ASCO eLearning Podcasts

Cancer Topics - New Therapies for Lymphoma (Part 1)

In the second edition of this two-part Oncology, Etc. episode, hosts Dr. Patrick Loehrer (Indiana University) and Dr. David Johnson (University of Texas) continue their conversation with Dr. Otis Brawley, a distinguished professor of Oncology at Johns Hopkins and former Executive Vice President of the American Cancer Society. Subscribe: Apple Podcasts, Google Podcasts | Additional resources: elearning.asco.org | Contact Us Air Date: 10/5/2021   TRANSCRIPT [MUSIC PLAYING] SPEAKER: The purpose of this podcast is to educate and inform. This is not a substitute for medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. [MUSIC PLAYING] DAVID JOHNSON: Welcome back to Oncology, Etc, and our second segment of our conversation with Otis Brawley, professor of Medicine at Johns Hopkins Medical School and the Bloomberg School of Public Health. Pat, I don't know about you, but Otis is a very impressive man, and he had a lot of really interesting things to say about his career development, family, et cetera in the first segment. This second segment, we're going to get to hear more about his time at the ACS. What were your thoughts about segment one? PATRICK LOEHRER: Well, I loved talking to Otis, and you too, Dave. Parenthetically, Otis once told me in a dinner conversation we had that he felt like Forrest Gump, and I can identify with that. Where over the field, our field of oncology over the last several decades, we've met some incredibly wonderful people, and we've been lucky to be part of the history. The three of us, I think, do have a deep sense of the historical context of oncology. This is a young field, and there's just some extraordinary people, many of them real true heroes, and Otis has his figure on the pulse of that. DAVID JOHNSON: Yeah, that's why he's been in some of the right places at the right time, and we'll hear more about that in this segment coming up now. PATRICK LOEHRER: Now Otis has had a career in many different areas, including ODAC, the NCI, the ACS, now at Hopkins. So let's hear a little bit more about Dr. Brawley's experience at the American Cancer Society and particularly with his experience with the former CEO, John Seffrin. DAVID JOHNSON: Sounds great. [MUSIC PLAYING] OTIS BRAWLEY: John and I had a wonderful run at the American Cancer Society. Got to do a lot of things. Got to testify for the Affordable Care Act. Got to do some of the science to actually argue that the Affordable Care Act would help. And I was fortunate enough to be there long enough to do some of the science to show that the Affordable Care Act is helping. DAVID JOHNSON: Yeah, I mean actually all of the things you accomplished at the ACS are truly amazing. Let me ask you, just on a personal level, what did you like most about that job, and then what did you like least about that job? [LAUGHTER] OTIS BRAWLEY: I like the fact-- there were a lot of things I liked about that job. There were a couple hundred scientists and scientific support people that you got to work with. And I used to always say, I do politics so you can do science. And what I used to like the most, every Wednesday afternoon that I was in town, I would walk around just to watch those people think. I used to joke around and say, I'm just walking around to see who came to work today. But I really enjoyed watching them work and watching them think, and that was fun. Another fun aspect of the job was people used to call and ask a little bit about the disease that they are a family member would have. And sitting down with them on the phone in those days-- we didn't have Zoom-- and talking to them through their disease. Not necessarily giving them advice on what to do in terms of treatment, but helping them understand the biology of the disease or connecting them with someone who was good in their disease. And I happen to, by the way, have sent some patients to both of you guys. That was a lot of fun. Then the other thing, of course, was the fact that you could actually influence policy and fix things. I'll never forget sitting across from Terry Branstad, then the governor of Iowa, and convincing him that the right thing to do is to raise the excise tax on tobacco in Iowa. Being able to see that you're effective and to see that you're positively influencing things. The bad side, some of the politics. I didn't necessarily like how some of the money was being raised or where they were raising money from. I think that you have to have a certain standard in terms of where you accept money. And we always had that tension with the fundraisers. But it's also true-- and I will give them a nod-- you can't do the fun things unless you raise money. So I really truly enjoyed my time at the American Cancer Society. And by the way, a shout out to Karen Knudsen, who is the CEO running the American Cancer Society now. And I'm fully committed to helping the ACS and helping Karen be successful. DAVID JOHNSON: One of the things I read-- I think I read this that you had said that one of your proudest accomplishments was revising the ACS screening guidelines. Tell us just a little bit about that. OTIS BRAWLEY: Yeah, going all the way back to the early 1990s, I started realizing that a lot of these guidelines for screening, or back then, this is before the NCCN guidelines for treatment even, that were published by various organizations, including the American Cancer Society. We're almost the equivalent of-- get the impression