Equity in Action | Addressing Biomarker Disparities in Lung Cancer

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Equity in Action: Addressing Biomarker Disparities in Lung Cancer from Patient Empowerment Network on Vimeo.

How can biomarker disparities be reduced in lung cancer patients? Experts Dr. Joshua Sabari from NYU Langone and Dr. Eugene Manley from SCHEQ Foundation discuss approaches that are being used for community engagement and further interventions that can be used to reduce disparities.

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Understanding Non-Small Cell Lung Cancer: Types, Biomarkers, and Treatment Insights

Understanding Non-Small Cell Lung Cancer: Types, Biomarkers, and Treatment Insights

 Navigating Lung Cancer Biomarker Testing | Challenges and Solutions for Timely Access

Navigating Lung Cancer Biomarker Testing | Challenges and Solutions for Timely Access

 When Should Lung Cancer Patients Receive Biomarker Testing?

When Should Lung Cancer Patients Receive Biomarker Testing?

Transcript:

Lisa Hatfield:

So, Dr. Manley, are there any promising approaches or interventions aimed at reducing biomarker disparities that you’ve currently been exploring or are advocating for?

Dr. Eugene Manley:

I will take several angles on this. One thing is there has to be much more community engagement and involvement and really going to community groups, whether they’re faith-based, whether they’re barbershops, really going out where people are and letting them know about lung cancer, lung cancer disparities, biomarker testing, what you can do. The other way is also going to conferences where there are more diverse scholars that are attending. So a lot of these are STEMM meetings. They may not be specific in lung cancer, but if you can go out there and get the word out about lung cancer and the disparities, then they can go back to their families and talk about, you know, screening and testing and making sure that their family members are aware.

And then, you know, we just published a paper recently that shows the upstream part of biomarker testing is where are we starting at with our cell line? We just did a review of all the lung cancer cell lines. Of over 800 cell lines, majority were European-based. Only 31 cell lines in total were from Black African American populations. None were from Hispanic, none were from Native American, Pacific Islander, none from Alaska Native.

So just think about this. If that is our starting material for all of our biomarker testing and TCGA and databases, then everything we’re developing is on a population that already has great access and outcomes. But they don’t have the greatest disparities. So then you’re getting through doing all these trials, and then you have biomarkers, and you have immunotherapies coming out, and then you’re seeing adverse events in these diverse populations at the end because you don’t have the starting material.

Lisa Hatfield:

And, Dr. Sabari, after hearing Dr. Manley’s comments about that, how do you…or do you know of any approaches or interventions that are aimed at reducing these biomarker disparities? Because maybe they aren’t being acknowledged yet. Maybe they’re only being seen in certain populations.

Dr. Joshua Sabari:

Yeah, I think Dr. Manley hit it on the head. First off, we don’t even know the correct or true numbers for certain mutations in specific patient populations. And I just read an article about patients from Latin America, different rates of EGFR, ALK, and other mutations. You can imagine a study population from Africa, for example. And then obviously studying a population of Black Americans here in the United States as well.

We know that most of the cell lines, most of the data that we’ve had, particularly TCGA  (Tumor Cell Genome Atlas) is from a Caucasian or North European patient population. So I think we need to do better in that sense. I think equally as important, are clinical trial enrollment needs to diversify. Again, it’s mostly women. It’s mostly Caucasian women. We have very, very low rates of Hispanic patients enrolled on clinical trials, Blacks enrolled on clinical trials.

So I think we need to do better in that sense. One thing that we’ve really pushed for in academic medicine is to at least report who is being enrolled on trials so that we can understand is this data generalizable to my own clinical practice? And oftentimes if you look at the clinical characteristics of patients enrolled on the trial, it likely does not match what you see in your own practices.

So we need to do better in that sense. So I think the FDA, and especially pharmaceutical companies, are clearly looking to expand and broaden their inclusion criteria and also access to patients so that we can actually have a more diverse patient population that represents our country enrolled on these trials.

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When Should Lung Cancer Patients Receive Biomarker Testing?

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When Should Lung Cancer Patients Receive Biomarker Testing? from Patient Empowerment Network on Vimeo.

Biomarker testing is vital for non-small cell lung cancer (NSCLC) patients, but when should it happen? Expert Dr. Joshua Sabari from NYU Langone discusses cancer cell mutations and ideal timing for biomarker testing for the best patient care.

Download Resource Guide  | Descargar guía de recursos

See More from [ACT]IVATED NSCLC Biomarkers

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Understanding Non-Small Cell Lung Cancer: Types, Biomarkers, and Treatment Insights

Understanding Non-Small Cell Lung Cancer: Types, Biomarkers, and Treatment Insights

 Navigating Lung Cancer Biomarker Testing | Challenges and Solutions for Timely Access

Navigating Lung Cancer Biomarker Testing | Challenges and Solutions for Timely Access

 Equity in Action | Addressing Biomarker Disparities in Lung Cancer

Equity in Action | Addressing Biomarker Disparities in Lung Cancer

Transcript:

Lisa Hatfield:

And just from the patient perspective, does a patient need to be tested for these biomarkers throughout the course of their treatment, or is it done initially upon diagnosis or before second-line treatment?

Dr. Joshua Sabari:

Yeah, that’s a great question. You know, most mutations are clonal, meaning that they start in the original cancer cell and then the subsequent cells, daughter or son cells, also have that same mutation. So I would recommend doing next-generation sequencing up front in all patients. Now, some people have a specific mutation that we block with a targeted therapy. It could be pills. It could be an infusional targeted therapy. And that might change the sort of milieu or landscape of that mutational profile. So subsequently, after treatment, you may see acquired resistance or secondary mutations that will prevent the therapies from being effective. In those cases, I do recommend re-profiling.

So the most common example in lung cancer is the EGFR mutation, stands for epidermal growth factor receptor. We know that this mutation occurs in 20 to 25 percent of people diagnosed with non-small cell lung cancer. If you’re matched to a targeted therapy and don’t unfortunately have progression of disease, it may be very helpful to re-biopsy or re-sequence using both tissue and plasma to help us guide subsequent therapy. But if you do not have a targeted mutation and you’re treated with either chemotherapy and immunotherapy or immunotherapy alone, re-biopsy may not be as helpful in matching to further therapy.

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Navigating Lung Cancer Biomarker Testing | Challenges and Solutions for Timely Access

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Navigating Lung Cancer Biomarker Testing | Challenges and Solutions for Timely Access from Patient Empowerment Network on Vimeo.

To achieve accurate biomarker data for lung cancer patients, what are challenges and solutions? Expert Dr. Joshua Sabari from NYU Langone discusses challenges that can arise during the biomarker testing process, solutions to overcome the challenges, and proactive advice to help ensure optimal patient care. 

