ECOG-ACRIN Health Equity Committee Continues to Address Health Disparities in Cancer Research and Care

Edith P. Mitchell, MD, MACP, FCPP, FRCS

The need for equality in terms of representation, access to screening and care, and opportunities to participate in pivotal clinical trials within the cancer field has become underscored in light of the ongoing COVID-19 pandemic, according to Edith P. Mitchell, MD, MACP, FCPP, FRCS, who added that several efforts are being made by the ECOG-ACRIN Health Equity Committee to address existing health care disparities and improve patient outcomes.

Mitchell, who is co-chair of the Health Equity Committee, has remained at the forefront of efforts dedicated to addressing inequalities faced by underrepresented populations. Key focuses of the committee include, boosting representation of Black doctors in the field of oncology, promoting collaboration and education opportunities to all physicians, increasing accessibility to screening services and treatment, and strengthening efforts to accrue underserved groups to ongoing clinical trials.

Whatever the barrier is for patients, whether it is individual- or community-based, it is important that we address existing issues faced by our patients, [including those] who are in need of cancer screening, cancer care, or [those who are facing other] economic concerns,” Mitchell said. “Therefore, socioeconomic concerns, educational issues, access to health care centers, for example,with screening and obtaining mammograms or colonoscopies—[these factors] are all very important.”

In an interview with OncLive®, Mitchell, clinical professor, director of the Center to Eliminate Cancer Disparities, and program leader in Gastrointestinal Oncology at Sidney Kimmel Medical College of Thomas Jefferson University, shared the inspiration behind the ECOG-ACRIN Health Equity Committee, efforts made to address health disparities, how the pandemic has impacted screening and care in the cancer field, and what needs to be done to get back on track.

OncLive®: You are the co-chair of the ECOG-ACRIN Health Equity Committee. What inspired the creation of this committee, and what did you hope to accomplish with this effort?

Mitchell: For one, my experience with disparities in health care [served as inspiration for this effort]. I decided when I was 3 years old that I would become a doctor and ensure that Black [patients] received good treatment. My great grandfather at age 89 became ill, and I overheard other family members and friends setting up a schedule to be with him during this illness because it was assumed that it would be his last. I heard them say, ‘Well you can’t take him to the hospital because old, Black people do not get treated right.’

At the time, there was a family physician who made a house call, and I looked at the doctor, and I thought, ‘This is so important.’ I remember it vividly. I told my great grandfather, ‘Do not worry, when I grow up, I’m going to be a doctor…and I’ll make sure you receive good care.” My grandfather patted me on my head and said that as I grew up, I could do anything I want to do, but I had to study hard and plan well to become a doctor. He also said I had to do well in school. There was no kindergarten for Black kids where I grew up, so I went to first grade, and I told the teacher that I needed to study hard so I could become a doctor.

I have been working with disparities a long time. [Former ECOG-ACRIN chief executive officer] Robert L. Comis, MD knew that I was interested in disparities, and he allowed me to make plans for ECOG-ACRIN and to direct programs. We eventually set up the Health Equity Committee, with the goal of ensuring that disparities in cancer was a topic of involvement, and that it [would] be [woven] throughout the fabric of ECOG-ACRIN. We [knew that we needed to] ensure that there is equity [in terms of] providing our protocols and our educational programs to many individuals. We also needed to ensure that ECOG-ACRIN recognized the importance of [addressing] disparities in cancer care.

One of the [efforts that we made with this committee] was to ensure that we were providing that educational and collaborative [opportunity] to others. [To this end,] we set up the ECOG National Medical Association [NMA] panel, where we had Black doctors from the NMA be a part of ECOG. Each year after we set that up in 1998, Dr. Comis attended the NMA meetings, spoke with NMA physicians, gave lectures, and collected information from the Black doctors that we would then take back to ECOG. He did this every year up until his death.

[It was important to us that we provided] that education to, and collaborated with, Black physicians who were members of the NMA, as well as [foster] collaboration to increase the accrual of Black patients to ECOG-ACRIN clinical trials. More recently, in 2017, we set up a project to increase the pipeline, and therefore, increase the number of Black doctors who were in cancer medicine. We have had medical students, residents, [and] fellows involved [in this effort]. We also now have undergraduate medical students who we mentor and work with to increase the number of individuals who are preparing for a career in medicine.

With ECOG-ACRIN, we have been able to set up all these processes over the years, and that [led to the formation of] the Health Equity Committee. In that committee, we have not only physicians, but also clinical research assistants and many individuals from various fields of cancer research; all [of these individuals are] involved [in this effort] and all are working together.

