1 00:00:05,080 --> 00:00:10,720 >> I AM RE-INTRODUCING MYSELF 2 00:00:10,720 --> 00:00:12,040 FROM YESTERDAY, SHEILA 3 00:00:12,040 --> 00:00:13,400 RAJAGOPAL. 4 00:00:13,400 --> 00:00:16,560 I AM THE SESSION CHAIR TODAY FOR 5 00:00:16,560 --> 00:00:18,440 THE UPCOMING SESSION THIS 6 00:00:18,440 --> 00:00:19,640 MORNING. 7 00:00:19,640 --> 00:00:21,080 ONE QUESTION FOR THE AUDIENCE 8 00:00:21,080 --> 00:00:23,280 MEMBERS WHO ARE HERE THIS 9 00:00:23,280 --> 00:00:25,120 MORNING, VERY MUCH APPRECIATE 10 00:00:25,120 --> 00:00:27,080 IT, HOW MANY OF YOU ALL DO WORK 11 00:00:27,080 --> 00:00:29,040 EITHER IN ADVOCACY OR RESEARCH 12 00:00:29,040 --> 00:00:30,560 THAT'S RELATED TO GLOBAL HEALTH? 13 00:00:30,560 --> 00:00:36,040 RAISE YOUR HAND. 14 00:00:36,040 --> 00:00:36,760 OKAY, GOOD! 15 00:00:36,760 --> 00:00:38,120 THAT'S MORE THAN I WAS EXPECTING 16 00:00:38,120 --> 00:00:39,280 BUT STILL NOT AS MANY AS WE 17 00:00:39,280 --> 00:00:41,840 WOULD LIKE TO SEE WHEN WE GET 18 00:00:41,840 --> 00:00:42,960 SUCH A MIX OF PEOPLE INTERESTED 19 00:00:42,960 --> 00:00:44,480 IN WORKING ON DISPARITIES IN 20 00:00:44,480 --> 00:00:47,440 DIFFERENT WAYS. 21 00:00:47,440 --> 00:00:51,880 SO IT IS MY PLEASURE TO 22 00:00:51,880 --> 00:00:54,320 INTRODUCE DR. GOPAL JOINING US 23 00:00:54,320 --> 00:00:55,480 FROM OUR CONFERENCE ON GLOBAL 24 00:00:55,480 --> 00:00:57,320 HEALTH THAT'S ALSO TAKING PLACE. 25 00:00:57,320 --> 00:00:58,040 WE VERY MUCH APPRECIATE HIS 26 00:00:58,040 --> 00:00:58,360 TIME. 27 00:00:58,360 --> 00:01:00,280 HE'S THE DIRECTOR FOR THE CENTER 28 00:01:00,280 --> 00:01:01,960 OF GLOBAL HEALTH HERE AT THE 29 00:01:01,960 --> 00:01:03,240 NCI. 30 00:01:03,240 --> 00:01:04,560 AND HE'LL BE TALKING TO US 31 00:01:04,560 --> 00:01:04,840 TODAY. 32 00:01:04,840 --> 00:01:05,400 VERY MUCH APPRECIATE IT. 33 00:01:05,400 --> 00:01:07,800 THANK YOU SO MUCH. 34 00:01:07,800 --> 00:01:11,640 [APPLAUSE] 35 00:01:11,640 --> 00:01:13,120 >>THANK YOU SO MUCH, SHEILA, 36 00:01:13,120 --> 00:01:23,560 AND THANKS FOR HAVING ME. 37 00:01:26,720 --> 00:01:29,400 JUST BRIEFLY FOR THE AUDIENCE, 38 00:01:29,400 --> 00:01:33,080 THE ONES WHO ARE HERE IN PERSON, 39 00:01:33,080 --> 00:01:34,520 THEY HAVE THE MICROPHONES TO ASK 40 00:01:34,520 --> 00:01:35,080 THE QUESTION. 41 00:01:35,080 --> 00:01:37,160 FOR THOSE JOINING US VIRTUALLY, 42 00:01:37,160 --> 00:01:38,160 YOU CAN SUBMIT THE QUESTIONS 43 00:01:38,160 --> 00:01:40,320 WITH SLIDO AND INSTRUCTIONS ARE 44 00:01:40,320 --> 00:01:40,840 ON THE WEBSITE. 45 00:01:40,840 --> 00:01:42,880 THANK YOU. 46 00:01:42,880 --> 00:01:43,840 >>GREAT. 47 00:01:43,840 --> 00:01:44,720 WELL, THANKS SO MUCH FOR HAVING 48 00:01:44,720 --> 00:01:45,360 ME. 49 00:01:45,360 --> 00:01:47,920 MY NAME IS SATISH GOPAL, I 50 00:01:47,920 --> 00:01:49,200 DIRECT THE CENTER FOR GLOBAL 51 00:01:49,200 --> 00:01:50,680 HEALTH AT THE NATIONAL CANCER 52 00:01:50,680 --> 00:01:51,720 INSTITUTE IN THE U.S. 53 00:01:51,720 --> 00:01:54,120 AND I'M REALLY PLEASED IN THIS 54 00:01:54,120 --> 00:01:55,960 SESSION TO TRY TO OFFER A BIT OF 55 00:01:55,960 --> 00:01:58,600 A GLOBAL PERSPECTIVE ON WHAT I 56 00:01:58,600 --> 00:02:00,680 UNDERSTAND AND APPRECIATE IS A 57 00:02:00,680 --> 00:02:02,120 LARGELY DOMESTICALLY ORIENTED 58 00:02:02,120 --> 00:02:03,600 DISPARITIES MEETING. 