Tag Archive for: biomarker testing

What Is the Role of Biomarker Testing in Stomach Cancer?

What Is the Role of Biomarker Testing in Stomach Cancer? from Patient Empowerment Network on Vimeo.

What’s the current status of biomarker testing in gastric cancer? Expert Dr. Joo Ha Hwang from Stanford Medicine shares an update about biomarker testing in gastric cancer research, H. pylori infection testing, and proactive patient advice about H. pylori and potential symptoms.

[ACT]IVATION Tip

…go to your doctor, especially if you come from an area, or your parents come from an area that has high prevalence of H. pylori, which is pretty much anywhere in the world besides the United States, then you should talk to your doctor about getting H. pylori testing, especially if you have any abdominal pain symptoms or changes in appetite.”

 

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Transcript:

Lisa Hatfield:

Dr. Hwang, can you speak to the role biomarker testing plays in gastric cancer? And what key information should patients know about early detection as it relates to biomarker testing?

Dr. Joo Ha Hwang:

So, currently there are no good biomarkers to detect gastric cancer at an early stage. So there’s a lot of investigation going on. Unfortunately, up to this point, gastric cancer research has been woefully underfunded on a national level. Most gastric cancer research has been funded by foundations and smaller interests. The NIH up until now has not put a lot of money into gastric cancer. Fortunately, we see this environment changing, and there’s an increasing interest at the NIH to fund gastric cancer research.

But that’s where identification of biomarkers comes from. There are companies out there that are looking at like circulating tumor DNA and other biomarkers. Again, I would say that there are very preliminary. And so I wouldn’t at this point recommend having these tests done because they’re so preliminary.

The one thing that I wouldn’t call a traditional biomarker, but is something that really increases your risk would be the presence of H. pylori infection. And so you can be tested for H. pylori infection by, there’s serum testing, there’s breath testing, you can get it on endoscopy, or the most common way is a stool antigen to test to see if you had H. pylori. The reason that that’s important is H. pylori is considered the number one cause of chronic gastric inflammation that then leads to gastric cancer.

And so the WHO has classified this as a class one carcinogen. And if you do have H. pylori, you should definitely get that treated. And depending on your age and how long you’ve had H. pylori infection, you should probably have endoscopy if you’re over the age of 40 to determine whether or not there’s any changes in the lining of your stomach that would increase your risk for developing gastric cancer. 

So, my activation tip for this would be go to your doctor, especially if you come from an area, or your parents come from an area that has high prevalence of H. pylori, which is pretty much anywhere in the world besides the United States, then you should talk to your doctor about getting H. pylori testing, especially if you have any abdominal pain symptoms or changes in appetite.


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Empowered by Biomarker Testing: Amber’s Journey with Stage IV NSCLC

Empowered by Biomarker Testing: Amber’s Journey with Stage IV NSCLC from Patient Empowerment Network on Vimeo.

Amber, a 56-year-old living with stage IV non-small cell lung cancer (NSCLC), shares her journey of empowerment through biomarker testing and targeted therapy. From recognizing symptoms and proactive healthcare to managing her condition with the latest treatments, Amber’s story emphasizes the importance of personalized care and staying informed. Her advocacy for biomarker testing and clinical trials aims to inspire others facing similar challenges to take an activated approach in their lung cancer care.

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[ACT]IVATED NSCLC Biomarkers Toolkit Checklist

How Can We Leverage Lung Cancer Biomarker Data to Address Health Disparities?How Can We Leverage Lung Cancer Biomarker Data to Address Health Disparities What Are the Noted Disparities in Lung Cancer Screening and Access

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


Transcript:

Embracing an activated approach to non-small cell lung cancer (NSCLC) care is indispensable for every patient. My name is Amber, I am 56 years old and living with non-small cell lung cancer. Recognizing the importance of proactive healthcare and being in good physical condition, I sought medical attention upon experiencing troubling symptoms. 

I was 54 when I started experiencing symptoms of coughing, wheezing, and decreased stamina. I worked as a nurse practitioner and knew lung cancer can happen to anyone with lungs. After getting a CT scan, they discovered a spot on my lung and swollen lymph nodes in my chest. A PET scan and brain scan came next to help determine my diagnosis.