[ACT]IVATION TIP

“…not only know your mutation, but speak up for yourself. Speak up for your loved one. Make sure that the correct testing is done and that there is sufficient tissue, both for blood and tissue from the biopsy, to do the correct testing to allow us to potentially match people to the best treatments available.”

Download Resource Guide  | Descargar guía de recursos

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Understanding Non-Small Cell Lung Cancer: Types, Biomarkers, and Treatment Insights

 When Should Lung Cancer Patients Receive Biomarker Testing?

When Should Lung Cancer Patients Receive Biomarker Testing?

 Equity in Action | Addressing Biomarker Disparities in Lung Cancer

Equity in Action | Addressing Biomarker Disparities in Lung Cancer

Transcript:

Lisa Hatfield:

So, Dr. Sabari, this is a multi-part question here, so I’ll break it down a little bit. What are some of the main challenges in collecting accurate biomarker data, and how can researchers overcome these challenges? And considering the challenges that oncologists face in retrieving testing results at second-line treatment, what technological advancements or procedural changes could streamline the process and ensure timely access to biomarker testing results?

Dr. Joshua Sabari:

So when we talk about biomarker testing, we’re generally talking about testing the tissue, as well as sometimes testing blood or plasma. And it’s important that if you have a good and accurate biopsy with sufficient tissue, that then gives us the ability to select or do the correct biomarker testing. So that’s first and foremost, you know, fine needle aspiration, small aspirations may give us insufficient tissue. You know, whereas if you do a core needle biopsy, whether it be percutaneous through the chest with an image or bronchoscopically through the mouth with a camera, we’re able to get a large sample of tissue.

This will give us the amount of tissue needed to do the correct biomarker testing. We call it next generation sequencing or short for NGS, where we’re able to actually identify the mutations or abnormalities in your DNA. The other type of test we can do is on plasma, where we sometimes call it a liquid biopsy. That’s a simple blood test where, you know, a team will draw about two 10 cc blood tubes, where we’re then able to sequence, you know, DNA in your blood to help identify these alterations.

So having sufficient tissue or having the blood drawn, that’s important. 

But then also having your physician and your clinician and healthcare team order the appropriate test. You know, it’s unfortunate. A lot of folks that I see in my practice have not had adequate testing done in the frontline setting. Oftentimes, clinicians will be in a rush to start systemic treatment, both because patients are symptomatic, but also because they want to get going with treatment for patients. So, you know, stopping your physician, your team and saying, hey, what is my mutational profile? What is my mutational status is an extremely important discussion to have with your clinician. So a lot of times we only see this being done in the second-line setting.

So having that information up front could allow you and your family members to be matched to the best possible therapy. Now, if you’ve started a treatment and you don’t have genetic testing or molecular testing done in the front line, I would then have it done in the second-line setting. So one of my activation tips here is not only know your mutation, but speak up for yourself. Speak up for your loved one. Make sure that the correct testing is done and that there is sufficient tissue, both for blood and tissue from the biopsy, to do the correct testing to allow us to potentially match people to the best treatments available.

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Understanding Non-Small Cell Lung Cancer: Types, Biomarkers, and Treatment Insights

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Understanding Non-Small Cell Lung Cancer: Types, Biomarkers, and Treatment Insights from Patient Empowerment Network on Vimeo.

How can non-small cell lung cancer (NSCLC) patients be empowered when newly diagnosed? Expert Dr. Joshua Sabari from NYU Langone discusses what he shares about NSCLC incidence rates, histology, and biomarkers with patients and families.

[ACT]IVATION TIP

“…know what type of cancer you have, the histology. Whether it be adenocarcinoma or squamous cancer. And equally as important, know your biomarker, what mutation is driving your cancer and what PD-L1 expression your tumor harbors.”

Download Resource Guide  | Descargar guía de recursos

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When Should Lung Cancer Patients Receive Biomarker Testing?

 Equity in Action | Addressing Biomarker Disparities in Lung Cancer

Equity in Action | Addressing Biomarker Disparities in Lung Cancer

Transcript:

Lisa Hatfield:

Dr. Sabari, how do you explain non-small cell lung cancer to your patients and their care partners and families?

Dr. Joshua Sabari:

Yeah, so non-small cell lung cancer is a common cancer in the United States. It’s actually the third most common cancer. And really, you know, non-small cell lung cancer makes up multiple different histologies or types of cancer in the lung. The most common being adenocarcinoma, which is probably about 60 percent to 70 percent of non-small cell. We also hear about squamous cell cancer. And what this means is what is the original cell where the cancer arose? So adenocarcinomas occur in gland cells.

Whereas squamous cancers occur in cells such as the lining part of the lung. And it’s important to know what type of cancer you have because these are treated differently. And when you think about non-small cell lung cancer, we said there are many different ways that people can present. Some people can have shortness of breath, cough, you know, and weight loss. Whereas other people may have no symptoms at all.

So again, the important thing here is that lung cancer can be diagnosed in anybody. All you really need to have is lungs. We see lung cancer in people who’ve smoked in the past, but we also see lung cancer in people who’ve never smoked. And that brings me to a really important point. Once we understand the histology, the type of cancer that it is, we then want to understand some of the biomarkers, right? What are biomarkers?

Biomarkers are distinct sort of entities that help us better understand things about your cancer. And allow us to potentially match people to therapies. So two biomarkers that we generally think about, one is molecular or mutational biomarkers. These are the mutations or abnormalities that led to the cancer. Two kinds of mutations. One is a germline mutation, which is inherited from mom and dad and has a risk of being passed on to your children.

These are uncommon in lung cancer. The second type is called a somatic mutation. And these are mutations that are acquired from the environment, from smoking, for example, from pollution, from radon. And these are not generally inherited mutations. So really important to understand mutational profile and ask your doctor, what is my mutation? Because we can then match people to targeted therapies. The second biomarker that is really important is something called PD-L1 or programmed death-ligand 1. I know it sounds exotic.

But that’s a biomarker that helps us guide how likely immunotherapy will work in your cancer. If the PD-L1 expression is high, greater than 50 percent, immunotherapy may be a very good option. If the PD-L1 expression is low, immunotherapy may sometimes be used, but more commonly in combination with chemotherapy. So my activation tip here is know what type of cancer you have, the histology. Whether it be adenocarcinoma or squamous cancer. And equally as important, know your biomarker, what mutation is driving your cancer and what PD-L1 expression your tumor harbors.

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Advancements in Lung Cancer Clinical Trials | Updates for Veterans

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Advancements in Lung Cancer Clinical Trials: Updates for Veterans from Patient Empowerment Network on Vimeo.