that in the 1960s, it would have been a smoke-filled room. But you gather a bunch of people into a room, and they come up with, this is what we should be doing. Indeed, the American Cancer Society in 1991 endorsed annual PSA screening for prostate cancer based purely on getting a group of primarily urologists into a room, and that's what they came up with. There was very little review of the science. There really was no science at that time except the science to show that PSA screening found cancer. There were no studies to show that led to men benefiting in that they didn't die. Indeed, in 1991, there was no study to show that treatment of early prostate cancer saved lives. The study to show treatment of prostate cancer saves lives was first published in 2003, and the radiation saves lives in 1997, 1998. Surgery saves lives in 2003 and screening has a small effect published in 2009. But they started recommending it in 1991 in this almost smoke-filled room kind of atmosphere. When I got to the American Cancer Society, I started an effort, and we involved people from the National Academy of Medicine, we involved people from the NCCN, from the American Urological Association, the American Academy of Family Physicians, the American College of Physicians. And we got together in that almost smoke-filled room again, but the idea was, how do you make responsible guidelines? And we wrote that up into a paper guide widely accepted by all of the organizations, and it involves a review of the literature that is commissioned by someone. And they spend a long time reviewing the literature and writing a literature review. And then you have a group of experts from various fields to include epidemiology and screening, social work, someone who's had the disease. Not just the surgeons and medical oncologists who treat the disease but some population scientists as well. They sit down and they reveal all of the scientific data, and then they start coming up with, we recommend this. And then they rank how strong that recommendation is based on the data. We published this in 2013 in The Journal of the American Medical Association. I do think that was important, you're right. That's Otis trying to bring his policy and his belief in orthodox approach to science and bring it all together. PATRICK LOEHRER: So let me reflect a little bit more on something. There is a book that I also just recently read by Dax-Devlon Ross, and it's a book entitled, Letters to my White Male Friends, and it was a fascinating read to me. You have this public persona and professional persona of being an outstanding physician, clinician, public speaker. But what we the three of us have never really had the conversation today is we have much more interest now in DEI. One of our other speakers talked about the fact that there's a tax that is placed upon underrepresented minorities and academics. They are all expected to be on committees. They have to be doing different things. And so the things that they love to do, they can't do it because they have to represent their race or their gender or their ethnicity. OTIS BRAWLEY: I have been blessed and fortunate. There are problems, and there are huge burdens that Black doctors, and women doctors by the way, have to carry. I have been fortunate that I have skated through without a lot of that burden. Maybe it has to do with oncology, but I will tell you that I have been helped by so many doctors, men and women, predominantly white, but some Asian, Muslim, Jewish, Christian. I don't know if it's oncology is selective of people who want to give folks a fair shake and really believe in mentoring and finding a protege and promoting their career. I have been incredibly, incredibly fortunate. Now that I say that, there are doctors, minority doctors and women, who don't have the benefits and don't have the fortunes that I have had, and we all have to be careful for that. As I said early on, John Altman told me that I will thank him by getting more Blacks and women into the old boys club. And so that was his realizing that there is a-- or there was a problem. I think there still is a problem in terms of diversity. Now I have seen personally some of the problem more outside of oncology in some of the other specialties. More in internal medicine and surgery, for example. By the way, there are also some benefit. I did well in medical school in third and fourth year in medical school at the University of Chicago because there were a group of Black nurses who were held that I wasn't going to fail. The nurses took me under their wing and taught me how to draw blood, how to pass a swan. The first code I ever called, there was a nurse standing behind me with the check off list. And so there are some advantages to being Black as well. But there are some disadvantages. I've been very fortunate. My advice to Black physicians is to keep an open mind and seek out the folks in medicine who truly do want to help you and truly do want to mentor you. And for the folks who are not minority or not women in medicine, I say, try to keep an open mind and try to help everybody equally. PATRICK LOEHRER: Thank you. DAVID JOHNSON: I want to go back to your book for a moment. And again, for those who've not read it, I would encourage them to do. So it's a really honest book, I think, well-written. You made a comment in there-- I want to make sure I quote it near correctly. You said that improvement in our health care system must be a bottom up process. What do you