I was shocked to learn I had stage IV lung cancer that spread. My oncologist knew about the latest in biomarker testing and immediately scheduled it, which determined I was EGFR-positive. Even though that sounded frightening, I learned there was targeted therapy that worked well for EGFR-positive patients.  

I’ve been on this EGFR blocker since my diagnosis. My tumor is no longer visible, and my lesions have decreased considerably. I’m monitored regularly and stay active hiking and spending time with my family. I’m so thankful biomarker testing enabled my care team to prescribe targeted therapy. It’s a huge advancement in lung cancer care. And if you’re a former smoker and are unsure when to start lung cancer screening, ask your doctor. Even if you smoked many years ago, you should continue to receive lung scans. 

I hope that sharing my story will help other patients understand the importance of biomarker testing. 

Here are my activation tips:

  1. Ask your care team questions to learn about biomarker testing, treatment options, and what to expect during and after treatment.
  2. Don’t allow stigmas to keep you from getting the best personalized lung cancer care.
  3. Ask if a clinical trial may be a potential treatment option for your type of lung cancer.

Remember, no matter who you are and what kind of health history you have, being proactive is everything. Stay activated by being informed, empowered, and engaged in your lung cancer care.


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How Has Lung Cancer Molecular Testing Evolved?

How Has Lung Cancer Molecular Testing Evolved? from Patient Empowerment Network on Vimeo.

What are the latest advances in lung cancer testing? Dr. Thomas Marron discusses the role of molecular testing when choosing therapy and how innovations in technology have revolutionized lung cancer care.

Dr. Thomas Marron is Director of the Early Phase Trials Unit at the Tisch Cancer Institute at Mount Sinai Hospital. Dr. Marron is also Professor of Medicine and Professor of Immunology and Immunotherapy at the Icahn School of Medicine at Mount Sinai. Learn more about Dr. Marron.

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Transcript:

Katherine Banwell:

What should patients understand about the results of molecular testing? 

Dr. Thomas Marron:

So, molecular testing is extremely important and anybody who has metastatic non-small cell lung cancer should get it. And increasingly, with the new drug approvals, even patients that have earlier stage disease, stage II and III disease should also get molecular testing. Molecular testing is important to identify if there is a potential therapeutic target.  

But it’s also important to know that it may predict a response to a therapy, whether that be a targeted therapy or something like immunotherapy. But there is no guarantee. So, there’s no specific result from a molecular test that tells you there’s 100 percent chance you’re going to be cured by Drug X.  

And so, it’s important to always know that we’re following the data and we’re giving patients the drugs that, based on the knowledge we have today is the best option for them, based on their molecular test. But it isn’t a guarantee. And sometimes these drugs will work transiently.  

And so, they may work for weeks, months, year but then they might stop working. And it’s also important to understand that the mutational profile may change over time, which is one of the reasons why we do these genetic tests. Oftentimes multiple times. Not just at the time of diagnosis, but also when patients’ cancer starts to grow so that we can see if there’s a new molecular target that we might be able to identify and treat with a novel therapy.  

Katherine Banwell:

Dr. Marron, are there innovations in technology that are aiding in the advancement of lung cancer research?  

Dr. Thomas Marron:

Yeah, so there’s lots of developments in the molecular tests that we’re doing. One of them is that we’re able to track circulating tumor DNA. So, as cancer is growing, it grows in this very unorganized aberrant way, because the on and off growth switches within the cancer, within the DNA are very dysregulated. And what happens is that often times, they’re releasing a lot of cancer cells as they’re growing or also dying and releasing their DNA into the blood.  

And so, through blood tests, we’re now able to identify the mutations in a patient’s cancer. And this is a real revolution in the initial diagnosis of metastatic lung cancer because in the past, we had to wait for three, four, five weeks in order to know whether a patient had a targetable mutation like an EGFR mutation. Or if we should use a more agnostic approach, immunotherapy or chemotherapy to treat the patient.  

But now when I see a patient, typically I see lung cancer patients on Fridays, I will take some of their blood, I send it off for the liquid biopsy analysis. And by that following Friday, so just one week later, I typically have an answer of if the patient has a mutation that I can target, let’s say with an oral medicine or if they’re a patient that I should be treating with immunotherapy. Additionally, circulating tumor DNA, increasingly we can use it to identify or track a patient’s progress, as far as response to therapy.  

