Health eq­ui­ty in­no­va­tion must go be­yond the sci­ence

Just as sci­en­tif­ic in­no­va­tion is es­sen­tial to ad­vanc­ing health, sys­temic health­care in­no­va­tion is re­quired to tack­le health dis­par­i­ties. Fac­tors out­side of sci­ence – such as racism, dis­crim­i­na­tion, and lack of ac­cess to qual­i­ty health care – cre­ate bar­ri­ers that pre­vent some peo­ple from ben­e­fit­ing from hard-won sci­en­tif­ic ad­vance­ments. In­no­va­tion must go be­yond sci­ence to ad­dress dis­par­i­ties in can­cer care.

“We need trans­for­ma­tion­al med­i­cines to close the health eq­ui­ty gap, but we can’t stop there,” says Michael Petrout­sas, SVP, Head of the US On­col­o­gy Busi­ness Unit, GSK. “Re­duc­ing in­equities will take col­lab­o­ra­tion through­out our in­dus­try and en­gage­ment with providers and pa­tients.”

Dis­par­i­ties are dire through­out on­col­o­gy, in­clud­ing in ovar­i­an can­cer and mul­ti­ple myelo­ma. More than 20,000 in­di­vid­u­als will be di­ag­nosed with ovar­i­an can­cer in the U.S. this year, join­ing the 235,000 al­ready liv­ing with the dis­ease.¹ While ovar­i­an can­cer im­pacts all races and eth­nic­i­ties, Black and His­pan­ic pa­tients were found to have a sig­nif­i­cant­ly longer time to di­ag­no­sis.² Black and Asian peo­ple are the least like­ly to be re­ferred to ge­net­ic test­ing and coun­sel­ing, al­though they show high­er rates of HRD mu­ta­tions com­mon in ovar­i­an can­cer tu­mors.³

Black peo­ple al­so face in­creased risk for mul­ti­ple myelo­ma and have high­er mor­tal­i­ty rates com­pared to white peo­ple, with­out ex­pe­ri­enc­ing the same sur­vival gains over time.⁴ The high­er death rates among Black pa­tients with mul­ti­ple myelo­ma are like­ly due to low­er treat­ment uti­liza­tion and ac­cess ⁵ – His­pan­ic and Black pa­tients are less like­ly to be treat­ed with stem cell trans­plan­ta­tion than white pa­tients. To bet­ter un­der­stand these dis­par­i­ties and de­vel­op strate­gies to re­solve them, the in­dus­try must com­bine sci­ence and tech­nol­o­gy with com­mu­ni­ty part­ner­ship and trans­par­ent con­ver­sa­tions.

En­sur­ing in­clu­sion in clin­i­cal re­search.

To un­der­stand how med­i­cines will work in the pop­u­la­tions that need them most, clin­i­cal tri­als must rep­re­sent the de­mo­graph­ics of the pa­tients af­fect­ed by the dis­ease. Di­ver­si­fy­ing clin­i­cal tri­als re­quires col­lab­o­ra­tion, with com­pa­nies work­ing with peers, providers and pa­tients to re­shape how clin­i­cal tri­als are con­duct­ed and en­rolled.

“The di­ver­si­ty in our clin­i­cal tri­als must mir­ror the pa­tient com­mu­ni­ties the treat­ment hopes to serve,” says Michel Reid, Sr. Di­rec­tor and Head, Glob­al De­mo­graph­ics and Di­ver­si­ty, GSK. “For 2022, we’ve com­mit­ted to in­sti­tut­ing di­ver­si­ty plans to en­roll pa­tients rep­re­sen­ta­tive of the epi­demi­ol­o­gy of the dis­ease we’re study­ing in at least 75% of our Phase 3 clin­i­cal tri­als.”

New ap­proach­es to clin­i­cal re­search can al­so sup­port ad­vances in health eq­ui­ty. Col­lect­ing re­al world ev­i­dence ex­pands the un­der­stand­ing of health dis­par­i­ties in can­cer and in­forms so­lu­tions for pa­tients. For ex­am­ple, poly (ADP-ri­bose) poly­merase (PARP) in­hibitors, al­so re­ferred to as main­te­nance ther­a­py, can be ef­fec­tive in de­lay­ing ovar­i­an can­cer from re­turn­ing in cer­tain pa­tients. How­ev­er, a rig­or­ous analy­sis of ovar­i­an can­cer treat­ment re­vealed a no­table dis­par­i­ty: Black women were treat­ed with PARP in­hibitors at a sub­stan­tial­ly low­er rate than white women and were un­der­rep­re­sent­ed in the in­dus­try-wide tri­als used to val­i­date these ther­a­pies.^6,7

An­oth­er way to di­ver­si­fy clin­i­cal re­search is to con­duct geospa­tial analy­sis of epi­demi­ol­o­gy across ge­o­gra­phies to iden­ti­fy where needs are most preva­lent, which makes it pos­si­ble to en­gage with pa­tients and place tri­als where they can do the most good.

Build­ing con­nec­tions and earn­ing trust.

