#ACCCNOC: Advancing Global Health Equity

The third and final day of the Association of Community Cancer Centers (ACCC) 41^st National Oncology Conference began with the meeting’s inaugural international panel. Cancer care providers representing Mexico, Puerto Rico, Brazil, Egypt, Sweden, Nigeria, and Australia came together to share and learn from common challenges and best practices.

Come Together: A Global Perspective on Cancer Care Delivery

Megan O’Neill, MS, executive director of ACCC, introduced the esteemed panelists: Enrique Soto Pérez de Celis, MD, PhD, associate director for Global Oncology, University of Colorado Cancer Center; Marcia Cruz-Correa, MD, PhD, AGAF, FASGE, executive director, Centro Comprensivo de Cáncer de la Universidad de Puerto; Theodora Karnakis, PhD, coordinator of Oncogeriatrics, Cancer Institute of the State of São Paulo-ICESP/FMUSP, coordinator of Oncogeriatrics, Hospital SírioLibanês; Inas Maged Moaz, MD, lecturer of Public Health, medical coordinator of Baheya Research Center, Baheya Foundation for Early Detection and Treatment of Breast Cancer; Mef Nilbert, MD, PhD, professor, Department of Oncology, Skåne University Hospital and Lund University; Modupe Elebute-Odunsi, MBBS, MD, FRCP, FRCPath, founder/CEO, Marcelle Ruth Cancer Centre and Specialist Hospital, founder/Chair Board of Trustees, Women In Healthcare Network; and Christopher Steer, MBBS, FRACP, medical oncologist, Albury Wodonga Regional Cancer Centre.

Moderated by current ACCC President Nadine J. Barrett, PhD, MA, MS, FACCC, the discussion opened with challenges each delegate has experienced in their country of origin. Dr. Pérez de Celis identified fragmentation of care as one of the most salient issues in both the US and Mexico. “Health care systems have a difficult time talking to each other and there’s a lack of clear guidelines for patient referral pathways throughout treatment,” he said. “Inequality in access to care is another challenge, and largely depends on where patients live.” With a population of 200 million dispersed across a large rural expanse of land, a lack of infrastructure in Nigeria poses a huge challenge, according to Dr. Elebute-Odunsi. Meanwhile in Australia, universal health care and Medicare mean that the population doesn’t face the same challenges of access to care as other nations. “[Rather], rebuilding the workforce is our biggest challenge,” said Dr. Steer. “We face an aging demographic in our community, creating too many patients with not enough people to look after them.”

Leaning into the theme of community engagement, the panelists commented on the strategies they have implemented in their practices to engage with diverse communities to deliver education on cancer prevention and treatment. “It’s about understanding your population, and not trying to put processes in place that are foreign to them and will not be accepted,” said Dr. Elebute-Odunsi. “We must understand patients’ religious backgrounds and cultural backgrounds. The only way you can bridge this gap is not through national policies made by leaders who don’t truly know the community; you have to engage with people in the community in the way they understand.” Dr. Pérez de Celis built on this sentiment: “This work starts with administrators. The entire health care workforce needs to be educated on the relevance of providing care for diverse communities. Is it that these people don’t have the knowledge or that we don’t know the community?”

2023-2024 ACCC President Olalekan Ajayi, PharmD, MBA, FACCC shifted the conversation to supporting the cancer workforce, and asked panelists about innovations and processes they’ve used to mitigate oncology workforce shortages. Dr. Pérez de Celis emphasized the importance of meeting the social and emotional needs of providers. “We forget that physicians and providers are people too, not saints. We need to make sure our workforce is healthy mentally, or the entire system collapses,” he said. “It’s also important for them to feel like what they do matters. We must give physicians the time and the resources they need to connect with patients and build those relationships.” Dr. Moaz echoed the challenges of shortages in the workforce. “We have thousands of Egyptian medical students graduating every year, but there’s a migration of health care workers outside of Egypt to more urban areas,” she said. “This shortage puts extra pressure on the existing providers, elevating levels of physical and emotional exhaustion and depersonalization, while decreasing job satisfaction.”

More than Words: Leveraging Governance and Partnerships to Advance Health Equity

The distinguished panel was followed up by a keynote presentation from Maria Hernandez, PhD, president and COO of Impact 4 Health. Successful health equity initiatives transform the health care delivery landscape to deliver more safe, effective, patient-centered, and equitable care to all populations, especially underserved and marginalized communities. “When we think of improving patient care, we think of access to care, better patient engagement, better care coordination and patient navigation assistance. But we need to add culturally effective care, understanding social drivers that impact the patient, and integrating health equity as a strategy to that list,” urged Dr. Hernandez.

To illustrate the importance of health equity from the patient perspective, Dr. Hernandez reflected on her father’s experience of being diagnosed with cancer. She recalled that he asked his family members not to speak Spanish in front of the providers because he didn’t want to be viewed as ignorant or unintelligent. “We need to recognize that our nation has very high standards about equality and treating everyone the same way,” she said. “But in health care, everyone comes from different communities with different levels of education and access to transportation. In my father’s case, his comfort zone was speaking Spanish. Equity is distributing resources based on people’s needs, but historically in our country, we believe in equality.”