And so, this has really been developed in other tumor types, but increasingly we’re using it in lung cancer where we can either track how much cancer they have in their body. So, very early on, we can see if the cancer is shrinking or growing. And additionally, we can use it to detect patients after surgery, whether or not they have residual disease in their body.

And so, a lot of the times patients will undergo surgery because let’s say on a CAT scan, you might only see one large, isolated tumor. But after we take that tumor out, now we can do a blood test to see if there might be microscopic bits of that cancer that were left over, that we weren’t able to see on a CAT scan or PET scan.  

And it’s that patient population that we think benefits most from either chemotherapy or targeted therapy after surgery. So, we’re using circulating tumor DNA, both in the metastatic setting, where cancer has already spread to other parts of the body. And also, in the perioperative setting, around the time of surgery or radiation where we’re trying to cure patients. And we’re now able to use this technology to hopefully increase the likelihood that we’re curing them. 

Prostate Cancer | Advances in Research and Technology

Prostate Cancer | Advances in Research and Technology from Patient Empowerment Network on Vimeo.

What are the latest prostate cancer research advancements? Expert Dr. Rana McKay discusses recent prostate cancer treatment approvals, ongoing research, and genetic testing developments.

Dr. Rana McKay is an associate clinical professor of medicine at Moores Cancer Center at UC San Diego Health. Learn more about Dr. McKay.

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Transcript:

Katherine:

Well, let’s dive into developing research and what it could mean for patients. Are there recent research highlights that you could share with the audience?  

Dr. McKay:

Absolutely. I think the newest approvals that have occurred in prostate cancer have been the approvals of combination PARP inhibitors, which block the ability of cancer cells to repair their DNA combined with hormonal agents such as abiraterone (Zytiga) or enzalutamide (Xtandi) for patients who have specific mutations in their tumor and their tumor is no longer responding to treatment. Those are the newest FDA approvals that were recently highlighted and shared.  

Katherine:

What areas of research do you specialize in? 

Dr. McKay:

The areas of research that I specialize in are particularly around novel therapeutics for patients with advanced prostate cancer, biomarker development precision medicine strategies for patients across the spectrum. And actually, also, in the localized setting, thinking about how we can attempt to cure more patients with prostate cancer by integrating our systemic therapy with surgical and radiation strategies to improve survival outcomes for patients and ultimately, cure it for patients by using effective systemic therapy early on so patients never recur.   

Katherine:

We’ve been hearing a lot recently about innovations in technology. How are these advances accelerating prostate cancer care?  

Dr. McKay:

Innovations of technology have absolutely been revolutionizing prostate cancer care I think from the diagnostic side, there’s new imaging modalities that are getting more refined. On the molecular side, there’s now different kinds of genetic tests. And our ability for us to do these tests, and do them quickly, and get results in real time that we can make decisions on we’ve come a long way from when we first sequenced the human genome. We’re now able to do that so quickly multiple times over in a very streamlined kind of way. And then, I have to say that there’s been tremendous improvement in our modalities of administrating therapies.  

So, our therapies are getting more novel, they’re getting more precise. What I mean, by that is targeted radioligand therapy, targeting linking a small molecule that binds PSMA, labeling it with a payload that is radiation therapy or kind of radio therapy/radio particle doing the same thing with chemotherapy, developing antibody drug conjugates. There’s androgen receptor degraders. There’s different ways of administrating immunotherapy by specific antibodies. So, there’s just the different sorts of treatments that are out there.  

We’ve just come such a long way from hormone therapy, which is still very important in chemotherapy to other different modes of action with the different systemic treatments we have.  

Katherine:

What about individual patients? Is there research into understanding a person’s – just one person’s disease?  

Dr. McKay:

Absolutely. I mean, that is in essence, precision medicine. I think we are now molecularly profiling tumors that is standard of care for anybody with advanced disease to undergo hereditary tumor profiling and – or hereditary profiling of just normal cells in the body, if there’s any sort of genetic abnormalities. But also, the tumor itself, and able to do that all for the actual biopsy specimen, or surgical specimen, and also blood. And then, based off of that individual’s genetic makeup, or the genetic makeup of the tumor, or the immune profile of the tumor actually trying to target therapy.  