mean by "bottom up?" OTIS BRAWLEY: Well, much of it is driven by demand from patients and other folks. The name of the book was, How We Do Harm. And the synopsis is there are bunch of people who are harmed because they don't get the care that they need. And there's a bunch of people who are harmed because they get too much medicine and too much care. And they rob those resources away from the folks who don't get care at the same time that they're harmed by being overtreated, getting treatments that they don't need. The other thing, if I can add, in American health care, we don't stress risk reduction enough. I used to call it "prevention." Some of the survivors convince me to stress "activities to reduce risk of disease." We don't do a lot in this country in terms of diet and exercise. We try to do some work somewhat successfully on tobacco avoidance. We need to teach people how to be healthy. And if I were czar of medicine in the United States, I would try to make sure that everybody had a health coach. Many of us go to the gym and we have a trainer. We need trainers to teach us how to be healthy and how to do the right things to stay healthy. That's part of the bottom up. And in terms of costs you know my last paper that I published from the American Cancer Society, I published purposefully, this is my last paper. Ahmedin Jemal who's a wonderful epidemiologist who I happen to have worked with when I was at the National Cancer Institute and again later in my career at the American Cancer Society, I pushed Ahmedin-- he publishes these papers, and we estimate x number of people are going to be diagnosed with breast cancer and y number are going to die. He and I had talked for a long time about how college education reduces risk of cancer death dramatically. If you give a college education to a Black man, his risk of death from cancer goes down to less than the average risk for a white American. There's something about giving people college education that prevents cancer death. I simply challenged Ahmedin, calculate for me how many people in the United States would die if everybody had the risk of death of college-educated Americans. And he came back with of the 600,000 people who die in any given year, 132,000 would not die if they had all the things from prevention through screening, diagnosis, and treatment that college-educated people. Just think about that-- 132,000. Then I started trying to figure out what drug prevents 132,000 deaths per year? And I couldn't think of one until recently, and it happens to be the coronavirus vaccine. Which ironically has shown itself to be the greatest drug ever created in all of medicine. But in cancer, there's no breakthrough drug that is more effective than just simply getting every human being the care from risk reduction and prevention all the way through treatment that every human being ought to be getting. The solution to some of that starts with fixing third grade and teaching kids about exercise, about proper diet. PATRICK LOEHRER: We're going to have to wind things up here. But real quickly, a book you would recommend? OTIS BRAWLEY: Skip Trump, who's someone that we all know, wonderful guy used to run Roswell Park Cancer Center, just published a book actually it's coming out in September called, Centers of the Cancer Universe, A Half Century of Progress Against Cancer. I got a preprint of that, and it is a great book. It talks about what we've learned in oncology over the last 50 years since Richard Nixon signed the National Cancer Act. Keep in mind, he declared war on cancer on December 23, 1971. So we have an anniversary coming up in December. PATRICK LOEHRER: I want to close. Another book, I read the autobiography of Frederick Douglass. It's a wonderful read. It really is good. There were some endorsements at the end of this book, and one of them was written by a Benjamin Brawley, who wrote this review in a book called, The Negro in Literature and Art in 1921. And Benjamin Brawley was writing this about Frederick Douglass, but I would like to have you just reflect a moment. I think he was writing it about you, and I'm just going to read this. He basically said, at the time of his death in 1895, Douglass had won for himself a place of unique distinction. Large of heart and of mind, he was interested in every forward movement for his people, but his charity embraced all men in all races. His mutation was international, and today, many of his speeches are found to be the standard works of oratory. I think if your great, great grandfather were here today, he would be so incredibly proud of his protege, Otis. And it's such a privilege and pleasure to have you join us today on Oncology, Etc. Thank you so much. OTIS BRAWLEY: Thank you. And thank both of you for all the help you've given me over the years DAVID JOHNSON: Great pleasure having you today, Otis. I want to also thank all of our listeners for tuning in to Oncology, Etc. This is an ASCO educational podcast. We really are here to talk about anything and everything. So we're looking for ideas. Please, if you have any suggestions, feel free to email us at education@ASCO.org. Thanks again, and remember, Pat has a face for podcasts. [MUSIC PLAYING] SPEAKER: Thank you for listening to this week's episode of the ASCO e-learning weekly podcasts. To make us part of your weekly routine, click Subscribe. Let us know what you think by leaving a review. For more information, visit the comprehensive e-learning center at elearning.asco.org.

