Terrell Coring, PharmD, MD, transitioned from the pharmacy field to now pursuing oncology and cancer research. In this Q&A, Dr. Coring shares how a Conquer Cancer award helped accelerate his work in cancer care. The award enables non-oncology physician-residents from populations that have been structurally excluded from medicine to attend the ASCO Annual Meeting, where they network with leading oncologists and learn about career options in the oncology field. 

Dr. Coring also reflects on personal experiences with structural racism in medical education, highlights the necessity of diversifying the oncology workforce, and talks about why it matters to elevate racial and ethnic representation in clinical research.  

1. What drew you to the field of oncology from the pharmacy space? 

After becoming a pharmacist, I transitioned to practicing clinical pharmacy from community pharmacy. As a clinical oncology pharmacist, it was inspiring to see some patients with lung cancer transition from traditional chemotherapy to targeted therapy. Gradually, select patients were being treated with mono-immunotherapies. These patients,  in addition to patients treated with targeted therapy, experienced drastically positive outcomes. The moment the field started to incorporate tumor genetic mutations into cancer treatment (targeted therapy) was the moment I knew that I wanted to be part of the oncology world in a more prominent way. This shift revolutionized how I perceived cancer as well as medicine. Watching a disease take someone’s life within a year, to now watching people survive more than 5 years, is astonishing – astonishing enough for me to aspire to become an oncologist and physician-scientist who will discover more mutations for targeted drug therapy.

Now as a physician, I am motivated to help patients fight cancer while utilizing the safest and most effective approach. Targeted therapy is the way; therefore, I am currently involved in research with my mentor Dr. Irinia Veytsman, a thoracic oncologist, to identify other pathological targets that drive cancer formation, growth and progression. Specifically, targeting the tumor microenvironment and studying how this environment can lead to drug resistance and cancer growth. 

2. How have Conquer Cancer donors enabled you to make a tangible difference for patients?

Because of the funding I received from Conquer Cancer, I was able to attend the 2022 ASCO Annual Meeting. This award paved the way to access amazing resources. After attending the Annual Meeting, exposure to cutting-edge research and gaining inspiration from brilliant scientists were made possible. Mentorship opportunities and access to career-building seminars were also made possible.

I am forever thankful to Conquer Cancer donors for making this possible. It is their philanthropy that has allowed me the exposure and inspiration of fellow researchers within oncology. As a result, I am involved in multiple research projects with my mentor Dr. Veytsman at my training institution that will hopefully have a great impact on patients in the future.

3. What were the benefits of attending the 2022 ASCO Annual Meeting? In what ways did these experiences support your research initiatives and residency training?

• I had one-on-one virtual conversations with Medical Oncologist Fellowship Program directors to discuss oncology fellowships/training programs. It was enlightening to understand what program directors value in their Fellows. 

• I took advantage of a Diversity in Oncology Meet and Greet. During this meeting, I was able to network with individuals who are dedicating their careers to improve cancer health equity. 

• I participated in the Buddy Program Match, in which I was assigned an oncology fellow within my geographical area; I am now working with him at his training institution. 

• I also met with a mentor who is working on cancer genomics and precision medicine. His work has inspired me to join my mentor, Dr. Veytsman, in researching ethnic differences in cancer risk that may cause genetic variation. We are now partnering on a project to explore this potential in patients with head and neck cancers.

4. What are some takeaways from your experiences in residency at a hospital serving populations that have been structurally excluded from cancer research and equitable oncology care?

Image

A patient presented to my training hospital due to drastic weight loss, fever and night sweats. Ultimately, during her hospitalization, she was diagnosed with an uncommon form of leukemia. The patient was an otherwise healthy, middle-age African American woman and did not take any medications. She was a single mom with two kids, working a slightly above minimum wage service job. Therefore, she stated that she could not afford health insurance.

Unfortunately, the patient was discharged with hydroxyurea and could not follow up with a cancer specialist due to lack of health insurance. This saddens me, because a newly diagnosed patient with cancer may not get the care they need due to their socioeconomic status. I have learned there is a lack of equitable cancer care specifically for uninsured patients of middle-age, especially those with a poor socioeconomic background. There is a tremendous opportunity to help these populations through reforming our current healthcare policies.

5. Do you have a personal experience with structural and/or institutional racism in the medical and oncology fields that you are willing to share?

There is a reason that less than five percent of doctors in the U.S. are African American males. There is also reason that most U.S. medical schools do not enroll a student body that resembles the patient population that are treated in America.

In 1910, the Flexner Report was published in the U.S. and used as the gold standard of medical training in the U.S. and Canada. However, this controversial report presented ideologies of racial and gender bias, resulting in the closure of Black medical schools in the U.S. and ultimately exacerbating systemic racism within medicine and medical education. In my opinion, it was the result of systemic racism within the U.S. medical education system that I was subjected to attend a Caribbean medical school instead of a U.S. medical school – even after applying to multiple medical schools with a prior doctorate degree and tons of health care experience.

A 2011 article published in the Yale Journal of Biology and Medicine highlighted the fact that the Flexner Report model remained in place more than 100 years later. Nevertheless, diversity and inclusion efforts are getting better within our medical education system. For instance, the Association of American Medical Colleges (AAMC) recently renamed a prestigious award that was once named after Abraham Flexner (the author of the Flexner Report) to the AAMC Award for excellence in Medical Education.

6. From your perspective, why is it vital to support the advancement of Black oncology professionals? Why is it important for Black patients and patients of color to see themselves more equitably and meaningfully represented in research and cancer care?

Our field must continue to strive for cancer health equity. Accessibility to care, including equitable access to participation in clinical research opportunities, is critical to cancer health equity. Mistrust of the health care system, lack of clinical trial awareness, poor health literacy, and poor access to clinical trial sites are also prominent amongst people of color. Advocacy is vital to overcoming these barriers. I believe the fastest way to cancer health equity is the advancement of oncology professionals of color with the hopes of accumulating a diverse clinical research workforce.

Clinical trials establish the safety and efficacy of new cancer treatments for all patients. The substantial lack of sociodemographic diversity among clinical trial participants is a major barrier to advancing care for all patients, including patients of color. There is well-documented research addressing the critically low representation and participation in clinical trials among racial and ethnic minorities, and individuals living in rural areas or low-income settings. According to the 2022 AACR Cancer Disparity Report, the participation of racial and ethnic minorities and other underserved populations in clinical trials is critical to accurately determine the efficacy – as well as potential toxicities – of new treatments within these populations.

In the wake of precision medicine and molecular targeted therapies, cancer pathologies are now being approached in a more heterogeneous way. We are learning more and more that there are numerous cancers that do not behave the same from a molecular standpoint, therefore it is vital to understand how environment, ethnicity and social behaviors affect molecular cancer biology. It may be empowering for patients of color to understand that their cancer progression may have been based on their unique tumor genomics, which may be influenced by their social determinants of health.

7. How did your Conquer Cancer–funded experience lay the groundwork for next steps in your cancer research? 

Exposure, mentorship, and opportunities are keys to success for minority healthcare professionals. Support from Conquer Cancer donors, in some form, provided me with all three. The main takeaway, however, was exposure. Being exposed to research of this magnitude was not only enlightening but inspiring. Hence, my career aspirations are now heavily influenced by clinical research. That being said, I would like to take this opportunity to show appreciation for my current mentor, Dr. Veytsman, for her support in my research, which helped me to access a Conquer Cancer award and ultimately attend the 2022 ASCO Annual Meeting. Thank you to Dr. Veystman, to ASCO, and to Conquer Cancer!