There is a clinical trial that we are eagerly developing through the alliance, which we hope will open to enrollment before the end of the year, called the PREDICT Study. And this study is using that very notion of taking somebody’s DNA and RNA from their specific tumor, and based off of their results, strategizing the treatment around what kind of genetic makeup is in the tumor. And I think we’re moving towards that.  

Katherine:

What about common genetic mutations and what are you learning about people who have other genetic mutations like the BRCA mutation?  

Dr. McKay:

For patients who have BRCA mutations, first I’ll say, the prevalence of BRCA mutations varies across the stage of prostate cancer that somebody has. In the localized setting, the prevalence is a lot lower on the order of 2 to 4 percent depending on somebody’s risk profile. In the advanced setting, it is higher, 6 to 8 percent. Patients who have BRCA alterations are particularly susceptible to PARP inhibitors, which are oral drugs that can be given that when given in an individual who’s got a BRCA mutation, can cause cell death; can cause a tumor cell to die. And so, that’s a very good thing.  

I think the other thing, if thinking about the type of BRCA alterations, if there’s something that’s hereditary, this information is prognostic and predictive in that in can guide how people are going to – how we think they may do and what they may respond to. But it’s also really important because it can inform cascade testing for family members. It could also inform screening for secondary cancers in that individual who has prostate cancer with a known BRCA alteration. So, I think there’s a lot of personalization that happens based off of the molecular profiling results.  

Dr. Eugene Manley: Why Is It Important for You to Empower Patients?

Dr. Eugene Manley: Why Is It Important for You to Empower Patients? from Patient Empowerment Network on Vimeo.

Drawing from his experiences interacting with patients, survivors, and caregivers, Dr. Eugene Manley emphasizes the significance of providers meeting patients “where they are” emotionally, mentally, and logistically.

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Dr. Charlotte Gamble: Why Is It Important for You to Empower Patients? 

Transcript:

Dr. Eugene Manley:

So, you know, I talk to patients here and there and I’ve talked to survivors and I talk to caregivers of families, of people that have had family members that have, unfortunately, passed away from lung cancer. And the key thing they always say is they, you have to meet people one where they are and not where you want them to be.

So that means you have to really listen to what they need and say break down the jargon, be comfortable, ask, answering the questions because the patients don’t know any of this stuff when they go in. And pretty much when you are hit with a cancer diagnosis, there are 10 other thoughts going through your mind beyond just the cancer. 

Like, how am I going to pay for rent, food? Can I tell my family? Do I…will I lose my job? Will I lose my insurance? There are many, many other thoughts, and then it’s like, well, how much time do I have left? And then that’s where you even start thinking about, okay, what are my options? So you have to really walk with them.

I think a key part in this that we often don’t have are those nurse navigators are really, really key in this stage is they help really translate and walk the patient from dealing with the clinician into all the stuff that’s going to be going downstream. So just really, really critical to listen to the patients and try to have that ear and really think what’s in their best interest and not dismiss them.

How Can We Leverage Lung Cancer Biomarker Data to Address Health Disparities

How Can We Leverage Lung Cancer Biomarker Data to Address Health Disparities? from Patient Empowerment Network on Vimeo.

How can biomarker disparities be overcome by data collection? Experts Dr. Joshua Sabari from NYU Langone and Dr. Eugene Manley from SCHEQ Foundation discuss the status of biomarker data sharing, biobanks, and improvements that can be made toward the future.

Download Resource Guide  | Descargar guía de recursos

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Lung Cancer Biomarker Disparities | How Precision Medicine and Research Can Help

Transcript:

Lisa Hatifeld:

Are there any national or international databases that collect information from those biopsies, like a biopsy data bank of some kind so they can look at this disparate group of mutations? Or is it just institutional, like if an institution collects that tissue, they keep that information? I’m just wondering if that could help in any way with the disparities we see in those biomarkers.

