The social determinants of health disparities have expanded the definition of personalized medicine, Karen Winkfield, MD, PhD, said.
One positive outcome of the COVID-19 pandemic has been the increased attention to advocating for change and bridging gaps in oncology care. The social determinants of health disparities have expanded the definition of personalized medicine, Karen Winkfield, MD, PhD, said.
“Unfortunately, the COVID-19 pandemic has shown that in the United States we don’t quite have the public health infrastructure that we need, not yet,” said Winkfield, executive director of the Meharry-Vanderbilt Alliance, the Ingram Professor of Cancer Research, and professor of radiation oncology at Vanderbilt University Medical Center in Nashville, Tennessee, during the Greenspan Lecture at the 39th Annual CFS® hosted by Physicians’ Education Resource®, (PER®), LLC.1
Despite the downward trends in cancer-related deaths observed across all racial and ethnic patient populations, health disparities still exist, Winkfi eld explained.2 For example, one of the most widely known disparities in cancer care exists between White and Black patients.
There has been a decline in disparity for overall cancer deaths between Black patients and White patients from 33% in 1990 to 14% in 2016.2 However, achieving health equity remains a key goal in cancer care, Winkfield said.
Although biologic determinants like genetics, biology, and comorbidities inevitably have a role in creating these disparities, Winkfi eld hypothesized that social determinants, such as socioeconomic status, access to care, and sociocultural barriers, are the main contributors to these gaps.
Social determinants of health include economic stability, neighborhood and physical environment, education, food, community, and social context, and health care system factors. Negative social determinants, such as low income, lack of access to transportation, food, and social support, literacy challenges, and limited health care provider availability, are associated with poor health outcomes, including increased mortality and morbidity, lowered life expectancy, increased health care expenditures, decreased health status, and functional limitations.
“The social determinants go beyond just food; it is transportation, employment, literacy, and health literacy,” Winkfield said.
Although social determinants of health are becoming better understood, significant efforts from a socioeconomic and political context are needed to address them and provide precision medicine to all patients, Winkfi eld said.
Notably, the COVID-19 pandemic required rapid integration of many technologies that may start to bridge some of these gaps influenced by social determinants of health such as accessibility. The utility of telemedicine during the height of the pandemic is 1 takeaway lesson. Winkfield underscored that the pandemic showed the feasibility of localized or virtual care for certain procedures and patient conversations. For instance, clinical trial consent forms now are likely able to be signed virtually rather than having patients come into the clinic.
Importantly, adding virtual elements to cancer care can significantly lower the burden of treatment for patients, particularly for those who live in rural communities or who must rely on public transportation.
“Our ability to innovate the way that we have done with COVID-19 where telehealth is being compensated, these are the sorts of things we need to advocate for because, frankly, it makes it much easier for patients. This is what patient-centric care is about,” Winkfield said.
A study published in the International Journal of Radiation Oncology, Biology, Physics stated that achieving health equity is of critical importance for patients receiving radiation therapy and that the renewed passion to protect vulnerable patients observed during the COVID-19 pandemic should continue to address the disparities in care.3
Winkfield advised oncologists to be advocates of bringing more equitable cancer care in clinical trials and policy implications to their institutions and communities. Developing a diverse workforce and working in direct collaboration with community-engaged investigators is a great start to addressing these gaps, she said.
Specifically, Winkfi eld called attention to the need for redesigned and inclusive clinical trials. She highlighted the example of multiple myeloma. Although Black individuals comprise 20% of the multiple myeloma population in the United States, they make up only 5% of FDA registration trials in multiple myeloma.4
“If we are only getting the clinical trials in the spaces at the places that are very homogenous or have not done a good job at being inclusive, are we really moving the needle?” Winkfield asked.
Ultimately, developing an understanding of the issues that span the entire cancer care continuum from prevention to detection, diagnosis, and treatment to survivorship and end of life is critical, Winkfi eld said. In addition to health equity, some of these issues include quality of care, communications, and decision-making.
“We need to figure out how we can create an environment where we provide precision oncology, but we provide it for every patient so that every patient gets the right treatment at the right time,” Winkfi eld concluded.
1. Winkfield K. Precision medicine: ensuring every patient gets the right treatment at the right time. Presented at: 39th Annual CFS®: November 3-5, 2021; New York, NY.
2. AACR cancer disparities progress report 2020. AACR. Accessed November 4, 2021. https://cancerprogressreport.aacr.org/disparities/
3. Siker ML, Deville C Jr, Suneja G, et al. Lessons from COVID-19: addressing health equity in cancer care. Int J Radiation Oncol Biol Phys. 2020;108(2):475-478. doi:10.1016/j.ijrobp.2020.06.042
4. Loree JM, Anand, Dasari A, et al. Disparity of race reporting and representation in clinical trials leading to cancer drug approvals from 2008 to 2018. JAMA Oncol. 2019;5(10):e191870. doi:10.1001/jamaoncol.2019.1870