Pilot Projects to Reduce Cancer Care Disparities Deserve Support, Speakers Say

Practice-level efforts to reduce cancer care disparities should be funded, because they offer “the only path forward” in achieving health equity, according to the head of a nonprofit that offers support services and financial assistance to patients.

Patricia J Goldsmith, CEO of CancerCare, said a pilot project by Carolina Blood and Cancer Care Associates (CBCCA), centered in Rock Hill, South Carolina, should be replicated to reduce the number of cancer deaths that can be tied to patients’ income, housing situation, ethnic background or other factors known as social determinants of health (SDOH).

Goldsmith appeared Thursday at a panel discussion on reducing disparities in care at the 2022 Community Oncology Conference, presented by the Community Oncology Alliance (COA). Kashyap Patel, MD, who is COA president, discussed theinitiative at CBCCA, where he serves as CEO. Early results from the project, called No One Left Alone (NOLA), appeared Tuesdayin Evidence-Based Oncology™ (EBO), a publication of The American Journal of Managed Care^®.

In a yearlong pilot, CBCCA dedicated 2.5 full-time equivalent staff to helping patients with cancer secure free drugs or financial assistance for out-of-pocket costs, if they met income requirements. The initiative raised $1.7 million in various forms of financial assistance, helping nearly half the patients treated at CBCCA. The 154 patients who received help had a median household income of $38,766, well below the US and South Carolina median levels.

Patel said NOLA has already moved into stages of the project that will help patients gain access to next-generation sequencing (NGS). Several speakers at COA said NGS presents unique reimbursement challenges, despite the mounting evidence in support of precision medicine. Long term, Patel said CBCCA will work to improve diversity in clinical trials; he said smaller practices like his are often excluded from participation, despite their ability to reach underrepresented populations.

“This is exactly what we need,” Goldsmith said. No single initiative will address all SDOH issues in cancer; thus, “we're going to have to demonstrate results in small but very impactful ways.”

Nicolas Ferreyros, who serves as COA’s managing director for Policy, Advocacy and Communications, moderated the panel and highlighted a study that COA undertook with Avalere Health; results were published Monday in EBO. That study, which followed earlier work that documented the drop-off in cancer screenings during the early months of COVID-19, showed that screenings rates did not recover evenly, and some minority groups still have lower screening rates than they did before the pandemic.

Ferreyros guided Patel through a discussion of how the quest to address disparities became a central focus for COA during Patel’s tenure as president. Patel said that the death of his father in 2019, combined with turning 60 years old, caused him to think more deeply about serving those with the
greatest need. “In the last quarter of my life,” Patel said, “I decided to tackle disparities….This was almost like a higher calling.”

Ferreyros also highlighted data in the 2020 report from the American Association of Cancer Research (AACR), which found that 34% of all cancer deaths are due to disparities.

“Now, 34% does not sound like a huge number,” Patel said. But in absolute numbers, it translates to nearly 225,000 Americans each year. Those statistics should shock most people, but they don’t get enough attention, he said.

One piece of COA’s effort to reduce disparities focuses on cancer screening. COA has collaborated with CancerCare and other partners on “Time to Screen,” which puts a focus on underserved groups. Susan Sabo-Wagner, RN, BSN, OCN, clinical director of Oncology Consultants in Houston, Texas, shared how materials were translated in Spanish, Vietnamese, Chinese, and Haitian-Creole.

Sabo-Wagner’s practice is using artificial intelligence (AI) to go a step beyond waiting for patients to miss an appointment or a treatment to learn there’s a social or financial barrier to care. Building predictive models will identify which patients are likely to have problems with treatment adherence, she said.

“We have our advocates reaching out to patients with the resources,” and then Sabo-Wagner organizes the follow-up to ensure patients connect with available help. Using AI, demographic data, and a survey tool allows the practice to “pinpoint what we should be doing for patients, ahead of what we need to do.”

Patel agreed that cancer clinics often have no idea how SDOH affect patients unless they ask. He shared the story of one patient who had been living out of his car, but until the staff asked his housing status they were unaware.

He challenged the pharmaceutical industry to move beyond “the ivory towers” and ensure that community oncology practices have more research opportunities. Only then will the population in clinical trials start to represent the country’s diverse population, he said.

“The current model has failed,” Patel said. Nearly a third of Americans have diabetes, he said, and these are the patients who show up at his clinic with cancer. Yet too few patients with comorbidities take part in studies.

Goldsmith, who worked in academia before leading CancerCare, said it wasan eye-opener to her how much small grants and support services can make a difference for patients with limited means. She commended Patel for creating NOLA without outside funding, “because of your passion.”