59 00:02:03,600 --> 00:02:07,840 STEPHAN STEFAN AND I HAVE ALREAY 60 00:02:07,840 --> 00:02:08,920 DISCUSSED HOW WE INTEND TO 61 00:02:08,920 --> 00:02:10,120 CHANGE THAT NEXT YEAR. 62 00:02:10,120 --> 00:02:11,760 IF YOU'LL INDULGE ME, I JUST 63 00:02:11,760 --> 00:02:14,720 WANTED TO DO ONE SLIDE ON CANCER 64 00:02:14,720 --> 00:02:17,880 BURDEN GLOBALLY, JUST FOR 65 00:02:17,880 --> 00:02:19,200 CONTEXT, AGAIN, APPRECIATING 66 00:02:19,200 --> 00:02:20,960 THIS IS A LARGELY DOMESTICALLY 67 00:02:20,960 --> 00:02:22,080 ORIENTED MEETING BUT I THINK AS 68 00:02:22,080 --> 00:02:23,560 IS FAMILIAR TO ALL OF YOU, 69 00:02:23,560 --> 00:02:24,440 GLOBAL CANCER DEATHS ARE 70 00:02:24,440 --> 00:02:27,080 INCREASING RAPIDLY, AND 71 00:02:27,080 --> 00:02:28,200 APPROXIMATELY 70% OF THESE WILL 72 00:02:28,200 --> 00:02:30,040 OCCUR IN LOW AND MIDDLE INCOME 73 00:02:30,040 --> 00:02:31,600 COUNTRIES BY 2040. 74 00:02:31,600 --> 00:02:33,080 THESE ARE DATA FROM OUR 75 00:02:33,080 --> 00:02:34,280 COLLEAGUES AT THE INTERNATIONAL 76 00:02:34,280 --> 00:02:38,480 AGENCY FOR RESEARCH ON CANCER OR 77 00:02:38,480 --> 00:02:40,520 IARC TO CLASSIFY CANCER BURDEN 78 00:02:40,520 --> 00:02:40,920 IN 2020. 79 00:02:40,920 --> 00:02:42,800 THESE ARE DEATHS SHOWN IN THE 80 00:02:42,800 --> 00:02:44,560 OPEN CIRCLES AT THE BOTTOM AND 81 00:02:44,560 --> 00:02:45,920 THEN PROJECTED DEATHS SHOWN IN 82 00:02:45,920 --> 00:02:47,360 THE COLORED -- IN THE SOLID 83 00:02:47,360 --> 00:02:49,360 CIRCLES AT THE TOP WITH 84 00:02:49,360 --> 00:02:50,760 COUNTRIES CLASSIFIED BASED ON 85 00:02:50,760 --> 00:02:52,640 THEIR HUMAN DEVELOPMENT INDEX 86 00:02:52,640 --> 00:02:54,400 CATEGORY OR HDI. 87 00:02:54,400 --> 00:02:56,640 AND GENERALLY SPEAKING, THE 88 00:02:56,640 --> 00:02:58,360 THREE CATEGORIES SHOWN IN THE 89 00:02:58,360 --> 00:03:01,080 BOX CORRESPOND WITH THE WORLD 90 00:03:01,080 --> 00:03:03,000 BANK CLASSIFICATIONS WITH 91 00:03:03,000 --> 00:03:03,920 LMICs. 92 00:03:03,920 --> 00:03:05,360 THE THING I LIKE TO POINT OUT -- 93 00:03:05,360 --> 00:03:06,880 SO WHAT YOU'LL SEE HERE IS THAT 94 00:03:06,880 --> 00:03:08,840 MOST CANCER WORLDWIDE OCCURS 95 00:03:08,840 --> 00:03:11,160 TODAY IN LOW AND MIDDLE INCOME 96 00:03:11,160 --> 00:03:12,720 COUNTRIES AND THIS WILL BECOME 97 00:03:12,720 --> 00:03:13,560 INCREASINGLY TRUE GOING FORWARD, 98 00:03:13,560 --> 00:03:15,400 AND THAT THE LARGEST 99 00:03:15,400 --> 00:03:16,440 PROPORTIONAL INCREASES IN CANCER 100 00:03:16,440 --> 00:03:18,320 BURDEN WILL OCCUR IN THE LOWEST 101 00:03:18,320 --> 00:03:18,760 INCOME COUNTRIES. 102 00:03:18,760 --> 00:03:20,880 SO FOR EXAMPLE, THE LOWEST HD 103 00:03:20,880 --> 00:03:21,920 I-CAT GRI WILL SEE A NEAR 104 00:03:21,920 --> 00:03:24,280 DOUBLING OF CANCER DEATHS 105 00:03:24,280 --> 00:03:26,160 BETWEEN 2020 AND 2040. 106 00:03:26,160 --> 00:03:27,360 EVEN -- AND THIS IS OCCURRING 107 00:03:27,360 --> 00:03:28,600 OBVIOUSLY IN HEALTH SYSTEMS THAT 108 00:03:28,600 --> 00:03:30,840 ARE ALREADY OVERSTRETCHED, AND 109 00:03:30,840 --> 00:03:32,880 FACING MANY COMPETING HEALTH 110 00:03:32,880 --> 00:03:33,920 PRIORITIES, INCLUDING A 111 00:03:33,920 --> 00:03:35,680 CONTINUING LARGE BURDEN OF 112 00:03:35,680 --> 00:03:37,640 COMMUNICABLE DISEASES. 113 00:03:37,640 --> 00:03:38,600 THE OTHER POINT I ALWAYS LIKE TO 114 00:03:38,600 --> 00:03:40,080 MAKE, AND I WON'T BELABOR THIS 115 00:03:40,080 --> 00:03:43,080 AS I SOMETIMES DO IN TALKS, IS 116 00:03:43,080 --> 00:03:44,320 THAT THIS IF ANYTHING, I THINK, 117 00:03:44,320 --> 00:03:45,480 IS AN UNDERESTIMATE. 