NewPublicHealth Q&A: Clifford A. Hudis, MD, American Society of Clinical Oncology
Several leading cancer organizations recently formed a think tank to address health disparities in cancer research with the goal of improving treatment access and outcomes for underserved populations. “Closing the inequality gap will not happen easily, and won’t get done if any of us goes it alone," said Otis W. Brawley, MD, chief medical officer of the American Cancer Society (ACS), one of four groups involved, in addition to the American Association for Cancer Research (AACR); the American Society of Clinical Oncology (ASCO); and the National Cancer Institute (NCI), a branch of the National Institutes of Health (NIH).
“Cancer mortality rates are decreasing for most minorities, but absolute death rates continue to be higher," said NCI Deputy Director Doug Lowy, MD. Lowy adds that it’s important to understand the sources of the disparities in order to reduce them.
The goal of the collaboration is to address the fact that that some racial and ethnic minorities in the United States are more likely to develop cancer, less likely to access high-quality cancer care and more likely to die from cancer when compared to others and to whites. For example, the death rate for cancer among African-American males is 33 percent higher than among white males, and the rate for African-American females is 16 percent higher than it is for white females.
“We must move from describing the problems to more quickly identifying and implementing solutions to address the racial and economic-based disparities that continue to affect many cancer patients and families in the United States,” said ASCO president Clifford A. Hudis, MD.
NewPublicHealth recently spoke with Hudis about the new collaboration.
NewPublicHealth: What key issues help explain—and then overcome—differences in cancer incidence and severity among different populations?
Clifford A. Hudis: We can’t completely disentangle environmental factors, which include nutrition, access to care, general health behaviors, exercise and education, which relates to behaviors such as tobacco use. And of course underlying that is the socioeconomic status. But there also is a burgeoning understanding of the role of genetic variations that may be clustered in various populations and may influence things such as drug metabolism and diseases.
I think that we are gaining the ability to apply the same molecular biology that we’re using to understand disease at the cellular level to also understand the context of disease at the human level, and to incorporate some of the variations in various ethnic backgrounds, though I don’t know that we will ever be able to completely separate some of those other important influences.
NPH: What are your early goals?
Hudis: What we want is the ability to do really high-quality science, and to do that you have to have standard definitions and terms. One of the key benefits of this collaboration is defining terms, defining standards and then beginning the process of having everybody record their observations in the same way. So that means having clinicians record ethnicity, disease states, outcomes, all of that, in a consistent fashion.
That means bringing the right research questions to bear and I think each of the organizations here has a lot to contribute. AACR has scientific rigor; ASCO has scientific rigor and clinical research especially; the ACS has tremendous outreach into the community in terms of patient education; and of course the NCI has the research structure of the NIH behind it. We all see the need for one set of standards, one set of definitions and the building of collaborative data sets that we can later explore.
NPH: Is there a time frame for the first set of treatment and outcome goals?
Hudis: That is still an area of active discussion. Once we have the resources in place we can start to figure this out. And I think we’re going to get different kinds of answers over different timelines. One initiative that plays so well into this is the Cancer Link Project at ASCO, which really is intended to leverage the fact that 60-70 percent of medical oncologists now render all of their medical care in using electronic records, and we’ll see there’s suddenly the ability to start to mine huge amounts of data. So if this collaboration helps establish standards for how that data’s recorded, you could see that in a few years’ time we will have the ability to gather data on the majority of cancer patients, in the United States at least, in terms of their care, their outcomes and the impact of socioeconomics on all that.
>>Bonus Link: Read a recent NewPublicHealth interview with Nadine Gracia, MD, MPH, director of the U.S. Department of Health and Human Services Office of Minority Health.