Experts Call for More Equitable, Coordinated Cancer Care

Patient outcomes can be improved through more equitable, coordinated, and precise care across the cancer continuum, a theme highlighted in 4 panel discussions at the Institute for Value-Based Medicine^® (IVBM) event in Tampa, Florida, on January 29, 2026, where local oncology experts shared their perspectives.

Addressing Access, Equity, and Coordination Across the Cancer Care Continuum

The IVBM opened with the “From Vision to Reality: Building Diversity in Clinical Trials” panel, which focused on making clinical trial populations more representative by addressing barriers across the continuum of screening, diagnosis, and trial enrollment. Moderated by Manish Patel, MD, director of drug development at Florida Cancer Specialists & Research Institute (FCSRI), the conversation featured 3 experts from Moffitt Cancer Center in Tampa: Kedar Kirtane, MD, physician director for engagement of special populations for clinical trials and medical director for solid tumor cellular therapy; Hatem Soliman, MD, medical director of the Clinical Trials Office; and Susan T. Vadaparampil, PhD, MPH, associate center director of community outreach and engagement.

The panelists emphasized that logistical and financial burdens could limit participation. Kirtane described “time toxicity,” the cumulative burden of travel, extra visits, and procedures on top of already demanding treatment regimens. Financial pressures compound the problem; Kirtane noted that for patients who cannot afford to miss work, clinic conversations become “10% clinical, 90% logistics.”

Access and awareness challenges also play a role, with trials often concentrated at major institutions. Soliman cautioned against clinician self-censorship, in which physicians sometimes assume patients from distant areas will not be willing or able to participate and never make the offer to them. Instead, he advocated for expanding community-based trial capabilities and bringing trial activities closer to where patients live. Soliman also highlighted the importance of simplifying trial identification, as complex eligibility criteria and changing enrollment slots make it difficult for physicians to track available studies.

Vadaparampil highlighted, however, that efforts to address these disparities are underway. She described partnerships with federally qualified health centers to improve screening and early detection in underserved populations, along with geographically targeted outreach in communities with higher proportions of Black and Hispanic residents. In addition, technology such as prescreening tools and emerging artificial intelligence (AI)–based trial matching systems may help identify eligible patients more efficiently.

Patel concluded that improving diversity in clinical trials is essential to ensuring new therapies are tested in broader populations and to avoid unequal outcomes once treatments are implemented into routine clinical practice.

“At the end of the day, in every trial that you read about, unfortunately, a lot of the backgrounds of these patients are very similar, and it’s hard,” Patel concluded. “When we start treating these patients later with the drugs that are commercially approved, you wonder why certain groups do worse or have more toxicities, and [it’s] probably because they weren’t represented well in the trials.”

The event continued with the “Pharmacy at the Helm: Medically Integrated Dispensing in Oncology” panel. Moderated by Kenneth Komorny, PharmD, BCPS, vice president and chief pharmacy officer at Moffitt, the conversation featured 3 experts: Amy Schneider, PharmD, BCOP, advanced clinical pharmacy specialist in medical oncology at Moffitt; Frank Scimeca, PharmD, MBA, BCOP, vice president of pharmacy services at FCSRI; and Katherine Tobon, PharmD, BCOP, advanced clinical pharmacy specialist in malignant hematology at Moffitt.

Medically integrated dispensing (MID) pharmacies are specialized pharmacies embedded within Oncology Centers of Excellence where pharmacists are fully integrated into the multidisciplinary care team and have access to the electronic medical record (EMR). Komorny noted that, unlike external or pharmacy benefit manager (PBM)–owned specialty pharmacies, MID pharmacies allow oncology pharmacists to actively participate in patient care, creating a more coordinated approach to dispensing and therapy monitoring.

The experts emphasized that the value of MID pharmacies is reflected in speed, safety, and clinical outcomes. Scimeca cited benchmarking data showing external specialty pharmacies take approximately 9.7 days to fill oncology prescriptions compared with an average of 2 days for MID pharmacies, a critical difference for patients who cannot afford treatment delays.

Schneider also shared internal Moffitt Cancer Center data showing that patients with metastatic prostate cancer using its MID pharmacy experienced faster access to therapy, greater prostate-specific antigen (PSA) reductions, fewer adverse effects, and lower hospitalization rates, helping avoid tens of thousands of dollars in hospital costs.

