SWOG's Quality Findings at ASCO Symposium
Today is the first day of the two-day 2020 ASCO Quality Care Symposium, the premier showcase for a very special type of cancer care research. Cost, value, policy, safety, innovation, and equity are the central themes of the work presented. This year, SWOG will shine at the virtual conference.
First, our NCORP Vice Chair Dr. Dawn Hershman serves as chair of the meeting, providing the vision for the scientific and educational aspects of the program. In addition, we’ve got five presentations by SWOG members on SWOG trials. Kudos to all of the presenters – Drs. Veena Shankaran, Joe Unger, David Feldman, Julia Mo, and Riha Vaidya.
As you can see from the press release, two of the ASCO presentations are pretty blockbuster.
Veena Shankaran is sharing for the first time results of S1417CD – the first prospective, multi-center study of financial toxicity in the NCI’s National Clinical Trials Network. She found that nearly 75 percent of patients experienced major financial hardship 12 months into cancer treatment. That means most people who received treatment also accumulated debt, sold their homes, saw their incomes drop by 20 percent or more, or had to take out loans or otherwise borrow money to pay for their cancer care.
What’s even more stunning is that about a quarter of the 368 eligible participants in Shankaran’s study were older, white, employed men with health insurance – so patients from all walks of life experienced major financial hardship. Clearly, Shankaran says, clinical and policy interventions are needed to protect people diagnosed with cancer from financial devastation.
Look for her results soon in a peer-reviewed journal, and additional results reporting on financial distress in caregivers, the association between financial strain and quality of life, the correlation of credit report data with patient self-report data, and more mining from this landmark trial. I’m really proud of Dr. Shankaran, and SWOG, for this work – which was funded by a Hope Foundation Coltman fellowship!
The other big-splash finding of the symposium comes from Joe Unger, who adds a major finding to his growing body of work on disparities in cancer clinical trials.
At ASCO tomorrow, he presents surprising results on trial participation. We all know the classic, miserable stats: Only 5-8 percent of American adults with cancer take part in a clinical trial. Unger wanted to dive deeper. So, he did a meta-analysis of 35 trials launched over a 20-year period to find out, for patients actually offered a study, how many participate?
Overall, about 55 percent of people offered a spot on a cancer trial take that opportunity. So, a majority of people say “yes” when they are asked. What’s more, Joe and his team found that Black, Asian-Pacific Islander, and Latinx patients participated in trials at rates as least as high as white patients.
Unger says the findings show that the real problem of low participation in cancer trials does not lie with patients. It’s not that they’re not interested. It’s not that they distrust the system. Rather, the culprit is the system itself, which is beset with structural and clinical barriers, such as strict eligibility requirements. The work was simultaneously published this week in JNCI – see it here – with this accompanying editorial.
I’m proud of SWOG’s cancer care research. It is relevant. And it informs policy. I’m also proud that two of the five ASCO presentations are coming out of our palliative and end of life care committee, which is already proving its worth.