The road to democratizing cancer care: City of Hope leader weighs in

The California Cancer Care Equity Act was signed into law Sept. 27, expanding access to specialized care to Medi-Cal patients with complex cancer, according to the Cancer Care is Different Coalition.

The law takes effect Jan. 1 and makes optimal cancer care services such as genomic testing, precision medicine-base care and clinical trials more readily available to vulnerable populations, according to a Sept. 28 news release from the Coalition.

Oncologist Joe Alvarnas, MD, vice president of government affairs at Duarte, Calif.-based City of Hope cancer care center, connected with Becker's to discuss the effects of this law and how other systems can democratize cancer care.

Editor's note: Responses have been edited for length and clarity.

Question: How will this law affect oncologists in California and their ability to prescribe cancer treatments?

Dr. Joe Alvarnas: I think it gets community oncologists to look very carefully at the patients before them and assess refractoriness of their cancers, persistence of their cancers or intolerance to known and effective treatment strategies. It gives those doctors the additional option of referring that patient to a National Cancer Institute or comprehensive cancer center in order for them to see whether or not a clinical trial, reanalysis based upon new genomic technologies or an alternative approach might be suitable.

Q: What outcomes do you expect to see once this bill takes effect in January?

JA: Well, that's when the work begins. Right now we are setting up meetings with the California Department of Health Care Services to figure out how best to operationalize the new law so that we translate it from a legislative victory to something that materially can support patients through their cancer journey. So establishing the mechanics and structure for how this works will be very important. The other two essential components are reaching out to patients and doctors to spread awareness of the new options.

Q: What are steps other hospitals and systems could take to get similar legislation passed in their states?

JA: Prior to this law, there was this thing called SCR 11, the cancer patient bill of rights. It sets out six core principles that every patient should expect as they go through their cancer journey. Part of this involves having their diagnosis explained to them in terms and in ways and languages that they can understand; to get immediate access to the right care expertise; to have their pain effectively managed; and to have the ability to access care at a center that can deliver clinical trials. I think the core principles created by SCR 11 point toward the priorities that we want either embedded in legislation, national legislation, or alternatively in things like the administrative rule set that Medicare relies upon as it evolves its programs. 

We see a lot of opportunities. I'll say it here: We're available as a resource to anybody who wants to move this kind of initiative forward.

Q: How else is City of Hope working to democratize cancer care?

JA: Our model for democratizing cancer care is really reliant upon three perspectives. One is through clinical trials create new care technologies so that patients can expect better outcomes tomorrow. The second part is always ensure that care is humanized both linguistically and culturally to make the cancer journey as humane as possible. And the third is build partnerships, both statewide and nationally, and ensure that they translate into an experiential difference for patients and families in communities.

Q: Is there anything else you want hospital executives to know? 

JA: I think it can be a frightening thing to go down the road of legislation. I think when you allow the voices of patients and their families to be heard by legislators and administrators, either at a state or federal level, extraordinary things can happen. And my advice to executives is, find a way to make that patient's voice heard so that they drive the greatest impact and create the greatest opportunities.

Q: Do you have advice on how to find and ask those patients to share their stories?

JA: If you've decided that you want to be an active participant in legislation and advocacy, then you have to work collaboratively because finding these patients' stories usually begins with someone speaking to their physician about how the system either treated them very poorly or very well. Both stories are valuable. That gets escalated through marketing communication so that we can make sure that their voice is heard in a way that maximizes impactful. You can't dabble in that. If that's the outward-facing presence that an executive wants to seek for their institution or for their system, then you have to build that prospectively.

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