Making Medical Strides, Despite Socioeconomic and Cultural Setbacks

Last month, when I sat down to write this message, we were on the cusp of the spring oncology meetings with the bright prospect of warm and sunny days, great science, and camaraderie that most of us have not had a chance to enjoy for more than two years. While the American Society of Clinical Oncology (ASCO) and European Hematology Association (EHA) Annual Meetings delivered in spades on all the things I was looking forward to, the world around us has not been quiet. As nearly all my colleagues have reminded me, the political discord, specter of gun violence, and impact of an economic downturn will affect each of us or those we serve.

The heated arguments over the ASCO Plenary talk on the role of transplant in myeloma were a wonderful reminder of the pre-COVID-19 era when these discussions occurred in person, not just on social media. In the interest of full disclosure, I am an author on the abstract and paper and have very strong evidence-based views on how this trial sets a new bar for remission duration for newly diagnosed myeloma patients.* But what does this mean for the patient who can’t afford to travel to a transplant center to get this important care because of resource limitations as a consequence of our current economic state or the challenge of getting high-touch care several hours from home?

In the area of lymphoma advances, important data were presented on limited-duration bispecific administration that results in very high overall response rates and long-term remission. But what does this mean for the patient who doesn’t have adequate—or any—health care coverage for any number of reasons, including living in a state where the Affordable Care Act has not been adopted?

In the treatment of myeloid malignancies, we have made huge strides to get away from the toxic ‘7+3’ and move toward more targeted treatments using small molecule inhibitors or tyrosine kinase inhibitors. Consequently, we have fundamentally changed the treatment landscape for all myeloid malignancies.

But these advances pale in comparison to the anguish we have witnessed among the families of shooting victims in general and specifically in schools. As hematologists and oncologists, we take great pride in how the collective field has changed over the past 20 years, but on the front lines, access to care and public health measures have fallen by the wayside. As we have seen with the reduction in median survival in the United States during the pandemic, their impact on median survival is far greater than any new drug or treatment we discover in blood cancers.

So how do we reconcile these two disparate issues? Is all hope lost and our work to be for nothing? My LOUD response is absolutely not! ASCO, EHA, and other medical society meetings represent the best of who we are—people working together toward a common goal, which is improving outcomes for the patient in front of us. In any given setting, all we can do is try to impact what is in front of us, either through our work or activism. But it is also clear to me that there are more of us who want a better world than the naysayers and people who continue to foment division and strife.

I am proud to be part of the fellowship of physicians who are striving to create a better world, in any way possible. Whether outside the clinic by advocating for social justice or in the clinic as part of clinical trials moving the field forward—or both—we should continue to set an example for what collaboration and teamwork look like, along with the outstanding work you will see presented in this issue of Blood Cancers Today. Enjoy this issue, keep your head up, and keep up the great work.

*Results of the phase III DETERMINATION trial were presented at the 2022 ASCO Annual Meeting and published in The New England Journal of Medicine.

Sagar Lonial, MD, FACP, is Chair and Professor in the Department of Hematology and Medical Oncology, the Anne and Bernard Gray Family Chair in Cancer, and Chief Medical Officer of Winship Cancer Institute at Emory University School of Medicine in Atlanta, Georgia.