Cancer Care’s Road to Recovery from the Global Pandemic

An interview with Debra Patt, MD, PhD, MBA, FASCO, Executive Vice President, Public Policy and Strategic Initiatives, at Texas Oncology  

ACCCBuzz: Dr. Patt, you’re delivering a keynote session at the upcoming ACCC 38th [Virtual] National Oncology Conference, October 20-22, in Austin, Tex. Interestingly, you were the closing keynote presenter at ACCC’s last in-person meeting way back in March 2020: the ACCC 46th Annual Meeting and Cancer Center Business Summit. Before we get started, do you care to comment on that? 

Dr. Patt: [Laughs] I remember. And I also remember asking myself at the time, “Should I even be here [in a room of 500+ attendees]? Is this going to be a problem?” But it is so nice to now be coming together again. We recently hosted a COA [Community Oncology Alliance] meeting in Washington, D.C., and I told my colleagues that they need to come to Austin for the ACCC National Oncology Conference. 

ACCCBuzz: Your keynote session is titled, “Cancer Care’s Road to Recovery from the Global Pandemic.” With such a broad topic and with the enormous impact that COVID-19 has had on—not just oncology—but the entire U.S. healthcare delivery system, how will you focus your presentation? 

Dr. Patt: I will start out presenting data on what we saw in terms of how COVID-19 greatly reduced access to cancer care. And I will go on to discuss how these delays in cancer screening and treatment translate into cancer mortality. We then can discuss what we have learned and how we will do better. So, start with the bad news and then move into the good news. And the good news is that innovative approaches we’ve adopted [as a result of the global pandemic] have the potential to reduce disparities in cancer care. Since COVID-19, we've seen an affirmation of the [benefits of] digital healthcare, which have allowed more people access and improved care delivery. Launching telehealth has been a little extracurricular activity for The US Oncology Network. [Laughs] We’ve only done something like 250,000 telemedicine visits since the public health emergency was declared in Texas alone.  

ACCCBuzz: One of the biggest concerns in oncology is the effect that the pandemic has had on cancer screening rates, including lower rates of Pap tests, mammograms, screenings for colorectal cancer, etc. Many providers believe—and there is now data supporting this belief—that these screening delays will result in people presenting with later-stage disease. You’ve published on this topic, including on the impact of COVID-19 on American seniors. Can you give our readers a peek at some of the data you will be presenting during your keynote? 

Dr. Patt: There’s been a more than 30 percent reduction in cancers that have been diagnosed [in 2020]. But most importantly, we need to recognize that the challenges to accessing quality cancer care are regional problems that require tailored, regional solutions. And just because something is not a problem for your program, or just because you don’t see these access barriers where you practice, doesn’t mean they’re not there. But we [the oncology community] can use digital technology to close these gaps in care in terms of remote patient monitoring, ePROS [electronic patient-reported outcomes], etc.  

ACCCBuzz: I’m glad you mentioned remote patient monitoring. Inova Schar Cancer Institute, one of the 2021 ACCC Innovator Award winners, is presenting on the remote patient monitoring process it developed and implemented during the pandemic. It’s just one of so many advances that ACCC member programs have made during a time of unprecedented adversity. It’s been amazing and inspiring to see what cancer care providers have been able to accomplish while being under-staffed and—in many instances—under-resourced. 

Dr. Patt: Thank you. [Pause] It was my hardest year in practice. But these past 12-plus months served as a great reminder of why I practice medicine—and that is to help people who are vulnerable. The pandemic offered some silver linings, perhaps the greatest being that we [the oncology community] now have an opportunity to make a difference. Over the past year, we saw a “reclaiming” of what the oncology community and healthcare community are capable of delivering.  

ACCCBuzz: So, programs and practices are seeing more people diagnosed with more advanced cancer, and they are doing so at a time when many are under-staffed and under-resourced. Can you comment on the impact the COVID-19 pandemic has had on The US Oncology Network and Texas Oncology, where you practice? 

