also still disparities in care. But the fundamental problem is not so much that the doctors don’t have information. Every doctor that I talk to, no matter where they are in the world, is pretty up to date on what are the most recent advances in oncology that they would like to be able to apply to their patients. The issue is can their healthcare system afford it and can the patients that they’re seeing access the care. In many places, of course, that means do the patients have adequate transportation to get to where the care is delivered? Do the patients have themselves the financial resources to make whatever commitment they have to make to access the care? Are they even aware of what their treatment options are? Do they have enough contact with local care providers who are knowledgeable enough to advise them on what their options are? You and I know very well that for many, many years years ago cancer was widely viewed as a death sentence and people would throw up their arms and say, ‘There’s nothing to be done.’ That’s certainly no longer the case – for  every cancer there are always options, there are always things that can be done. But, there may still be parts of the world where the prevailing view is that cancer is a death sentence because people are not connected to the cancer care teams that can show them that there is a path forward. Those are some of the challenges, it seems to me, that have to be overcome in other parts of the world.

EC: I think that we have the same vision but many of the obstacles or challenges that you are describing cannot be solved by the doctors. How we, ASCO or medical oncologists all over the world or doctors, can really be more proactive in the sense of integrating the stakeholders so that they can make the change?

RS: The best thing that ASCO can do is to provide information to people who wish to advocate for change in their countries to be able to demonstrate what is achievable, what can be accomplished, to provide data on where disparities exist, to point out those disparities with hard evidence, to be able to demonstrate that in those parts of the world where the disparities have been addressed that the outcomes of patients actually do improve. ASCO does a lot of advocacy work in the United States, we’re not well equipped to do advocacy work all over the world, we don’t understand the healthcare systems well enough, we don’t understand the policy making well enough and we don’t have the resources to do it. So we need the people in country to advocate what is going to be best for their patients. But one of the things that we can do is to give them as much information as possible to use as the fuel for their advocacy work.

EC: Yes, I think that this description that you are making fits very well with the concept that the cancer problems are global but the solutions are local. So this strategy, to me, seems very really practical.

RS: And in fact we see this even in the US. This year our President, Monica Bertagnolli, has put a big emphasis on healthcare disparities. She’s travelled across the United States to all kinds of communities, many rural, many underserved, many economically disadvantaged where they are struggling to deliver high quality cancer care. The same observation that you just made is true in the United States – the problems are fairly global but the solutions are all local and they start in the local communities. That’s where ASCO can be most effective in partnering with oncologists in the countries where they work. We have to understand from our members who are working outside the US what do they need to convince their policymakers that change needs to be made and then how can we support them in their efforts.

EC: Yes, I was really amazed attending the opening session because of this real commitment of Dr Bertagnolli for networking, for knowing the situation in different parts of the US and that is fantastic. Also it was really surprising with this presentation of the chemo way of this young oncologist of New Zealand that I think is a common situation in many parts of the world. At the same time I think that it showed the commitment of ASCO in order, as you said, to overcome disparities and all these challenges for better cancer control.

RS: Absolutely. Our Board has made it clear that ASCO really is a global organisation, that we have to serve oncologists wherever they work in the world, we have to serve cancer patients wherever they reside in the world. As you point out, each country, each region is going to require a different solution but as long as we work together to understand the problems and understand what the possible solutions could be and do our part, as the professional society that represents clinical oncologists globally, to equip our members with the information and the tools and the skills that they need, hopefully we can really make progress in resolving these disparities.

EC: Dr Schilsky, thank you very much and thank you ASCO for really hosting this superb scientific meeting.

RS: Thank you Eduardo.