Lori Pierce, MD, FASTRO, FASCO, is the President of the American Society of Clinical Oncology (ASCO) for the 2020-2021 term. In a Q&A with Conquer Cancer, the ASCO Foundation, Dr. Pierce reflects on why ASCO and Conquer Cancer are calling on donors to help expand equity-centric programs and research opportunities. She draws on personal experiences and data around existing disparities to explain why advancing equity in cancer care helps every patient.
Why did you launch ASCO’s 2021 presidential theme: “Equity: Every Patient. Every Day. Everywhere.” focused on driving health equity for all patients with cancer?
LP: Equity in cancer care has been a focus of mine for a very long time. It is a major part of ASCO’s mission to conquer cancer through research, education, and the promotion of the highest quality patient care. However, we haven’t had a focus specifically on equity of care as a presidential theme before. I wanted to highlight this because health care equity is at the forefront of all we do at ASCO and Conquer Cancer.
I think we’re all acutely aware of how different many health outcomes are for people of color compared to white people—how they are often less favorable in terms of receiving health care—and there are reasons to explain this. Quite often, these disparities are not due to biology, but rather many patients within marginalized communities have a lower socioeconomic status, a late diagnosis, an inability to receive treatment, and/or transportation issues. We must use cancer research to uncover the root causes of these factors and better understand the barriers that patients face if we're going to really make a difference.
Why does your presidential theme matter to you personally?
LP: I’m fortunate to embody three groups: I am a woman, I am African American, and I am a radiation oncologist. This collectively gives me a unique perspective on the field of oncology. I hope my leadership has encouraged other women and people of color to see ASCO is committed to elevating workforce diversity. I want to leverage that acceptance to increase ASCO membership and encourage more researchers to apply for Conquer Cancer grants and awards. Increased membership and research participation comes with more representation and chances to challenge the status quo—this can potentially improve patient outcomes. We also need a more diverse workforce to mirror the patients we serve.
What inequities do you see in cancer research and cancer care?
LP: One statistic* from the American Cancer Society I find very disturbing: About 42% of cancer cases—and 45% of cancer deaths—in the United States are linked to modifiable risk factors, including smoking, excess body weight, physical inactivity, and alcohol abuse. These factors are well under our control to address, and Conquer Cancer is ultimately working to help change these patterns through research.
There are some things we can’t do, such as affect people’s income. However, we can improve risk reduction by funding researchers who are considering and measuring the impact of lifestyle changes on patient outcomes and quality of life.
How has the COVID-19 pandemic exacerbated the existing health inequities in cancer care?
LP: I chose my presidential theme before the pandemic. It was just the theme I felt was appropriate at this point. Then the pandemic happened, and we saw how it disproportionately affected those with comorbidities, essential workers, and people who didn't have the luxury to work from home. Often, the people with a lot of comorbidities are the ones most at risk for contracting the virus and subsequently dying from the virus.
It's not enough to say, ‘OK, these people do poorly with this.’ We must dissect the reasons why and provide explanations, so we get to the root of the problem. We must acknowledge that structural racism and other oppressive structures exist in and beyond health care. Now that many more people are acknowledging that, we are initiating mandatory steps to eradicate it.
What’s your outlook on the future of equity in cancer care?
LP: During my time as president of ASCO, I’ve helped to establish metrics needed to inform how we can achieve equitable patient care that can be followed over time. These measurables will serve as crucial launching points for further learning and actions we need to take to advance health equity. Such significant steps forward are marking huge milestones for the patients we serve.