Presenter at the 2023 Community Oncology Alliance meeting notes that oncology has become more of a duality between molecular and genetic subsets, leading to huge developments in targeted and personalized care.
Although having data to understand inequities can be helpful, health care providers must move beyond passive data collection to take real action, according to presenter Richard L. Martin III, MD, MPH, in a session at the 2023 Community Oncology Alliance meeting.
For the better part of the 19th and 20th centuries, Martin said oncology was defined by the cell of origin. Although that is still somewhat true, oncology has become more of a duality between molecular and genetic subsets, leading to huge developments in targeted and personalized care. In much the same way, clinicians must utilize existing data on health care inequities to make real changes in the way these problems are approached.
In addition to supporting core values, such as justice and compassion, as well as the Hippocratic Oath and the Oath of the Pharmacist, Martin said making real change in health care inequities is important for both health care practice and performance.
For example, if a Black woman newly diagnosed with cancer were to ask how immunotherapies work in Black women specifically, Martin said that her care team would not be able to provide a very helpful answer due to the lack of representation in immunotherapy trials. Similarly, there is a lack of robust data around whether transgender women who are transitioning with hormones need to have breast cancer screenings, particularly if they have a family history of breast cancer.
“It’s ok to tailor different strategies to different communities, based on differences,” Martin said. “You don’t have to wait until it becomes a thing that impacts everyone if you can help certain communities.”
Crucially, however, having these data available is not enough. Martin pointed out that there is at least a decade of data showing that for Black men with prostate cancer in randomized clinical trials, their outcomes are just as good as those of white men. In real-world data, however, their outcomes are not as positive, which illustrates that clinical trials are not a substitute for good standards of care.
When beginning to consider strategies to make active changes in diversity, equity, and inclusion in their communities, Martin urged attendees to consider the 5 A’s of access to care: accessibility, availability, affordability, accommodation, and acceptability. Rather than looking at these issues retrospectively, however, it is important to think about them as up-front standards and make proactive change.
The Enhancing Oncology Model (EOM) also has quality metrics related to equity and inclusion. The 5 key EOM requirements around equitable health access include incentivizing care for underserved communities; collecting beneficiary-level sociodemographic data; identifying and addressing health-related social needs; improving shared decision-making and care planning; and continuous quality improvement. Although the model is mostly preparatory right now, Martin said it will eventually focus on holding oncology practices accountable on these issues.
Martin said that efforts to improve diversity and equity are often organic and disparate because individual employees or teams are passionate and want to make a change. By developing a structural perspective from the beginning, starting with the organizational mission and policies, the costs and time commitment of these efforts could be easier.
One key strategy to improve diversity and equity is involving the community in any of these efforts. Several organizations have developed community advisory boards to advise staff on issues the community is facing and solutions that can be truly impactful. In his own organization, Tennessee Oncology, Martin said they are proposing 4 non-mutually exclusive boards including a Black and African American board, a rural residents board, a Sex and Gender Minorities board, and a LatinX board.
Finally, rather than improving representation in research to then use those data in improving clinical practice, Martin said providers should think of that in reverse. Developing relationships with the community and building trust are crucial in order to build equitable recruitment for research efforts.
“Without equitable standard of care or clinical care, how can we begin to conduct equitable research?” Martin concluded. “If we can’t get our core right, all that other stuff is just fluff. We need to have equity in what we do fundamentally, every day.”
Martin RL. Enhancing Equity in Clinical Research: Lessons Learned From Community Oncology Engagement Efforts. Presented at: Community Oncology Alliance 2023 Meeting. March 23, 2023.