Dr. Joshua Sabari:

Yeah, it’s a great question. AACR American Association for Cancer Research, a nonprofit, has started a biobank called the Genie Biobank, where you can input clinical as well as genomic information from patients. But to be honest, it’s very scattered. I mean, most of the databases that we have are individual institutions. There is very little sharing of data from institution to institution. There’s very little sharing of data from pharmaceuticals to institutions and vice versa.

I think everybody really needs to work in and pitch in together here that this is a common theme that comes up at a lot of our national meetings is how do we get everyone on the same page as opposed to everybody working in their different silos. It would be very helpful if all genomic data at every institution was available to everybody, but you can understand how that could be both confidential as well as proprietary. So, unfortunately in 2024, we don’t have broad biobanks or databases that are available publicly for consumption of investigators.

Dr. Eugene Manley:

And I think on top, beyond there not really being a massive biobank, there are still differences in what we can capture in race/ethnicity in the U.S. versus Canada and Europe. Sometimes they don’t even consider race as a category, which sometimes people think race is a social construct, but at the same token, there are distinct disparities we see in the U.S., because we capture this data, and it’s hard to then do this globally when we aren’t able to capture all it does.

But if you think about it, if you look across there are even genetic differences across each of those countries, we just don’t routinely think about it. So it’s really, we need to work on developing one, but it takes time, money and groups willing to work together, and we just, unfortunately, are not there yet.


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Lung Cancer Biomarker Disparities | How Precision Medicine and Research Can Help

Lung Cancer Biomarker Disparities | How Precision Medicine and Research Can Help from Patient Empowerment Network on Vimeo.

How can lung cancer research and precision medicine help with biomarker disparities? Experts Dr. Joshua Sabari from NYU Langone and Dr. Eugene Manley from SCHEQ Foundation discuss testing factors that need improvement, patient groups that show disparities, and how clinical trial participation can move research forward.

[ACT]IVATION TIP

“…we really have to more universally test everyone equally to really have an impact on outcomes.”

Download Resource Guide  | Descargar guía de recursos

See More from [ACT]IVATED NSCLC Biomarkers

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Transcript:

Lisa Hatifeld:

So, how can advancements in precision medicine be made more inclusive and equitable to ensure that biomarker-driven treatments benefit diverse populations equally? Second part is, what do you see as the most pressing research priorities in understanding and mitigating these biomarker disparities?

Dr. Joshua Sabari:

So I think first and foremost, testing is key. I mean, educating clinicians, healthcare providers, that every single patient, no matter what clinical characteristic that may be, age, sex, ethnicity, race needs to be tested broadly with the same mutational sort of profile or same biomarker profile. Having somebody in your office who never smoked, those patients generally will have broad panel and next generation sequencing. If you have an 85-year-old patient who is a former heavy smoker, the rate of mutational testing comes down.

So I think we need to remove that bias, that those clinical biases that we have, that we carry with us on a day-to-day basis. We need to test all patients with lung cancer regardless of any clinical characteristic. And what I tell my fellows, my residents, and what I talk to patients about is really all you need is lungs to develop lung cancer.

We need to remove that stigma and when we remove that stigma, we will be testing more broadly in our practices. There are also a lot of systemic biases, a lot of racism that exists, that prevents clinicians, I believe, from doing the best thing for their patients. And if you look at clinical trial enrollment in this country and that’s something that we do need to improve in order to develop better treatment options for our patients, particularly our patients of Latin American descent or Black Americans in the United States.

We need to enroll more patients of more diverse backgrounds onto our trials. Otherwise, we’re only limiting our treatments to specific or small percent of our patient population. So to be honest, I don’t know how well our EGFR inhibitors work in Black patients. I know it’s approved and we utilize it, but we don’t have nearly as much data prospectively treating novel therapies.

A lot of our trials have inclusion rates as low as 2 percent to 3 percent. And we know that our Black patient populations make up 13 percent to 15 percent of our practices. So I think more needs to be done to align our enrollment on trial, I think from institutional policies as well as governmental. So the FDA has really made a forceful statement here to pharmaceutical companies that if your data is not inclusive of a U.S. patient population, this will have ramifications for approvals in the future.