118 00:03:45,480 --> 00:03:47,720 THAT IS, WHEN IARC PROJECTS 119 00:03:47,720 --> 00:03:49,960 FORWARD TO 2040, THEY LOCK IN 120 00:03:49,960 --> 00:03:51,120 CURRENT AGE STANDARDIZED RATES 121 00:03:51,120 --> 00:03:53,160 AND THEN PROJECT THOSE FORWARD 122 00:03:53,160 --> 00:03:54,360 ON TO ANTICIPATED GROWTH AND 123 00:03:54,360 --> 00:03:57,480 AGING OF POPULATIONS WORLD WILD. 124 00:03:57,480 --> 00:03:57,760 WORLDWIDE 125 00:03:57,760 --> 00:03:59,240 SO THESE REALLY REFLECT 126 00:03:59,240 --> 00:04:00,640 DEMOGRAPHIC CHANGES GLOBALLY. 127 00:04:00,640 --> 00:04:02,600 WE KNOW SAN KER RATES ARE 128 00:04:02,600 --> 00:04:03,320 DIFFERENTIALLY CHANGING AROUND 129 00:04:03,320 --> 00:04:03,960 THE WORLD. 130 00:04:03,960 --> 00:04:05,440 WE IN THE U.S. AND OTHER HIGH 131 00:04:05,440 --> 00:04:07,320 INCOME COUNTRIES HAVE ENJOYED 132 00:04:07,320 --> 00:04:09,240 GENERALLY DECLINING AGE-SPECIFIC 133 00:04:09,240 --> 00:04:10,600 CANCER INCIDENCE AND MORTALITY 134 00:04:10,600 --> 00:04:11,880 RATES IN RECENT YEARS AND AS YOU 135 00:04:11,880 --> 00:04:14,200 KNOW, THE REIGNITED CANCER 136 00:04:14,200 --> 00:04:15,840 MOONSHOT HAS NOW CALLED ON US TO 137 00:04:15,840 --> 00:04:17,080 FURTHER ACCELERATE THAT PROGRESS 138 00:04:17,080 --> 00:04:19,000 TOWARDS A 50% REDUCTION OVER THE 139 00:04:19,000 --> 00:04:20,160 NEXT 25 YEARS. 140 00:04:20,160 --> 00:04:21,720 THAT IS NOT OCCURRING. 141 00:04:21,720 --> 00:04:22,960 IT'S ACTUALLY THE CONVERSE IN 142 00:04:22,960 --> 00:04:25,200 MOST LOW INCOME COUNTRIES, WHERE 143 00:04:25,200 --> 00:04:26,480 THEY'RE SEEING INCREASES IN THE 144 00:04:26,480 --> 00:04:27,800 AGE STANDARDIZED CANCER 145 00:04:27,800 --> 00:04:28,840 INCIDENCE AND MORTALITY RATE. 146 00:04:28,840 --> 00:04:30,400 SO IF YOU APPLY DIFFERENTIALLY 147 00:04:30,400 --> 00:04:31,480 CHANGING RATES AROUND THE WORLD 148 00:04:31,480 --> 00:04:33,440 ON TO THESE ANTICIPATED 149 00:04:33,440 --> 00:04:35,680 DEMOGRAPHIC CHANGES, I THINK IF 150 00:04:35,680 --> 00:04:36,720 ANYTHING, LMICs WILL BEAR AN 151 00:04:36,720 --> 00:04:38,480 EVEN LARGER BURDEN OF CANCER 152 00:04:38,480 --> 00:04:38,960 BURDEN GOING FORWARD. 153 00:04:38,960 --> 00:04:40,800 AT THE BOTTOM, I'VE JUST 154 00:04:40,800 --> 00:04:41,600 ILLUSTRATED, THIS IS NOT TO 155 00:04:41,600 --> 00:04:43,360 ARGUE THAT CANCER IS MORE 156 00:04:43,360 --> 00:04:44,760 IMPORTANT THAN COVID, BUT WHAT 157 00:04:44,760 --> 00:04:49,040 THIS TRANSLATES TO IN 2020 IS 158 00:04:49,040 --> 00:04:50,640 APPROXIMATELY 27,000 REGISTERED 159 00:04:50,640 --> 00:04:51,880 GLOBAL CANCER DEATHS PER DAY, AS 160 00:04:51,880 --> 00:04:53,120 COMPARED WITH, ACCORDING TO DATA 161 00:04:53,120 --> 00:04:54,320 THAT I PULLED DOWN FROM THE 162 00:04:54,320 --> 00:04:56,560 INSTITUTE FOR HEALTH MATRIX AND 163 00:04:56,560 --> 00:04:59,040 EVALUATION YESTERDAY ABOUT 6,800 164 00:04:59,040 --> 00:05:00,120 GLOBAL COVID DEATHS PER DAY 165 00:05:00,120 --> 00:05:00,760 REPORTED CURRENTLY. 166 00:05:00,760 --> 00:05:02,040 THIS NUMBER HAS GONE UP RECENTLY 167 00:05:02,040 --> 00:05:03,600 OVER THE LAST SEVERAL MONTHS, 168 00:05:03,600 --> 00:05:05,040 LARGELY DUE TO THE INCREASED 169 00:05:05,040 --> 00:05:09,360 CASE COUNTS IN CHINA. 