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Tackling Health Inequities in Cancer Care: An Interview with ASCO President Dr. Lori Pierce
The BCRF investigator speaks about her research—and the theme driving her forthcoming term
In June, BCRF researcher Dr. Lori Pierce began her year as president of the American Society of Clinical Oncology (ASCO), one of the most prominent professional organizations for oncology professionals and physicians in the world. Her appointment marked the eighth time a BCRF investigator was elected to this position.
Eliminating racial and socioeconomic disparities in cancer outcomes has been a career-long passion for Dr. Pierce, so it was only fitting that she announced a health equity theme (“Equity: Every Patient. Every Day. Everywhere.”) for her ASCO presidency. As the COVID-19 pandemic disproportionately devastated communities of color, and mass demonstrations against racism spread across the country this summer, Dr. Pierce’s choice of theme became even timelier.
“As an African American, I’ve been acutely aware of the health disparities for people of color,” Dr. Pierce told BCRF. “In almost any tumor you look at, people of color experience worse outcomes. That has stayed with me throughout the years. When I was fortunate enough to be elected president of ASCO, I knew I was going to pick an equity theme.”
Dr. Pierce, who will also join BCRF’s Scientific Advisory Board in November, recently spoke with BCRF about how she hopes to move ASCO—and cancer care—forward.
Tell us about your research.
My BCRF-supported work primarily looks at cancers that are resistant to radiation. We know the vast majority of women with early-stage breast cancer are treated extremely well with lumpectomy and radiation. But about 10 percent of women have resistant cancers, even with standard treatment. Through funding from BCRF, we look at radiation sensitizers [such as chemotherapy and PARP and androgen inhibitors] that will allow us to have greater tumor kill and ensure normal tissues tolerate treatment.
You’ve long been interested in health equity. How does that play into your own research?
Our work looking at radiation sensitizers will help all patients. That said, there are certain agents, such as the inhibitors that block the androgen receptor, that may especially help women of color. The androgen receptor is in all cancers, including triple-negative breast cancer, which disproportionately affects women of color [and still lacks targeted treatment].
But, again, these types of research programs help all patients. And I’ve often said to my residents, cancer cells can’t tell what color you are. We give them far too much credit. They function by the biology of the cancer. So, if you can understand that biology, you can then overcome that biology. Because conversely, there are many African American women who have indolent disease.
Where I think race comes in is more in socioeconomic issues. Race almost becomes a surrogate for socioeconomic status. Some of my other research focuses on this aspect [of cancer care]. For instance, look at hypofractionated radiation. We know from many trials that shorter courses of radiation are just as effective as the longer courses. Many women prefer them over standard treatment.
I published a paper in the 1990s showing that breast conservation was an excellent option for women of color, which of course now seems so obvious. But back then, a lot of women of color were not being offered breast conservation. I felt I had to publish the obvious. Now, we fast forward to hypofractionation. For a recent study, we looked at hypofractionation rates, and they were significantly less than women of color. So here we go again. We found that if you corrected for the institution where they were treated, then there were no differences. That suggests there are more people of color going to institutions that are not actively using hypofractionation.
This is a reminder to offer the best therapies to all of our patients. There should be no difference based on race. I think you have to consider biology and socioeconomic differences to really get at the heart of these issues.
How has ASCO previously worked to improve health equity?
Health equity is at the very heart of what ASCO does. Trying to make sure that everyone has access to high-quality care is the very foundation of ASCO. My role as president, and in promoting my theme, is to make existing programs much more visible and then augment what ASCO is already doing with other programs.
What new programs can you tell us about now?
One of the programs I’m very excited about aims to improve the enrollment of underrepresented minorities on clinical trials. I’m preaching to the choir here, but we know that clinical trials are the best way to overcome cancers in both current patients and future patients. Despite that fact, we also know minorities enroll in lower numbers. Hispanics and African Americans make up about three to six percent of patients on clinical trials, whereas they make up about 13 to 15 percent of patients with cancer. There’s clearly a disconnect and much work to be done. ASCO is now partnering with the Association of Community Cancer Centers (ACCC) on an initiative to improve enrollment of underrepresented minorities. We sent out a request for ideas to the ASCO and ACCC communities for strategies and proposals to implement. I think we can move the needle forward.
Another initiative will try to understand the importance of social determinants of health for our cancer patients. They are the circumstances under which we’re born, where we live, where we work. Everything about our lives has to do with social determinants of health. It all comes down to power and money. I don’t think we, as physicians, think enough about the barriers our patients face, and how they affect patients’ ability to get care. We want to increase awareness of social determinants of health. We’re focusing primarily on oncology fellows and early-career faculty—our leaders of tomorrow. We’re putting together a series of podcasts about social determinants of health, and, in planning that, we’re tapping into a focus group of fellows and early-career faculty to get their thoughts on how they best learn and what topics they want us to cover. I would envision the first podcast will be a basic 101 on social determinants of health. Another might be about taking a social determinants of health history—asking questions about transportation and financial toxicities to understand the barriers a patient will. As oncologists, we have all these wonderful advances. But if patients can’t come and get them—if they have to work or they don’t have transportation—then all this is for naught.
What initiatives are you working on to diversify the oncology workforce?
For medical students of color, ASCO already has in place a few programs, including stipends for attending the annual meeting and mentor pairing. We also have our Medical Student Rotation for residents to get a better appreciation of what oncology is all about.
If you look at the data on internal medicine residents and the fellowships they chose to go into, oncology was at the bottom. That is just not acceptable, because it means that they don’t know all that oncologists do. They don’t know all of the different ways they can impact patients’ lives. It’s up to us to make it even clearer to our trainees that oncology is a wonderful field. I don’t want to get into too many specifics, but I can tell you there will be a program that will be set up during my year and carried out the following year where we will create more concentrated experiences for underrepresented medical students in oncology.
I’m personally committed to bringing more underrepresented minorities and women on committees in ASCO, because I know that’s how you ascend the ladder—and how your voice is heard. I’m also committed to embedding equity into our annual meeting. Others have told me they’ve tried and have been unsuccessful. But that’s just not acceptable to me. There are ways I’m convinced we can fold equity into our themes. We’ve typically had specific sessions on health equity, and quite honestly, they haven’t been attended. I don’t think that’s because people aren’t interested—there are just so many things going on at ASCO. We have to bring equity to the masses. I’m hoping I can push this agenda forward.
This interview has been edited and condensed. Watch more interviews with BCRF researchers on our YouTube channel.