#ASCO21 Cancer Disparity Sessions

The theme for this year's ASCO annual meeting was EQUITY: EVERY PATIENT EVERY DAY EVERYWHERE.  I attended a number of sessions including  Equality in Care for All Women: Addressing Disparities in Gynecologic Malignancies and Social Determinants, Not Biology: Time to Reappraise Genetics- Based Theories of Racial/Ethnic Cancer Outcome Disparities and More Than the Patient: Structural Racism and Cancer Disparities.

Here are the tweets I posted during the sessions.

Watching: Intersectionality in Cancer Care w/ Dr Brewer. This is a method to understand how "multiple forms of inequity & disadvantage sometimes compound themselves" gather not only demographic data but social determinant data #ASCO21 #gyncsm

— Dee Sparacio (@womenofteal) June 4, 2021

https://twitter.com/womenofteal/status/1400889490294648837?s=20 

Equality in Care for All Women: Addressing Disparities in Gynecologic Malignancies

#ASCO21 #gyncsm
Botswana : Developed smart phone app with reminders for treatment etc.
HIV status did not impact cervical cancer survival
20% Women < age 40 - Alter screening guidelines?
2/2 pic.twitter.com/ly3DnsO49X

— Dee Sparacio (@womenofteal) June 4, 2021

International Disparities in Gyn cancer
Dr Das #ASCO21 #gyncsm
Low and Mid income countries have lower HPV vaccination rates.
Africa and Asia have highest gyn cancer incidence.#ovca Access to Parps limited in low - Mid income countries pic.twitter.com/IJ7vMQMYHA

— Dee Sparacio (@womenofteal) June 4, 2021

Pierce #ASCO21 #gyncsm
Data supports molecular differences at the tumor level need to invest
There are differences in tumor mutational burden by race.
Immunotherapies GOG3023 Tisodamab Vindontin mostly white women in trial - are responses the same for all? pic.twitter.com/l42J9QvgoO

— Dee Sparacio (@womenofteal) June 4, 2021

Dr Pierce #ASCO21 #gyncsm
"Toxic individualism" leading to low HPV vaccination rates in the US.
Need better education on HPV and highlight the benefits of vaccine in reducing cervical cancer rates.
Excellent discussion after presentations Drs Grover, DAs, Pierce pic.twitter.com/549Q2ugaQv

— Dee Sparacio (@womenofteal) June 4, 2021

Opening Session

.@RheaBoydMD lists ACTIONS to help us become #AntiRacist

1. Create Black Sanctuaries
2. Confront Whiteness#ASCO21 pic.twitter.com/hzg0kVahTU

— Stephanie Graff, MD, FACP (@DrSGraff) June 5, 2021

 

Social Determinants, Not Biology: Time to Reappraise Genetics-Based Theories of Racial/Ethnic Cancer Outcome Disparities 

Prepping for
Social Determinants, Not Biology: Time to Reappraise Genetics-Based Theories of Racial/Ethnic Cancer Outcome Disparities
Robert Timothy Dess, MD
Marvella Elizabeth Ford, PhD
Nestor F. Esnaola, MD#ASCO21 #gyncsm pic.twitter.com/AOCUSU6mBQ

— Dee Sparacio (@womenofteal) June 6, 2021

Robert Timothy Dess, MD
Ed Session Social Determinants, Not Biology: Time to Reappraise Genetics-Based Theories of Racial/Ethnic Cancer Outcome Disparities
Prostate Cancer
Race is a social construct. Treatment Guidelines have race as risk factor. #ASCO21 pic.twitter.com/UpkvB0oH6M

— Dee Sparacio (@womenofteal) June 6, 2021

Social Determinants, Not Biology: Time to Reappraise Genetics-Based Theories of Racial/Ethnic Cancer Outcome Disparities #ASCO21 #gyncsm
Dr Ford: Biological Association of obesity and cancer. SC case I-95 corridor case study most residents are black, > poverty> Cancer rates pic.twitter.com/7bvM4pLdda

— Dee Sparacio (@womenofteal) June 6, 2021

Social Determinants, Not Biology: #ASCO2021 #lcsm
Nestor F. Esnaola
Patient Navigation may be beneficial @OncNav
Southern lung cancer study in progress 2/2 pic.twitter.com/MzCXWpjhLc

— Dee Sparacio (@womenofteal) June 6, 2021

Social Determinants, Not Biology:
Discussion : #ASCO21
Easier to focus on bio than social determinant impacts . What is driving these issues. Esnaola

Limited wi-fi /Techimpacts telehealth. All need access, do patients need help with monthly data/minutes for cell phone. Ford

— Dee Sparacio (@womenofteal) June 6, 2021

 

More Than the Patient: Structural Racism and Cancer Disparities

Education Session
Ansell Matter of Life & Death: The legacy of structural racism.
Gap in mortality from BC in Chicago increased from the 1990's to today 62%.
Inequality in Quality!
Chicago improved quality care and navigate to better treatment pic.twitter.com/fPlbBJCuLr

