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Advocating for Action in HCC Advocating for Action in HCC: Delivering Impartial and Personalized Care This transcript has been edited for style and clarity and includes all slides from the presentation. This activity is provided by This educational activity is supported by a medical education grant from Exelixis, Inc., and is supported by an educational grant from Genentech, a member of the Roche Group. Advocating for Action in HCC: Delivering Impartial and Personalized Care Monica L. Baskin, PhD and Josep M. Llovet, MD, PhD u Monica L. Baskin, PhD: Hello and welcome to this educational activity, Advocating for Action in HCC: Delivering Impartial and Personalized Care. u I’m Dr. Monica Baskin. I’m delighted to present to you a little bit more about understanding health disparities and inequities in HCC. Dr. Llovet will then join us to discuss targeted therapies Monica L. Baskin, PhD and a new era in HCC management — combination Professor of Preventive Medicine therapies. Associate Director for Community Outreach and Engagement University of Alabama at Birmingham School of Medicine O’Neal Comprehensive Cancer Center Birmingham, Alabama Advocating for Action in HCC: Delivering Impartial and Personalized Care – 1 u Here is a disclaimer and disclosure indicating that we may be discussing off-label use DISCLAIMER of approved agents or agents Participants have an implied responsibility to use the newly acquired information to enhance patient that are in development. outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patients’ conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities. DISCLOSURE OF UNLABELED USE This activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications. The opinions expressed in the activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings. u Here’s our financial disclosure information. Disclosure of Conflicts of Interest o Monica L. Baskin, PhD, has no real or apparent conflicts of interest to report. o Josep M. Llovet, MD, PhD, reported a financial interest/relationship or affiliation in the form of Consultant: Eli Lilly and Company; Bayer HealthCare, Inc; Bristol-Myers Squibb Co; Eisai Inc; Celsion Corp; Exelixis, Inc; Merck & Co, Inc; Ipsen Pharmaceuticals; Genentech, Inc; Roche; Glycotest Diagnostics; Fortress Biotech, Inc; Nucleix; Can-Fite BioPharma; Sirtex; MiNA Therapeutics; and AstraZeneca Pharmaceuticals. LP. Research grant: Bayer HealthCare, Inc; Eisai Inc; Bristol-Myers Squibb Co; Boehringer Ingelheim; and Ipsen Pharmaceuticals. Advocating for Action in HCC: Delivering Impartial and Personalized Care – 2 u And these are the learning objectives for this activity. Learning Objectives Upon completion of this activity, participants should be better able to: o Describe health disparities in o Identify patient populations at risk of hepatocellular carcinoma (HCC) developing HCC to eliminate that contribute to inequalities in disparities in HCC care for all health outcomes patients o Implement HCC screening and o Select appropriate treatment surveillance in racial and ethnic approaches for patients with HCC groups, disadvantaged populations, to help overcome disparities in care and in those at high risk for and promote health equity and development of HCC to improve improve quality of life early detection and prognosis u To start, let’s make sure we understand what is meant by health and healthcare disparities. Understanding Health Disparities and Inequities in HCC Advocating for Action in HCC: Delivering Impartial and Personalized Care – 3 u So when we’re talking about health and healthcare What Are Health and Healthcare Disparities? disparities, we’re referencing the difference in health or healthcare between groups o Health and healthcare disparities refer to differences in health and that are closely linked healthcare between groups that are with social, economic, and closely linked with social, environmental disadvantage. economic, and/or environmental So these can be examples disadvantage such as race and ethnicity, – Disparities occur across many dimensions, including race/ethnicity, socioeconomic status, their socioeconomic status, age, location, physical location, sex, disability sex, disability status, and sexual status, and sexual orientation. orientation Artiga et al. 2020. https://www.kff.org/racial-equity-and-health-policy/issue-brief/disparities-in-health-and-health-care-five-key-questions-and-answers/. u More specifically, the National Cancer Institute defines What Are Cancer Health Disparities? cancer health disparities as differences in cancer measures Cancer disparities (cancer health disparities) consist of differences in such as the number of new cancer measures such as: cases, all existing cases, deaths, cancer-related health – Incidence (new cases) – Survivorship, including quality of life complications, survivorship, after cancer treatment – Prevalence (all existing cases) financial burden, screening – Mortality (deaths) – Financial burden of cancer or rates, or stage at diagnosis. – Morbidity (cancer-related health related health conditions complications) – Screening rates – Stage at diagnosis National Cancer Institute. 2020. https://www.cancer.gov/about-cancer/understanding/disparities Advocating for Action in HCC: Delivering Impartial and Personalized Care – 4 u One such example is depicted Cancer Death Rates* by Race and Ethnicity, here in this graph by the Centers for Disease Control US, 2013-2017 and Prevention. It’s looking at cancer death rates by race and ethnicity for the years 2013 to 2017. What you will see here is that the rates of cancer deaths do vary by race and ethnicity with non-Hispanic blacks, both male and female, having higher rates of cancer deaths during that period than any other racial and ethnic group. You might also notice the *Per 100,000, age-adjusted to the 2000 US standard population. †Data based on Purchased/Referred Care Deliver Area counties. ‡Persons of Hispanic origin may be of any race. differences between males and Sources: National Center of Health Statistics, Centers for Disease Control and Prevention, 2019. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2020/incidence-and-mortality-rates-race-and-ethnicity-2012-2017.pdf females where overall, males were more likely to die from cancer than females across each of those groups. u Why do these disparities exist? There are a number Why Do Health Disparities Exist? of reasons in the literature that suggest why we may o Social determinants of health see the differences in cancer health outcomes. There are o Unconscious/implicit bias social determinants of health Limited trust between patients and provider so things beyond biology o may be implicated in these o Limited trust between patients and the healthcare system disparities. We also know that unconscious or implicit bias o The payment system for medical professionals has a role, as well as limitations in trust both between patients and providers as well as patients and the healthcare system, in general, and there may be implications of the way in which health systems and providers are paid that may play a role. So we’ll briefly talk about each one of those now. Advocating for Action in HCC: Delivering Impartial and Personalized Care – 5 Social Determinants of Health Economic Neighborhood and Community and Health Care Stability Physical Environment Education Food Social Context System Employment Housing Literacy Hunger Social Health Integration Coverage Income Transportation Language Access to Healthy Options Support Provider Expenses Safety Early Childhood Systems Availability Education Debt Parks Community Provide Vocational Medical Bills Playgrounds Engagement Linguistic and Training Cultural Support Walkability Discrimination Higher Education Competency Zip Code/ Stress Quality of Care Geography Health Outcomes Mortality, Morbidity, Life Expectancy, Health Care Expenditures, Health Status, Functional Limitations Artiga et al. 2020. https://www.kff.org/racial-equity-and-health-policy/issue-brief/disparities-in-health-and-health-care-five-key-questions-and-answers/. u First is social determinants code in determining your in the disparity. So whether of health. So we all probably health.’ So where you live, your you have appropriate social easily recognize that our housing and transportation, all supports to help you through biology and our genetics of that plays a role in terms of your cancer and other issues, play a role in our health and our health outcomes. whether you’re experiencing health outcomes. But what Education is another one of a significant amount of stress literature has shown is that those areas that’s considered or discrimination, and how there are these other things to be a social determinant well you’re integrated with that are not related directly of health.
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