“I was just so excited and quite pleasantly surprised,” replied Kashyap Patel, MD, CEO of Carolina Blood and Cancer Care Associates (CBCCA) and president of the Community Oncology Alliance (COA), when asked about being included in the 2022 Narratives in Oncology, a special issue introduced by the American Society of Clinical Oncology’s (ASCO) The ASCO Post.1
Each year since 2012,2 from among ASCO’s approximately 45,000-strong global membership,3 10 leaders have been nominated by their peers to be recognized in Narratives, which is published during the ASCO annual meeting. Besides Patel, who is associate editor of Evidence-Based Oncology™ (EBO), this year’s class includes EBO board member Debra Patt, MD, PhD, MBA, executive vice president of health care policy and strategic initiatives at Texas Oncology and a clinical professor at Dell Medical School at The University of Texas at Austin. Patt is the current secretary of COA.
Patel elaborated on this year’s ASCO honor in an interview with EBO.4 “I think I was given this award because of my contribution to community oncologists and how we are trying to survive and play many roles—policy, science, disparities, access to care, all of that.”
Patel launched his career in medicine with a neurology fellowship before opening a private hematology/oncology practice and spending several years as an academic oncologist. He has now been with CBCCA for more than 20 years, fulfilling his self-proclaimed role as a people person and continually stoking his interest in health care policy.5 Speaking of his time in academia as a hematology/oncology fellow, he has said that although the work was interesting and he was very involved in research and publishing, “I was concerned I’d be unfilled in academic oncology, so I began looking for a position in a community practice.”1
From his start at CBCCA, Patel has been on the go. Not only is he a practicing oncologist, he also works for better outcomes in the community setting by improving the care experience for patients and physicians alike through his efforts to eliminate community oncology–related health care disparities, elevating value-based care and enable access to care through practice-level changes.
“I do believe that appropriate representation of population genomics is a key to the success of precision medicine,” Patel told EBO. “As well for clinical trials, without appropriate representation of minorities in clinical trials, we cannot know if a drug works best in every population.” This is particularly important in this era of precision oncology and personalized medicine and ensuring patients who are candidates for targeted treatment receive optimally effective treatment.
To that end, Patel and CBCCA have partnered with Sema4, a health intelligence company that uses artificial intelligence and machine learning “to build dynamic models of human health and define optimal individualized health trajectories,”6 and LabCorp, the global life sciences behemoth using technology to improve care delivery,7 to investigate genomic testing disparities in the community oncology setting. Data from this ongoing study, the primary goal of which is to achieve a clearer understanding of how social determinants of health (SDOH) influence the receipt of and outcomes in oncologic care in underserved communities, were presented at ASCO 2022.8,9
Results from the first abstract show that 43.2% of patients reported an annual household income below $25,000 and the remaining 57.8% reported an annual household income below $50,000. This lack of adequate income as an SDOH was found to be associated with both financial and food insecurity, with patients in these households stressed about their potential inability to pay for food or medical care; 15.1% also reported they had run out of food in the past year. “This ongoing observational study will integrate SDOH, genomic characteristics, and clinical outcomes from a diverse cohort of patients seen in community oncology practices,” Patel and his coauthors wrote.10
Findings from the second abstract show that whole-exome sequencing (WES) and next-generation sequencing (NGS)—offered via liquid biopsy or tissue-based testing—can be scaled up when necessary to help identify potential candidates for targeted therapies, “providing better outcomes and reduced toxicity” and improving cancer-related health disparities (CHDs). These may contribute to almost 34% of deaths among adult cancer patients and additional spending of $230 billion, the analysis noted. Part of the study in the first abstract, this analysis utilized the Sema4/LabCorp partnership to create a real-world evidence registry of biomarker-based testing results (ie, germline implications and actionable variants); 31% of the patients who underwent NGS were reported to be members of ethnic minority groups.11
These ongoing efforts aimed at overcoming CHDs are being made in conjunction with No One Left Alone, CBCCA’s comprehensive program that hopes to improve access to cancer care by addressing financial toxicity.9
Phase 1 of this program tracked the socioeconomic aspects of cancer care that often adversely affect that care, including transportation and insurance coverage (or lack thereof). Among the major findings, $1.63 million alone in free drug coverage was provided to patients between January and December 2021.10 But addressing financial toxicity was just the first step in designing a road map of sorts that the team hopes to eventually share with other practices around the country.4
Phases 2a and 2b of the program comprise the partnerships with Sema4 and LabCorp, through which close to 85% of eligible patients with cancer have so far received NGS testing,4 a finding in stark contrast to the 25% to 45% reported in precision medicine literature, Patel and his team reported.11 Phase 3 will encompass additional data collection, for lung, breast, cervical, colorectal, and prostate cancers, and phase 4 will address clinical trial access.12
“I’ve narrowed down the disparities causes to: access to care for financial reasons; access to cancer screening; access to NGS testing, molecular testing; SDOH; and access to clinical trials. We have to try one or all of these together in multiple settings to see what works best,” Patel said.
