Making Health Care Accessible for Acute Myeloid Leukemia Patients With Ian Bouligny, MD
At the 2022 American Society of Hematology (ASH) Annual Meeting, Dr. Ian Bouligny, Hematology/Oncology Fellow at Virginia Commonwealth University (VCU) Massey Cancer Center, spoke with Oncology Data Advisor about his abstract regarding health care disparities faced by Black patients with acute myeloid leukemia (AML). Dr. Bouligny explains the factors that contribute to treatment disparities and shares strategies for equalizing health care accessibility on both the local and the national levels.
This podcast episode was recorded live by Oncology Data Advisor and ConveyMED at the 2022 ASH Annual Meeting in New Orleans.
Oncology Data Advisor. Welcome to Oncology Data Advisor. Today I'm here with Dr. Ian Bouligny, who is here to talk about his abstract on health care disparities in AML treatment. Thanks much for being here today.
Ian Bouligny, MD: Yes, thank you very much. Thanks for having me, I appreciate it.
Oncology Data Advisor: Would you like to tell us a little bit about yourself and what you do?
Dr. Bouligny: Sure, I am a third-year Hematology/Oncology Fellow at VCU Massey Cancer Center. My area of clinical focus is acute leukemia, both acute myeloid leukemia and acute lymphoblastic leukemia (ALL). I'm going to be a third-year Hematology/Oncology Fellow for another six months, and then I will be going to the University of Texas MD Anderson Cancer Center in Houston, Texas.
Oncology Data Advisor: That's great. I know you have your study here on health care disparities in AML treatment. Would you like to tell us a little bit about the background behind this study and why you decided to investigate it?
Dr. Bouligny: Absolutely, I'd be delighted to. This work actually builds on several studies that we have done in the past year, which have been presented at national conferences—ASH last year in Atlanta, as well as the American Society of Clinical Oncology (ASCO) meeting in Chicago just this summer. We previously reported outcomes on AML and ALL patients receiving therapy, specifically looking at health care disparities between minorities and non-minorities. We were able to show quite a few striking findings.
One of the big findings that was concerning in our patient population specifically, which was reflective of a national population as well, was that minorities tended to have slower rates of proceeding to stem cell transplant, which is a curative modality. They tended to have lower rates of insurance coverage, as well. We hypothesized that the two may have been related. In addition to that, we also noticed lower rates of response and lower survival, particularly for the minority group. They tended to not do as well compared with the non-minorities.
The purpose of this year's presentation was to build on that data. We wanted to essentially be able to pin down what is happening in some of these specific minority groups. Minorities are a very, very large and diverse group. We specifically focused on African Americans in this study, which I'll just refer to as Black patients from here on out. One of the big findings that we discovered in this year's study was that Black patients, specifically Black males, were very much underrepresented. About 30% of our Black cohort was male, and 70% was female. This is strikingly different from national Surveillance, Epidemiology, and End Results (SEER) data, which is usually a 50/50 distribution between the sexes.
In addition to that, patients in our Black patient population cohort were also significantly more likely to not have private insurance coverage. They were either uninsured or they had Medicaid. In addition to that, after we had analyzed the baseline factors, we found that our Black cohort had lower overall survival numerically, but not statistically, compared with our White cohort. We had accounted for these differences when looking at issues with the biology of the disease, whether it was intermediate-risk versus adverse-risk AML. We accounted for those factors, and we found that in both cohorts, the survival was numerically shorter and favored the White cohort and not the Black cohort, and that shouldn't be happening.
We wanted to try to find out what factors had led to that. Those were our findings, and they really suggest a need for, first of all, more accessible health care for everyone, to be able to try to equalize those outcomes and try to get everyone a transplant, ideally, if we can. Second, the difference between Black males and the White cohort in being able to get treatment and have access to health care is very striking and very concerning. It's indicative that maybe we need to do a better job as physicians at reaching out to people, educating people, and trying to get these people in for follow-up so that they can be a treated. That was our study.
Oncology Data Advisor: Do you have any recommendations for how these findings could be implemented into practice in the future, both on a community level or even on a broader level?
Dr. Bouligny: Absolutely. There are a lot of ways, because with the state of health care in America right now, there are a lot of opportunities for improvements that we can certainly make. But with the results of our study, we found that the factor that represented the most striking area for improvement was being able to target populations of patients who may not have access to care, who are localized in certain areas in the community. Perhaps we can do something like open up a new clinic or a satellite clinic in those areas or make it easier for transportation to be accessible from our main center to those areas.
Those are some ways that we can increase the accessibility of health care, at least locally. But on a national level, more change has to happen—ideally, programs better than Medicaid or some other alternative programs that may offer partial coverage to try to get to stem cell transplant. It needs to be able to be offered to these patients and to happen for these patients. We don't really have anything like that. We have some patient assistance programs, but we really need to be able to build on what we can offer our patients so we can get them to transplant.
Oncology Data Advisor: Yes, definitely. Is there anything else you'd like to share, either about your research or about the other research you've seen presented here?
Dr. Bouligny: We do quite a bit of research on health care disparities, but a vast majority of our research is actually on molecular outcomes in particular for both AML and ALL. I do have another abstract that is being presented today in a poster presentation this afternoon, looking at molecular stratification of azacitidine or decitabine with venetoclax in the treatment of AML.
There has been considerable interest in this particular topic, because given the popularity and success of the combination regimen, we're always looking for ways that we can improve treatment outcomes and find certain molecular cohorts that may benefit from these drugs. That's exactly what we did. If you'd like to come by, I'd be happy to show you something about it.
Oncology Data Advisor: Definitely, and thanks so much for sharing all this. It was really great hearing about it.
Dr. Bouligny: Thank you very much, I appreciate it.
Thank you for listening to this podcast recorded live at the 2022 ASH Annual Meeting by Oncology Data Advisor and ConveyMED. For more expert perspectives on the latest in cancer research and treatment, be sure to subscribe to the podcast at OncData.com and conveymed.io. Don't forget to follow us on social media for news, exclusive interviews, and more!
About Dr. Bouligny
Ian Bouligny, MD, is a Hematology/Oncology Fellow at VCU Massey Cancer Center in Richmond, Virginia. His research focuses on health care disparities and molecular outcomes in acute leukemias, and he has presented his work at several national conferences.
For More Information
Bouligny IM, Murray G, Tran V, et al (2022). Healthcare disparities among African Americans are pervasive in the treatment of AML. 64th American Society of Hematology Annual Meeting. Abstract 2314.
Bouligny IM, Murray G, Tran V, et al (2022). IDH1/2mut for the win: comprehensive molecular stratification of venetoclax in combination with hypomethylating agents in AML. 64th American Society of Hematology Annual Meeting. Abstract 2817.
Transcript edited for clarity. Any views expressed above are the speaker's own and do not necessarily reflect those of Oncology Data Advisor.