Improving Access and Outcomes in HR+/HER2– Breast Cancer Treatment

Mabel Mardones, MD, board certified medical oncologist and hematologist with an advanced subspecialty in breast cancer at Rocky Mountain Cancer Centers, moderated and contributed to the Denver Regional Institute for Value-Based Medicine^® event during the session, “New Treatment Opportunities in HR+/HER2- Breast Cancer”.

Mardones spoke with The American Journal of Managed Care^® to discuss the importance of providing effective cancer treatments to all patients, regardless of socioeconomic status or location, and stresses the value of representation in the medical field, which can build trust with patients. She advocates for using resources, colleagues, and community outreach to ensure diverse patient populations have access to clinical trials while also highlighting the need to address personal biases among providers and to educate on these biases.

This transcript has been lightly edited.

Transcript

How can we accelerate the development and translation of novel therapies into clinical practice? What role can collaboration between researchers, clinicians, and industry play in this process?

We can't move the needle forward if we don't access clinical trials and if we don't bring them to patients, in my opinion, in the community. It's great to have academic centers who are collaborators and are pushing the needle forward in other ways, but I think our patients really live in communities and they want to be able to be treated in their communities without having to travel far for that treatment. In my opinion, the collaboration has to be uniform between pharmaceutical companies, where many of our sponsors [are], academics, and community; it really has to be a blend of the 3.

The way to do it is research, and the way to also do that effectively is to do a better job at making inclusion criteria for trials more representative of who our patients truly are. This has become topline priority for the FDA with the idea that minorities are representing less than 5% of all our clinical trials, and that does a disservice to the true representation of what our communities are like.

I think if we do a better job at offering clinical trials, dismantle the idea that clinical trials are often taboo for many communities, and do a better job at education, then bringing this to the community is probably the way to move forward.

How can we ensure that patients with HR+/HER2– breast cancer have access to the latest and most effective treatments, regardless of their socioeconomic status or geographic location?

I think representation on the other side of the forward-facing patient is super important. In my opinion, I think if you have a physician who represents a portion of that population (ie, a Latinx physician, an African American physician), you get an immediate sense of trust. It really does happen. I've seen that be the case. I'm Latinx myself, and being able to speak in the language that they feel most comfortable with, not having to have a intermediate person or a translator is a huge way to build trust.

We can't all be of all different backgrounds in oncology, but what we can do is use our resources, use our colleagues, use educators, use nurse navigators, use the collaborative relationships that already exists in coming out to the community and make that happen.

But I think the most important thing also, which I believe wholeheartedly in, is the idea of dismantling some of our own misconceptions about who are the ideal patients. I think all of us have biases built in, no one can say they don't. I think whether that's because someone comes from a less accessible area of town and doesn't have a ride, maybe we would never present a trial to them, whereas we might have the idea that someone else could and would accept a clinical trial, and therefore why waste your time bringing that to their attention? I think checking in with biases is super important from a provider and physician perspective as well.

To summarize, it's really education, checking biases, making sure that community-based practices have access to those clinical trials. That's personally what we're all about at The US Oncology [Network] and now with our merger with Sarah Cannon Research Institute. It is really important to make sure that there's a varied representation of these patients into clinical trials, and I think we're doing that very effectively with our merger.