How can veterans help move lung cancer clinical trial advancements forward? Expert Dr. Drew Moghanaki from UCLA Health explains clinical trial groups that need more participants, available support resources for veterans, and patient advice. 

[ACT]IVATION TIP

“…speak up and ask if there is a clinical trial that you may be eligible for to help another veteran. And, of course, when you enroll in a trial, you’ll be getting basically the best treatments that we think are available at this time.”

Download Resource Guide | Descargar guía de recursos

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 Are There Lung Cancer Outcome Disparities for Veterans?

Are There Lung Cancer Outcome Disparities for Veterans?

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Veteran Lung Cancer Risk | Understanding Exposures and Screening Protocols

Transcript:

Lisa Hatfield:

Dr. Moghanaki, can you speak to ongoing clinical trials and research specifically for veterans? And are there any clinical trials or research studies available that focus on lung cancer treatments specifically tailored to veterans from underrepresented communities?

Dr. Drew Moghanaki:

Yeah. So we want to focus on the people we care about the most, which for many of us are veterans, but at the end of the day, partnering nationally and globally in clinical trials is probably the best thing that we can do. We don’t really think that the lung cancer is…that our veterans are dealing with is necessarily different than what a civilian may be. So by partnering, we have bigger scale to tackle these problems and get these studies done as quickly as possible.

When it comes to underserved communities, same thing. We do the VA and VA researchers definitely make a point of trying to get more underrepresented communities access to clinical trials. But again, we just usually geographic challenges are our biggest barrier. Someone wants to live in this beautiful part of the country up in a mountainside near a lake, but they’re two-and-a-half hours away from a city. That can be challenging for us.

But the good news is that the VA does provide a lot of housing. So for those veterans who live far away, if they want to come, we’ll take care of them. We’ll provide, if they’re eligible for your VA healthcare, we’ll provide them housing. We can even provide them with their meals. And so, and get them access to the best care. So basically my activation tip here is to be aware that clinical trials are really critical.

It’s how we’ve moved forward. It’s a tremendous opportunity to help other veterans behind themselves who will get lung cancer in the future. There’s nothing we can do at this time to stop the number of people getting lung cancer. And so the more research we can do, the better this world can be. And my activation tip is to speak up and ask if there is a clinical trial that you may be eligible for to help another veteran. And, of course, when you enroll in a trial, you’ll be getting basically the best treatments that we think are available at this time.

 

Lisa Hatfield: Great. Thank you. Thank you so much. Those activation tips were really great and patient-centered. And I think that’s what, at least me as a patient, watching that in the audience, that’s what I want to hear is what can I do to help advocate for myself? So thank you for those responses.

 

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Lung Cancer Care for Veterans: Advancements in Radiation Oncology

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Lung Cancer Care for Veterans: Advancements in Radiation Oncology from Patient Empowerment Network on Vimeo.

What should veterans with lung cancer know about radiation oncology advancements? Expert Dr. Drew Moghanaki from UCLA Health explains recent advancements in radiation oncology and radiotherapy, where the advanced therapies are accessible, and proactive patient advice.

[ACT]IVATION TIP

“…make sure you do your homework and try to make sure that the department of radiation oncology you’re going to really does have the best technologies. And there’s lots of different ways to look at this, including going online and reading more about what the quality of care might be in the community.”

Download Resource Guide | Descargar guía de recursos

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Combating Disparities: Veterans’ Healthcare Access and Quality

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 Advancements in Lung Cancer Clinical Trials Updates for Veterans

Advancements in Lung Cancer Clinical Trials Updates for Veterans

Transcript:

Lisa Hatfield:

Dr. Moghanaki, are there any promising advancements or techniques in radiation oncology that could potentially improve outcomes for veterans with lung cancer?

Dr. Drew Moghanaki:

Yeah, there really are. So back in the old days, radiotherapy was just an open beam that we would shine towards a general area of the body. And they did a good job of getting control of the cancer, but, unfortunately, it would injure a lot of normal tissues. Today, radiotherapy is much more precise and targeted. In fact, our precision is within less than a millimeter of what we aim at. And so military analogy is this is like your best sharpshooter that can hit a small, less than a one-inch target from a 1,000 yards away.That’s basically what we’re able to do. We’re not a 1,000 yards away. The machine’s right there. We can see inside the human body. We can see the tumor, especially if it’s moving, and we can deliver highly concentrated high dose X-rays specifically to the tumor with a very little amount of exposure to the area around it.

So we’re just not seeing our patients getting injured from radiotherapy, and we’re seeing sometimes some situations up to 100 percent complete tumor control with no further growth. So it’s really important for veterans to know. So my activation tip is if surgery is on the table, you might want to check in with a radiation oncology team as well to see, well, is radiotherapy an option as an alternative? It might be safer and just as good and maybe better. So a lot of people don’t know about this because this is not taught as much, but radiotherapy is really one of the major forms of curative therapy for lung cancer.

Lisa Hatfield:

Okay, thank you. As a patient, I always have follow-up questions to clarify a couple of things. So I have another follow-up question to this, the question you just answered. So I know that not all veterans are seen at VA hospitals or VA facilities. If they are being seen at a VA facility, will they have access to the latest and greatest radiation radiotherapy services, or do only some centers have these special types of therapies?

Dr. Drew Moghanaki:

Yeah, well, when it comes to the VA’s commitment to provide the best care for every single veteran who’s eligible, there’s a logistical challenge in that it’s hard to deliver care to veterans everywhere, especially super sub-specialty care like thoracic surgery or radiation therapy. The equipment’s expensive. There’s a lot of staff that has to be hired. You can just look at airports. We don’t have a major commercial airport in every town and city in the U.S. They’re in major towns, major cities.

And that’s kind of how things are with the VA medical centers. And even when you look at the network of 130 VA medical centers in the 50 states of the U.S. only just more than 40 of them actually have radiotherapy on site at that VA medical center. So a lot of veterans who actually need radiation therapy are going to be getting that through the VA referred out to the community providers.

And so it’s important to if you’re at the VA, you’re very likely to get high-quality radiation therapy because a lot of oversight, the federal government’s watching. In fact, it’s the most regulated radiation oncology service in this country at this time. But if you’re going out into the community, make sure you do your homework. And my activation tip would be then make sure you do your homework and try to make sure that the department of radiation oncology you’re going to really does have the best technologies. And there’s lots of different ways to look at this, including going online and reading more about what the quality of care might be in the community.

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Are There Lung Cancer Outcome Disparities for Veterans?