So a lot needs to be done in the sense of education both from the healthcare provider and…but also from the patient, and to really motivate patients to enroll in trials. And one positive that I’ve seen from the patient support groups, the advocacy groups, particularly EGFR Resisters Group, for example, we’ve seen a tremendous sort of push for patients to enroll on trials, again, to benefit themselves as an individual patient diagnosed with EGFR mutant lung cancer, but also to help those who come before or after them in their journey with lung cancer.

Lisa Hatfield:

And, Dr. Manley, do you have anything to add to that?

Dr. Eugene Manley:

I think he hit most of it, but I will say that you have to test everyone because there are people that have risk factors for lung cancer and those that don’t. And like, one of the leading risk factors is history of smoking, but there’s a significant population of specifically Asian females that don’t smoke. Even recently, that have been showing that Black women that don’t smoke also have increased rates of lung cancer. And these are, we don’t know why.

So we still need to be able to test all these patients across all the indications and maybe cross-reference with stress income, socioeconomic status and really try to determine maybe if there are certain specific drivers and what we didn’t talk about. We know that there are some epigenetic changes that may occur due to stress. We also know that there are some changes in tumor mutational burden, some stuff out of MSK. And I think there is some stuff that even shows differences in the immunomarker frequency and response in Black populations. So, we really have to more universally test everyone equally to really have an impact on outcomes.


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Hope Unleashed: Advancing Therapies for Defiant Mutations in Lung Cancer

Hope Unleashed: Advancing Therapies for Defiant Mutations in Lung Cancer from Patient Empowerment Network on Vimeo.

What promising studies in lung cancer mutations are there that patients should know about? Expert Dr. Joshua Sabari from NYU Langone discusses common lung cancer mutations, incidence rates, promising and potential studies, and proactive patient advice.

[ACT]IVATION TIP

“…no matter what your lung cancer type is, no matter any clinical characteristic, you need next generation sequencing done, biomarker testing done, to identify these mutations. And even when we identify the mutation, I think as a group, as an academic community, we need to do more to study novel therapeutics and to better understand the biology of these mutations so that we can get better treatments to our patients.”

Download Resource Guide  | Descargar guía de recursos

See More from [ACT]IVATED NSCLC Biomarkers

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Maximizing Biomarker Equity: Leveraging Partnerships to Close Biomarker Disparities in Lung Cancer

Maximizing Biomarker Equity: Leveraging Partnerships to Close Biomarker Disparities in Lung Cancer

Lung Cancer Biomarker Disparities | How Precision Medicine and Research Can Help

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How Can We Leverage Lung Cancer Biomarker Data to Address Health Disparities?

How Can We Leverage Lung Cancer Biomarker Data to Address Health Disparities

Transcript:

Lisa Hatfield:

Dr. Sabari, can you speak to some of the more defiant mutations in lung cancer, and what promising studies are we looking at right now?

Dr. Joshua Sabari:

Yeah, so I think in lung cancer the most common mutations that we see are EGFR and KRAS. EGFR mutations are a quite broad range of alterations. The most common are in exon 19 deletion and exon 21. These are the location of the mutations. They make up about 80 percent to 85 percent. We have phenomenal treatments in the frontline setting, but most patients only remain on therapy for about two years before there is progression. So, we need to better understand resistance mechanisms, and we need to better understand the next generation of therapies that are available.

In contrast to EGFR, KRAS is equally as common. We see this in about 25 percent to 30 percent of the patient population. Unlike EGFR, KRAS is almost exclusively seen in people who’ve smoked in the past. And there are many different KRAS mutations or alleles. There’s KRAS G12C where we have two FDA-approved match targeted therapies in the second-line setting.

But we need better options, better opportunities for our patients in the frontline setting. And for KRAS, we’re not doing as well as we should, right? KRAS mutations, most people have about a 30 percent to 40 percent chance of responding to therapy. And the median time on treatment is in that six to seven month range. So this is a defiant mutation. It’s a mutation where we need to do better and we need to really develop the next generation of inhibitors for our patients.

So I guess the activation tip here is, again, no matter what your lung cancer type is, no matter any clinical characteristic, you need next generation sequencing done, biomarker testing done, to identify these mutations. And even when we identify the mutation, I think as a group, as an academic community, we need to do more to study novel therapeutics and to better understand the biology of these mutations so that we can get better treatments to our patients.