170 00:05:09,360 --> 00:05:11,440 IT WAS QUITE A BIT LOWER SEVERAL 171 00:05:11,440 --> 00:05:12,080 MONTHS AGO. 172 00:05:12,080 --> 00:05:14,280 SO NOT TO ARGUE THAT CANCER IS 173 00:05:14,280 --> 00:05:15,920 MORE IMPORTANT THAN COVID BUT 174 00:05:15,920 --> 00:05:17,280 CANCER DOESN'T TEND TO ATTRACT 175 00:05:17,280 --> 00:05:19,080 THE KIND OF POLITICAL 176 00:05:19,080 --> 00:05:19,960 ATTENTION/URGENCY THAT COVID 177 00:05:19,960 --> 00:05:21,280 DOES, ESPECIALLY GLOBALLY, GIVEN 178 00:05:21,280 --> 00:05:23,160 THAT THIS IS A PUBLIC HEALTH 179 00:05:23,160 --> 00:05:24,320 EMERGENCY THAT IS DEVELOPING 180 00:05:24,320 --> 00:05:26,440 OVER YEARS IF NOT DECADES. 181 00:05:26,440 --> 00:05:30,040 SO THAT'S IT FOR BURDEN. 182 00:05:30,040 --> 00:05:31,400 THEN I WOULD LIKE TO TALK A 183 00:05:31,400 --> 00:05:32,640 LITTLE ABOUT CANCER RESEARCH, 184 00:05:32,640 --> 00:05:34,720 AND AGAIN, THIS IS A POINT THAT 185 00:05:34,720 --> 00:05:36,120 I OFTEN BELABOR OVER MANY SLIDES 186 00:05:36,120 --> 00:05:37,520 BUT I WON'T DO THAT TODAY JUST 187 00:05:37,520 --> 00:05:39,000 IN THE INTEREST OF TIME. 188 00:05:39,000 --> 00:05:41,440 BUT IF CANCER BURDEN IS GOING TO 189 00:05:41,440 --> 00:05:43,240 INCREASINGLY LIE IN LOW AND 190 00:05:43,240 --> 00:05:45,560 MIDDLE INCOME COUNTRIES GOING 191 00:05:45,560 --> 00:05:46,440 FORWARD, HOW GOOD HAVE WE BEEN 192 00:05:46,440 --> 00:05:48,120 AS A CANCER RESEARCH COMMUNITY 193 00:05:48,120 --> 00:05:52,200 IN ADDRESSING THAT PROBLEM? 194 00:05:52,200 --> 00:05:53,520 NOT SURPRISINGLY, THE ANSWER 195 00:05:53,520 --> 00:05:54,760 CERTAINLY IN MY VIEW IS NOT VERY 196 00:05:54,760 --> 00:05:56,120 GOOD, AND THIS IS JUST ONE 197 00:05:56,120 --> 00:05:56,600 ILLUSTRATION OF THAT. 198 00:05:56,600 --> 00:05:57,880 SO THIS IS A REALLY NICE PAPER 199 00:05:57,880 --> 00:05:59,000 FOR THOSE OF YOU WHO ARE 200 00:05:59,000 --> 00:05:59,560 INTERESTED. 201 00:05:59,560 --> 00:06:01,760 THESE AUTHORS SYSTEMATICALLY 202 00:06:01,760 --> 00:06:04,000 REVIEWED ALL ONCOLOGY RANDOMIZED 203 00:06:04,000 --> 00:06:05,800 CONTROL TRIALS PUBLISHED BETWEEN 204 00:06:05,800 --> 00:06:07,320 2014 AND 2017. 205 00:06:07,320 --> 00:06:08,760 THESE WERE ENGLISH LANGUAGE 206 00:06:08,760 --> 00:06:10,400 REPORTS OF PHASE THREE STUDIES 207 00:06:10,400 --> 00:06:12,720 TESTING ANY CANCER DIRECTED 208 00:06:12,720 --> 00:06:13,200 THERAPY. 209 00:06:13,200 --> 00:06:15,080 THERE WERE NEARLY 700 SUCH 210 00:06:15,080 --> 00:06:18,000 STUDIES, OF WHICH 8% WERE IN LOW 211 00:06:18,000 --> 00:06:19,920 AND MIDDLE INCOME COUNTRIES. 212 00:06:19,920 --> 00:06:22,360 SO AT LEAST 70% OF CANCER BURDEN 213 00:06:22,360 --> 00:06:24,640 AND 8% OF ONCOLOGY RANDOMIZED 214 00:06:24,640 --> 00:06:25,920 CONTROL TRIALS. 215 00:06:25,920 --> 00:06:28,480 51 OF THESE WERE IN UPPER MIDDLE 216 00:06:28,480 --> 00:06:29,320 INCOME COUNTRIES. 217 00:06:29,320 --> 00:06:31,520 THE VAST MAJORITY WERE IN CHINA. 218 00:06:31,520 --> 00:06:34,480 SEVEN WERE IN LOW MIDDLE INCOME 219 00:06:34,480 --> 00:06:35,520 COUNTRIES, THE VAST MA JORTD IN 220 00:06:35,520 --> 00:06:37,040 INDIA AND THERE WERE NO 221 00:06:37,040 --> 00:06:38,240 RANDOMIZED CONTROLS FOR CANCER 222 00:06:38,240 --> 00:06:39,920 FOR THIS PERIOD CONDUCTED IN A 223 00:06:39,920 --> 00:06:41,320 WORLD BANK CLASSIFIED LOW INCOME 224 00:06:41,320 --> 00:06:42,440 COUNTRY. 225 00:06:42,440 --> 00:06:44,680 AND SO THIS IS LIKE RESEARCH 226 00:06:44,680 --> 00:06:45,320 101, RIGHT? 227 00:06:45,320 --> 00:06:47,200 A BIASED SAMPLE GIVES YOU BIASED 228 00:06:47,200 --> 00:06:47,440 RESULTS. 