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Are There Lung Cancer Outcome Disparities for Veterans? from Patient Empowerment Network on Vimeo.

Do lung cancer outcome disparities exist for veterans? Expert Dr. Drew Moghanaki from UCLA Health discusses veteran outcome studies for civilian versus VA healthcare, efforts on improving outcomes over time, and proactive advice for accessing the best lung cancer care.

[ACT]IVATION TIP

“…if you’ve got cancer, to really understand lung cancer, to really appreciate that there’s been a lot of advances and if you’re not feeling that you have access to those advances, get a second opinion and go to a bigger place that actually has an integrated approach to lung cancer care with a multidisciplinary team with the doctors in different specialties are working together and are focused on giving the best lung cancer care.”

Download Resource Guide | Descargar guía de recursos

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Combating Disparities | Veterans' Healthcare Access and Quality

Combating Disparities: Veterans’ Healthcare Access and Quality

 Veteran Lung Cancer Risk | Understanding Exposures and Screening Protocols

Veteran Lung Cancer Risk | Understanding Exposures and Screening Protocols

 Lung Cancer Care for Veterans | Advancements in Radiation Oncology

Lung Cancer Care for Veterans | Advancements in Radiation Oncology

Transcript:

Lisa Hatfield:

Dr. Moghanaki, can you discuss any disparities or differences in health outcomes among veterans compared to the general population when it comes to lung cancer treatment?

Dr. Drew Moghanaki:

Yeah, when it comes to lung cancer treatment, there’s new data that’s showing that since the discovery of better drugs and safer surgery and more effective radiotherapy, that survival rates are improving gradually, especially over the last 10 years. We’ve seen this same trend with VA data as well, that veterans, whether they’re getting care in a community or in the VA, the outcomes are getting better.

Are there disparities? Well, there’s notable disparities that we’ve identified which is that although outcomes in general are getting better for female and male and Black and white and other ethnic sections of the population, there continues to be a disparity in the civilian sector in that our Black patients, whether civilian or veteran, have inferior outcomes. And, of course, we know this is associated largely with other socioeconomic issues related to a long history of racism in this country that’s led to segregation and unequal access to health care and well-being opportunities.

But what we see in the VA, whether you’re Black or white, actually the outcomes are the same. So there’s something that VA is doing that’s addressing the barriers that are affecting people in the general population. And in fact, we see in some of our studies, Black veterans actually have better outcomes. And so we’re learning that it’s much more than just biology by itself, that there really are socioeconomic factors. And when you’ve got a healthcare system that’s more than just a healthcare system, it’s a benefit system as well.

We really provide a nice safety net that helps address those disparities. But the sad truth is that it definitely disparities do continue to exist outside the VA healthcare system. So my activation tip is, if you’re a veteran with maybe some less resources than others, again, check into the VA because the VA provides not just healthcare, but also a lot of support services, especially when you have lung cancer, which as mentioned, is just very difficult to deliver and requires more than just access to a doctor.

Lisa Hatfield:

And I’d like to mention a paper also that you published regarding improving outcomes over a certain time period. There was a paragraph in there where you had a discussion about potential contributing factors to the improvement of outcomes over time. Are you willing to discuss those a little bit, what those potential factors are for improving outcomes in patients with lung cancer?

Dr. Drew Moghanaki:

Yeah, there are three main components. One is making sure you get the diagnosis right. Making sure you do the right biopsies and you send the specimens for what’s called biomarker testing to make sure you know what type of lung cancer. There’s now more than a dozen different types of lung cancer. And if you don’t get that biomarker test, you’re not going to know. You’re just going to be treated with standard therapy. If you get the biomarker testing, you can get personalized medicine with a drug that’s more likely to work and probably safer than the older conventional chemotherapies, which still has a role. But sometimes we can skip chemotherapy altogether and go directly to a targeted therapy.

The second big advancement comes in the treatment delivery itself. So surgical treatments are now much less invasive than ever before. In fact, many of our patients, they go to the operating room, they wake up with four Band-Aids, and half their lung is removed. Remarkable technology using robotic and video-assisted technologies. Same with radiotherapy.

Patients lay on a table and the machine, the very sophisticated machine just rotates around them, zaps these tumors. The patient can actually drive themselves back and forth to treatment and go home and and live their lives. We’ve got patients getting lung radiotherapy, and they’re playing golf the next day. It’s unbelievable. And then the third really comes down to survivorship, which is that our patients, even if we really can’t cure their cancer, like a lot of advanced diabetes, we just can’t cure, we can keep our patients going as they live a high-quality life moving forward and make sure that their journey, unfortunately, with their lung cancer that they obviously didn’t ever want to have, that their journey is the best that it can be. 

So my activation tip here is if you’ve got cancer, to really understand lung cancer, to really appreciate that there’s been a lot of advances and if you’re not feeling that you have access to those advances, get a second opinion and go to a bigger place that actually has an integrated approach to lung cancer care with a multidisciplinary team were the doctors in different specialties are working together and are focused on giving the best lung cancer care.

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Veteran Lung Cancer Risk | Understanding Exposures and Screening Protocols

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Veteran Lung Cancer Risk: Understanding Exposures and Screening Protocols from Patient Empowerment Network on Vimeo.

What’s important for veterans to know about lung cancer risk? Expert Dr. Drew Moghanaki from UCLA Health discusses known veteran lung cancer risk factors, screening recommendations, and proactive patient advice involving the PACT Act.

[ACT]IVATION TIP

“…if you’ve had an office job, well, you probably have the same risk as your neighbor wherever you’re living. But if you were in a combat zone or on a base where there were a lot of chemicals, probably want to pay a little more attention and check in with your primary care doctor to get some appropriate screening tests for yourself.”

Download Resource Guide | Descargar guía de recursos

See More from [ACT]IVATED NSCLC Veterans

Related Resources:

Combating Disparities | Veterans' Healthcare Access and Quality

Combating Disparities: Veterans’ Healthcare Access and Quality

 Are There Lung Cancer Outcome Disparities for Veterans?

Are There Lung Cancer Outcome Disparities for Veterans?

 Lung Cancer Care for Veterans | Advancements in Radiation Oncology

Lung Cancer Care for Veterans | Advancements in Radiation Oncology

Transcript:

Lisa Hatfield:

Dr. Moghanaki, there is a stigma around military personnel being at higher risk for lung cancer than civilians. Is there an elevated risk for those in the military? If so, why and who should be screened?

Dr. Drew Moghanaki:

Yeah, the stigma of veterans being at higher risk for lung cancer is real. And I think Hollywood had a big role in it. And is it appropriate? Well, I never liked the word stigma, but I think it’s important for the public. And of course, soldiers or any military personnel who served in the armed forces appreciates that back in the days the bases were much dirtier than they are today. And there was a lot of exposure to a lot of things that can cause cancer and actually other health problems as well, such as diabetes and Parkinson’s disease and Alzheimer’s and other things.