— Dee Sparacio (@womenofteal) June 8, 2021

Scarlett Lin Gomez Ed session Health Place and Social Justice #ASCO21 @OncoAlert
Prostate CA Higher burden
RESPOND :
higher levels of redlining
Racial bias in mortgage lending
among AA men
What to do: Address Data needs, examine neighborhood context pic.twitter.com/bHv7kEhhgo

— Dee Sparacio (@womenofteal) June 8, 2021

Jennifer J. Griggs
Racism in the Oncology Workforce #ASCO21 #gyncsm
Underepresented groups may be invisible as well as hypervisible
There is fatigue in code switching.
It is hard to not unsee what we see with racism. pic.twitter.com/2s6OUuFVzG

— Dee Sparacio (@womenofteal) June 8, 2021

Digging deeper into More Than the Patient: Structural Racism and Cancer Disparities#ASCO21
We need to mindful about inclusion in the workforce and research- Gomez
We need more Native American oncology providers ( there are only 12 in the US) - Griggs pic.twitter.com/ULRCIggf8R

— Dee Sparacio (@womenofteal) June 8, 2021

 

There are so many areas where we all can improve the care for "every patient everywhere" and these open  and honest discussions can make these needed changes happen.  

 

Dee

Every Day is a Blessing! 

Disparity Research - #ASCO20 Virtual Annual Meeting

For the past year, I have been a member of Community Action Board at the Rutgers Cancer Institute. The Board advises the Center of Health Equity and Engagement led by Dr. Anita Kinney. The Center's role is to improve patient engagement for underserved and underrepresented communities in NJ in order to improve screening, prevention and access to treatment and clinical trials.

With that role in mind I took some time during the ASCO annual meeting to review studies related to cancer disparities. Here are just a few of the studies I viewed.

Uterine Cancer
Abstract 6089

#6089 Uterine cancer histology and stage at presentation in black & white women:
A cohort study of 488,000
Compared to white women black women are more likely to be dx with serous, clear cell,carcinosarcoma, leiomyosarcomas at adv stages #gyncsm #ASCO20 #OVCA #cancerdisparity

— Dee Sparacio (@womenofteal) May 29, 2020

Impact of Obesity Ovarian Cancer
e18067

"Obese patients were more likely to experience carboplatin under dosing in the neoadjuvant and adjuvant setting. No association with survival was observed for dose reduction and BMI #gyncsm #ASCO20 #OVCA #cancerdisparity 2/2

— Dee Sparacio (@womenofteal) May 29, 2020

Opiod Access / End Of Life Care 
Abstract 7005

Fleishman: Health Services Research and Quality Improvement Highlights #ASCO20
Racial / ethnic disparities in Opiod Access at EOL

Reducing implicit bias is still a challenge ; calls to pharmacy may help alleviate issue#cancerdisparity #Healthservices pic.twitter.com/Y5Kph11K5t

— Dee Sparacio (@womenofteal) May 31, 2020

Gender based disparities in clinical trials
Abstract # 2058

2/2
Of the trials lacking balance, the vast majority (80%) had under-representation of women.
Early phase > #disparity

future work: Why is there underrepresentation of women?
Is it time? child care issues? travel? Lots more to learn #ASCO20

— Dee Sparacio (@womenofteal) May 31, 2020

Survival outcomes by race minimally invasive versus open surgery
 Abstract #6029

Are outcomes better if open radical hysterectomy used?
Data from Nat Cancer Database-
Black women with open radical hysterectomy have lower survival than white women who had MIS . #ASCO20 #gyncsm #disparity 2/2

— Dee Sparacio (@womenofteal) May 31, 2020

Financial Toxicity
Abstract 6079

"The cohort of women with high #financialToxicity demonstrated higher mean scores on screening measures for depression and anxiety as well as persistently lower quality of life." #gyncsm #ASCO20 #ovariancancer https://t.co/J0EGQlyjRI pic.twitter.com/Yk8lq2DO4f

— Fumiko Ladd Chino, MD (@fumikochino) May 29, 2020

Geography and Cancer Care
Poster  1574
This study assessed overall survival (OS) of patients with all cancers, chronic myeloid leukemia (CML), and lung cancer while assessing distance from each county to the one (NCI-CC) in Georgia. Researchers conclude that disparity in cancer care exists between geographic conditions.

Black and white disparities in triple negative breast cancer ... Nurses’ Health Study
Poster 1655
This study examined disparities in triple negative breaset cancer by socioeconomic position, reporductive factors and diabete.  " observed racial differences in TNBC diagnoses may be at least partially mediated by differences in socioeconomic position and reproductive patterns, namely breastfeeding."

 
Breast and cervical cancer screening disparities among transgender patients
Poster 7024
About 1 million Americans identify as transgender. Limited primary care access and poor adherence to breast and cervical cancer screening are evident for transgender populations.

