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Expert Advice | Shining a Light on Equitable AML Care

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Expert Advice | Shining a Light on Equitable AML Care from Patient Empowerment Network on Vimeo.

While treatment options are improving, there are still many factors impacting equitable care for AML patients. Dr. Ann-Kathrin Eisfeld shares advice for improving research and clinical trials for underserved AML populations.

Dr. Ann-Kathrin Eisfeld is Director of the Clara D. Bloomfield Center for Leukemia Outcomes Research at The Ohio State University and a member of the Leukemia Research Program at the OSUCCC – James. Learn more about Dr. Eisfeld.

See More From INSIST! AML

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Advances in AML Research: Where Do Clinical Trials Fit In?

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What is the Purpose of AML Genetic Testing?

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How Does the Presence of Molecular Testing Affect AML Care?

Transcript:

Katherine Banwell:

Dr. Eisfeld, we’ve covered a lot of information related to AML care. As a researcher, what other topics are currently top of mind for you in the field of AML? What are you passionate about? 

Dr. Eisfeld:

Again, so many parts. I think there are probably three main things that I’d like to name. And I think about it as a little bit outside the box. Most of what we know about AML, we have become so much better. It’s because we have been studying patients who were treated over the past decades on clinical trials and very often here in the U.S. or in Europe.  

But all clinical trials have a bias in that most of them have been done A) on patients who are younger than the age of 60. And B) fewer patients of other races and ethnicities included. And had patients not included that have AML, for example, not only in the bone marrow but on extramedullary sites – how we call it – up to 10 percent of their patients. And also, very often have not been done on very old patients where the AML is very common. So, all the patients – patients from other race, ethnicities, or underrepresented minorities, and patients who present with extramedullary disease are currently in my – underserved.  

And these are exciting areas and opportunities of research and of active clinical practice. Because those are the patients we need to include if it’s possible now to include them in clinical trials. 

If there are no trials available, then make sure any other additional molecular testing it done to understand them better and to advance our disease knowledge that we make sure that we can give the best possible care.  

I think that the most important part is to get the molecular testing, and to enroll into clinical trials, and then to very often biobanking 

Why am I saying that is because our knowledge AML comes from patients who donated some tissue so that we could learn – researchers decades ago could learn about the genes. We know that leukemias differ so much in between patients.  

So, I am worried that we are yet missing out on potentially important genes that need to be discovered and where we could develop docs for. This will only be possible with these additional testing. 

 The second part is to really consider going to larger treatment and larger treatment cancer center. And there are support systems in case that can help in here.  

And the third part is to get involved even as early as possible even if you’re not personally affected, with Be The Match – with bone marrow transplant because there’s a paucity of donors, of people of color that makes it harder for these patients to get a potentially curative treatment in here.  

We have other options now in bone marrow transplant where one can use only half-matching donors and or other availabilities. But again, that doesn’t outweigh that the bone marrow and donor registry that we need to get better at.  

And I can – there are just so many factors – such a high degree of structural racism that affects people from every corner. And I think we as physicians, as society, and everybody need to acknowledge that. And we have to make sure that we get better to, again, give every patient the best care and keep the patient in mind and see what’s right for them at the right moment.    

Katherine Banwell:

Where can patients or people who are interested find out about being a donor? 

Dr. Eisfeld:

There is the website called “Be the Match” that one can put in. This is probably the best way to get first information.  

And usually, at all the cancer sites. And sometimes, there is information at lab donation places, universities, either or the American Red Cross. Usually those places have information laid out there as well. 

Noted Racial, Ethnic, and Socioeconomic Disparities In Breast Cancer Outcomes

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Noted Racial, Ethnic, and Socioeconomic Disparities In Breast Cancer Outcomes from Patient Empowerment Network on Vimeo.

What are breast cancer disparities? Expert Dr. Demetria Smith-Graziani explains notable disparities seen in breast cancer risks, treatments, and outcomes – and questions for patients to ask their doctor to help ensure their best care. 

Demetria Smith-Graziani, MD, MPH is an Assistant Professor in the Department of Hematology and Medical Oncology at Emory University School of Medicine. Learn more about Dr. Smith-Graziani.

[ACT]IVATION TIP

“…have an open and honest discussion with your physicians about the, your particular breast cancer risk and about the specific treatment recommendations that you receive, why you’re receiving those recommendations, and how people who get those treatments usually do.”

