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Dr Joseph Alvarnas Discusses Nationwide Implications of the California Cancer Care Equity Act, Opportunities for Federal Legislation


Joseph Alvarnas, MD, vice president of government affairs at City of Hope and chief clinical adviser of AccessHope in Duarte, California, spoke on the influence that the California Cancer Care Equity Act is having on legislative efforts in other states, as well as future steps to promote accessible, affordable, and effective cancer care for patients nationwide.

Clinicians and medical groups from other states have taken action to follow the example set by the California Cancer Care Equity Act passed recently, with further efforts warranted on a federal level to ensure all patient populations receive access to value-based cancer care, said Joseph Alvarnas, MD, vice president of government affairs at City of Hope and chief clinical adviser of AccessHope in Duarte, California.


Have you heard from cancer centers in other states about the Cancer Care Equity Act or other efforts by City of Hope?

We have, actually. I have to say first we've worked with some great partners who have a national presence. That includes the American Cancer Society Cancer Action Network, the Leukemia and Lymphoma Society [LLS], it includes Be The Match NMDP [National Marrow Donor Program], and without them and others, this would not be possible.

But we've seen and heard from others. So, LLS had worked with a group in New York to ensure that their state Medicaid beneficiaries could get access to care at Memorial Sloan Kettering [Cancer Center], and that would be considered part of the network. We've had clinicians reach out to us from Texas looking for some help in drafting language. So, I think what we're seeing is the beginning of this.

The predecessor of SB 987, or the California Cancer Care Equity Act, was something called the Cancer Patient Bill of Rights [SCR 11], which was nonbinding, but what it did was establish 6 core principles through which we believe the state should use as litmus tests as they consider legislation that will impact the lives and needs of patients with cancer. We think that those core principles established in a first-in-the-nation Cancer Patient Bill of Rights could also have relevance across other states in the United States.

What about federal legislation? Wasn’t there a law to ensure that Medicaid recipients had access to clinical trials?

I'll say there are piecemeal components within existing law that can create a path forward. And in a way to start thinking about this is as part of the Affordable Care Act, when essential minimal benefits were defined, those included access to clinical trials that qualified by virtue of some very reasonable criteria, including being NCI [National Cancer Institute] funded.

That said, our system of care unfortunately creates artificial barriers for patients and families that result in patients actually not getting access, timely access to the care that they need. I do think that there are great opportunities on a federal level to try to bring some ease for patients and families, and to help overcome those barriers. Given the complexities of the federal government's role in legislation, potential places to look would include not only at patients who are Medicare beneficiaries, but also those who are beneficiaries of Medicare Advantage, where access to clinical trials or access to expert cancer care services tends to lag behind that of other patients.

So, we see great opportunities on a federal level, and we believe that as we move forward, the ultimate test for whether or not we're moving toward the right goals is whether or not this can ensure greater care equity.

We know that underserved patient populations don't get access to clinical trials. We know that with profound gaps, they don't benefit from genomic testing and therapeutics based upon those genomic data, and we know that survival outcomes for patients from underserved communities, including those of rural areas, lag significantly below those living in urban areas. So with that said, there's a lot of room for improvement. And as part of that, we view not only SCR 11, the Cancer Patient Bill of Rights, but SB 987, as small incremental steps that are building us in the right direction.

I didn't start out in government affairs, and a lot of what we've done here has been inspired by the words of our patients and the frustrations of their families as they've experienced our system of care at its worst, barrier laden and insensitive to their needs. Throughout this country, there are many clinicians who experienced the frustrations of their patients and understand the flaws within our system.

The best way to fix this isn't just to get frustrated, it's to move forward with advocacy and to try to incrementally improve our system. The most important thing was we can get involved. We can be vocal, we can speak to members of Congress, we can speak to our legislators, and we can get back to CMS when they open up opportunities for comment. Physicians and clinicians and other key health care stakeholders have a profoundly powerful voice that far too often isn't heard. And I think SB 987 is a great example of the ways in which we can succeed if we just start down that path.

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