Drs David and Scott Penberthy Are Working to Evolve Cancer Care in the 21st Century

On day 1 of this year’s Association of Community Cancer Centers’ (ACCC) National Oncology Conference, The American Journal of Managed Care®(AJMC®) sat down for a conversation with David Penberthy, MD, MBA, ACCC’s president for the 2022-2023 term, and his brother Scott Penberthy, PhD, MS, director, Applied AI, Office of the CTO, at Google.

David Penberthy’s theme for his presidential tenure is “Leveraging Technology to Transform Cancer Care Delivery and the Patient Experience,” and Scott Penberthy presented the session, “Cancer Program Technology in 2040: The Google Perspective,” in which he explored how artificial intelligence (AI) data-driven initiatives are helping to evolve health care information retrieval for more precise clinical care.

Their shared focus on technological innovation in oncology is a main goal as they both work to help propel improved care in the oncology space, while also considering those beyond the doctor-patient relationship, such as front-desk staff, nurses, and professional staff. The discussion also touched on the Enhancing Oncology Model (EOM), physician burnout and mental health, phenomics and genomics, and how AI is transforming oncologic care.

This interview has been edited lightly for clarity.

AJMC®: How was the theme for your term as ACCC president been interwoven into this year’s National Oncology Conference?

David Penberthy: We’re having ongoing dialogues with many of the stakeholders on the oncology care spectrum, and we’re finding recurring themes that are heavily technology driven. For instance, the home as a site of health care is an ongoing effort. It’s a patient satisfier, but we need technology to be able to effectively deliver care in the home. Things like remote access, Zoom meetings, Microsoft Teams—all of those technologies are allowed right now through government funding [under] the public health emergency. We’re advocating that the government make those programs permanent. And so, during this conference, we’re looking at all sorts of technology solutions to mitigate challenges that many oncology programs throughout the nation are feeling.

Another example is the workforce shortages. We’re seeing challenges across the health care spectrum with the nursing staff, with professional staff, with a workforce that is more and more mobile. If workers are in a situation that they want to change, then they’re doing that, and we’re seeing that throughout the health care spectrum: from the front desk staff to the professional staff to physicians. We're trying to be creative to figure out ways that we can still provide excellent care with these challenges, and so we’re looking at all sorts of solutions—and a lot of those solutions have a technology component to mitigate that.

AJMC®: Can you discuss ways in which AI has changed and has the potential to change oncologic care?

Scott Penberthy: Where can we use AI or where is it making a difference today? Have you Googled lately? If you think of doctors every day just asking questions and they’re going to Google and seeing what’s the latest care that’s coming out, and there’s a lot of interaction of finding the latest PubMed papers and whatnot, when you’re getting results from Google, that’s actually AI under the covers. It’s understanding human language much better than it ever had before.

But if you actually get down to the care side, where you can see a bit more of the private data and that sort of thing, we’re finding now that there’s a lot of AI happening around the world. [There's] sort of an obsession with, can we actually help diagnostics and actually help you get better with more accuracy? We’re finding outside the United States, or even with value-driven care, that works pretty well. For example, detecting polyps and looking at [gastrointestinal issues]. What we’re finding is, if it’s in a value-based care envelope, then it’s beneficial to the physician and it’s beneficial to the insurer as well, in the sense that you have incentives that are aligned.

But we’re finding those outside that area of incentives aren’t so well aligned. What we’re finding, what it ends up doing is, it will go down to the physician where they’re spending less time with the patient and special technology costs a lot more money.

So, what we’re doing at Google is trying to figure out, where could we be most helpful in a situation? And we’re finding that AI is actually helpful in taking away the mundane, in taking the robot part out of the human. It's simple things like looking across multiple PDFs and trying to answer the question, “Are my benefits covered?” Right now you call somebody and you ask a question, and they’ve got to go through files and try to figure out, is this covered? Who’s available? And all those sorts of things. We can now use AI to answer some of those questions or to take clinical notes and abstracts away and find common patterns to help you basically have accurate notes.

So a lot of AI is now being used in much more the mundane—I call it the boring billions—of health care, and can we take some of that out so you can spend more time with patients and doing what you do best, which is the diagnostic.

AJMC®: There has been a push to increase oncology clinical trial participation, both overall and in particular for historically underrepresented populations. Can you discuss how recruitment efforts consider patient costs—such as transportation, gas, housing, days off work, child care? How is ACCC working to address that?

David Penberthy: The presidential theme a couple of years ago was increasing participation in clinical trials in community oncology programs. That’s a recognized challenge. Through clinical trials, that’s how medical care and oncology care is advanced throughout the nation, so we want to encourage more clinical trial participation.