Patel remains rooted in his role as a community oncologist whose first priority has always been his patients and ensuring they get the care they need when they need it.
“I’ve spent over 1500 hours now, in the last 2 years, studying about the equity impact of disparities in cancer care. I’ve written about it. I’ve published about it. I’ve walked the talk. I feel that this problem will not be solved by policy makers in Washington, DC—there’s been too much fragmentation and partisanship in DC about the smallest issue. I think we have to start different models and pilots in different regions,” Patel stated. “It’s going to be a learning experience. But until then, that 34% of preventable cancer that’s happened in America haunts me every night before I go to bed, so we just do our best.”10
1. Piana R. A community practitioner and policy advocate who stresses holistic, patient-centered care: Kashyap Patel, MD. The ASCO Post: Narratives in Oncology. June 3, 2022. Accessed June 26, 2022. https://bit.ly/3A6hDa7
2. Narratives in Oncology through the years. The ASCO Post: Narratives in Oncology. June 3, 2021. Accessed June 25, 2022. https://bit.ly/3NlgZbS
3. Membership. ASCO. Accessed June 25, 2022. https://bit.ly/3A5lbt6
4. Caffrey M, Shaw M. Dr Kashyap Patel updates on exciting developments at ASCO22. The American Journal of Managed Care®. June 1, 2022. Accessed June 25, 2022. https://www.ajmc.com/view/dr-kashyap-patel-updates-on-exciting-developments-at-asco22
5. Kashyap Patel, MD. Community Oncology Alliance. Accessed June 25, 2022. https://bit.ly/3neME49
6. Our story. Sema4. Accessed June 26, 2022. https://sema4.com/our-story/
Company information. LabCorp. Accessed June 26, 2022. https://www.labcorp.com/frequently-asked-questions/patient/general/company-information
7. Patel KB, Jun T, Chhadwa S, et al. Social determinants of health in a prospective study of whole-exome sequencing in advanced cancer patients from underserved communities. Abstract presented at: ASCO 2022 Annual Meeting; June 3-7, 2022; Chicago, IL. Abstract e18539. Accessed June 26, 2022. https://meetings.asco.org/abstracts-presentations/206529
8. Gor AS, Patel KB, Rabara V, Clinton N. The role of real-world evidence (RWE) registries using NGS testing to address cancer health disparities (CHD) in small community oncology practices. Abstract presented at: ASCO 2022 Annual Meeting; June 3-7, 2022; Chicago, IL. Abstract e18519. Accessed June 26, 2022. https://meetings.asco.org/abstracts-presentations/206499
9. Clinton N, Patel KB, Gor AS, Rabara V. Addressing cancer health disparities (CHD) in an independent community cancer clinic: all solutions are local. J Clin Oncol. 2022;40(supp 16):e18522. doi:10.1200/JCO.2022.40.16_suppl.e18522
10. Patel K, Mukhi H, Mehta D, Patel A, Oh W, Reddy P. Incorporating biomarker testing in community cancer clinics: a real-world pilot study. Targeted Therapies in Oncology. May 16, 2022. Accessed June 26, 2022. https://www.targetedonc.com/view/incorporating-biomarker-testing-in-community-cancer-clinics-a-real-world-pilot-study
11. Patel K, Mukhi H, Patel A, et al. Addressing cancer health disparities in a multilateral collaboration in an independent community cancer clinic: translating words into action. Evidence-Based Oncology®. March 15, 2022. Accessed June 26, 2022. https://bit.ly/3HR17N0