Improving Clinical Trial Diversity Through Language-Inclusive Approaches: Daniel Virnich, MD

At a recent Institute for Value-Based Medicine® event, Daniel Virnich, MD, CEO of The Oncology Institute in Los Angeles, California, shared his perspectives on addressing social determinants of health (SDOH) in oncology practice and advancing equitable access to cancer care. He discussed the current challenges of limited SDOH screening and the need to make such assessments actionable in daily practice, highlighting barriers such as language fluency in clinical trial enrollment and financial burdens that restrict patient access to care.

Virnich also emphasized the role of value-based treatment decisions in reducing patient costs and underscored the importance of policy reforms to expand access for Medicaid and MediCal populations, ensuring that all patients benefit from the latest advances in cancer treatment and research.

This transcript was lightly edited; captions were auto-generated.

Transcript

How are SDOH currently being screened in oncology care, and what strategies can help make this screening actionable in day-to-day practice?

[SDOH], unfortunately, are not widely screened in oncology care, and that's a major problem in terms of ensuring health equity for patients that we serve. At The Oncology Institute, we try to determine [SDOH] upfront so that we can provide optimal services to patients, whether that is a language fluency issue or a financial issue or some other obstacle to receiving optimal care.

What barriers exist to clinical trial enrollment among communities affected by SDOH, and what approaches can improve representation and participation in these trials?

One of the most major obstacles for clinical trials enrollment is language fluency. Most clinical trial sponsors only write their protocols in English, and the outreach to patients is typically done in English, which leads to a major disparity in access to trials for those that don't have English as a first language. One of the ways around that is by incorporating a clinical research program where you try to meet patients where they are with their language of choice, and therefore help drive enrollment.

What are some innovative ways to reduce patient financial responsibility and improve equitable access to cancer care?

One of the easiest ways to improve patient access to cancer care and reduce financial responsibility is to make value-based treatment decisions—that is, choosing drugs that have equal clinical efficacy but are financially more affordable, and therefore might have a lower patient out-of-pocket component.

Looking ahead, what systemic and policy changes are essential to support equitable cancer care across diverse communities?

For me, one of the biggest areas where I see major disparities in access to cancer care is with Medicaid and MediCal populations. I think improving regulations that ensure that population has equal access to care at tertiary and high-level centers of care is going to be very important to ensure that they've got access to the latest and greatest innovations in treatment, trials, research, and other activities that'll help them get better outcomes.