Recapping the ASCO 2021 Annual Meeting Opening Session & Presidential Address

Leading the charge on equity and equality, day two of the 2021 American Society of Clinical Oncology (ASCO) Annual Meeting kicked off with an address led by ASCO President Dr. Lori J. Pierce.

Dr. Pierce began the session by exploring the presidential theme of “Equity. Every Patient. Every Day. Everywhere,” and explained that the phrase “equity” was added into ASCO’s mission statement to reflect a key component of the organization’s objectives. With the pandemic disproportionately affecting people of color, she highlighted the need for equity now more than ever and encouraged clinicians to pour the same energy and focus into confronting racism as they do in conquering cancer itself.

Fostering Inclusivity at the National Cancer Institute

Following Dr. Pierce’s opening address, Dr. Norman E. Sharpless, Director of the National Cancer Institute, took a look at some of the progress ASCO has made in its fight against cancer and emphasized the importance of diversity and inclusion in cancer research. Dr. Sharpless highlighted three areas where the National Cancer Institute is taking steps towards battling this disease, including:

• Fostering equity and inclusivity within the individual organization to ensure research is robust and comprehensive
• Researching cancer health disparities and strengthening their portfolio in that area to ask the right questions
• Encouraging diversity across the field of cancer research to reflect the patients the National Cancer Institute serves

Dr. Sharpless shared a number of initiatives the National Cancer Institute has taken in order to promote diversity within the workforce for cancer research, including the Continuing Umbrella of Research Experiences (CURE) and Partnerships to Advance Cancer Health (PACHE), to encourage diversity and inclusion in fields such as cancer prevention, behavioral sciences, epidemiology, genetics, immunotherapy, and technology transfer.

Dr. Sharpless emphasized how important diversity and inclusion have become to the National Cancer Institute and encouraged others with the same passion to join forces to create a more inclusive environment in cancer research.

Life After the COVID-19 Pandemic: Building a Better Normal for Cancer Patients

Following Dr. Sharpless’ presentation, Dr. Julio Frenk, President of the University of Miami, spoke about the direct and indirect impacts of the COVID-19 pandemic on cancer research and care, the global shifts in medicine that were caused by the pandemic, and the new global and social compact needed around the world to ensure safety and adequate care.

• Direct & Indirect Impacts
  • Misdiagnosed coronavirus cases were a direct result of the pandemic, but delays in diagnosis and treatment were an indirect impact.
  • A primary indirect impact is excess mortality, which is the number of deaths from all causes during a crisis that goes above and beyond what we would have expected to see under 'normal' conditions.
  • Gloomy & Luminous Changes
    • Gloomy: Some of these changes include social inequality, structural weaknesses in health systems, and weakness of global health security arrangements.
    • Luminous: Some of these include the development of exemplary scientific collaboration, innovations in healthcare delivery, and enhanced attention to interdependence.
    • New Global Social Impact
      • Public health innovations: These include the development of a global sentinel network, ready-made technology platforms, and a rapid deployment force.
      • Improved legal and institutional frameworks: More specifically, the enforcement of the Institute of Health Research and a new global health convention.

According to Dr. Frenk, pandemics are not a natural occurrence; they’re as anthropogenic as climate change, and their increasing frequency in the latter half of the 20^th century reflects the invasion and destruction of natural habitats along with the unsustainable and inhumane practices associated with the mass production of poultry and livestock and crowded and promiscuous wet markets. A stronger global health system will help us address threats like cancer.

An Anti-Racist Imperative for Cancer Care

Following Dr. Frenk, Dr. Rhea W. Boyd, a pediatrician, child health advocate, and the Director of Equity and Justice for The California Children’s Trust, discusses the urgency of anti-racist agendas in medicine.

Dr. Boyd explored the differences in health disparities and health inequities that arise when certain populations are made vulnerable to illness or disease, often through the inequitable distribution of protections and support.

She encouraged researchers to make sure that they’re asking the right questions about the legacies of Jim Crow, a century-long period in which white supremacy was codified into law through forms of racial exclusion, discrimination, disinvestment, and violence, and how they’re impacting health outcomes now.

Looking back at that period, researchers have found that the Jim Crow birthplace was associated with increased odds of ER- breast cancer only among Black women, with the effect strongest from women born before 1965. And it’s important to note that statistics like these are indicative that racism impacts health outcomes.

According to Dr. Boyd, in order to adequately respond to statistics like these and to encourage equity in medicine, we need to response to racism as a public health crisis; we must name it, identify the mechanism by which it creates health inequalities, and then eliminate it.

Upon researching the inclusion of racism in four of the top medical publications from 1990 to 2020, less than 1 percent were empirical investigations of racism.

Since May 2020, the medical community has begun shifting to call out and condemn racism, but Dr. Boyd emphasized the danger that still remains in white supremacy and encourages individuals in medicine to have conversations about white nationalism and authoritarianism’s impact on equality and health outcomes worldwide.

So how do we address it in medicine? This commonly happens through resource distribution, and the medical community is currently shifting to refocus the conversation on equity rather than equality. Dr. Boyd explained that one way we can address racism is to create a sanctuary in the spaces where we work so that patients are not facing racism.

But she explained that one of the primary strategies we can use to reduce racism in the medical community is to confront whiteness and the deepening racial division in our country. We need to commit ourselves, to tell the truth, our institutions participate in racism, reconcile for these institutions, and make reparations to help develop a sanctuary for our patients of color.

President’s Address: Combating Cancer Care Inequities

Coming back to ASCO’s President, Dr. Pierce took us back to the origins of ASCO and the racial turmoil taking place back in 1964. She offered insight into growing up in the nation’s capital, surrounded by all of that racial tension, and its impact on medicine.

She emphasized that every patient everywhere should receive cancer care that results in the best possible outcomes. Here are a few areas where ASCO has made progress:

• Research: While cancer care is covered by Medicaid, the government doesn’t cover the routine costs of participating in a clinical trial. ASCO’s advocacy arm pushed for Medicaid to cover these costs, and that Clinical Treatment Act was passed into law in December. Conquer Cancer is scaling and growing funding diversity inclusion and research on underrepresented populations by underrepresented populations.
• Education: Knowledge conquers cancer, but biology cannot provide all of the answers to cancer care. ASCO began educating physicians on the social determinants of health and modifiable risk factors of health. ASCO has also launched a podcast on the social determinants of health for oncology specialists.
• Quality: Last year, ASCO formed a task force called Serving the Underserved Task Force to better understand the needs of underserved communities. The task force continues to work to provide resources for patients around the world to ensure equal access to care.

Dr. Pierce and ASCO aim to provide equitable access to care to patients all over the world because according to Dr. Pierce, it is our time, our responsibility, and ASCO’s destiny.