So yes, it’s true that our veterans, especially if they were working around toxic chemicals or in the Middle East, where the open burn pits were leading to inhalation of a lot of toxic fumes, that these folks are at a higher risk and should be more proactive with any symptoms. So if you’re just a 45-year-old, 55-year-old male or female, and you’ve got a cough, generally speaking, you may not be so worried and just hope it goes away.

But if you’ve been on these dirty bases, it’s important to look into this and find out now how dirty are the bases? Well, there’s been the media I think over exaggerates exactly what was going on and what was on these bases. But there are lots of federal reports that have documented exactly some of the, for example, like if you were stripping aircraft with a certain stripping material, a lot of these substances are currently now chemicals are banned because we as soon as we learn that they’re toxic, we basically ban them.

But generally speaking, yeah, health concerns are a little bit elevated if you’ve served in the military and especially if you’ve been deployed in the field of battle. And so my activation tip is if you’ve had an office job, well, you probably have the same risk as your neighbor wherever you’re living. But if you were in a combat zone or on a base where there were a lot of chemicals, probably want to pay a little more attention and check in with your primary care doctor to get some appropriate screening tests for yourself.

Lisa Hatfield:

Are there any programs in place right now where veterans who’ve had those exposures or potential exposures, where they are being screened regularly or is it up to the veteran to ask that question?

Dr. Drew Moghanaki:

So if a veteran is plugged in with the VA healthcare system, the primary care network here is set up to offer the appropriate screening. But if you’re not, it’s important to look into this. Again, I’m just going to keep saying over and over again, if you’re a veteran who’s not yet eligible, if you know anyone, please check in. Congress has radically expanded the eligibility within the PACT Act is actually primarily centered around this issue of risk. It’s about toxic exposures that the VA is still learning about and VA physicians like myself are still learning about. And so these programs definitely exist to address them, but the best way to do it is to get registered for VA healthcare.

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Combating Disparities: Veterans’ Healthcare Access and Quality

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Combating Disparities: Veterans’ Healthcare Access and Quality from Patient Empowerment Network on Vimeo.

Where can veterans locate quality healthcare and healthcare access? Expert Dr. Drew Moghanaki from UCLA Health shares information from VA healthcare research studies and proactive advice for patients to access the best care.

[ACT]IVATION TIP

“…make sure that the quality of care isn’t inferior, check in with the VA and see how they might be able to help you, especially if you’ve got lung cancer, because lung cancer care is complicated.”

Download Resource Guide | Descargar guía de recursos

See More from [ACT]IVATED NSCLC Veterans

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Veteran Lung Cancer Risk | Understanding Exposures and Screening Protocols

 Are There Lung Cancer Outcome Disparities for Veterans?

Are There Lung Cancer Outcome Disparities for Veterans?

 Advancements in Lung Cancer Clinical Trials Updates for Veterans

Advancements in Lung Cancer Clinical Trials Updates for Veterans

Transcript:

Lisa Hatfield:

Dr. Moghanaki, are there disparities in the quality of care received by veterans compared with other patient populations? And can you speak to the strategies or programs that have been effective in addressing barriers to healthcare access for veterans?

Dr. Drew Moghanaki:

I love this question because it is one of the most informative things that I’ve learned since becoming a VA physician. Study after study has shown that the quality of care received by veterans is equal or superior to that received in the community. And that’s largely in the VA healthcare system. So again, if you’ve got access to VA healthcare, I think you might be eligible, please look into it. The reports have been fantastic, and that’s because it’s a comprehensive approach to care. But for veterans who are receiving care in the community, it’s a little bit harder, actually it’s a lot harder to track. Because they may not be registered with the VA. And what’s happening, I saw the VA is happening outside the VA.

And I think that largely speaking veterans are just going to get the same kind of level of care as their neighbors might who are civilian. And so where they’re going for their care really affects that. Now, veterans may have more resources, because they can tap into the VA to find out where they may go. VA has incredible tracking systems, a lot of data to help us make better decisions and for them to make better decisions. And so my activation tip here is to make sure that the quality of care isn’t inferior, check in with the VA and see how they might be able to help you, especially if you’ve got lung cancer, because lung cancer care is complicated.

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Insights into Veteran Healthcare | Perspectives from VA and Civilian Systems

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Insights into Veteran Healthcare | Perspectives from VA and Civilian Systems from Patient Empowerment Network on Vimeo.

What can veterans expect for the patient experience in VA versus civilian healthcare systems? Expert Dr. Drew Moghanaki from UCLA Health explains common experiences for veterans in VA  and civilian healthcare systems and information about the PACT Act.

[ACT]IVATION TIP

“…be aware of who’s providing care, and obviously give them a break if they don’t understand anything about what it means to be a veteran. The quality of healthcare really builds upon a culture of trust. You may be better served finding other physicians or providers who are veterans themselves.”

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See More from [ACT]IVATED NSCLC Veterans

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How Can Advanced Lung Cancer Be Explained to Newly Diagnosed Veterans?

How Can Advanced Lung Cancer Be Explained to Newly Diagnosed Veterans?

 Lung Cancer Strategies for Veterans | Research and Care Insights

Lung Cancer Strategies for Veterans | Research and Care Insights

 Do Black and Latinx Veterans Face Unique Lung Cancer Challenges

Do Black and Latinx Veterans Face Unique Lung Cancer Challenges?

Transcript:

Lisa Hatfield:

Dr. Moghanaki, are there systemic issues within the healthcare system that disproportionately affect veterans?

Dr. Drew Moghanaki:

Well, this makes me realize that healthcare systems aren’t just automatic systems. They’re environments where there are people like myself who work in a healthcare system. And depending on where a veterans getting care, that staff may or may not know much about what it means to be a veteran. So let’s take three different examples. Obviously, if you come to VA Medical Center, our veterans, many of them told me they feel like they’re back on base. We understand the mission. We understand the cause. We understand the victory. We also understand the suffering. And we can connect better than anyone else in this country with veterans. 

And we’ve got the access to the best treatments available to truly take the best care that we can with a comprehensive approach through the VA healthcare network, which now consists of over a 1,000 clinics and over 100 high-quality, multi-functioning health care medical centers. But let’s take option number two, where a veteran may be receiving care in a community hospital. And in that situation, you may run across some of the healthcare providers who know something about what it means to be a veteran.