229 00:06:47,440 --> 00:06:49,680 I THINK THE BODY OF COLLECTED 230 00:06:49,680 --> 00:06:51,000 KNOWLEDGE RESULTING FROM OUR 231 00:06:51,000 --> 00:06:52,720 CANCER RCTs ARE BIASED IN 232 00:06:52,720 --> 00:06:53,640 SEVERAL IMPORTANT WAYS. 233 00:06:53,640 --> 00:06:54,440 AND THAT'S IMPORTANT TO 234 00:06:54,440 --> 00:06:55,760 ACKNOWLEDGE. 235 00:06:55,760 --> 00:06:57,440 THEY'RE POORLY MATCHED TO GLOBAL 236 00:06:57,440 --> 00:06:58,480 CANCER BURDEN. 237 00:06:58,480 --> 00:07:00,560 THESE AUTHORS FOUND THAT THE 238 00:07:00,560 --> 00:07:02,000 RCTs THAT WERE CONDUCTED IN 239 00:07:02,000 --> 00:07:04,120 LOW AND MIDDLE INCOME COUNTRIES 240 00:07:04,120 --> 00:07:05,280 ACTUALLY MORE FREQUENTLY 241 00:07:05,280 --> 00:07:07,280 IDENTIFIED EFFECTIVE THERAPIES 242 00:07:07,280 --> 00:07:08,960 WITH LARGER EFFECT SIZES. 243 00:07:08,960 --> 00:07:11,760 PERHAPS DESPITE BEING A BETTER 244 00:07:11,760 --> 00:07:14,120 MATCH FOR GLOBAL CANCER BURDEN 245 00:07:14,120 --> 00:07:15,720 AND THERAPIES WITH LARGER EFFECT 246 00:07:15,720 --> 00:07:17,000 SIZE, THEY WERE GENERALLY 247 00:07:17,000 --> 00:07:19,000 PUBLISHED IN THE LOWEST IMPACT 248 00:07:19,000 --> 00:07:20,320 ONCOLOGY JOURNALS, I THINK 249 00:07:20,320 --> 00:07:21,600 SUGGESTING SOME REAL PUBLICATION 250 00:07:21,600 --> 00:07:22,240 BIAS THAT EXISTS. 251 00:07:22,240 --> 00:07:23,640 THIS IS JUST A FIGURE FROM THE 252 00:07:23,640 --> 00:07:25,560 PAPER SHOWING TOP 10 CANCERS 253 00:07:25,560 --> 00:07:27,200 GLOBALLY BY MORTALITY AND THEN 254 00:07:27,200 --> 00:07:29,520 THE TOP 10 CANCERS BY RCTs. 255 00:07:29,520 --> 00:07:31,200 FOR SOME PEOPLE IN AN IDEAL 256 00:07:31,200 --> 00:07:33,240 WORLD, THERE WOULD BE A DIRECT 257 00:07:33,240 --> 00:07:34,720 CORRELATION HERE, BUT ONE CAN 258 00:07:34,720 --> 00:07:36,560 SEE THAT THERE REALLY ISN'T. 259 00:07:36,560 --> 00:07:37,840 AND PARTICULARLY FOR SOME OF THE 260 00:07:37,840 --> 00:07:39,680 CANCERS THAT OCCUR MOST 261 00:07:39,680 --> 00:07:41,080 FREQUENTLY IN LOW AND MIDDLE 262 00:07:41,080 --> 00:07:43,360 INCOME COUNTRIES, FOR EXAMPLE, 263 00:07:43,360 --> 00:07:44,480 LIVER CANCER, CERVICAL CANCER, 264 00:07:44,480 --> 00:07:45,920 THEY ARE VERY INFREQUENTLY 265 00:07:45,920 --> 00:07:48,440 REPRESENTED IN ONCOLOGY RCTs. 266 00:07:48,440 --> 00:07:49,520 SO I THINK THIS IS A REAL 267 00:07:49,520 --> 00:07:50,760 CHALLENGE TO ALL OF US TO THINK 268 00:07:50,760 --> 00:07:52,280 ABOUT HOW MEANINGFULLY WE WANT 269 00:07:52,280 --> 00:07:55,080 TO ADDRESS THIS GOING FORWARD. 270 00:07:55,080 --> 00:07:57,840 SO THAT'S BURDEN, THEN SOME OF 271 00:07:57,840 --> 00:07:59,720 WHAT I CONSIDER TO BE THE 272 00:07:59,720 --> 00:08:00,880 INADEQUACY OF THE RESEARCH 273 00:08:00,880 --> 00:08:04,600 RESPONSE TO DATE. 274 00:08:04,600 --> 00:08:06,000 SO THIS IS A DISPARITIES MEETING 275 00:08:06,000 --> 00:08:07,240 AND I'M REALLY GRATEFUL TO BE 276 00:08:07,240 --> 00:08:08,280 HERE BECAUSE WE HAVE BEEN 277 00:08:08,280 --> 00:08:09,880 THINKING QUITE A LOT ABOUT WHAT 278 00:08:09,880 --> 00:08:11,200 IS THE RELATIONSHIP BETWEEN 279 00:08:11,200 --> 00:08:13,720 HEALTH DISPARITIES AND GLOBAL 280 00:08:13,720 --> 00:08:14,480 HEALTH? 