BLOG: Creating systemic change with the ASTCT-NMDP ACCESS Initiative
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“With great power comes great responsibility.”
“Talent is equally distributed; opportunity is not.”
“Cancer doesn’t discriminate.”
At face value, these commonly recited quotes seem unrelated. However, if you are a cell therapist or transplanter, the commonality between them is painstakingly clear.
We are fortunate to practice in an era in which “no available donor” is a phrase rarely uttered, given the advances in donor sources, manipulation and risk mitigation.
We feel great power given our ability to offer cell therapies capable of eradicating the most refractory hematologic malignancies. Our treatments enable quality life for patients who have exhausted all options.
Then, there’s the talent. Transplantation and cell therapy centers around the country are translating groundbreaking therapies in record speed. Indeed, talent seems equally distributed within the field.
But are opportunities for the patients we serve equally distributed? Is it our responsibility as a society to ensure greater access to the evidence-based therapies our guidelines support?
These questions clearly are rhetorical. Our answer is a resounding yes, but how?
We often state that cancer doesn’t discriminate. The sentiment of this statement is clear: Cancer affects people young and old, regardless of race, ethnicity, sexual orientation or socioeconomic status. However, access to equitable cancer care can be discriminatory, often via the same mechanisms that enable systemic and societal inequalities.
In 2023, we are beyond the stage of simply defining these inequities. We are partnering to systematically dismantle access barriers that plague our patients throughout the therapeutic continuum.
The ASTCT-NMDP ACCESS Initiative is a key example of channeling the great power of these combined organizations to create change.
Following a series of planning meetings, a diverse group of key stakeholders from both organizations convened a workshop to identify solutions to enhance accessibility.
The awareness, poverty and racial/ethnic inequities working groups recently presented a summary of the workshop proceedings and next steps, which include creation of educational toolkits for referring physicians and updating national guidelines for indications for bone marrow transplantation (BMT).
Great attention was paid to addressing unconscious bias or unawareness that may limit referrals of patients based on socioeconomic status, limited support or race/ethnicity.
The groups recognized that responsibility does not start and end with the health care team.
State-based advocacy teams that address financial and psychosocial needs and partnerships with community organizations to deliver education will play key roles in enhancing access.
The race/ethnicity equity team emphasized that inequity solutions are not one-size-fits-all. To understand inequities based on race/ethnicity, centers must take stock of how their BMT/cell therapy demographics compare to expected demographics based on eligible patients within the catchment area and referral base.
To know where we are going, we must understand where we began.
“Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”
These powerful words, spoken by Dr. Martin Luther King, could not ring truer today.
The ASTCT-NMDP ACCESS Initiative gives us the opportunity to improve the experience of the many patients who may benefit from BMT and cell therapies.
With great power, comes great responsibility.
References :
- Auletta JJ, et al. Transplant Cell Ther. 2022;doi:10.1016/j.jtct.2022.09.020.
- Healio. BLOG: Organizations partner to expand access to bone marrow transplant, cell therapy. Available at: https://www.healio.com/news/hematology-oncology/20221219/national-organizations-partner-to-expand-access-to-bone-marrow-transplant-cell-therapy. Published Dec. 20, 2022. Accessed Jan. 28, 2023.
- NCI. Cancer Disparities. Available at https://www.cancer.gov/about-cancer/understanding/disparities. Accessed Jan. 28, 2023.