From your experience, what are some of the biggest remaining unmet needs for these populations in the cancer field? Are there certain groups that are more vulnerable than others?

Although we started our work with Black patients, Black communities, [and] black physicians, we have since expanded to other individuals who are also in need. It does not matter about the racial or ethnic background of our communities that we work with, [we want to help those who are in need]. For instance, many do not [realize] that [similar needs can exist for some White patients; these needs] could be related to socioeconomic concerns, a lack of access to care, or a lack of insurance, [for example].

Another example is that many [individuals] must ride 3 different [modes] of public transportation just to get to a center [for cancer screening]. As such, 1 of the things that we are doing now is, with our mobile units, we are going to the communities [and providing these individuals with] easy access to appropriate cancer screening. We have also increased the hours for our treatment centers [to stay open] until 9 PM or 10 PM, whatever time we finish with the last patient, so that individuals do not have to miss work to [participate in] our clinical trials [or receive certain] cancer treatments.

We are looking at all aspects of care—from community needs to community involvement to partnerships with individuals to basic science research to our clinical research and our data collection and evaluation. We are bringing all of that together because it is so important. It is important for our physicians, and it is well recognized that most clinicians who take care of cancer patients are White. Therefore, it is important to ensure that we understand the community, their needs, and that we bring together all of our resources; that includes our health research and understanding, as well as implementation.

On any given day, there could be representatives from Congress calling me to discuss a specific issue, as well as our Pennsylvania team and state legislators who also call me periodically. In fact, I was invited to the Pennsylvania House legislature and was given an award and a standing ovation for my efforts in terms of communities; I am really appreciative of this. This is all about bringing all collaborators and components together so that we are all working [toward the] same [goal] and ensuring that we are addressing [any existing issues] at that specific time.

We are very fortunate here, at [Thomas Jefferson University], that we have resources and research [options] available for our patient constituents, both for screening as well as treatment. We have a program for mammograms and cervical cancer detection for individuals who lack resources or access to those programs. We reach [these] individuals, cover the cost of the mammograms, Pap smears, and human papillomavirus tests, provide those resources, and follow-up.

For example, I was able to work with the Pennsylvania legislature and the Medicaid program, so that for individuals who are diagnosed with cancer and are eligible for Medicaid, we can work with the Medicaid office to get that person on Medicaid resources. [This is] so they can get, for example, further diagnostic tests if needed.

Another example would be, for someone with an abnormal mammogram, who might need an ultrasound, MRI, or biopsy, those resources are there for them. If they are diagnosed with cancer, they can then receive treatment at Jefferson. [With this in place], there is no delay in [getting a] diagnostic test or implementing any needed therapeutic interventions.

Over the course of the COVID-19 pandemic, increasing reports have shone a light on the existing biologic and care disparities in patients with cancer who come from different backgrounds. What needs to be addressed going forward?

Many articles over the past 2 years have [detailed how] the pandemic has affected medical care; that is related to the fact that for many health care institutions, there were changes made in services to patients to allow for the urgent care of individuals suffering from COVID-19. Consequently, many institutions cancelled elective surgery and diagnostic procedures. This is important to mention because cancer screening is imperative; it allows for earlier diagnosis of cancer conditions. The earlier a cancer is found and treatment is implemented, the better the therapeutic outcomes [will be].

It was noted that there was an increase in later stage [disease] development and patients with cancers that had unfortunately progressed. Therefore, we had to reassess our processes. We are now increasing screening [efforts to encourage the] earlier diagnosis of cancers.

In fact, a report…from the National Cancer Institute [showed] that it is estimated that the number of cancers will increase. Therefore, overall mortality from cancer [is] at risk to increase in the next few years. As you likely know, the National Cancer Institute was a beneficiary of the 1971 National Cancer Act signing on December 23, 1971. Of course, the year 2021 marked 50 years of the National Cancer Act. Since that time, there has been a continuous decline in cancer mortality rates in this country. To see a model that estimates that this overall decline may be negatively affected by the COVID-19 pandemic is disappointing.

That report from the director of the National Cancer Institute has been a contributing factor to the fact that we are now [focused on] increasing cancer screening rates, although we are still not back to best levels yet. We need to incorporate COVID-19 treatment [into the care of] patients with those conditions that we have done well with over the years; that includes [working to get an] earlier diagnosis of cancer [so that we can continue to see a] decline in the cancer-related mortality rates in this country.