The Abramson Cancer Center is committed to reducing health disparities and providing the highest quality cancer care to everyone. The center’s embrace of diversity, equity and inclusion can be seen in everything from its community outreach and hiring practices to improving access to clinical trials for all patients.
Even as the medical community makes strides in reducing cancer deaths, wide disparities in cancer outcomes still exist. Black patients have higher cancer mortality rates than White patients, a difference that is seen across a number of cancer types.
According to the American Association for Cancer Research’s Cancer Disparities Progress Report 2022, Black men are twice as likely to die from prostate cancer than White men, and Black women have a 40% higher risk of dying of breast cancer than White women. The Abramson Cancer Center has long sought to reduce disparities like these through targeted efforts and community collaboration.
In 2020, as public discourse on racism and equity grew, we revisited this commitment and also took a deep look both inward and outward, asking what more we can do to eliminate bias within our organization and how can we better serve the economically, racially, and ethnically diverse communities that surround our hospitals and clinics. These thoughtful conversations launched a number of new initiatives to support employees, improve patient outcomes, and bolster outreach to the community. At its core remains a commitment to helping people live longer, healthier lives, either by preventing high-risk cancers or improving access to cutting-edge cancer treatments, in an environment in which everyone—patients, employees and community members—is treated equitably and with dignity.
It has been 10 years since the Abramson Cancer Center first created a dedicated leadership position focused on reducing health disparities, a role currently held by Carmen Guerra, MD, MSCE, FACP, Associate Director of Diversity and Outreach. We continue to expand both research and outreach, making progress toward reducing disparities in prevention, early detection and treatment through innovative, targeted programs.
Everyone has BRCA1 and BRCA2 genes. They repair damaged DNA and support the normal production of cells. When those genes mutate, they no longer function properly and the risk of breast cancer (as well as ovarian, pancreatic, prostate and melanoma) increases. These genetic mutations are passed from generation to generation, by both men and women.
Genetic testing to identify BRCA mutation carriers, accompanied by counseling, allows individuals the opportunity to consider preventative surgeries or receive surveillance screenings to catch cancer early. Without knowledge of family history—and subsequent counseling and testing—some people may not learn they have a gene mutation until they are diagnosed with cancer.
The Basser Center for BRCA at Penn Medicine is the first comprehensive center for the research, treatment and prevention of BRCA-related cancers. In 2020, the Center launched two initiatives to address racial disparities in cancer care: LATINOS & BRCA and BLACK & BRCA.
Through these programs, the Basser Center collaborates with patient advocates, researchers, and healthcare professionals to empower members of Latino and Black communities to understand their family history and take preventative action. Because early detection vastly improves patient outcomes, these efforts are key to saving lives. The American Cancer Society reports that while Black and White women are diagnosed with breast cancer at similar rates, Black women are more likely to be diagnosed at later stages of the disease when it is harder to treat. They are also less likely to have a medical provider recommend genetic testing.
The Basser Center’s LATINOS & BRCA and BLACK & BRCA programs offer targeted outreach to:
Genetic testing is one part of precision oncology—individualizing treatments based on a person’s hereditary risk or the molecular characteristics of their cancer. By beginning conversations related to genetic testing, we help people take charge of their health and potentially take meaningful steps to prevent cancer in themselves or their loved ones.
Clinical trials give patients an opportunity to receive the most advanced care and be part of the development of effective cancer therapies of the future. In many cases, a clinical trial may be a patient’s best hope to manage cancer. Yet, Black patients have been historically underrepresented in these efforts.
To address gaps in cancer care and improve access and treatment, the Abramson Cancer Center organized a five-year community outreach and engagement program to increase the enrollment of Black participants in cancer clinical trials. The efforts include:
These efforts reached more than 15,000 individuals in Philadelphia-area churches, neighborhoods and community centers, and the percentage of Black participants in cancer treatment trials at the Abramson Cancer Center doubled—from 12% to 24%.
Despite this success, the Abramson Cancer Center has not remained complacent. Several new programs were developed to ensure that patients have equitable access to participating in cancer clinical trials. One such effort is based on a partnership with the Lazarex Cancer Foundation to establish the Improving Patient Access to Cancer Clinical Trials (IMPACT) program, which provides lower income patients with financial reimbursement for cancer clinical trial travel- and lodging-related expenses.
The Abramson Cancer Center has also piloted a new program—the Clinical Trials Ambassador Program—designed to educate lay volunteers on cancer and cancer research and train them to be ambassadors for clinical trials in their communities. Armenta Washington, MS, senior research coordinator, in collaboration with Dr. Guerra, developed the curriculum for the cancer center’s inaugural program. Its first cohort of 19 ambassadors graduated in October 2021 and have since been conducting peer-to-peer education about clinical trials in their communities and providing valuable patient perspective to Abramson Cancer Center researchers.