Either, if you’re lucky, they themselves were a veteran and provided some service, or they were raised in a family where they know other people who have served in the military and they understand the basic principles.  And so those healthcare providers, even though they may be civilians themselves or veterans working in a community hospital, at least kind of get it.

But then there’s a third scenario where veterans will go to a community hospital, and the people taking care of them don’t really know what it means to be a veteran. They only know the television version or the Hollywood version of it. And they think they know, but they really don’t know. And I’ll tell you, that’s who I was when I first started working in the VA about 12, 13 years ago. And I’ve been so fortunate to get a lot of lessons on what it means to be a veteran. And over time, I’ve gotten to know a lot of soldiers and veterans myself just in my personal life to truly understand. And so I think my activation tip for here is to really be aware of who’s providing care, and obviously give them a break if they don’t understand anything about what it means to be a veteran.

The quality of healthcare really builds upon a culture of trust. You may be better served finding other physicians or providers who are veterans themselves. And, of course, if you’ve got access to VA healthcare, check-in with the VA Medical Center and see, hey, what’s the quality of my care here? And I’ll probably be saying this later on in this recording, which is that if you are a veteran and not yet eligible for VA healthcare, please do check in because the PACT Act recently approved by Congress has truly expanded eligibility, and you may be eligible and not know about it.

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Do Black and Latinx Veterans Face Unique Lung Cancer Challenges?

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Do Black and Latinx Veterans Face Unique Lung Cancer Challenges? from Patient Empowerment Network on Vimeo.

What unique challenges do Black and Latinx veterans face in lung cancer? Expert Dr. Drew Moghanaki from UCLA Health explains the importance of trust, second opinions, and proactive advice for the best care.

[ACT]IVATION TIP

“…for anyone who might have some trust concerns. No one owns you as a provider that you have to get care from them. If you’re comfortable, you can ask for a second opinion. If not, it is absolutely okay. Patients all the time are getting second and sometimes even third opinions. And I strongly recommend getting another opinion if you’ve got any questions or doubts, because that trust alliance is so important to get the best lung cancer care…”

Download Resource Guide | Descargar guía de recursos

See More from [ACT]IVATED NSCLC Veterans

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How Can Advanced Lung Cancer Be Explained to Newly Diagnosed Veterans?

How Can Advanced Lung Cancer Be Explained to Newly Diagnosed Veterans?

 Lung Cancer Strategies for Veterans | Research and Care Insights

Lung Cancer Strategies for Veterans | Research and Care Insights

 Insights into Veteran Healthcare | Perspectives from VA and Civilian Systems

Insights into Veteran Healthcare | Perspectives from VA and Civilian Systems

Transcript:

Lisa Hatfield:

Dr. Moghanaki, what specific challenges do veterans from the Black and Latinx communities face when trying to access healthcare services, and what are we learning from these challenges, and how is that information shaping care for veterans facing lung cancer?

Dr. Drew Moghanaki:

Well, this question just reminds me that healthcare is complicated, especially lung cancer care. And the most important thing for anybody getting care, regardless of what social, economic background or ethnic background they may be from, is to find a team that you trust and who you know will care about you. And that’s the best way to make sure you get the best treatment. I myself as a physician. I’ve also been a patient at times.  And if I don’t trust my care provider, I basically ask for a change. And I know that can be difficult.

And so here’s my activation tip for anyone who might have some trust concerns. No one owns you as a provider that you have to get care from them. If you’re comfortable, you can ask for a second opinion. If not, it is absolutely okay. Patients all the time are getting second and sometimes even third opinions. And I strongly recommend getting another opinion if you’ve got any questions or doubt, because that trust alliance is so important to get the best lung cancer care, because it’s not going to be a one-time visit. You were talking about relationships that can last months or even years to get the best treatment for your lung cancer.

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Combat and Courage | A Veteran’s Lung Cancer Battle

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Combat and Courage: A Veteran’s Lung Cancer Battle from Patient Empowerment Network on Vimeo.

Derrick, a resilient veteran and lung cancer survivor graciously opens up about his journey, detailing his experience from initial screening and diagnosis through to treatment. He candidly discusses crucial aspects of lung cancer care for veterans and offers insights drawn from his journey. In Derrick’s own heartfelt words, he emphasizes the importance of empowerment through knowledge, stating, “It’s your body and your life, and you deserve to learn all you can to gain knowledge and confidence about your cancer.” 

Download Resource Guide  |  Descargar guía de recursos

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What Do Lung Cancer Patients Need to Know to Build a Treatment Plan

 Persistence in the Face of Dismissive Healthcare: One Patients’ Journey

Persistence in the Face of Dismissive Healthcare: One Patient’s Journey 

 What Are the Noted Disparities in Lung Cancer Screening and Access

What Are the Noted Disparities in Lung Cancer Screening and Access?

Transcript:

Derrick:

Being ACTIVATED in your lung cancer care is a necessity, take it from me. 

After my friend who I served with in Iraq was diagnosed with lung cancer, I knew that it was time to get  serious about my lung cancer screenings at the Veterans Affairs Hospital. As a lung cancer survivor, I want to share my story as a Black military veteran. Lung cancer is the leading cause of cancer-related death in veterans, and Black veterans are less likely to complete lung cancer screening.  However, a recent VA report showed that Black veterans receive equal or superior care through VA hospitals in comparison to Black patients in the general population.

I was already 52 when I received my first lung cancer screening. I only learned later that I should have started receiving screening at age 50 at the VA. It was winter when I went in for my screening. I’d had a nagging cough but didn’t think twice about it. It was a winter season with multiple respiratory viruses circulating at the time. I was shocked when the radiologist informed my doctor that they found a spot on one of my lungs. I felt like I wasn’t old enough to have cancer.

I was really nervous about it beforehand, but I had surgery to remove the tumor from my lung. I felt fortunate to have my friend I served with to talk with about lung cancer, but I know not everyone is this fortunate. I’m sharing my story in the hopes that it will help other veterans. I continue to receive regular scans of my lungs and urge other veterans to start your lung cancer screening on schedule. Ask your doctor or VA administrator if you’re unsure about when you should start. It’s your body and your life, and you deserve to learn all you can to gain knowledge and confidence about your cancer.

There have been a lot of recent advancements in lung cancer diagnosis and treatment. I hope that sharing my perspective will make a difference for other veterans. We served proudly for our country, and we deserve the best lung cancer screening and care as part of the respect that we earned.

Stay [ACT]IVATED with these tips. 

  1. Don’t allow stigmas to keep you from getting the best care, now is the time to get the right care no matter how you got the cancer.
  2. Ask your care team questions to learn about treatment options and what to expect during and after treatment.
  3. Ask if a clinical trial may be a potential treatment option for you.
  4. Stay abreast of lung cancer treatment options and research advancements

Whether it’s combat in war or fighting cancer, no matter who you are, being proactive is everything. Stay [ACT]IVATED by being informed, empowered, and engaged in your care.