Oncology, Etc. - In Conversation with Dr. Otis Brawley (Part 2)

In this Social Determinants of Health (SDOH) episode, Dr. Jacquelyne Gaddy (UNC-Chapel Hill) speaks with Dr. Marvella Ford (Medical University of South) and Dr. Jennifer Ligibel (Dana-Farber Cancer Institute) on obesity and energy balance as modifiable risk factors and how clinicians can respectfully engage with their patients on this topic. View COI. Subscribe: Apple Podcasts, Google Podcasts | Additional resources: education.asco.org | Contact Us Air date: 9/29/2021

Social Determinants of Health - Modifiable Risk Factors - Obesity and Energy Balance

Dr. Rodrigo Munhoz (Sírio Libanês Hospital, Brazil) moderates a discussion highlighting the impact that COVID-19 has had on clinical research. Featuring Drs. Nathan Pennell (Cleveland Clinic), Kathryn Mileham (Atrium Health), and patient advocate Dr. Jane Perlmutter. Subscribe: Apple Podcasts, Google Podcasts | Additional resources: education.asco.org | Contact Us Air Date: 9/22/2021

Cancer Topics - Impact of COVID-19 on Clinical Research

In this two-part episode of Oncology, Etc., hosts Dr. Patrick Loehrer (Indiana University) and Dr. David Johnson (University of Texas) speak with Dr. Otis Brawley, a Bloomberg Distinguished Professor of Oncology at Johns Hopkins and former Executive Vice President of the American Cancer Society, about his incredible life and career. Subscribe: Apple Podcasts, Google Podcasts | Additional resources: education.asco.org | Contact Us Air Date: 9/7/2021   TRANSCRIPT SPEAKER: The purpose of this podcast is to educate and inform. This is not a substitute for medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. No mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. PAT LOEHER: Hi. I'm Pat Loeher. I'm director of the Centers of Global Oncology and Health Equity at Indiana University Melbourne and Bren Simon Cancer Center. DAVID JOHNSON: And good morning. I'm Dave Johnson. I'm professor of Internal Medicine Oncology at the University of Texas Southwestern in Dallas. We're really excited to be back with the second episode of our ASCO Educational Podcast Oncology, et cetera. And I don't know about you, but my arm's really sore from entering all the fan mail we got from the first episode. Either that or maybe it was that shingles shot I got last week I don't know. PAT LOEHER: No, I agree. I really appreciate Bev. Your wife just kept texting me how wonderful I was, and it was-- I enjoyed it. DAVID JOHNSON: Well, I'm glad you mentioned that, because I wanted to read this one fan mail. It says, dear, Dave. Thanks for carrying Pat [INAUDIBLE]. I don't know who that is, but I appreciate it. PAT LOEHER: Yeah, it works both ways. Works both ways. So what have you been reading lately, Dave? DAVID JOHNSON: Well, as you know, I love to read. And actually what I'm reading right now is The Howe dynasty by Julie Flavell. It's about the brothers Howe that were involved in the Revolutionary War. But the book I finished just prior to the one I'm reading now is Adam Grant's Think Again, which I really enjoyed. It made me think again. What about you? PAT LOEHER: How many times have you read the book by the way? DAVID JOHNSON: Again. Twice. PAT LOEHER: Think again. Yeah. There was the book that's called The One Thing. I know if you saw that book which I read a while back. It took me, like, a year to do it, because I just kept doing other things while I was reading it. I felt so guilty about it. I did read the book Caste recently, and it was on Oprah Winfrey's list. Barack Obama picked it. And actually read that on my way to Kenya a couple of months ago and found it very fascinating actually. You know, the notion of the juxtaposing of Nazi Germany, of the caste system in India, and the racial struggles that was going on here in this country. And I thought it was a very well written book. DAVID JOHNSON: Yeah. You mentioned that book to me, and I finished reading it a couple of weeks ago. I agree with you. I enjoy it very much. I learned a lot. We want to introduce today's guest. We're really, really fortunate to have with us today Dr. Otis Brawley. Dr. Brawley Is the Bloomberg Distinguished Professor of Oncology and Epidemiology at Johns Hopkins University. He's a graduate of the University of Chicago School of Medicine. He completed a residency in Internal Medicine at the University Hospitals in Cleveland Case Western Reserve and did a Fellowship in Medical Oncology at the National Cancer Institute, where he spent a good portion of his early career. In the 2000s, he relocated to Atlanta, where he became medical director of the Georgia Cancer Center for Excellence at Grady Memorial Hospital. One of the really most famous safety net hospitals in America. He was deputy director of Cancer Control at the Winship Cancer Institute of Emory University. And then he moved on to really a significant role. He became the chief medical and scientific officer and executive vise president of the American Cancer Society from 2007 to 2018, and we'll have a chance to perhaps query him about that. Currently, he leads a broad interdisciplinary research program on cancer health disparities at the Bloomberg School of Public Health and the Johns Hopkins Kimmel Cancer Center. Dr. Brawley has received innumerable awards. It would take the whole podcast to list them all. But among them are the American Medical Association Distinguished Service Award, University of Chicago Alumni of Professional Achievement Award, and-- one that I think is particularly poignant for ASCO members-- the Martin D. Abeloff Award for Excellence in Public Health and Cancer Control. In 2015, Dr. Brawley was elected to the National Academy of Medicine and well deserved. So just welcome to oncology, et cetera. Thank you so much for taking the time to be with us today. OTIS BRAWLEY: Thank you for having me. It's a pleasure to be with you and Pat. DAVID JOHNSON: Well, it's great to have you. I can tell you that. So let's just start with just a little background. Why don't you tell us about yourself? Where are you from? Where did you grow up? OTIS BRAWLEY: I grew up in Detroit. I grew up in one of the automobile worker neighborhoods, a blue collar neighborhood, and went to the Catholic schools there. The nuns in grade school pushed me toward the Jesuit school for high school, and the Jesuits in high school taught me how to think and really propelled me. And indeed much of my career, much of my writings, my philosophy toward medicine was really influenced by early education with the Jesuits. DAVID JOHNSON: Wow. PAT LOEHER: Hey, Otis. I just want to throw in-- in terms of books that we've read, one of the other books that I want to give a shout out is the book you wrote called How We Do Harm, which was really a wonderful book. I think it was several years in the making. Would love to hear how you made