ASCO’s Dr Lori Pierce on Equity in Cancer Care: “History Has Its Eyes on Us”

After a year like no other, when COVID-19 laid bare the disparities that had long persisted in health care and beyond, the president of the American Society of Clinical Oncology (ASCO) opened the annual meeting by calling it like she sees it.

Equality in care is not sufficient, said Lori Pierce, MD, FASTRO, FASCO, a radiation oncologist from the University of Michigan. Achieving equity—which means that patients have similar outcomes in cancer care, regardless of circumstance—is harder to achieve, in part because it requires overcoming the structural racism that exists not just in society but in health care itself.

Equity is a theme across this year’s ASCO meeting, which is in a virtual format for the second year due to the pandemic. In 2018, when Pierce was selected as the 2020-2021 ASCO president, Clifford Hudis, MD, FACP, FASCO, ASCO’s CEO, said no one could foresee the role that Pierce would play when she would lead the organization during the pandemic. At this year's meeting, Hudis said that Pierce has proven to be the right person at the right time.

“Sometimes it is said that leaders have to grow and rise to meet the moment, but that was not the case this year,” he said.

Throughout her career, Pierce has worked to address equity issues in health care generally and cancer care specifically; the pandemic has highlighted gaps in access to care and outcomes, and from the start oncologists have braced for a wave of late-stage diagnoses as patients miss screenings and follow-up care, or regimens have to be altered due to pandemic protocols.

In her remarks, Pierce drew on her own experience, growing up in the 1960s, of how laws may change but inequities persist. As a child, she was aware of the civil rights movement. “Although I didn't realize that at that time, I was observing segregation’s impact on health care,” she said. When she visited her father's family in Ahoskie, North Carolina, “White residents had access to many high-quality health care options,” but “Black people were largely treated by a single African American doctor.”

“Looking back, no matter how skilled he was, he was still one doctor treating an entire community—every person, every age, every condition. And that, by definition, is limited,” Pierce said.

“As I got older, attending college and then medical school, I became more aware that while the legal segregation I saw in North Carolina in the 1960s was over, health care inequality remained firmly entrenched in the US and worldwide. As a resident in radiation oncology, and then as a breast cancer physician and researcher, I became increasingly committed to improving outcomes for all people with cancer.”

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