These efforts to reduce disparities have served as a model for outreach around other diseases at Penn Medicine and beyond. For example, Dr. Guerra testified at a Pennsylvania Senate Hearing on racial disparities related to COVID-19, and proposed strategies that local and state agencies can take to overcome social determinants of health affecting these communities.
In June 2020, Abramson Cancer Center Director Robert Vonderheide, MD, DPhil, made a pronouncement via email that affirmed the Abramson Cancer Center’s position and prioritized new and ongoing initiatives focused on diversity, equity and inclusion: "The Abramson Cancer Center repudiates racism and discrimination of any kind, and is committed to leading by example in fostering a community inclusive of all—among our researchers, faculty, staff, trainees and patients."
His words created a ripple effect across the organization, validating existing efforts and spurring new ones. Oncology clinical units embraced the vision, as evidenced by the progress made by Hematology/Oncology, Radiation Oncology and Surgical Oncology to focus on eliminating bias and developing more diverse clinical groups to better meet the needs of our patient population.
The Division of Hematology/Oncology within the Department of Medicine has long been focused on improving the care and lives of patients of color. A Diversity, Equity and Inclusion (DEI) committee of 21 dedicated oncologists, faculty, fellows and staff leads this effort. Together, they are passionate about ensuring that their work is not just a reflection of the moment, but a movement that draws strength from their collective voices. Following Dr. Vonderheide’s statement, the committee was further inspired to look inward and see what the Abramson Cancer Center and Penn Medicine could do better.
Yehoda Martei, MD, MSCE, Vice Chief of Diversity, Inclusion and Health Equity in the Division of Hematology and Oncology, shares, "It was important for us to reflect on the fact that what we see on the national stage affects us locally, too, and realize that we still have a lot of work to do. I think sometimes when we think about disparities in care, we think about it happening ‘out there,’ because we do have such great initiatives at Penn. But we need to make sure that greatness is translating to all groups within our patient population."
A series of unconscious bias and upstander training sessions with staff and clinicians created a forum for clinicians to better understand their own biases and consider ways to ensure that every one of our patients receives the same incredible care.
"Often physicians look at their patient panel and say, ‘Well, I treat all my patients the same’," Dr. Martei says. "Yet the data tell another story. It helps us realize that as a health system, we have to think about more systematic ways to address some of these health equity gaps."
In addition to offering anti-bias trainings, the Department of Radiation Oncology focuses on creating a culture of humility, according to their Vice Chair for Inclusion, Diversity and Equity, Theresa M. Busch, PhD. They achieve this through education and civic engagement. Their website hosts a rich array of resources related to diversity and inclusion including "Listen Deeply"—educational content on topics such as unconscious bias, allyship and intersectionality. The department has also strengthened its connection to the community by teaming up with local schools and nonprofits on activities such as sock and school supply drives. Community partners include Greater Hope Christian Academy, University City Green and Philly Unknown.
This has been a time of reflection, not only in the toll racism has played in patient disparities, but also for our providers and staff in the clinic. The Division of Hematology/Oncology’s DEI committee recognized the need to discuss these very real issues openly in a space where people would feel heard.
The inaugural event, "Let’s Talk About It: Racism in the Clinic," began with Safiya Shabazz, MEd, sharing her own story of the racism she has faced in her role as an administrator.
"What started out as a service to help others understand they’re not alone actually became quite healing for me," Shabazz says. "So often we just suppress these emotions because we become accustomed to the racism and the injustice—we become numb. It was very healing to be able to share."
Others began sharing their own experiences as well, and leaned on one another for support.
"It just felt like such a sense of togetherness, because sometimes we get so bogged down with our day to day that we’re not able to connect with our faculty and staff," Shabazz says. "But in that moment, we were all one. Regardless of title, regardless of role, we were people dealing with all these emotions that we didn’t know how to deal with, and we were here to help each other."
There was such a positive reaction from the discussion that the committee held nine more sessions throughout the summer and into the fall.
"I will tell you, there were many tears shed throughout these sessions; they were hard. But out of them came a sense of community, a sense of trust that leadership cared and valued our perspectives and voices and that the division wanted to make real change," says Shabazz. "This wasn’t just a moment in time, this was a moment forever, and everyone felt it and continues to feel it because we continue to do the work."
Research shows patients who receive care from a clinician of the same race have better patient satisfaction and better outcomes when compared to patients who do not receive racially concordant care.
"I think people are realizing that it’s more than just a statistic, and to increase the odds of better outcomes, people are looking for diverse providers to see in the clinic and the hospital," says Yehoda Martei, MD, MSCE. "When you see people you trust, you tend to follow their recommendations more, and then you tend to have better outcomes."