At the same time, there are populations that you describe whose basic needs are not always being met. They may have challenges such as their housing, or they may not have transportation. We’re looking at all of those things—and that’s under the heading of social determinants of health—to try to figure out how we can effectively mitigate those things. And so we’re looking at grants, we’re looking at volunteerism, and we’re looking at ways the community can address those concerns.

We’re trying to do that by engaging the community in an effective way. Oftentimes, marginalized community members may have slight hesitancy to use traditional medicine, and so we’re trying to meet people where they are with people that are of similar background to them so that they have increased trust in the system. Building trust is paramount to increasing clinical trial participation in those populations.

AJMC®: Your talk focused on “The Age of Phenomics.” Can you explain what this field of research is and how it has evolved from but continues genomic research?

Scott Penberthy: What is phenomics? Essentially, it’s a new term coined by Leroy Hood, MD, PhD, or Lee Hood, one of the early fathers of genomics. He talks about, could we actually use hyperscale AI in these large-pattern recognition systems to rack and stack your points in time? A point in time for a human being would be your genome, which is sort of static, and then you look at the epigenome and things like transcriptomics—and we’re looking at all these analytes you might measure for one point in time. That's one state of your health. If you look at these over a period of time, and you look at the outcomes, you can start to find patterns.

A young company called GRAIL had this idea about 6 or 7 years ago and realized that if you actually take what's called a phenome, which is your patient record as well as your whole genome and what's going on in your body, we can look at basically garbage floating in your blood from the cancer—it's called methylated DNA—and you can actually find patterns in that and identify, is it a cancer? If it's cancerous, what organ is it and what stage is it? That’s just one example. And that is sort of an early example of this branch of medicine where it’s much more computational, where you have to understand what's going on your body at a nano scale, like down to individual molecules inside your DNA and RNA, and actually using that to understand what’s going on in your body, and then once you identify the connection, reverse what’s happening.

AJMC®: What are some top concerns or misconceptions patients who prefer in-person care may have about the use of technology to guide their care? What should they know about the good parts of AI that are being used to improve care?

Scott Penberthy: The good parts of AI that are being used is going back to this thing called the boring billions. There's the care piece, and we want to enable physicians to spend more time with their patients, in a sense that let them make the diagnostic. AI can also be seen like a microscope; it’s a tool for them. But also where AI is taking away a lot of the pain is with the administrative pain. So think of [a situation where someone might ask], “Is this patient we authorized, are you sure this patient will be covered?” Right now it’s an expensive phone call to the insurer, a lot of dialogue back and forth. Computers can help with that now, because we can actually understand language.

It's the same thing for, “Well, gosh, there’s 4 doctors. I can't wait on the phone anymore, but she’s busy and he’s not covered.” We can now use things, and we're looking at, can you actually have a computer make the phone call for you and the computer can use a human voice to interact because of the ultimate API [application programming interface] is the human voice. Those are the kinds of things where we're finding AI is really taking some of the drudgery out of medicine and getting back to that time where you’re spending more time with your doctor.

I think the headlines are a lot about the AI diagnostics and the AI doctor. In reality though, a lot of the traction we're finding is in much more of just making life a lot easier and restoring that patient-doctor relationship.

AJMC®: A principal element of the EOM, set to start in July of next year, is the starkly reduced funding for enhanced services. For patients in rural and underserved areas for whom access to the most basic community oncology care may be difficult, how might the lack of reimbursement reverberate going into the EOM?

David Penberthy: That’s a profoundly challenging question. We deal with the very basics. We need people to have access to food, access to transportation, and to get their services. Any funding cuts create a barrier to appropriate care. We’re working with the people who are instituting the EOM to figure out ways to mitigate those challenges. That’s an ongoing effort, and so we’re working with our advocacy professionals to look to ways that we could mitigate those funding shortfalls.

AJMC®: If the pandemic has highlighted anything among physicians, it’s burnout and mental health aspect. What programs or initiatives does ACCC have in this area?

David Penberthy: So last year’s presidential theme was all about wellness in the health care team, and burnout was highlighted in that. We have a strong component with the psychosocial services, with social work, and we’re recognizing that that is an ongoing issue. And so, again, we’re looking at creative solutions to mitigate that problem of provider burnout—and it’s not just physicians. It’s front desk staff, it’s everybody along the health care team. Our top priority is recognizing that it is an issue and then figuring out ways to affect favorable change.

One of the great things about ACCC is that it has such a wide breadth of experience with its membership that we oftentimes can find a program that is either community based or academically based that is doing something very well to mitigate things like burnout, and so organization such as ACCC can promote those practices to better address those challenges that many oncology programs are facing.