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When Should Lung Cancer Patients Receive Biomarker Testing?

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

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

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.”

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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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Are There Lung Cancer Outcome Disparities for Veterans?

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.”

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Combating Disparities: Veterans’ Healthcare Access and Quality

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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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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? 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.

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“…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.”

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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:

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?

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

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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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Improving Biomarker Testing Access for Rural Lung Cancer Patients

Improving Biomarker Testing Access for Rural Lung Cancer Patients from Patient Empowerment Network on Vimeo.

What are the barriers for rural patients hoping to access biomarker tests? Dr. Samuel Cykert discusses the barriers for underrepresented lung cancer patients in rural areas face in accessing biomarker testing, citing issues like health insurance, economics, and language.

Download Resource Guide | Descargar guía de recursos

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

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

What Urgent Innovations Can Advance Lung Cancer Precision Medicine?

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Transcript:

Lisa Hatfield:

Dr. Cykert, one of the main barriers preventing Black and Latinx patients with lung cancer in rural areas from accessing biomarker testing, and what steps can be taken to address these barriers, including improving awareness, affordability, and availability of testing facilities?

Dr. Samuel Cykert:

Yeah, great, great question. There are several issues here. One is the issue of rural, and the other issue is patients of color who may have barriers of health insurance, barriers of economics, barriers of education, and especially in the case of Latinx folks, barriers of language. So it really is a multiple question, but one thing for sure is we know from past studies that technology diffusion is slow and tends to get out to rural areas later than other areas, and the other problem is treatment volume in rural areas.

So a lot of rural hospitals don’t do bio specimen testing, don’t have the capability of doing that, and so you have this kind of double whammy of low volume testing plus low volume treatment, it’s well-known that surgeons who do more operations, for instance, do better. So given all those factors, I would recommend that rural patients who have presumptive diagnosis of lung cancer, even a suspicion of lung cancer, for instance, a large mass, a greater than 2 centimeter mass on an x-ray or a CT scan, that those patients ask to be referred to the closest high volume center.

I think that’s an important step, and we also have to have close interactions with our rural colleagues so that they’re comfortable of treating aggressively things that are well-treatable in the rural environment and going on to the high-volume centers, the more specialized centers, when things have to be done more aggressively.

When you look at a lot of different healthcare disparities, especially in advanced diseases, a lot of them come from being in areas where technology diffusion hasn’t happened and people don’t have access to the same treatments that they do at higher volume centers.  My activation tip here is, for things like biomarker testing and advanced treatments, you need to go to the closest high volume center.


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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 from Patient Empowerment Network on Vimeo.

What are challenges and solutions to quality care for Black and Latinx non-small cell lung cancer (NSCLC) patients? Expert Dr. Samuel Cykert from UNC School of Medicine discusses challenges, solutions, and proactive patient advice toward quality care.

[ACT]IVATION TIP

“…for things like biomarker testing and advanced treatments, you need to go to the closest high volume center.”

Download Resource Guide | Descargar guía de recursos

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

Related Resources:

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?

What Urgent Innovations Can Advance Lung Cancer Precision Medicine?

What Urgent Innovations Can Advance Lung Cancer Precision Medicine?

Transcript:

Lisa Hatfield:

Dr. Cykert, what specific challenges do Black and Latinx patients with lung cancer often encounter in advocating for themselves within the healthcare system, and how can they navigate these challenges effectively to ensure they receive equitable and quality care?

Dr. Samuel Cykert:

Yes, and in our past research we discovered that there are certain implicit biases and communication biases that affect patients of color, and because of that, I think it’s really important to approach the clinical encounter with cancer care decision-makers with enthusiasm, that meaning making a direct statement that I’m very enthusiastic about getting care for my lung cancer, I’m very enthusiastic about biomarker testing, tailored therapy, surgery and research protocols. So please consider me for all those results, and I know what I said was just a mouthful.

And even if you can remember to just start with, I’m very enthusiastic about getting treatment, and biomarker testing would be good and I’m positive about it, how do you feel about it? Engage the clinician in the conversation so they really know that you’re part of the team and they’re part of the team, and you’re ready to move toward excellent treatment and you’re willing to consider even research stuff.


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