The National Comprehensive Cancer Network (NCCN) 2021 Annual Conference convened virtually March 18-20, drawing attendees from more than 40 countries to discuss updates to NCCN’s Oncology Clinical Practice Guidelines, new and emerging therapies, best practices in oncology care, as well as keynote sessions on HPV vaccinations, racial disparities in guideline-adherent cancer care, and effects of the pandemic on cancer care.
Elevating Racial Equity in Cancer Care
Representatives from the Elevating Cancer Equity Working Group, a collaboration between the American Cancer Society Action Network (ACS CAN), the National Minority Quality Forum (NMQF) and NCCN, spotlighted racial disparities in guideline-adherent cancer care and outlined recommendations for reducing inequality in cancer screening and treatment. A growing body of evidence demonstrates that Black, Latinx, and Indigenous populations are less likely to receive guideline recommended cancer screening and face higher death rates and shorter survival rates compared to non-Hispanic white patients. Disparities in care in the U.S. have been documented in numerous cancer types such as ovarian, breast, prostate, and lung cancer. The NCCN Chief Executive Officer Robert W. Carlson, MD spoke to the urgency of developing ways to make quality cancer care more accessible and equitable.
One of the recommendations from the session was to review clinical practice guidelines to assess areas where disparities could be reduced or eliminated, as well as incorporate frameworks to account for health disparities. Along these lines, the United States Preventative Services Task Force (USPSTF) recently updated the lung cancer screening guidelines. These updates expanded eligibility to younger populations and to people who have smoked fewer cigarettes, which is particularly helpful in increasing screening eligibility among black and female populations. In addition, the Task Force is currently in the process of updating the breast cancer screening guidelines and has proposed contextual questions in the draft research plan that explore disparities in breast cancer screening. One of the contextual questions published in the draft research plan states: “How do structural racism, social inequalities, unequal access to high-quality healthcare, and other factors contribute to disparities in breast cancer screening, diagnosis, treatment, and health outcomes?” A growing focus on health equity will continue to influence and inform clinical practice both from the top down, as with USPSTF and ASCO, as well as bottom-up from growing awareness among healthcare providers.
Effects of the COVID-19 Pandemic on Cancer Care
The final keynote session of the conference convened five administrators and clinicians from leading cancer centers in the U.S. to discuss the impact of the pandemic on cancer care. The panel discussed how COVID-19 related restrictions and patient avoidance of healthcare settings resulted in delayed cancer screening, detection, and treatment during the peak months of the pandemic. As a result, cancer centers have looked for creative ways to safely increase screening volumes such as ramping up mobile-screening programs and moving cancer screening appointments into ambulatory care settings. Health plans have responded by launching or expanding programs for at-home cancer screening sample collection kits for colon cancer creating an opportunity for innovators that offer less invasive screening tests.
While the discussion focused on what providers are doing to facilitate cancer services during the pandemic, innovators in med tech also have a vital role to play in this effort. Less-invasive screening tests, such as those that reduce reliance on advanced imaging, and particularly those for which samples can be collected in an at-home test kit, are proving to be vital in the midst of the pandemic and will continue to play an important role in the future.
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