Empowering Lung Cancer Patients | Embracing Hope, Treatment, and Teamwork

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Empowering Lung Cancer Patients: Embracing Hope, Treatment, and Teamwork from Patient Empowerment Network on Vimeo.

What does the future of non-small cell lung cancer (NSCLC) treatment and care look like? Expert Dr. Samuel Cykert from UNC School of Medicine shares his outlook about the future of care and his advice to patients to help build emotional support.

[ACT]IVATION TIP

“…don’t give up, and one thing I’ve heard from patients over time, particularly among Black patients, there’s a tremendous faith community, and understanding that tremendous faith, faith is excellent, but also use that faith to understand that your belief in God, your interaction with God, God is using those doctors and those healthcare professionals to help you, so it’s not a solo effort, get everybody on the team.”

Download Resource Guide | Descargar guía de recursos

See More from [ACT]IVATED Non-Small Cell Lung Cancer

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Enhancing Lung Cancer Care for Black and Latinx Patients | Tackling Challenges, Implementing Solutions

Enhancing Lung Cancer Care for Black and Latinx Patients | Tackling Challenges, Implementing Solutions

 Improving Biomarker Testing Access for Rural Lung Cancer Patients

Improving Biomarker Testing Access for Rural Lung Cancer Patients

 How Can We Advance Equitable Access to Precision Medicine in Lung Cancer Care?

How Can We Advance Equitable Access to Precision Medicine in Lung Cancer Care?

Transcript:

Lisa Hatfield:

If you could give one suggestion to patients out there who may not be following up with their appointments, perhaps also in addition to the racial disparities? The unfortunate stigma surrounding lung cancer, and I wonder sometimes if that’s a barrier to continuing treatments or going to appointments, you could give one suggestion or sentence of encouragement to patients to seek out those high volume facilities if they’re diagnosed, if there’s a suspicion of lung cancer and to continue with treatment, what would your message be to those patients?

Dr. Samuel Cykert:

My message to patients, really it’s two-fold. On the medical side, lung cancer deaths are falling, all cancer deaths are falling, and they’re falling because of earlier detection, but they’re also falling because of these new treatments. And so it’s really, really important, particularly if you’re physically able, if you have a good functional status and you’re able to walk around and do things, it’s important that you really, really consider aggressive treatments because lung cancer isn’t an immediate death sentence anymore.

It is true that there are some lung cancers that are not curable, but with some of the new biologic treatments and chemotherapy regimens, people can live years with a good quality of life, even with some advanced lung cancers. So my advice on that side is don’t give up, and one thing I’ve heard from patients over time, particularly among Black patients, there’s a tremendous faith community, and understanding that tremendous faith, faith is excellent, but also use that faith to understand that your belief in God, your interaction with God, God is using those doctors and those healthcare professionals to help you, so it’s not a solo effort, get everybody on the team.

Lisa Hatfield:

Great message. Everybody on the team, I like that. Thank you, Dr. Cykert, and I appreciate all of your answers, and I’m hoping that this message, what people are watching that, understanding those statistics from your research, people who sometimes miss appointments or have transportation issues, maybe this will inspire them to continue finding ways to get there and to keep going, to keep fighting it and getting everybody on their team, I appreciate your message a lot. Thank you.

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How Can We Advance Equitable Access to Precision Medicine in Lung Cancer Care?

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How Can We Advance Equitable Access to Precision Medicine in Lung Cancer Care? from Patient Empowerment Network on Vimeo.

With non-small cell lung cancer (NSCLC) precision medicine, what are disparities and strategies to equitable access? Expert Dr. Samuel Cykert from UNC School of Medicine discusses disparities, strategies to overcome disparities, and proactive patient advice toward optimal care.

[ACT]IVATION TIP

“…I know you do electronic health records, and as soon as this visit is done, you have data about my visit, so have you thought about creating a real-time registry to see how I’m progressing with my care and see how others are progressing with their care, whether to make sure that we don’t have missed appointments and to make sure that I’m not falling behind where I should be.”

Download Resource Guide | Descargar guía de recursos

See More from [ACT]IVATED Non-Small Cell Lung Cancer

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Enhancing Lung Cancer Care for Black and Latinx Patients | Tackling Challenges, Implementing Solutions

 Improving Biomarker Testing Access for Rural Lung Cancer Patients

Improving Biomarker Testing Access for Rural Lung Cancer Patients

 Empowering Lung Cancer Patients | Embracing Hope, Treatment, and Teamwork

Empowering Lung Cancer Patients | Embracing Hope, Treatment, and Teamwork

Transcript:

Lisa Hatfield:

Dr. Cykert, are there any disparities in access to biomarker testing for Black and Latinx patients with lung cancer compared to other racial or ethnic groups, and if so, what strategies or initiatives can be implemented to address these disparities and promote equitable access to precision medicine?

Dr. Samuel Cykert:

Yeah, biomarker testing followed up by precision medicine is really fairly new in the last half-dozen years, so there haven’t been a lot of studies done looking at how well we’re doing in different groups, but there’s a journal called The Journal of Clinical Oncology and precision medicine that published such a study in 2022.

And what that showed…and again, keep in mind that in a lot of…as they do in a lot of database studies, they are a couple of years behind, but what they showed in looking at the cases of over 20,000 patients, is that on first time testing, we talked about initial biopsies, when the initial biopsy is tested, there is actually about a 7 percent difference between Black and white patients with the white number being only 37 percent and the Black number being 30 percent, so that was low all the way around.

And then if you look at any biomolecular testing at any stage of the cancer, those numbers change to around 55 percent for white patients and 44 percent for Black patients, and I want to point out that for Asian patients and Latinx patients, the numbers were also low, but there weren’t enough patients in the database to achieve statistical significance, but it looks like things are going in the wrong direction there too, and when you think about it, in the state of the right now, those numbers ought to be close to 100 percent for everybody, at least in some of the basic markers like ALK and EGFR and PD-L1.

So there’s a lot of work to do. So there is a disparity. It has been documented, but we’re not getting perfect care to even anyone, and in the ACCURE (Accountability for Cancer Care through Undoing Racism and Equity) Study that I had described a little bit earlier, where we did an intervention, we created real-time transparency through up-to-date electronic health records and digital data of where patients were in their care, we were able to create a real-time registry to know what had been done for every patient, and in the case of precision medicine, this would be so easy, because you basically put every patient that’s had a lung cancer biopsy in the registry, then you have another column in the registry tested for X, tested for Y, tested for Z, and then you have a next column that says, treated for X, treated for Y, and treated for Z. We have the digital information now to do all this in real time, and we have to build the systems to do it.