that. But I do-- while you're talking about your background, speak a little bit about Edward McKnight Brawley and Benjamin. OTIS BRAWLEY: Oh, OK. Benjamin Brawley was my grandfather's brother, and Edward McKnight Brawley was my grandfather's father. They're both ministers in the Methodist Church, the AME Church. Benjamin Brawley was dean of Morehouse College back in the 1920s, and he was the first Brawley to graduate from the University of Chicago. He got a PhD from the University of Chicago back during the 19-teens. And those are just a couple of my relatives. If you go to Morehouse, you'll find that the English building is Benjamin Brawley Hall, and Edward McKnight Brawley was his father and was a free Black back before the Civil War, and a minister before, during, and after. PAT LOEHER: Incredible legacy. Incredible legacy. DAVID JOHNSON: Those were your relatives from the South from the Georgia area? OTIS BRAWLEY: Well, my father grew up in Northwestern Alabama. An area called Leighton, Alabama. It's near Muscle Shoals. So those of us who remember the Beverly Hillbillies. My mother is from the middle of Arkansas. She's from Pine Bluff, Arkansas. And they met in Detroit. They were part of that northern migration in the early 20th century, where a large number of Blacks left the rural South and went up North to get jobs primarily in the industrial North. My father arrived there right after World War II. He served in World War II, got discharged, and went to Detroit. My mother actually went to Detroit really early on during World War II and worked in an airplane factory during the war. Then the two of them met. My father was a janitor at the Veterans Hospital in Detroit, and my mother worked in the cafeteria there. And that's how they met. They had my older sister, who was 8 years older than me, who became an attorney. And my younger sister was a certified public accountant. PAT LOEHER: What a remarkable story for your parents. And tell us a little bit about your journey to become a physician. How did that happen? OTIS BRAWLEY: It was very interesting. In high school, I was very talkative. I was very interested in policy. I did debate. It was very not a sciencey kind of person. In college, I became very interested in Chemistry and for much of College. I was going to go to graduate school in Chemistry. And luckily, when I was in college, I came under the influence of an infectious disease doc named Elliot Kieff. And he and I became very good friends. He was chief of infectious disease at the University of Chicago at that time. And over about two years, Elliott convinced me to drop the Chemistry thing and go to Medical school. And I applied to Medical school late, because I was so late in making that decision. I got into the University of Chicago and stayed there because my support system was there. And then in Medical school came across another gentleman. I've been very fortunate to have good mentorship and good people. They influenced me over the years. John Altman, who was one of the original medical oncologists back in the 1950s when there was arguments about how we should be staging people. Should there be four stages or three stages, and that sort of thing is when John really cut his teeth in Oncology. He became a great lymphoma doc. John took me under his wing while I was in Medical school, and pretty much open the world up to me, and explained to me how the world rotates in Medicine. And that heavily influenced me. Told me to go into Oncology because I still had an interest in Policy. And he said there's going to be a lot of policy in oncology in the future, and the best way to get involved with it is to get your credentials as a medical oncologist. And in many respects, I think in the early 1980s, John was thinking I was going to be chief medical officer of the American Cancer Society, which I obtained in 2007. PAT LOEHER: Wow. Yeah. We want to hear more about that. I just have to throw this in parenthetically that one of the things I did here is that I applied late to Medical school and got into the University of Chicago. I just wanted to know that I applied early, and there was a lesser known school in Chicago that sent me a rejection letter. And not only did they reject me, the last line of it says, good luck in whatever career you decide to go into, meaning that, if you can't get into our school, there's no way you'll be a physician. So I really admire you. DAVID JOHNSON: Yeah. I applied late too and-- PAT LOEHER: Got into Vanderbilt. DAVID JOHNSON: No. No. No, no. I didn't go to Vanderbilt. I only got into accepted to one medical school, and it was late. I was just like my career as a chief. And I was, like, the last person admitted to my class in med school. That's unbelievably interesting. Tell us, was John your influence to go to the NCI? Or what prompted you to choose the NCI for your medical oncology training? OTIS BRAWLEY: Actually, John was very influential in that decision. I told him I wanted to go into medical oncology when I was a resident in Cleveland. And he said, Otis, in his Austrian accent, I have been expecting this phone call. And he then told me where I was going to apply and gave me a list of nine places to apply. He told me I would get an interview at every one of those places. And as I was going place to place, I should rank them one, two, three, four. And so I called them with his ranking. And my first choice was not the National Cancer Institute. At which point he told me, if you go to that place, I will never speak to you again. PAT LOEHER: Oh wow. OTIS BRAWLEY: And I said, but you told me to go there to interview. He said, I wanted you to interview there, but I don't want you to train there. And I said, well, my first choice is the National Cancer Institute. And he said, fine. And a couple of days later, I got a phone call from the National Cancer Institute, and I got hired. And I will also tell you I called John up. And he says, Otis, I have been expecting this phone call. And then he said, now I want you to realize something. There is an old boys network, and your job is to get more Blacks and women into it. That's how you will thank me. PAT LOEHER: Wow. Wow. DAVID JOHNSON: So you were at the NCI at a period of time where many people would say it was the heyday of the NCI. I think it's still the heyday now, but tell us about your experiences there. What was it like? OTIS BRAWLEY: It was fascinating. It was when Vince DeVita was still the director. I was there for the transition. Eli Glatstein was the chair of Radiation Oncology. It was an amazing group of people. Dan Longo was there doing lymphoma. Marc Lippman was still there doing breast. It was just an amazing group of people when I applied, and interviewed, and when I first got there. And there was still a lot of excitement. We were still heavily involved in chemotherapy. Of