The panel also highlighted the role of MID pharmacies in improving equity, access, and patient support. Schneider explained that MID teams facilitate co-pay assistance, grants, and Quick Start programs for patients who might otherwise struggle to afford treatment. Even when insurance forces prescriptions to external pharmacies, MID teams can initiate prior authorizations and guide patients through the process. Tobon added that MID models provide real-time EMR documentation, allowing pharmacists, nurses, and physicians to better monitor adherence and manage toxicities.

Operationally, Tobon noted that establishing a MID program requires substantial investment in staffing, prescriber education, and specialty accreditations, with provider buy-in a persistent challenge. In addition, Scimeca underscored the importance of, and challenges surrounding, payer contracts when dealing with external specialty pharmacies.

He explained that PBMs often steer oral oncology prescriptions to their own specialty pharmacies, limiting MID access. However, FCSRI retained approximately 75% of oral fills in-house through aggressive contracting. By contrast, Komorny said Moffitt can internally fill approximately 46% of oral oncology prescriptions due to insurance requirements.

With oral cancer drugs outpacing intravenous approvals approximately 2:1, Komorny emphasized the growing importance of MID pharmacies in oral oncology management. Tobon added that these models are well positioned to address rising therapeutic complexity by preventing fragmented care, instead strengthening collaboration among pharmacists and care teams.

“Getting the message out about what a medically integrated pharmacy is, what the importance of it is, and then to be prepared for all the volume of new drugs that are coming out and…have the touches on those so that we can continue to see things like 2-fold reduction in PSA in patients who have metastatic prostate cancer—our goal is to see that happens,” Komorny concluded.

New Frontiers in Multiple Myeloma and Breast Cancer Care

The event concluded with 2 discussions on specific cancer specialties, beginning with “Scaling Innovation: Delivering Targeted Therapies, CAR-T, and Bispecifics in Multiple Myeloma.” The panel featured moderator Ivan Borrello, MD, director of myeloma, bone marrow transplant, and cell therapy at Tampa General Hospital, alongside panelists Ameet Patel, MD, MMHC, director of cell therapy at FCSRI, and Syeda Saba Kareem, PharmD, BCOP, clinical pharmacy supervisor in malignant hematology at Moffitt.

The experts first highlighted how recent advances in multiple myeloma are expanding the role of both chimeric antigen receptor (CAR) T-cell therapy and bispecific antibodies, with growing potential for outpatient management. Patel discussed findings from the phase 3 MajesTEC-3 trial (NCT05083169) in second-line relapsed myeloma, which demonstrated one of the strongest HRs observed in multiple myeloma to date, underscoring the impact of bispecific combinations.¹

Kareem added that institutions should focus on when, rather than if, they move these therapies to outpatient settings, noting that prophylactic tocilizumab combined with structured remote monitoring has been instrumental in making outpatient step-up dosing feasible at her institution.

Regarding safety, Borrello emphasized that clinicians’ understanding of cytokine release syndrome (CRS) and immune effector cell–associated neurotoxicity syndrome (ICANS) as key toxicities for CAR T-cell therapy and bispecific therapies has improved. Building on Kareem’s point, he added that prophylactic use of tocilizumab has substantially improved adverse event profiles, with grade 3 to 4 CRS and ICANS incidences now relatively low among the 4 FDA-approved bispecific antibodies used to treat multiple myeloma and further reduced in combination regimens.

“There hasn’t been a single drug developed in multiple myeloma that has activity as a single agent that hasn’t shown even better activity when combined with something else,” Borrello said.

Patel added that safe community implementation of these treatments requires multistakeholder education, access to the intensive care unit and neurology support, and strong acute-care partnerships, often through hub-and-spoke models where tertiary centers manage induction and community practices provide ongoing maintenance.

The experts also discussed how bispecifics may compete with CAR T-cell therapy as both move into earlier lines of therapy. Kareem noted that bispecifics are particularly valuable for patients who are ineligible for CAR T-cell therapy or face access barriers. However, she warned that both approaches carry infection and neurotoxicity risks.