Trust takes on an even greater level of importance for people with cancer and their family members. This is why the Abramson Cancer Center works collaboratively with key clinical departments to recruit, mentor and support Black, Latino and Asian clinicians. These efforts focus on faculty, fellows, medical students, undergraduates, and even extend to youth in the community.
"In our line of work, we take care of very seriously ill patients. Building cultural competency among our staff allows patients to see clinicians who might be able to identify with them or have knowledge of what community their family structures might be like. It is extremely important," says Pallavi Kumar, MD, MPH, Director of Oncology Palliative Care. "As clinicians, we need to understand what the context of someone’s life outside our clinic is. It’s not that everybody needs to get matched up with a provider who looks like them, but just knowing what questions to ask and what might affect a patient’s decisions, I think could be really helpful when we’re helping our patients navigate our health system."
Cary Aarons, MD, MSEd
Five years ago, when surgical oncologist Cary Aarons, MD, MSEd, was appointed Director of the General Surgery Residency Program, he observed that women and minorities were underrepresented among surgical trainees. He conducted a holistic review to understand why and then set out to very intentionally reverse this downward trend in the department.
The effort resulted in a doubling of minority and women fellows choosing to train at Penn Medicine from 14% to 31%. Key to this success is the recognition that maintaining a diverse workforce is more than checking boxes.
"Providing mentorship is integral to the process. We have to support trainees while they are here through structured mentorship," says Dr. Aarons.
Dr. Aarons was able to tap into resources already in place at Penn Medicine, especially the Alliance for Minority Physicians. The resources available through the Alliance help create an environment that fosters community and facilitates mentoring. Concurrently, the Department of Surgery, under the leadership of its chair, Ronald DeMatteo, MD, has been successful in recruiting underrepresented minority and female surgeons, particularly in oncology.
The increased energy around diversity has also been a boost for the Center for Surgical Health (CHS). What began in 2016 as free surgical consultations in West Philadelphia has evolved into an established clinical and outreach program to support uninsured and underinsured community members who need surgery. CHS works with community partners to identify people in need of help and match them with surgeons, including surgical oncologists.
The Abramson Cancer Center begins to identify and nurture talent long before residency. Outreach to high school and college students opens eyes to careers in academic medicine and creates pathways to achieving them. This is a special priority in radiation oncology, a field often unknown even to medical students before they discover it in medical school or after.
The Summer Undergraduate Program for Educating Radiation Scientists (SUPERS) brings high-achieving college students to campus for 10 weeks during the summer. Most of the students are underrepresented minorities or from economically disadvantaged backgrounds, including a number from Historically Black Colleges and Universities (HBCUs). Students work with a faculty mentor who introduces them to biomedical research on topics related to cancer biology, radiation oncology, radiation physics and math, and cancer imaging. Participants often go on to pursue medical degrees and doctoral programs.
"These opportunities are intended to be steppingstones to provide trainees or students to gain leverage in fields they are interested in," according to Dr. Busch, who also serves as leader of the Radiobiology and Imaging Program at the Abramson Cancer Center.
Department members also reach out to the community, speaking to teens at public high schools about career opportunities. A recent virtual event connected 14 radiation oncology professionals with students at Northeast High School.
The Division of Hematology/Oncology is formalizing a mentorship program for underrepresented minorities in medicine focused on fellows, medical students and undergraduates. The goal is to develop and retain a base of clinicians who are representative of the community we serve.
"One of our current fellows came to us and outlined the ways in which the medical school curriculum was not meeting the needs of diverse students and how they could do better," Erin Aakhus, MD, Director of the Hematology/Oncology Fellowship Program, shares. "It really opened my eyes to all the barriers minority physicians face early in their careers, and so I tried to envision a future for our program. How do we mentor and support individuals early on and maintain those relationships over time? Because that’s what it’s going to take. Resources are essential to providing mentorship at all levels—from undergraduate to faculty—to create these networks of support."
A recent gift from Thomas Rosato and his family is helping the team’s efforts by providing a stipend for two students from the Perelman School of Medicine who are underrepresented in today’s health setting, allowing them to explore their interest in oncology research and care in an eight-week summer intensive training program at the Abramson Cancer Center.
Increasing diversity within the department also shapes research, propelling studies that help us understand how different populations respond to new cancer therapies. Increasingly, Penn Medicine is able attract talented fellows and faculty because of the infrastructure and mentorship to support disparities research.
"It’s really notable how many of our fellows have been interested in disparities research," says Erin Aakhus, MD, Director of the Hematology and Oncology Fellowship Program. "I think having a more explicit focus on these issues as an institution is going to clear the path and open up opportunities for individuals who are very talented—who are going to be the future leaders of our field—to invest their time and their energy into trying to solve these problems."