Lisa Hatfield:

Could you share any examples of successful initiatives or programs aimed at improving the implementation of biomarker testing in lung cancer and what factors contribute to the success of these initiatives, and how can they be replicated or scaled in other healthcare settings?

Dr. Samuel Cykert:

I’ll have to plead my ignorance on this question because I haven’t talked to enough cancer centers on whether or not they’re creating real-time registries for whether all their patients with probable lung cancer are, [a] getting biopsied promptly, [b] getting biomarker testing, and then following those patients over time to see if they’re getting the treatments to match to that, so I know that at my own institution at the University of North Carolina Lineberger Cancer Center, we’re actively talking about building these systems, but we haven’t built them yet.

And so going back to the work that our UNC team has done in partnership with Greensboro Health Disparities Collaborative, we’ve done an intervention with real-time transparency in lung cancer treatment and breast cancer treatment, and real-time quality improvement and audit and feedback for accountability in those treatments and using navigation, particularly for high risk patients to make sure that they’re able to follow through with their diagnosis and treatment.

So with that combination in lung cancer, we got almost perfect care, 96 percent and 95 percent completing treatment, so there’s no reason that the same system cannot be applied to biomarker testing and biologic and immunotherapy, and we need to look at it and implement it and apply it as soon as possible, because when you think about all this, and I’m not just talking about cancer, but when you’re thinking about the whole picture, when you look at, for instance, Black, white disparities, whether it’s in cardiovascular care, whether it’s in diabetes, whether it’s in cancer care, if you look at the result of that in one year, if we brought up care to benchmark levels of the Black community on all those things, we would save 74,000 lives a year.

That’s incredibly impactful. And we need to quicken up the pace of doing this. I’ve been a disparities researcher and intervention researcher for over 20 years, and people really haven’t taken note of really doing interventions until the last five or six years. We need to pay attention, we need to move. It’s important. People’s lives depend on it. And care improved for everyone with these systems, it improved for white patients too. It’s not a zero-sum game.

Lisa Hatfield:

I’m wondering, as a patient, is there anything that I can do or that a patient can do to request or to ask if they use real-time data, that institution to help with the treatment or help with testing or whatever, is there a question the patient might be able to ask to ensure the real-time data is used? Because I imagine it’s not being used as often, so it could be, like you said, there probably isn’t a system in place.

Dr. Samuel Cykert:

Here’s my double activation tip. So at an institution, you don’t know if you have a problem until you look. So the first problem is, as I go back and look behind, am I making sure whether or not I’m seeing disparities, whether it’s a man, woman, Black, white, Latinx, do we have disparities in our treatment application and treatment outcomes in our institution? Because if we look at that, we can start brainstorming on how to possibly fix it, and then the second thing is, I know you do electronic health records, and as soon as this visit is done, you have data about my visit, so have you thought about creating a real-time registry to see how I’m progressing with my care and see how others are progressing with their care, whether to make sure that we don’t have missed appointments and to make sure that I’m not falling behind where I should be.

Lisa Hatfield:

Great, that’s perfect, thank you. Having the patients be…have that accountability too, to ask the question, if that exists, that real-time data, if there’s a way to use that. So thank you, I appreciate that myself personally, so thanks. 

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What Urgent Innovations Can Advance Lung Cancer Precision Medicine?

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What Urgent Innovations Can Advance Lung Cancer Precision Medicine? from Patient Empowerment Network on Vimeo.

How can non-small cell lung cancer (NSCLC) precision medicine be advanced through urgent innovations? Expert Dr. Samuel Cykert from UNC School of Medicine discusses technology and research innovations and epigenetics.

Download Resource Guide | Descargar guía de recursos

See More from [ACT]IVATED Non-Small Cell Lung Cancer

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Enhancing Lung Cancer Care for Black and Latinx Patients | Tackling Challenges, Implementing Solutions

Enhancing Lung Cancer Care for Black and Latinx Patients | Tackling Challenges, Implementing Solutions

 Improving Biomarker Testing Access for Rural Lung Cancer Patients

Improving Biomarker Testing Access for Rural Lung Cancer Patients

 Empowering Lung Cancer Patients | Embracing Hope, Treatment, and Teamwork

Empowering Lung Cancer Patients | Embracing Hope, Treatment, and Teamwork

Transcript:

Lisa Hatfield:

In your opinion, what are the most pressing research priorities or areas of innovation needed to further advance the implementation of biomarker testing and precision medicine in the management of lung cancer?

Dr. Samuel Cykert:

Yeah, there are two areas of this, the health services researcher side of me says institutions have to implement systems that follow patients in real time to making sure that they’re getting the testing and treatment that they need from the initial suspicion of lung cancer all the way to biomarker testing and therapies, whether they include surgery, chemo, radiation, biologics or immunotherapy. Those systems need to be areas of priority so that we’re really proactive of not only following patients, but from time to time, whether there are side effects or whether there is confusion, having those systems so we know when to re-engage patients when they’re not progressing along, so on the health services side, we have a lot of just phenomenal, phenomenal new treatments, and we have to make sure that every patient who is eligible is getting those treatments. Okay?

Now, on the other side of things, we’ve talked about racial disparities and other ethnic disparities in care, and one thing that people are observing over time is that in individuals and communities where racism is experienced, where the stress of racism is felt on a frequent basis, we know that outcomes are worse. And part of that may have to do with stress hormones themselves and how stress hormones interact with cancer treatments and hypertension treatment and other treatments, but the other possibility is there is a field called epigenetics, where genes change because of stressors.

And so it’s very conceivable now, in terms of the Human Genome Project, there is hardly a difference in the genome between white and Black people. Genetic race is a social construct, and genetically we’re almost identical, but if we’re experiencing epigenetics, if we are experiencing racism and that grind in daily life, it changes things within us, and so I think it’s important to get enough tissue on the research side from Black patients and other disadvantaged groups to look at the epigenetic part of it, because there may be new genes and new biomarkers we’re not experiencing now that are more prevalent in disadvantaged peoples, and so I think research has to go in that direction too, and even let’s talk about going upstream, maybe if we can prevent the effects of racism. I wish racism would end tomorrow, right, or today, but it doesn’t look like that’s happening. And so, is there any way we can attenuate the stresses of racism so that the downstream effects are prevented?

Lisa Hatfield:

Really interesting point you make about the stress of that. That’s super important. It’s something I hadn’t thought of. So thanks for mentioning that too. 

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