Patel acknowledged CAR T-cell therapy’s significant cost burden in community settings but argued against abandoning it, given its curative potential for some patients. Meanwhile, Borrello noted that treatment decisions often hinge on patient age and fitness, with bispecifics generally preferred for older patients with more frailty and CAR T-cell therapy for younger, fit patients seeking long-term remission.

“I think the reality is that there will always be patients [who] will be suitable for CAR T and there will always be patients [who] will be suitable for bispecifics, and I think there will also be patients who will ultimately be getting both of them,” Borrello said.

The IVBM concluded with the final panel, “Targeted Success: Operationalizing Therapies in Breast Cancer.” Soliman returned to the stage, this time to moderate the discussion between Kathrin Dvir, MD, MSc, assistant professor of medicine and oncology at Moffitt, and Jeanine Ewing, PharmD, BCOP, clinical oncology pharmacist at FCSRI.

The panel began by highlighting emerging therapies that are rapidly reshaping the treatment landscape for early and advanced breast cancer. Having presented previously at the San Antonio Breast Cancer Symposium in Texas, Dvir highlighted findings from the lidERA trial (NCT04961996), where the oral selective estrogen receptor degrader giredestrant demonstrated superiority over aromatase inhibitors and tamoxifen in early hormone receptor–positive/HER2-negative breast cancer, coupled with a more favorable adverse-effect profile, after only 3 years of follow-up.² She noted that these results suggest that giredestrant could redefine the adjuvant endocrine backbone.

Soliman and Ewing also emphasized the evolving role of antibody-drug conjugates such as trastuzumab deruxtecan and sacituzumab govitecan, alongside HER2-targeted and CDK4/6 inhibitor regimens. They noted that strategies are increasingly tailored to patient risk, with escalation for high-risk disease and de-escalation or maintenance approaches to preserve quality of life.

The panelists also highlighted how next-generation sequencing (NGS) and circulating tumor DNA (ctDNA) testing are becoming central to precision therapy in breast cancer. Because of this, Dvir and Ewing noted that identifying actionable mutations, such as ESR1 and PIK3CA, is critical for guiding targeted treatment. However, payer coverage and logistical hurdles often require extensive appeals or workaround solutions.

Although she routinely uses ctDNA and tissue testing to guide therapy at progression, Dvir emphasized that she avoids minimal residual disease–type ctDNA surveillance in early-stage disease outside of trials due to limited treatment guidance and the anxiety it can provoke for patients; this distinction underscores the evolving but nuanced role of molecular monitoring in clinical practice.

Despite a lifetime risk of approximately 1 in 8 women developing breast cancer, screening uptake and early detection remain a challenge, particularly for underserved or underinsured populations. The panelists pointed to cost, low perceived risk, and poor follow-up as barriers. To address these gaps, Dvir and Soliman advocated for reflex testing and integration of AI-based decision support within EMR automated workflows, such as triggering Oncotype DX or NGS testing when clinical criteria are met, which can reduce delays, standardize care, and mitigate bias while supporting the rapid incorporation of new evidence.

Soliman and Ewing stressed that AI is a tool to augment, not replace, clinician judgment. By combining automated decision support with individualized patient assessment, they noted that teams can more effectively integrate emerging therapies, molecular data, and patient-specific factors, ultimately improving outcomes while ensuring that care remains equitable and patient centered.

“I think AI is a good tool to help with deploying guideline changes so that people can be alerted when things need to be done, but at the end of the day, I think we need to make sure that there’s always expert oversight in that process so that it doesn’t get away from us,” Soliman concluded.

References

1. A study of teclistamab in combination with daratumumab subcutaneously (SD) (Tec-Dara) versus daratumumab SC, pomalidomide, and dexamethasone (DPd) or daratumumab SC, bortezomib, and dexamethasone (DVd) in participants with relapsed or refractory multiple myeloma (MajesTEC-3). ClinicalTrials.gov. Updated January 16, 2026. Accessed March 11, 2026. https://clinicaltrials.gov/study/NCT05083169
2. A study evaluating the efficacy and safety of adjuvant giredestrant compared with physician’s choice of adjuvant endocrine monotherapy in participants with estrogen receptor-positive, HER2-negative early breast cancer (lidERA breast cancer). ClinicalTrials.gov. Updated February 20, 2026. Accessed March 11, 2026. https://clinicaltrials.gov/study/NCT04961996