Impacts of Social Determinants of Health on Triple-Negative Breast Cancer Treatment With Nicholas Robert, MD

In this interview from the 2023 American Society of Clinical Oncology (ASCO) Annual Meeting, Oncology Data Advisor speaks with Dr. Nicholas Robert, Chief Medical Officer for Ontada, about his team’s abstract regarding the impacts of social determinants of health on genetic testing and treatment selection in triple-negative breast cancer (TNBC).  

Nicholas Robert, MD: My name is Nicholas Robert, the Chief Medical Officer for Ontada. Ontada is a McKesson company that’s involved with data analytics in technology in the oncology space.

Oncology Data Advisor: Today, we’re talking about your study here at ASCO on social determinants of health. Would you like to tell us about the study?

Dr. Robert: A little bit more than a year ago, Ontada decided that we wanted to give our physicians and our network, the US Oncology Network, the ability to do what we call investigator-initiated studies. We asked if they had questions around the issue of cancer care when it came to issues of social determinants of health. By social determinants of health, I mean issues like age, race, and ethnicity, as well as socioeconomic situations, status, and insurance.

We received a number of proposals, and we ended up doing two studies around the issue of triple negative breast cancer. Triple-negative breast cancer is an uncommon type of breast cancer, occurring in about 20% of patients, and it disproportionately affects African Americans. There were two questions we wanted to ask. One was about germline testing, which is looking for a genetic predisposition for cancer and seeing if there was any difference. And we also wanted to look at the use of neoadjuvant chemotherapy. That’s chemotherapy that’s given in early breast cancer, but prior to the surgery, thus it’s called neoadjuvant.

What we found, looking at these different social determinants of health, was that there was less testing in the African American population. It was still relatively high, around 67%; but in Whites, it was about 75%. Overall, the group actually had a high amount of testing, and that we think is related to the fact that the practices we evaluated have genetic screening programs in those practices. The number of over 70% is higher than what you would expect we would have found and what has been found elsewhere. So, there was a difference there.

But when we came and looked at the neoadjuvant use, we did not find a difference. We didn’t find a difference in African Americans versus Whites, and we didn’t find any difference between Hispanics and non-Hispanics. That was encouraging news. And that’s relative to the concern that African American women tend to not do as well with triple-negative breast cancer. One idea would be lack of treatment, but we didn’t see, at least when it came to the use of neoadjuvant chemotherapy, that it was a factor in this population of patients.

Oncology Data Advisor: That’s great. How do you suggest that these results can be used to inform treatment or inform practice?

Dr. Robert: It’s always good to do studies, but one should be thinking of what to do with the results. When it comes to screening, we need to raise awareness that all patients who are eligible should have genetic screening and should have germline testing. We know who these patients are. I mentioned that we’re a technology company. That means we, in this case, manage an electronic medical record (EMR) called iKnowMedSM. It’s an outpatient oncology EMR, and there are ways to increase the use of testing, including germline testing. We can modify and encourage use or add prompts to remind physicians and their teams when to do certain testing, like germline testing.

The other aspect is when it comes to outcomes and improving outcomes, at least we know in this group of patients that the use of neoadjuvant chemotherapy was appropriate. We have to think of other ways to improve the outcomes of this group of patients.

Oncology Data Advisor: Great. Since the theme of ASCO this year is “Partnering with Patients,” what are some of the ways you strive to do this at Ontada?

Dr. Robert: Partnering with patients is very important at Ontada, the US Oncology Network, McKesson, and Sarah Cannon Research Institute. Patients are front and center. We recently did a study with the University of Maryland, looking at social determinants of health when it comes to doing research in community oncology. The University of Maryland has what’s called a patient program, which gives patients the opportunity to provide feedback to researchers, which might not always be good news because you might get some information that you probably should have known but didn’t know. One of the takeaways is to reach out and engage patients.

For some time, the Institute of Medicine has said that patients should be the center and should be part of the decision-making process. Actually making that happen is a bit challenging. One of the things we’ve done in Ontada is that we have a patient portal called Ontada Health, and that gives patients an opportunity and a platform to reach out to their physicians and their teams. But it also gives us an opportunity to reach out and provide educational information, and it provides an opportunity to ask patients questions. Moving forward, per the theme of ASCO this year—just as it was only a couple years ago, when social determinants of health was a theme—I think we’ll find more efforts, both in academic settings but also in community oncology settings, where there’s more reaching out to the patient.

I’ll finish up by saying that we talked about social determinants of health. If you identify a patient with a barrier in terms of their health care, food insecurity, or transportation, it’s one thing identifying that. It’s another thing doing something about it. In our network, US Oncology, we are rolling out a platform called Find Help, where using the patient’s zip code, you can identify resources that can address some of those barriers, like food insecurity and transportation. I think we’re taking it to heart that our role is to improve patient care, and that journey certainly needs to involve the patient—not passively, but actively—and not only the patient, but also their caregivers.

Oncology Data Advisor: Absolutely. This is great to hear about. Thanks so much for talking about it with me.

About Dr. Robert

Nicholas Robert, MD, is the Chief Medical Officer for Ontada, a real-world data company focused on technology solutions for oncology providers, targeted channels for provider and biopharmaceutical engagement, and analysis of clinical research data and evidence solutions. At Ontada, Dr. Robert ensures scientific standards and clinical relevance for studies, data offerings, and educational programs, and he collaborates with physicians and physician-led groups to support clinical initiatives for the multidisciplinary team.

For More Information

Danso MA, Dye J, Leong T, et al (2023). Social determinants of health and utilization of neoadjuvant chemotherapy in patients with triple negative breast cancer (TNBC) in the community oncology setting. J Clin Oncol (ASCO Annual Meeting Abstracts), 41(suppl_16). Abstract 610. DOI:10.1200/JCO.2023.41.16_suppl.610

Transcript edited for clarity. Any views expressed above are the speaker’s own and do not necessarily reflect those of Oncology Data Advisor. 

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