281 00:08:14,480 --> 00:08:17,120 AND I THINK THERE ARE -- THIS IS 282 00:08:17,120 --> 00:08:18,440 A LITTLE BIT SIMPLE MINDED BUT I 283 00:08:18,440 --> 00:08:19,840 THINK THERE ARE TWO BASIC 284 00:08:19,840 --> 00:08:21,920 UNDERSTANDINGS OF WHAT THE 285 00:08:21,920 --> 00:08:22,440 RELATIONSHIP IS. 286 00:08:22,440 --> 00:08:24,000 ONE IS THAT ALL GLOBAL HEALTH IS 287 00:08:24,000 --> 00:08:24,920 ESSENTIALLY HEALTH DISPARITIES 288 00:08:24,920 --> 00:08:25,680 RESEARCH. 289 00:08:25,680 --> 00:08:27,520 SO GLOBAL HEALTH IS KIND OF A 290 00:08:27,520 --> 00:08:28,800 SUBSIDIARY BRANCH OF HEALTH 291 00:08:28,800 --> 00:08:29,560 DISPARITIES. 292 00:08:29,560 --> 00:08:30,760 ANOTHER VIEW, AND THIS TENDS TO 293 00:08:30,760 --> 00:08:33,160 BE MORE CONCORDANT WITH MY OWN 294 00:08:33,160 --> 00:08:35,200 THINKING, IS -- THESE ARE TWO 295 00:08:35,200 --> 00:08:36,040 INDEPENDENT DISCIPLINES THAT 296 00:08:36,040 --> 00:08:38,240 HAVE A LOT OF SCIENTIFIC AND 297 00:08:38,240 --> 00:08:39,960 PHILOSOPHICAL KINSHIP AND 298 00:08:39,960 --> 00:08:41,280 OVERLAP, AND TO BE HONEST, I 299 00:08:41,280 --> 00:08:44,800 FEEL WE HAVE BEEN NOT ADEQUATELY 300 00:08:44,800 --> 00:08:45,440 REALIZED THAT OVERLAP. 301 00:08:45,440 --> 00:08:46,960 THAT'S WHY I'M SO GRATEFUL TO BE 302 00:08:46,960 --> 00:08:49,040 PRESENTING AT THIS MEETING TODAY 303 00:08:49,040 --> 00:08:50,240 TO PERHAPS OFFER A GLOBAL LENS 304 00:08:50,240 --> 00:08:51,520 ON THE PROBLEM OF HEALTH 305 00:08:51,520 --> 00:08:53,960 DISPARITIES AND HAVE ALSO BEEN 306 00:08:53,960 --> 00:08:54,880 THINKING QUITE A LOT ABOUT HOW 307 00:08:54,880 --> 00:08:56,240 TO APPLY A HEALTH DISPARITIES 308 00:08:56,240 --> 00:08:57,600 LENS TO THE WORK THAT WE DO IN 309 00:08:57,600 --> 00:08:59,200 GLOBAL HEALTH BECAUSE I'M NOT 310 00:08:59,200 --> 00:09:02,600 ACCUSTOMED TO THINKING I MYSELF 311 00:09:02,600 --> 00:09:03,840 AS A HEALTH DISPARITIES 312 00:09:03,840 --> 00:09:04,360 RESEARCHER. 313 00:09:04,360 --> 00:09:05,480 I JUST WANT TO POINT OUT THERE 314 00:09:05,480 --> 00:09:07,120 HAVE BEEN SIMILAR DEFINITION 315 00:09:07,120 --> 00:09:08,120 CONCERNS ACTUALLY FOR HEALTH 316 00:09:08,120 --> 00:09:09,320 DISPARITIES AND MINORITY HEALTH, 317 00:09:09,320 --> 00:09:10,400 INCLUDING THIS REALLY NICE PAPER 318 00:09:10,400 --> 00:09:11,880 THAT I CAME ACROSS ABOUT A YEAR 319 00:09:11,880 --> 00:09:13,320 AGO AS WE WERE TRYING TO REFINE 320 00:09:13,320 --> 00:09:17,920 SOME OF OUR OWN THINKING BY DRS. 321 00:09:17,920 --> 00:09:21,160 DURAND AND PEREZ-STABLE FROM 322 00:09:21,160 --> 00:09:22,600 NIMHD TALKING ABOUT HOW MINORITY 323 00:09:22,600 --> 00:09:24,560 HEALTH AND HEALTH DISPARITIES 324 00:09:24,560 --> 00:09:25,400 ARE RELATED WITH DIFFERENT 325 00:09:25,400 --> 00:09:26,560 FIELDS OF RESEARCH. 326 00:09:26,560 --> 00:09:28,120 CURRENT RESEARCH OFTEN ASSUMES 327 00:09:28,120 --> 00:09:29,560 THAT MINORITY DIFFERENCES EQUATE 328 00:09:29,560 --> 00:09:30,760 TO HEALTH DISPARITIES WITH THE 329 00:09:30,760 --> 00:09:32,400 SAME CONTRIBUTING FACTORS, 330 00:09:32,400 --> 00:09:33,400 EQUATING MINORITY HEALTH AND 331 00:09:33,400 --> 00:09:34,600 HEALTH DISPARITIES ASSUMES THAT 332 00:09:34,600 --> 00:09:36,000 ALL MINORITY HAVE WORSE HEALTH 333 00:09:36,000 --> 00:09:37,240 OUTCOMES THAN THE REST OF THE 334 00:09:37,240 --> 00:09:38,040 POPULATION, YET IN SOME 335 00:09:38,040 --> 00:09:39,840 IMPORTANT CONDITIONS, SOME 336 00:09:39,840 --> 00:09:41,080 MINORITY GROUPS HAVE BETTER 337 00:09:41,080 --> 00:09:44,120 HEALTH OUTCOMES THAN WHITE. 