I look forward to next year's annual meeting whose theme was announce by incoming ASCO President , Dr Lori Pierce. 

I’ve been interested throughout my whole career in how to best create #equity in cancer care for all patients. So, I'm excited to introduce my @ASCO presidential theme, Equity: Every Patient. Every Day. Everywhere. pic.twitter.com/X8W3Qn8R9R

— Lori J. Pierce, MD, FASTRO, FASCO (@ASCOPres) June 1, 2020

We as advocates have a role to play to insure all patients receive appropriate and timely cancer care.

Dee
Every Day is a Blessing! 

SGO Annual Meeting - Saturday 3/16

Saturday SGO Meeting:

I wish I had been able to hear the SGO Presidential speech by Dr. Agnes Binagwaho (@agnesbinagwaho) .

Inspiring and impactful talk by Dr. @agnesbinagwaho. Social capital and reinforcing trust through information and participatory inclusion are keys to effective cancer care and prevention. #SGOMtg #sgohawaii50

— Yvette WilliamsBrown (@MYvetteWB) March 16, 2019

What a tremendous presentation from Dr. @agnesbinagwaho! Employing mechanisms for positive effect of social capital on health have led to school-based #HPVvaccination of >90% of Rwanda's girls. #AdvocacyInAction #HealthEquity #SGOMtg #SGOHawaii50 pic.twitter.com/ACDOlLcfcO

— Ali Saiz, MD (@AllisonSaizMD) March 16, 2019

Financial Toxicity

We need to do better understanding and appreciating what our patients consider toxicity. (The blue is what physicians think, the yellow is where we agree, the red is what patients think.) Need to think about pain and dyspnea more. #SGOMtg #SGOHawaii50 #gyncsm pic.twitter.com/FyxUIQmiqb

— Erin Stevens (@erinstevensmd) March 16, 2019

The presence of insurance coverage was NOT predictive of financial toxicity. We must screen all patients for this important quality of life measure. #SGOHawaii50 #SGOMtg

— BJ Rimel (@BJRimelMD) March 16, 2019

Most prospectively-followed patients starting new treatment for gynecologic cancer experience #financialtoxicity — glad this under-examined topic is being discussed at #SGOMtg #gyncsm @SGO_org pic.twitter.com/y9lh7qB5if

— Ross Harrison (@RossFH) March 16, 2019

Cancer care financial burden is devastating our patients. They have to live with the financial burden long after treatment is complete. “We are killing patients (financially) while trying to cure them.” - Dr Ruth Carlos #SGOHawaii50 #SGOmtg pic.twitter.com/DOUYLas0BD

— Erin Stevens (@erinstevensmd) March 16, 2019

Genetic Testing

Janice Kwon presents a discussion of #somatic testing for #BRCA mutation as a triage for referral to @GeneticCouns for #Germline #BRCA testing in #OvarianCancer. Tumor testing is more cost effective than universal Germaine testing! #SGOHawaii50 #SGOMtg #gyncsm pic.twitter.com/JDZZnY8tWa

— Shannon Westin (@ShannonWestin) March 16, 2019

PARP Inhibitors

Approximately 1/3 of patients remained at the maximum dose of niraparib #PARPi. Importantly, dose reductions did not impact efficacy in recurrent #ovariancancer #gyncsm #SGOHawaii50 #SGOMtg pic.twitter.com/PBy4r5oV6P

— Shannon Westin (@ShannonWestin) March 16, 2019

#PARPi after #PARPi in #ovariancancer - bottom line most benefit in patients with #BRCA mutation that had prior response to therapy. Must be cautious with these very small numbers #SGOHawaii50 #SGOMtg #gyncsm pic.twitter.com/dBhGV9Lpbv

— Shannon Westin (@ShannonWestin) March 16, 2019

Cancer Disparity

Interesting that this #disparity is eliminated when they get the appropriate treatment! Demonstrates that access and advocacy works for Black women with #cervicalcancer #gyncsm #SGOMtg #SGOHawaii50 https://t.co/gFm8yQLhqD

— Shannon Westin (@ShannonWestin) March 16, 2019

Leadership - Dr Parkham Zambia

Profound ABOG lecture by Dr. Groesbeck Parham. Leadership and saving women’s lives in Zambia. #sgomtg #gyncsm pic.twitter.com/uPMXd8F6O7

— Annie Ellis (@Stigetta) March 16, 2019

Thank you Yvette WilliamsBrown (@MYvetteWB), Ali Saiz, MD (@AllisonSaizMD), Shannon Westin (@ShannonWestin), Ross Harrison (@RossFH), Erin Stevens (@erinstevensmd), BJ Rimel (@BJRimelMD) and Annie Ellis (@Stigetta) for taking the time to tweet from the meeting.

Dee
Every Day is a Blessing!