Dr. Patt: [Like so many,] we have seen a decrease in new cancer patient visits, and that has had a negative impact on our bottom line. We’ve experienced stressors on our workforce that have led to inefficient care delivery. I have spent at least an extra five minutes every day with every patient, having to explain why tests and other care activities are delayed—sometimes taking a month to complete, when these same activities used to take a week. So, yes, we're facing capacity demands, workflow challenges, and staffing shortages—all of which limit our efficiency.  

ACCCBuzz: Let’s switch focus for a minute and address a question that is top of mind for ACCC members, and that is, “How do we ensure diversity in our cancer care teams—especially diversity among those in leadership positions?” ACCC is hosting two workshops at its National Oncology Conference that touch on the importance of increasing diversity and inclusion in our cancer programs. Members also share that their patients with cancer want people who look like them on their care teams. What is The US Oncology Network doing regarding diversity, inclusion, and equity?  

Dr. Patt: Cultural sensitivity training is critical, as is recognition within the organization that diversity is important, and recognition that we all benefit from diversity. In this era of such tremendous social change, we have an opportunity to do better. I think that we look to telemedicine as a virtual care strategy—as a command center for research—to help us [the oncology community] do better. This country has an incredible deficit in [clinical trial] accrual for minority and underserved patients. But if we [providers] can leverage telemedicine to talk to patients in their homes about [the benefits of] clinical trial accrual, we just might be able to improve those numbers. I’m doing a study right now with COA to understand how various issues impact our ability to accrue underserved patients to clinical trials.  

ACCCBuzz: It does seem like the time is now to really move the needle in a positive direction in terms of cancer research. As you know, ACCC is partnering with ASCO [American Society of Clinical Oncology] on an initiative to increase racial and ethnic diversity in clinical trials.   

Dr. Patt: [Nods] It’s been a challenging year. And we’ve not yet seen some of the negative ramifications of pandemic challenges manifest, and we likely won’t for years to come. But as we look back at this challenging year, it’s time to take our lessons learned and create a better future for cancer care. 

ACCCBuzz: We’ve heard from many of our members about how much they miss networking with their colleagues. Can you offer an elevator pitch for why it is more important than ever for cancer care professionals to travel to Austin and attend the ACCC National Oncology Conference in person?  

Dr. Patt: We [oncology providers and other members of the cancer care team] all learn so much from each other’s shared experience. And this is the best time to do it. We need to engage and see each other’s faces again. [Laugh] Be able to network in person, as opposed to Zoom, and learn from each other.  

ACCCBuzz: Any closing thoughts? 

Dr. Patt: Well, we haven’t even touched on policy. In addition to the tremendous social change we are experiencing, there have been—and continue to be—tremendous policy changes [affecting] cancer care both at the federal and state level. How these play out will dramatically impact our ability to provide care. US Oncology is focusing on ways to reinvent and improve telehealth so that we [providers] are more efficient and effective and able to meet new challenges. For example, in Texas, we see a lot of rural patients, many without broadband access. So, what can we do as providers—and what can we do on the legislative and regulatory front—to ensure these patients have the same access to quality cancer care as others do?   

Debra Patt, MD, PhD, MBA, FASCO is a practicing oncologist and breast cancer specialist in Austin, Texas. She is an active leader in breast cancer research, clinical cancer informatics, and system innovations to enhance care delivery. Dr. Patt is President of the Texas Society of Clinical Oncology, Secretary for the Community Oncology Alliance, and serves on the Council on Legislation for the Texas Medical Association. She is also the Editor-in-Chief of JCO Clinical Cancer Informatics. 

ACCCBuzz recently interviewed Dr. Patt about policy efforts specific to her state of practice, Texas. Two important pieces of legislation passed by the 87th Texas Legislature help set some guardrails around the influence of health insurers and pharmacy benefit managers on where and how patients can access prescription medications. HB1919 is strong anti-steerage legislation directed at health benefit plan issuers and pharmacy benefit managers; HB1763 precludes Direct and Indirect Remuneration (or “clawback”) fees.