This year marks the 50^th Anniversary of the National Cancer Act, which was signed into law by President Nixon in 1971 and represents the US commitment to holistically addressing cancer and its many challenges. The Act was truly a milestone that launched a National Cancer Program, establishing the National Cancer Institute (NCI) and other federal and nonfederal programs, such as 15 new cancer research centers, local control programs and an international cancer research data bank.

Since then, enormous progress has been made. As a result of the Nation’s investments in oncology, more people are surviving cancer than ever before. Two-thirds of those living with cancer survive at least five years after diagnosis, up from roughly one out of two in the 1970s. The national cancer death rate has also dropped 31 percent since the early 1990s. But despite this progress, more must be done. Indeed, cancer remains the second leading cause of death in the US, exceeded only by heart disease.

50 years of advancements in oncology

Reflecting on the past 50 years, we now understand that cancer is not one disease, but many highly complex diseases — each requiring unique treatment targeted to the specific biology and genetics of a tumor, and a patient. That knowledge has led to groundbreaking innovations in science and medicine to provide personalized treatment approaches that treat cancer more precisely.

This great progress is just the beginning and has helped redefine care for people with cancer. But despite how far we’ve come over the last 50 years, disparities in care – a reflection of the complex interplay of socioeconomic, racial, and geographic factors – were brought to light amid the Covid-19 pandemic.

Impact of Covid-19 on cancer care

Covid-19 has exposed various cancer disparities that have persisted for decades.

“From the earliest days of the pandemic, the public health community should have devoted greater attention to the pandemic’s disproportionate impact on underserved patients who have diminished access to routine preventive screening and specialized oncology care. As a result, there was a general lack of support for people most in need,” said Leigh Boehmer, PharmD, BCOP, Chief Medical Officer, Association of Community Cancer Centers (ACCC), an organization of more than 28,000 multidisciplinary practitioners that promotes quality cancer care in communities across our country.

The pandemic has also meant more people with cancer are getting diagnosed later in the course of their disease, when cancer can be more aggressive and less likely to respond to therapy.

“Lives are at stake and the public health imperative is real,” echoed Dave Fredrickson, Executive Vice President, Oncology Business Unit, AstraZeneca. “Cancer diagnoses have fallen by ~30-40% below pre-pandemic levels. Unfortunately, the healthcare system is diagnosing people with cancer in later stages of their disease, which is often associated with poorer outcomes.”

Many people who had already been diagnosed with cancer also delayed treatment because they were concerned about contracting Covid-19 at a healthcare facility. Those who tried to stay on treatment often faced appointment delays. And of course, diminished access to cancer screens and disruptions to overall care were more acutely felt by underserved communities.

“More emphatic and personalized communication is one way to reach underserved communities, some of whom understandably hold tenuous views toward healthcare systems caused by historical experiences like racial and ethnic marginalization and barriers imposed upon care. This, alongside widespread closures of health and wellness centers at the outset of the pandemic, have made it more difficult for people in remote areas to access care, which has contributed to delayed screenings that will likely create an influx of later-stage cancer diagnoses and mortality in the years ahead,” Boehmer said.

Beyond the patient experience, Covid-19 has also caused substantial disruptions to research and development programs designed to deliver next-generation biomarker tests and personalized medicines. A “biomarker” is like the “thumbprint” of a tumor, and this thumbprint may convey certain aspects of the tumor that can help guide treatment. As such, biomarker testing and personalized medicine together underpin each individual’s ability to access the right therapy for their cancer type at the right time, which is why disruptions to research are so precarious for people with cancer.

One thing that hasn’t changed – clinical trials remain central to research and development. Although much progress has been made in the sheer number of trials with a precision medicine focus versus 50 years ago, more needs to be done. Barriers still exist because of restrictive inclusion criteria, as well as patient-level barriers like health literacy, cost, and geographical limitations. These barriers are even more pronounced among the medically underserved, including certain racial and ethnic groups, people from rural areas, and those with lower incomes or those without health insurance.

“There’s no question that we’ll continue to see the residual effects of delayed diagnosis and treatment and disruptions in clinical research for years to come. This is evidenced by higher rates of later-stage cancer diagnoses, which underscores the need for early intervention and more equitable access to vital services,” Boehmer said. “Strengthening interdisciplinary partnerships among public health and oncology organizations that help reach underserved communities is critical for equitably expanding access to preventive screens and clinical trials that may lead to new targeted cancer therapies.”