course, I was up on the 12th and 13th floor building 10. Down on the second and third floor was Dr. Rosenberg doing his immunotherapy work, which of course, has now paid off dramatically. Some of the old monoclonal antibody work that led to a number of wonderful drugs was being started at that time in the mid to late 1980s. And so it was still a very, very exciting time at the National Cancer Institute. And in many respects, we were still on that burst of optimism that started with Nixon's war on cancer in 1971. It was still felt almost 20 years later at the National Cancer Institute. DAVID JOHNSON: And you linked up with an old friend of mine from the old Southeast Cancer City, a gentleman by the name of Barry Kramer? OTIS BRAWLEY: Yes. DAVID JOHNSON: What a wonderful relationship. So how influential was Barry in your involvement? OTIS BRAWLEY: Barry was incredibly influential. As I said, I have been very fortunate that along the way I have come under the influence of some amazing physicians, and I've had amazing mentorship. And that's actually, I think, important for all of us in oncology. Barry and I got to work together for quite a long while. Barry influenced me and literally taught me epidemiology. Got me some major opportunities at the National Cancer Institute and really was influential in promoting me and boosting my career. PAT LOEHER: I want to move you a little bit longer in your career and talk about the ACS and a little bit your experience there, Otis. And then with that, actually, maybe the secondary question is, a commentary on the leaders over the years that you have had-- the aspects of good things about leadership and the poor things. And obviously, you have certainly much to share on that. OTIS BRAWLEY: Yeah. Well, as I devote my career at the National Cancer Institute, I went to the Division of Cancer Prevention and Control. Under Barry, learned a lot of epidemiology, and learned a lot about screening, learned a lot about treatment outcomes, got very involved with some of the disparities or minority health issues. And then I was very fortunate to be detailed to work in the surgeon general's office and work with David Satcher when he was surgeon general. He's the one who started using the words, health disparities. Prior to that, we called it minority health or special populations. He used health disparities. And I was able to use some of my epidemiologic talents to develop some of those arguments using science to show. And actually some of the things that we had to show, believe it or not, was we had to show that equal treatment yields equal outcome amongst equal patients, because a lot of people, especially the politicians we need to deal with, were really hung up. And we still see this to this day that people are hung up that Black biology is different from white biology. Even in breast cancer today I hear that even though I like to point out there are now six states where the Black death rate for breast cancer is the same as the white death rate for breast cancer. And there are 12 states in the United States where white women have a higher risk of death from breast cancer than Black women in Massachusetts. But anyway, we got into this biology thing. And so I was very fortunate again to work for David Satcher and had some exposure to Tuskegee syphilis trial and the president's apology for that. So I was really involved with a number of things. And then the Jesuits still back there-- always think, always be contemplative, always reflect on what you're doing, always question what you're doing. Father Pawlikowski's maxims, which Dick Cheney sort of preferred is a few years later. And that is there are things you know, things you don't know, things you believe. Question what you know more so than anything else. And so that's really how I develop my concerns about orthodox use of Medicine. And using the science and applying it in a very Orthodox way, I started realizing that a lot of the disparities were due to wasted resources with people being non-scientific especially in the era of the 1990s, where everybody was doing prostate cancer screening, and there was not a single trial to show that prostate cancer screening saved lives. Yet all the resources were going into that, and people were literally-- I was able to go to various safety net hospitals and see all the resources being diverted away. People would shut down cervical cancer screening programs to do prostate cancer, which just didn't make sense. So I got very interested in how you practice medicine. Went to the Emory in 2001, because I wanted some practical experience outside of government. And had a wonderful opportunity to go there. Work at Emory. Work at one of the largest safety net hospitals in the country. Learn a little bit about the practical application of Medicine and some of the problems that people at safety net hospitals encounter. Worked with the School of Public Health and folks who did health education to learn how to convey messages. And then I was very fortunate. You know, the American Cancer Society is right down the street from Emory University. And I had met the chief medical officer of the American Cancer Society, Harmon Eyre, back in the 1990s when I was at the National Cancer Institute. And again this sort of mentoring thing comes up again. Harmon called me up one morning and said, why don't we go to lunch? And so we went to one of the student cafeterias at Emory and had lunch. And he essentially said, you know, I'm 67 years old. I've had this job for 20 years. I'm tired of it. Why don't you take it? PAT LOEHER: Wow. OTIS BRAWLEY: And so I applied to be chief medical officer of the American Cancer Society and got to know John Safran, who, at that time, was the CEO, who was a wonderful man with incredible vision. Again, this mentorship thing comes up again. PAT LOEHER: Well, Dave we had a lot of information here. We're going to carry this over. This concludes the first part of our two-part interview with Dr. Brawley. And our next episode will air on October 5. We'll talk a little bit more about Dr. Brawley's life experiences and particularly his work with the American Cancer Society NCI. He's been an incredible individual, and we look forward to finishing up this conversation. Thank you to all our listeners for tuning in to Oncology Et Cetera an ASCO Education Podcast, where we'll talk about anything and everything. If you happen to have an idea for a topic or guest you'd like to see on the show, please email us at education@ASCO.org. Thanks again. And remember Dave has a face for podcast. SPEAKER: Thank you for listening to this week's episode of the ASCO eLearning weekly podcast. To make us part of your weekly routine, click Subscribe. Let us know what you think by leaving a review. For more information, visit the comprehensive e-learning center at elearning.asco.org.