Also central to the discussion around instituting health equity is inclusive leaders. “Health equity starts with committed, inclusive leaders at every level of the organization. It starts with you,” Dr. Hernandez stated. She went on to describe the core competencies of an inclusive leader, such as self-awareness, responsiveness, flexibility, and advocacy. “An inclusive leader is one who actively seeks and integrates the voice of their constituents and community members to drive organizational results,” she affirmed.

In the same vein, such leaders build an inclusive workplace structure that inspires high employee and patient engagement by placing value in their unique perspectives and contributions. “This message of inclusivity needs to be prominent in everything you do,” emphasized Dr. Hernandez, “from posting it on the wall to putting it in the employee handbook to discussing it in meetings.”

Innovation in Navigation: An Early Phase Clinical Trial Nurse Navigator 

The afternoon continued with a discussion of the transformative role a nurse navigator can play in helping more patients access clinical trials. “Rural cancer patients make up 15-20% of all patients diagnosed with cancer, yet they experience decreased access to oncology specialists, travel burdens, limited access to clinical trials, and unique socioeconomic factors that adversely impact their cancer outcomes,” Eleanor Gibbons, BA, clinical research manager, Sanford Health USD Medical Center expressed. Phase I clinical trials often require complex coordination, frequent follow-up visits, and specialized support staff, traditionally limiting access for those living in rural or more remote areas of the country. In response, Sanford Cancer Center in Sioux Falls, South Dakota, recruited a dedicated Early Phase Clinical Trial Nurse Navigator who works closely with patients to remove barriers and provide education. More recently, this nurse navigator has been creating a referral network with other medical facilities in surrounding states and helping to replicate an early phase clinical trials program at other sites.

Supporting Children in Underrepresented Communities Whose Parent Has Cancer 

To better understand the impact of cancer on marginalized and underrepresented communities and to gather deep insights about being a parent while living with cancer, Kesem, a national nonprofit organization, completed a months-long research program to assess what is needed to build trust within marginalized communities and how to better support families impacted by parental cancer. “Families want us to meet them where they are,” stressed Trish Conklin, MS, manager of Corporate Giving at Kesem. Also central to providing the right kind of support is building trust. “In order to be seen as a viable resource, we need to be spending time in the community and listening to their needs,” she explained.

HER2+ Metastatic Breast Cancer: Current Landscape and Future Directions

HER2+ metastatic breast cancer is a more aggressive subtype associated with a poor prognosis, as well as an increased risk of developing brain metastases. While local therapies have advanced, patients and their caregivers still face the risk of serious complications that are difficult to manage. Rita Nanda, MD, associate professor of Medicine, director, Breast Oncology Program, University of Chicago Medicine explained that systemic therapy has emerged as a viable treatment option for brain metastases, and combination therapy, aiming for a comprehensive HER2 inhibition, has the potential to overcome resistance mechanisms and improve treatment outcomes.

Navigating Access and Equity: Providing the Answers That Matter 

From accessing health care to navigating financial toxicity, many legal issues exist in cancer care. “63% of social workers reported that financial issues reduce patients’ compliance with their cancer treatment,” stated Melanie Grant, Esq., staff attorney, Triage Cancer®, emphasizing the link between financial toxicity and treatment outcomes. To address this issue, the Triage Cancer Financial Navigation Program assists patients with a wide range of legal and practical issues, including health insurance coverage, employment rights, disability benefits, financial assistance programs, and estate planning. By integrating legal and financial navigation services into the continuum of cancer care, Triage Cancer empowers patients to advocate for their rights, make informed decisions, and achieve equitable outcomes, with a focus on underserved communities. “We bring this information to people where they are, providing resources specific to their situation in their communities, in their native language, and in a way they can understand it,” said Grant.

Developing a Malignant Hematology and Bone Marrow Transplant APP Fellowship  

Jannelle Vicens, DNP, APRN, FNP-BC and Sandra Sepulveda, AGPNP-BC, MSN, BMTCN of the Miami Cancer Institute wrapped up the conference with a discussion of their institute’s fellowship program for advanced practice providers (APPs). This program trains novice APPs to provide high-quality specialized care for acutely ill malignant hematology and bone marrow transplant patients. At program rollout, all existing APPs engaged in formal disease-specific training, after which those APPs became the trainers and acted as preceptors for new fellows. “It is rare that we find APPs who have specialized training when they are hired,” explained Vicens. “Having our APPs fully equipped to provide higher quality care helps them be more satisfied in their jobs, reduces burnout rates, and therefore improves patient outcomes.” To further elevate this program, Miami Cancer Institute has applied for APPFA (Advanced Practice Provider Fellowships Accreditation) certification.