338 00:09:44,120 --> 00:09:46,040 SO I THINK YOU COULD TAKE THIS 339 00:09:46,040 --> 00:09:50,320 ARTICLE, THE OPENING TO 340 00:09:50,320 --> 00:09:51,320 PAPER, SUBSTITUTE GLOBAL HEALTH 341 00:09:51,320 --> 00:09:52,760 AND I THINK IT WOULD BE FAIRLY 342 00:09:52,760 --> 00:09:53,560 CONCORDANT WITH MY OWN THINKING 343 00:09:53,560 --> 00:09:53,960 ABOUT THIS. 344 00:09:53,960 --> 00:09:57,800 SO THIS IS THE NIMHD FRAMEWORK 345 00:09:57,800 --> 00:09:59,120 WHICH I THINK ALL OF YOU ARE 346 00:09:59,120 --> 00:10:00,160 PROBABLY EXTREMELY FAMILIAR 347 00:10:00,160 --> 00:10:00,600 WITH. 348 00:10:00,600 --> 00:10:02,200 YOU LIKELY HAVE OTHER 349 00:10:02,200 --> 00:10:05,160 FRAMEWORKS, PERHAPS, THAT YOU 350 00:10:05,160 --> 00:10:05,640 PREFER. 351 00:10:05,640 --> 00:10:06,680 WE'VE SPENT A LOT OF TIME 352 00:10:06,680 --> 00:10:10,000 THINKING ABOUT THIS PARTLY 353 00:10:10,000 --> 00:10:13,360 BECAUSE WE'RE AT THE NIH, PARTLY 354 00:10:13,360 --> 00:10:15,520 BECAUSE WE WORK WITH NIMHD 355 00:10:15,520 --> 00:10:17,240 COLLEAGUES CLOSELY, PARTLY 356 00:10:17,240 --> 00:10:18,880 BECAUSE WE'RE DOING THE INVERSE 357 00:10:18,880 --> 00:10:20,240 OF WHAT I'M TRYING TO DO IN THIS 358 00:10:20,240 --> 00:10:22,280 SESSION WHICH IS APPLY A GLOBAL 359 00:10:22,280 --> 00:10:24,240 LENS TO HEALTH DISPARITIES 360 00:10:24,240 --> 00:10:25,000 RESEARCH, WE'VE BEEN THINKING 361 00:10:25,000 --> 00:10:26,720 ABOUT HOW TO APPLY A HEALTH 362 00:10:26,720 --> 00:10:28,320 DISPARITIES LENS TO SOME OF OUR 363 00:10:28,320 --> 00:10:29,600 WORK IN GLOBAL HEALTH. 364 00:10:29,600 --> 00:10:31,320 ONE OF THE THINGS THAT'S NICE 365 00:10:31,320 --> 00:10:33,200 ABOUT THIS NIMHD FRAMEWORK IS 366 00:10:33,200 --> 00:10:35,360 THE WAY IN WHICH IS JUST 367 00:10:35,360 --> 00:10:36,680 PROVIDES AN ORGANIZING STRUCTURE 368 00:10:36,680 --> 00:10:38,440 TO CAPTURE THE IMMENSE 369 00:10:38,440 --> 00:10:39,800 COMPLEXITY THAT ACCOMPANIES 370 00:10:39,800 --> 00:10:43,200 HEALTH DISPARITIES, AND SO 371 00:10:43,200 --> 00:10:45,560 TAKING A GLOBAL LENS, I WOULD 372 00:10:45,560 --> 00:10:47,880 SAY THAT ACROSS EACH ELEMENT IN 373 00:10:47,880 --> 00:10:49,960 THE NIMHD FRAMEWORK, THERE ARE 374 00:10:49,960 --> 00:10:51,320 SIMILAR PATTERNS BUT ALSO VERY 375 00:10:51,320 --> 00:10:52,120 IMPORTANT DIFFERENCES. 376 00:10:52,120 --> 00:10:55,000 AND I'LL TRY TO GIVE SOME 377 00:10:55,000 --> 00:10:57,160 ILLUSTRATIONS OF THAT. 378 00:10:57,160 --> 00:10:58,280 SO FOR EXAMPLE, I'VE GOT A 379 00:10:58,280 --> 00:11:02,000 COUPLE OF EXAMPLES RELATED TO 380 00:11:02,000 --> 00:11:03,880 WORK ON WOMEN'S CANCERS IN 381 00:11:03,880 --> 00:11:05,400 AFRICA, AND THEN WE'LL PIVOT AND 382 00:11:05,400 --> 00:11:07,160 TALK A LITTLE BIT MORE ABOUT HOW 383 00:11:07,160 --> 00:11:09,240 WE'VE SOUGHT TO KIND OF UNCOVER 384 00:11:09,240 --> 00:11:13,760 AND APPLY SOME OF THAT NIMHD 385 00:11:13,760 --> 00:11:14,600 FRAMEWORK IN SOME OF THE WORK 386 00:11:14,600 --> 00:11:16,480 WE'VE DONE IN MALAWI. 387 00:11:16,480 --> 00:11:17,800 BUT THIS IS WORK SUPPORTED BY 388 00:11:17,800 --> 00:11:21,240 THE NCI, CONDUCTED WITH 389 00:11:21,240 --> 00:11:23,280 COLLEAGUES AT IARC LOOKING AT 390 00:11:23,280 --> 00:11:25,080 BREAST CANCER SURVIVAL ACROSS 391 00:11:25,080 --> 00:11:26,080 MULTIPLE AFRICAN SETTINGS. 392 00:11:26,080 --> 00:11:27,840 WHAT THESE AUTHORS HAVE FOUND IS 393 00:11:27,840 --> 00:11:29,160 THAT THERE'S ACTUALLY QUITE 394 00:11:29,160 --> 00:11:30,040 SIMILAR STRUCTURAL 395 00:11:30,040 --> 00:11:31,280 DISCRIMINATION PATTERNS BY RACE 396 00:11:31,280 --> 00:11:32,960 FOR WOMEN WITH BREAST CANCER IN 397 00:11:32,960 --> 00:11:33,440 AFRICA. 