Oncology, Etc. - In Conversation with Dr. Otis Brawley (Part 1)

Social Determinants of Health – Modifiable Risk Factors – Tobacco Cessation

Cancer Topics - Advances in Triple-Negative Breast Cancer

Oncology, Etc. - Introducing Oncology, Etc.: Friendship, and the Majesty of our Profession

Cancer Topics - Young-onset Colorectal Cancer

In this episode of the Social Determinants of Health (SDOH) series, Dr. Shekinah Elmore (University of North Carolina at Chapel Hill) and Dr. Ramy Sedhom (Johns Hopkins University) provide research highlights in Social Determinants of Health topics from the recent 2021 ASCO Annual Meeting, provide context to the research, and discuss clinical implications. View episode slides and COI. Subscribe: Apple Podcasts, Google Podcasts | Additional resources: elearning.asco.org | Contact Us Air Date: 7/21/2021   TRANSCRIPT [MUSIC PLAYING] LORI PIERCE: Hello. I'm Dr. Lori Pierce, the 2020-2021 president of the American Society of Clinical Oncology. Thank you for tuning in for this discussion on social determinants of health and their impact on cancer care. The purpose of this video is to educate and inform. It is not a substitute for medical care, and is not intended for use in the diagnosis or treatments of individual conditions. Guests on this video express their own opinions, experiences, and conclusions. These discussions should not be construed as an ASCO position or endorsement. For this series on the social determinants of health, we invite Guests with a wide range of views and perspectives. Some of these conversations may be provocative, and some even uncomfortable. But ASCO is committed to advancing equitable cancer care for all individuals, every patient, every day, everywhere. I dedicated this vision to my term as ASCO president, and these conversations bring many voices to the table-- voices that we need to hear to move forward and find solutions. We hope you learn new ways of thinking about these issues, and we invite you to join us working toward a world in which every person with cancer, no matter where they live or what resources they have, receives high-quality, equity for cancer care. Thank you. SHEKINAH ELMORE: Hi, and welcome to the seventh episode of the ASCO Social Determinants of Health Series. I'm Dr. Shekinah Elmore, and I'm an assistant professor of radiation oncology and urology at UNC Chapel Hill. With me is Dr. Ramy Sedhom, a medical oncology fellow at Johns Hopkins. We're happy to be joining you, wherever you are in the world. RAMY SEDHOM: Yes, absolutely. This series is part of an initiative proposed by ASCO president Dr. Lori Pierce, focused on increasing oncologists' understanding of the social determinants of health, its impact on patients, and modifiable risk factors for cancer, inspired by Dr. Pierce's presidential theme of equity, every patient, every day, everywhere. In this episode, we will review highlights in social determinants of health topics from the recent ASCO annual meeting, provide context to the research, and discuss clinical implications. SHEKINAH ELMORE: In the social determinants, some of us might need a refresher, and that's OK, too. So the social determinants, as most of us know, are really those things at the interpersonal, community, social, structural higher levels that pattern health outcomes and access. So it's education, it's health care, its neighborhood and built environment, social and community context, and economic stability in one model from Healthy People 2030. But what we'll be talking about in many ways is at the individual level-- so the individual social risk factors that are lower than the social determinants of health. And then we'll also be talking a lot about race and racism. And so in terms of racism, the best definition that I have found is by Dr. Ruth Wilson Gilmore. She's a noted geographer. And that definition is that racism is the state-sanctioned or otherwise extralegal production and exploitation of group-differentiated vulnerability to premature death. And one of the benefits of the podcast format is that you can rewind, fix yourself on this slide, and read the definition a few times, like I did when I first came upon it, to just see how straightforward, but how all-encompassing, it is. And so racism is really a structural determinant of health. It sits above even some of these social determinants that we talk about. It patterns health inequities directly. It also has these interactions with all of the social determinants of health. And I think that that will become clear with the abstracts that we're talking about. RAMY SEDHOM: Really, really powerful definitions. And with regards to care access, almost 40 years ago, Penchansky and Thomas published their five As of access framework. And the five As, as you can see here, represents affordability. So thinking about what is the cost to patients. And there's been a lot of work coming out over recent years showing that these costs are increasing for patients directly with time. Accessibility-- what is the distance to location or a particular service for patients throughout the country. Availability-- what is the access to specialists and specialty resources, accommodation, flexible scheduling, and acceptability. And the reason why we bring up this framework is it's a context to discuss the first of the abstracts that we will discuss coming from Dr. Guerra and colleagues at the Penn Abramson Cancer Center. While published 40 years ago, these issues remain pertinent today. And we know that clinical trials do not operate in a vacuum, but instead mirror a lot of the problems within our current health care infrastructure. And that's what makes this work most impressive to me. I do encourage all to listen to the oral presentation from the ASCO annual meeting, abstract number 100, titled "Accrual of Black Participants to Cancer Clinical Trials Following a Five-Year Prospective Initiative of Community Outreach and Engagement." So what was the problem they were tackling? The team identified a major gap for full inclusion of minoritized patients in their cancer clinical trials network. And their goal, as highlighted by this abstract, was to increase the accrual of Black participants in cancer clinical trials. Importantly, they took a multilevel approach. But before thinking about any intervention, they went out into the local communities. They spoke to the patients, to the community leaders, pastors, community advocacy groups, and outreach groups to really listen to what the problems were. And by engaging with those most important stakeholders, did they really think about what were the most important interventions? And what did these interventions look like? Well the team at the Penn Abramson Cancer Center focused on educational efforts in Black communities dispelling many myths about cancer clinical trials. They also increased touch points and access points for patients to access care. Most importantly, these came through breast cancer and colon cancer screening for both insured and uninsured patients. One thing that really stuck out to me, very pragmatic and thoughtful in its design, was to make sure that culturally-tailored marketing strategies were also available for patients to see. They worked with pharma to make sure that Black patients were also shown on pamphlets discussing cancer clinical trials. And when thinking about access to care, we know that transportation is oftentimes a barrier, especially for our most vulnerable patients. So they had made sure to have contracts and connections with Lyft and other ride-sharing agencies to make sure that people can make it to the cancer center. And from the health care infrastructure side, they established new requirements for minority accrual plans, and made sure to use community health workers and one-on-one patient navigation. And what was the ultimate impact of their work? Over a five-year effort, they reached more than 10,000 individuals through various venues. And when looking at their primary outcome, they more than doubled the number of Black patients who were accrued on cancer treatment trials. And they saw up to a four-fold increase in the accrual of Black patients in non-intervention treatment trials. However, what is most important is they established a new level of trust with