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Cancer doesn’t discriminate, yet it doesn’t quite impact everyone in the same way, either. A significant body of evidence shows that race, ethnicity and social determinants of health, such as socioeconomic factors and geography, can influence who might develop cancer, the type of treatment a patient gets, and the likelihood of surviving the disease.
Consider, for instance, the fact that Black women with breast cancer are 41% more likely to die from the disease compared to white women, or that rates of colorectal, lung and cervical cancer are significantly higher in poor, rural Appalachia than they are in wealthier nearby urban areas.
Whether such discrepancies are due to differences in insurance coverage, patient health literacy, provider bias, biology, or some combination of these and other factors isn’t totally clear.
That’s where a brand-new program, led by Ontada in partnership with The US Oncology Network (The Network), comes in. The Health Outcomes Powered by Evidence (HOPE)™ Studies program will enable physicians and advance practice providers (APP) in The Network to work with real world evidence (RWE) researchers in Ontada to use existing, deidentified (anonymous) patient data with the goal of improving patient care.
“The evidence shows that health disparities exist, but we need to better understand what’s happening and why in order to drive change,” says Susan Shiff, PhD, president of Ontada, a McKesson business focused on oncology real-world data and evidence, clinical education and provider technology. “We believe that providers and their teams from The Network on the frontlines of cancer care may hold the key to asking the questions that will provide meaningful answers, which is why we’re excited to partner with them on this critical new initiative.”
The Network consists of just over 1,400 oncology physicians in community-based practices across the United States. These physicians and their teams devote their time caring for patients and rarely have the time and resources to investigate research questions that arise in the course of their work, so Ontada aims to change that with the HOPE Studies.
Unlike clinical trials that evaluate the effects of a specific intervention (such as a new drug) compared to a group that receives a standard therapy, the HOPE Studies will use real world data (RWD) that already exists.
“These are retrospective observational studies that will provide information about what’s happening as part of day-to-day typical care,” Shiff explains.
Specifically, HOPE studies will empower researchers to access deidentified patient data from electronic health records (EHRs) of participating Network practices to conduct research studies using RWD. Ontada is uniquely poised to advance this type of research using its proprietary EHR system, iKnowMedSM, which is used across hundreds of care sites in The Network and other community oncology practices and provides Ontada with a large repository of standardized data – more than 2.5 million patient records. The company also has a track record of expertise conducting retrospective observational studies.
“We already do these types of studies for life science companies,” says Nicholas Robert, MD, chief medical officer at Ontada, who adds that the HOPE Studies were created in an effort to advance science that might otherwise go unsponsored. “We know we have the capability to help answer some key questions that will help patients. The mission and vision of Ontada is to transform the fight against cancer at the intersection of technology and data analytics. The HOPE Studies are aligned to that mission.”
To kick off the project, Ontada put out a request for proposals (RFP) and encouraged oncologists and APPs in The Network to submit ideas related to healthcare disparities. After reviewing the first set of submitted proposals, a joint selection committee of program leaders in Ontada and The Network selected three proposals as the initial HOPE Studies projects, which are now underway.
Two of those proposals were combined into one study addressing breast cancer. Michael Danso, MD of Virginia Oncology Associates and Robert Reid, MD of Virginia Cancer Specialists look to assess the impact of race and socioeconomic factors on chemotherapy prior to surgery and the use of genetic testing in women with “triple negative” breast cancer (TNBC). Triple negative refers to cancer that is not fueled by estrogen, progesterone or a protein called HER2. It tends to be an aggressive breast cancer that occurs at a higher incidence in African Americans. Chemotherapy before surgery and genetic testing are a standard of care for TNBC. However, certain groups of patients may be offered these interventions at different rates, which may contribute to poorer outcomes.
“In the last few years, we have witnessed significant improvements in the management of early-stage triple-negative breast cancer,” Dr. Danso says. “These improvements include the incorporation of immunotherapy and chemotherapy in the neoadjuvant [before surgery] setting, as well as the addition of PARP inhibitors to adjuvant therapy. Ensuring that these therapies are available to all women with early-stage triple-negative breast cancer should be an important priority for our network.”
The second study will be led by Rahul Ravilla, MD, of New York Oncology Hematology. It will focus on the impact of socioeconomic barriers to prescribing advanced androgen blockade therapy to patients with metastatic prostate cancer. This treatment entails using medication to block the effect of testosterone, a male hormone that promotes cancer growth. Use of androgen blockade has been shown to improve survival; however, prescribing challenges exist for patients who are candidates for this treatment. Identifying these factors will help with strategies to potentially improve access to these medications – and thus – survival.
Findings from these studies will be shared with members of The Network, as well as disseminated to the public via upcoming scientific conferences or publications in medical journals.
Ontada plans to explore additional HOPE Studies on healthcare disparities, as well as launch research on other key health issues. Additionally, Ontada is independently sponsoring these studies in the name of advancing health outcomes.
“We have the patients, the Network and the data,” Dr. Robert explains. “At the end of the day, it’s about doing the right thing for patients.”
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