Community initiatives are key to addressing disparities

Since the start of the pandemic, the oncology community has come together to address disparities in cancer care by assessing clinical trial procedures and protocol requirements, adopting telehealth, and expanding research at clinical sites that are closer to peoples’ homes. Throughout it all, community-driven initiatives and collaboration have been a vital piece of the puzzle.

For example, ACCC has developed Improving Care Coordination: A Model for Lung Cancer, an interactive, online assessment that provides a framework for improving care for underserved patients diagnosed with lung cancer and can be deployed in any kind of cancer setting.

Additionally, the ACCC Community Oncology Research Institute (ACORI) was recently launched to help close research disparities through optimal community partnerships. “We believe that communities belong in cancer research and cancer research really belongs in the community,” Boehmer said.

Through ACORI, which is supported by multiple industry sponsors including AstraZeneca, ACCC has established several initiatives, including a collaboration with the American Society of Clinical Oncology (ASCO) to increase the participation rates of racial and ethnic minorities in clinical trials in two ways: a clinical trial site self-assessment tool and an implicit bias training program.

“We think this program will be key to raising awareness, skill-building, and realizing changes in knowledge and behaviors so multidisciplinary care team members can become more aware of their own personal biases, acknowledge the role of social determinants of health, and begin to approach their delivery of care through a lens of equity,” Boehmer said.

The ACCC also established the Oncology Practice Transformation and Integration Center (OPTIC), a network of community oncology clinicians engaged in the creation of online learning modules and boot camps to better facilitate the adoption and adaptation of innovations for community oncology, created with support from AstraZeneca.

“We are determined to support and spotlight organizations working on the frontlines of cancer care like ACCC to ensure the pandemic does not further delay progress, starting with early diagnosis, timely biomarker testing, and continued research and development, all of which are crucial to ensuring all people – regardless of socioeconomic and demographic factors – can receive the right treatments at the right time,” Fredrickson emphasized.

Recognizing the impact that Covid-19 has had on cancer care, AstraZeneca, along with advocacy groups and stakeholders in the oncology community like ACCC, have collaborated on the New Normal, Same Cancer campaign to raise awareness of the importance of getting routine checkups and seeing their doctor to help ensure that disease can be caught as early as possible. “It’s in coming together that we can make the most change and truly drive progress, especially as the pandemic continues to affect quality of life for so many. Now is the time to continue to drive progress towards early detection, screening and diagnosis that has been threatened because of the pandemic,” Fredrickson said.

Inspiring action by celebrating community difference makers

Although addressing health disparities in oncology will take many years, experts say it can be achieved through collaboration from a diverse set of stakeholders and by harnessing the power of grassroots innovators to integrate different perspectives into the cancer care delivery model.

“The only way trust can be built is through meaningful community engagement, and only then can we expect to bring about any change that will benefit underserved and vulnerable patients, and also help facilitate equitable care and outcomes for all,” Boehmer said.

Recognition of some of the important work underway took place this November, at ACCC’s 38^th Virtual National Oncology Conference, when two health systems were honored with Innovator Awards for their work to generate meaningful change among underserved populations.

One award winner was the Cone Health Cancer Center in Greensboro, NC, which implemented a screening tool to initiate transportation discussions with their patients before non-compliance with their treatment became an obstacle. The second winner was the Wayne University School of Medicine/Karmanos Cancer Institute which developed the DISCO (DIScussions of Cost) app to educate about potential treatment-related costs and generate tailored questions to prompt cost-related conversations with providers.

In October of this year, AstraZeneca, as part of the YOUR Cancer Program, hosted its third annual Cancer Community Awards (C2 Awards) to recognize and celebrate the unsung heroes of cancer care who drive change every day. This year, a fifth award category, the Catalyst for Equity Award, was introduced to recognize those addressing health disparities specifically among medically underserved racial and ethnic communities to ensure all people have equitable access to the latest in quality care.

“AstraZeneca’s mission in oncology is to eliminate cancer as a cause of death. But for us to achieve that ambition, it has to be for everyone who can benefit from our therapies, not just those who have access to the best treatment centers,” Fredrickson said. “Doing so requires the collective effort of all organizations working together – community leaders, academics, healthcare professionals, advocacy organizations, policy makers – to transform the lives of those affected by cancer.”