The health­care in­dus­try must earn the trust of skep­ti­cal com­mu­ni­ties who have faced med­ical mis­treat­ment. GSK funds projects to build con­nec­tions and earn trust in these com­mu­ni­ties by fos­ter­ing greater dis­ease aware­ness and bet­ter un­der­stand­ing of clin­i­cal re­search. For ex­am­ple, stu­dents in one for-cred­it col­lege course are trained by on­col­o­gists at GSK to con­duct sur­veys in com­mu­ni­ties of their own sim­i­lar so­cial con­text about ovar­i­an can­cer aware­ness, and then sched­ule fol­low-up phone calls to share more in­for­ma­tion for any­one in­ter­est­ed. They learn how to an­a­lyze their da­ta, present it at con­fer­ences, and pub­lish man­u­scripts. The stu­dents al­so share ed­u­ca­tion­al in­for­ma­tion about clin­i­cal tri­al par­tic­i­pa­tion and pro­vide re­sources to the com­mu­ni­ty mem­bers dur­ing their out­reach.

Am­bas­sador pro­grams should be ded­i­cat­ed to forg­ing com­mu­ni­ty con­nec­tions, lis­ten­ing, learn­ing and cre­at­ing ini­tia­tives tai­lor-made for the com­mu­ni­ties they serve. For ex­am­ple, one GSK On­col­o­gy pro­gram in­volves women liv­ing with ad­vanced or re­cur­rent ovar­i­an can­cer serv­ing as men­tors to women who are new­ly di­ag­nosed with the dis­ease, pro­vid­ing sup­port and an­swer­ing com­mon ques­tions.

Learn­ing from con­ver­sa­tions to help peo­ple get back to care.

Ear­ly in the COVID-19 pan­dem­ic, pre­ven­ta­tive care and can­cer screen­ings dropped sig­nif­i­cant­ly, es­pe­cial­ly among un­der­served pop­u­la­tions and women. That is why it is so im­por­tant to un­der­stand how to sup­port peo­ple in get­ting back to care. That in­sight takes more than da­ta. It takes con­nec­tion. Con­nec­tions lead to con­ver­sa­tions that help in­form thought­ful de­ci­sions about how to get peo­ple back to care.

“Ear­ly di­ag­no­sis is the best de­fense against can­cer,” says Petrout­sas. “De­lays in di­ag­no­sis for un­der­served com­mu­ni­ties dri­ve in­equity in over­all prog­no­sis and sur­vival. But a one-size-fits-all ap­proach will not get peo­ple back to care. We must see the whole per­son to un­der­stand how we can bet­ter sup­port their health. It starts with lis­ten­ing and learn­ing.”

Sup­port­ing broad ac­cess to care.

When peo­ple do need treat­ment for can­cer, fi­nan­cial con­cerns should not cre­ate a bar­ri­er.  Rec­og­niz­ing that treat­ment con­sid­er­a­tions and costs can add un­due stress, the To­geth­er with GSK On­col­o­gy pro­gram of­fers pa­tients and health­care pro­fes­sion­als var­i­ous ac­cess and re­im­burse­ment ser­vices for the com­pa­ny’s prod­ucts, all in one place.

Go­ing fur­ther by learn­ing to­geth­er.

The health­care in­dus­try’s re­sponse to COVID-19 showed what can be ac­com­plished when its lead­ers align on com­mon goals. That same uni­ty is form­ing around health dis­par­i­ties. Com­pa­nies through­out health­care ac­knowl­edge the sys­temic na­ture of health dis­par­i­ties and are be­gin­ning to take a sys­tem­at­ic ap­proach to eq­ui­ty. While ro­bust in­de­pen­dent ef­forts are im­por­tant, to tru­ly trans­form health­care – an in­dus­try that is strongest when it is col­lab­o­rat­ing – a col­lec­tive, holis­tic fo­cus on eq­ui­ty will en­sure bet­ter health for all. Unit­ing sci­ence, tech­nol­o­gy and tal­ent will make it pos­si­ble to get ahead of dis­ease to­geth­er.

Ref­er­ences:
¹Can­cer of the ovary – can­cer stat facts. SEER. https://seer.can­cer.gov/stat­facts/html/ovary.html
²Huepen­beck­er S, et al. Pre­sent­ed at: SGO An­nu­al Meet­ing on Women’s Can­cer; March 19-25, 2021
³Lin J, et al. Pre­sent­ed at: SGO An­nu­al Meet­ing on Women’s Can­cer; March 19-25, 2021
⁴Myelo­ma – Can­cer Stat Facts. SEER. https://seer.can­cer.gov/stat­facts/html/mul­my.html
⁵What are some dis­par­i­ties in the treat­ment and care of mul­ti­ple myelo­ma pa­tients? In­ter­na­tion­al Myelo­ma Foun­da­tion. https://www.myelo­ma.org/di­ver­si­ty/are-some-dis­par­i­ties-treat­ment-care-mul­ti­ple-myelo­ma-pa­tients
⁶Mo­jde­hbakhsh R, et al. Pre­sent­ed at: SGO An­nu­al Meet­ing on Women’s Can­cer; March 19-25, 2021
⁷Da­wood, et al. Pre­sent­ed at: ES­MO 2021; Sept. 16-21, 2021