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See More from [ACT]IVATED Breast Cancer

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What Treatments Are Available for HER2-Positive Metastatic Breast Cancer?


Transcript:

Lisa Hatfield:

Dr. Smith, what are the noted racial, ethnic, and socioeconomic disparities seen in breast cancer risk, treatment, and outcomes?

Dr. Demetria Smith-Graziani:

So a lot of work has been done over the years to really understand more about disparities in breast cancer. When it comes to breast cancer risk, we know that while white women are more likely in United States to be diagnosed with breast cancer, Black women are more likely to die from breast cancer. Black women also have a higher risk of triple-negative breast cancer, which is known to be a more aggressive form of breast cancer, and Black women are diagnosed on average at a younger age compared to white women.

When it comes to disparities in treatment and outcomes, we can see that a lot of what affects the type of treatment that you receive and how you end up doing after that treatment are related to not only your race or ethnicity, but also your income, your insurance status, what zip code you live in, and other social factors and structural factors in our country, it’s really important that both patients and providers are aware of the disparities and the causes, because it’s up to all of us, but especially those in the healthcare system, to think about the ways that we can address them.

So, my activation tip for patients is to be aware of the fact that these disparities exist and to have an open and honest discussion with your physicians about the, your particular breast cancer risk and about the specific treatment recommendations that you receive, why you’re receiving those recommendations, and how people who get those treatments usually do. 


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Eliminating Disparities in Breast Cancer | Tips for Navigating Inequities

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Eliminating Disparities in Breast Cancer: Tips for Navigating Inequities from Patient Empowerment Network on Vimeo

How can breast cancer patients and healthcare providers advocate for underrepresented  patients? Expert Dr. Demetria Smith-Graziani discusses how some providers are working to reduce care disparities and shares patient advice to help ensure optimal care.

Demetria Smith-Graziani, MD, MPH is an Assistant Professor in the Department of Hematology and Medical Oncology at Emory University School of Medicine. Learn more about Dr. Smith-Graziani.

[ACT]IVATION TIP

“…get your list of questions together about your concerns about your diagnosis and your treatment, and if you are feeling like you’re not heard, look for other doctors to talk to to get a second opinion.”

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See More from [ACT]IVATED Breast Cancer

Related Resources:

Practical Questions About Breast Cancer Treatment Patients Should Ask
 
What is Node-Positive and Node-Negative Breast Cancer?
 
How Advancements in Breast Cancer Are Driven By Clinical Trials
 

Transcript:

Lisa Hatfield:

What are some of the actions being taken to combat or eliminate disparities in breast cancer? How can those in marginalized communities best advocate for themselves?

Dr. Demetria Smith-Graziani:

That’s a great question, and I want to start by saying that the true burden should be on healthcare providers of those within the healthcare system to reduce and eliminate disparities in breast cancer, because patients already have enough to deal with and are receiving discrimination and structural racism from society at large and within the healthcare system. So for providers, it’s important for us to really take a good hard look at our practices with patients, think about the way that we are relating to patients, are we making any assumptions about treatments our patients may or may not want, or may or may not be a candidate for. Are we making those assumptions based on something not related to factual data, like their breast cancer itself or other health problems they have, are we making those assumptions based on their insurance status, based on where they live, based on other social factors like race.

It’s important for us to really reflect on that and think about how we can be more equitable in the way that we deliver our care. It’s also important for us to advocate for our patients to make sure that they are receiving the treatment that they need, and sometimes that means advocating to their insurance company, advocating to our health system, our health care employers advocating to the government to make sure that our patients are all receiving high-quality care no matter where they are, and no matter who they are, now, knowing that we live in this unjust society, what can patients do to navigate these disparities and these inequities.

I think it’s important for patients to be as informed as possible to make sure that they are getting all of their questions answered by their doctor, and if you don’t feel like your questions are getting answered, if you don’t feel like your concerns are being appropriately addressed or acknowledged, please make sure that you get a second or a third opinion and talk to another doctor to see if they can answer your questions.

No oncologist is going to be upset with you getting more information from another oncologist about your treatment options, and it’s important for you to pick the doctor that you are comfortable with, that you have a good relationship with and that you feel like you can speak to honestly, and that will give you honest answers, so my activation tip for patients is to get your list of questions together about your concerns about your diagnosis and your treatment, and if you are feeling like you’re not heard, look for other doctors to talk to to get a second opinion. 


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