patients in communities that they were not before reaching. And they were able to remodel their organizational care delivery infrastructure to address this major gap in care delivery. So what was the hallmark of the strategy and how can we pragmatically implement it in our own institutions? First, they focused on understanding local needs. Importantly, they established bidirectional relationships, and they made sure to acquire data to show the business case for why this is a return on investment for patients, their local city, and their health care infrastructure. I want to applaud Dr. Guerra and her team for making sure that this was a long-term investment in the Philadelphia area. What first started as a research grant later grew to involve the entire cancer service line, all the way with the director of the cancer center, and making sure to involve their entire organization. And what is the lesson learned? Well, Black participants are significantly underrepresented in clinical trials. But it is not because they are resistant to participating. Instead, this is likely due to structural, clinical, and organizational barriers. In our local communities, the underrepresented minoritized groups may look different. Perhaps they may be racial minorities. They may be rural dwellers, adolescents, or perhaps elderly patients, sexual and gender minorities, and so on and so forth. So I'd like to open this up to Dr. Elmore, and see if you have any other comments or thoughts from hearing about this. SHEKINAH ELMORE: This is such tremendous work. And I agree. I think that it's a testament to so many things. I think that responsive development of interventions is so critical, and that truly, Black patients and Black people want to be included in the things that are meaningful to changing health outcomes. And there's so much here, and I really hope to see more efforts like this in both trial enrollment and for standard of care enrollment. RAMY SEDHOM: Absolutely, and hats off for ASCO advocacy for really pushing forward the CLINICAL TREATMENT Act, which made sure to ensure that clinical trial costs were also covered. This was a landmark decision that came in December of this previous year. [AUDIO OUT] area. And we look forward to seeing this implemented on a larger scale through partnerships with ASCO in future years. And with that, I'd like to transition to our next abstract that Dr. Elmore will lead us through. SHEKINAH ELMORE: Great, thanks. So this abstract, "Financial Toxicity, Symptom Burden, Illness Perceptions, and Communication Confidence in Cancer Clinical Trial Participants," the first author is Dr. Subha Perni and the last author is Dr. Ryan Nipp, both of which I know well from MGH. And so the problem here that they were trying to address and explore is that trial participants are at high risk for adverse effects from financial toxicity. But we don't really know that much about what the scope and type of those adverse events might be. So with this study, they prospectively enrolled trial participants from MGH for about two years, and they saturated their sample with those that were already referred per their request for financial assistance. And so they assessed financial toxicity in these two ways, both asking these participants about financial burden overall of care, and then focusing in on trial cost concerns. And then they also asked, using standardized validated measures, about patient-reported outcomes. So physical and psychological symptoms, illness perception, and communication confidence. How confident are they in communicating with their care teams? The results are interesting. 200 patients-- so 57% in this group noted that they had financial burden overall, and 41% with trial cost concerns. Those that noted financial burden were more likely to be young patients, which makes sense. And trial cost concerns, those were more frequent among patients with lower incomes. Both of these were significant, and I think that that speaks to the validity of these constructs of financial toxicity. And then this is the most interesting part. Financial toxicity was associated with greater physical and psychological symptom burden, negative illness perception, and lower communication confidence. So the bottom line here is that financial toxicity was associated with worse patient-reported outcomes across all domains that were measured. Lots of future questions here. So how might financial toxicity operate in different clinical settings? These are trial participants at a designated cancer center. How does that work in community oncology practices or among non-trial participants? How might financial toxicity moderate some of those other social risk factors or social determinants of health? We know from other health outcomes that if you look at Black Americans and white Americans with the health outcomes disparity, that disparity sometimes widens as you climb socioeconomic strata. And then how might financial toxicity influence oncologic outcomes? More physical symptom burden, more psychological symptom burden, worse communication, that could all lead to worse oncologic outcomes. So lots of programmatic implications here. I think prospective identification of financial toxicity risk, those patients who are at risk for that, and then aligning that with social and economic interventions. But this certainly aligns with the previous abstract that we discussed, another lens on why people might not participate in trials, and just the financial burdens that care can bring to patients, and the fact that it impacts the very care that they're getting. RAMY SEDHOM: Yes, absolutely. Such great work by Dr. Perni and Dr. Nipp and their team. I think we're just scratching the surface, as you mentioned, with financial toxicity and its implications on patient care and the caregiver experience as well. So all in all, I think the concluding remarks we could probably make is that equity is a simple concept to grasp, but very complicated to execute and measure for success. We do want to thank our authors who did put time and effort in their careers to opening up our eyes, and Dr. Pierce for really making this the highlight and the theme of her tenure as ASCO president. So for those listening in, thank you for joining us for this episode of the ASCO Social Determinants of Health series. To keep up with the latest episode, please click Subscribe. Let us know what you think about the series by leaving us a review or by emailing us at professionaldevelopment@asco.org. On behalf of Dr. Elmore and I, thank you for listening in. SHEKINAH ELMORE: Thanks. [MUSIC PLAYING] VOICEOVER: Thank you for listening to this week's episode of the ASCO eLearning weekly podcast. To make us part of your weekly routine, click Subscribe. Let us know what you think by leaving a review. For more information, visit the comprehensive e-learning center at elearning.asco.org.

Social Determinants of Health - Highlights from the 2021 ASCO Annual Meeting

Cancer Topics - Burnout in Oncology: Trainee Perspective

Cancer Topics - Burned Out? Here's What You Can Do About It (Part 2)

Cancer Topics - Burned Out? Here's What You Can Do About It (Part 1)

Social Determinants of Health - Patient-Provider Relationships, Culture and Communication

Social Determinants of Health - Medical Racism and Patient-Clinician Trust

The ASCO eLearning Podcast is an educational series focused on helping learners identify knowledge gaps and stay up-to-date with the latest in new drug developments, cancer treatments and patient care approaches. The purpose of this podcast is to educate and to inform. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. It is no substitute for professional care by a doctor or other qualified medical professional and is not intended for use in the diagnosis or treatment of individual conditions. Guests who speak in this podcast express their own opinions, experience and conclusions. Neither American Society of Clinical Oncology nor any of its affiliates endorses, supports or opposes any particular treatment option or other matter discussed in this podcast. The mention of any product, service, organization, activity or therapy on the Podcast should not be construed as an ASCO endorsement.

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