398 00:11:33,440 --> 00:11:35,320 SO LOOKING ACROSS A VARIETY OF 399 00:11:35,320 --> 00:11:37,920 AFRICAN SETTINGS, CURRENT 400 00:11:37,920 --> 00:11:38,960 THREE-YEAR SURVIVAL IS SHOWN IN 401 00:11:38,960 --> 00:11:40,280 THIS BLUE COLOR, AND YOU CAN SEE 402 00:11:40,280 --> 00:11:41,680 THAT ACROSS AFRICA AND EVEN 403 00:11:41,680 --> 00:11:44,400 WITHIN SPECIFIC COUNTRIES, SO 404 00:11:44,400 --> 00:11:46,680 FOR EXAMPLE IN AMIVIA, WE SEE 405 00:11:46,680 --> 00:11:47,960 MANY OF THE SAME STRUCTURAL 406 00:11:47,960 --> 00:11:49,000 DISCRIMINATION PATTERNS THAT WE 407 00:11:49,000 --> 00:11:50,480 OBSERVE IN THE U.S., PERPETUATED 408 00:11:50,480 --> 00:11:51,840 EVEN IN AN AFRICAN CONTEXT. 409 00:11:51,840 --> 00:11:53,640 AND THERE SEEMS TO BE A DOSE 410 00:11:53,640 --> 00:11:53,960 RELATIONSHIP. 411 00:11:53,960 --> 00:11:55,280 THAT IS, THE MORE BLACK YOU ARE, 412 00:11:55,280 --> 00:11:57,000 THE WORSE YOU DO. 413 00:11:57,000 --> 00:11:59,960 SO WHITE WOMEN IN NA BIB YA DO 414 00:11:59,960 --> 00:12:03,080 QUITE WELL, MIXED RACE WOMEN DOO 415 00:12:03,080 --> 00:12:04,480 POOR, MORE POORLY, AND BLACK 416 00:12:04,480 --> 00:12:05,920 WOMEN DO THE WORST. 417 00:12:05,920 --> 00:12:07,120 THESE AUTHORS ADDITIONALLY 418 00:12:07,120 --> 00:12:09,400 SOUGHT TO APPORTION THE SURVIVAL 419 00:12:09,400 --> 00:12:11,760 GAPS BASED ON THE OBSERVATIONAL 420 00:12:11,760 --> 00:12:13,760 DATA THAT THEY HAD AND IN THEIR 421 00:12:13,760 --> 00:12:17,160 MODELING, CONCLUDED THAT AGAIN 422 00:12:17,160 --> 00:12:19,640 LIKE MANY STUDIES HAVE SHOWN IN 423 00:12:19,640 --> 00:12:21,360 THE UNITED STATES, MUCH OF THE 424 00:12:21,360 --> 00:12:23,720 SURVIVAL GAP CAN BE MADE UP 425 00:12:23,720 --> 00:12:25,120 THROUGH DOWNSTAGING OF TUMORS, 426 00:12:25,120 --> 00:12:26,680 IMPROVED TREATMENT AND REDUCED 427 00:12:26,680 --> 00:12:27,760 SOCIAL INEQUALITIES. 428 00:12:27,760 --> 00:12:29,160 THAT IS THE BIOLOGIC 429 00:12:29,160 --> 00:12:30,160 CONTRIBUTION TO THIS 430 00:12:30,160 --> 00:12:32,040 DIFFERENTIAL SURVIVAL FOR WOMEN 431 00:12:32,040 --> 00:12:33,600 ACROSS SUB-SAHARAN AFRICA, ALL 432 00:12:33,600 --> 00:12:38,200 WITH BREAST CANCER, CAN BE MADE 433 00:12:38,200 --> 00:12:39,520 UP THROUGH SOME MORE 434 00:12:39,520 --> 00:12:40,640 STRUCTURALLY AND PERHAPS 435 00:12:40,640 --> 00:12:44,320 SOCIALLY ORIENTED INTERVENTIONS. 436 00:12:44,320 --> 00:12:46,480 AS OPPOSED TO BETTER BIOLOGIC 437 00:12:46,480 --> 00:12:46,760 TARGETING. 438 00:12:46,760 --> 00:12:47,760 ANOTHER EXAMPLE, AGAIN, WHAT 439 00:12:47,760 --> 00:12:49,240 I'VE TRIED TO DO IS EMPHASIZE 440 00:12:49,240 --> 00:12:51,280 BOTH SIMILARITY AND DIFFERENCE. 441 00:12:51,280 --> 00:12:52,280 SO THERE IN THE PRIOR SLIDE, I 442 00:12:52,280 --> 00:12:54,000 WOULD SAY WE SEE SOMEWHAT 443 00:12:54,000 --> 00:12:55,480 SIMILAR PATTERNS TO WHAT WE 444 00:12:55,480 --> 00:12:56,200 OBSERVE IN THE U.S. 445 00:12:56,200 --> 00:12:57,560 AND OF COURSE ADDRESSING THEM, I 446 00:12:57,560 --> 00:12:58,760 THINK WILL BE INFORMATIVE TO HOW 447 00:12:58,760 --> 00:13:00,800 WE MIGHT ADDRESS THEM IN THE 448 00:13:00,800 --> 00:13:01,600 UNITED STATES AS WELL. 449 00:13:01,600 --> 00:13:04,520 IN ANOTHER -- HERE I WANT TO 450 00:13:04,520 --> 00:13:06,320 POINT OUT THERE'S IN OTHER 451 00:13:06,320 --> 00:13:06,800 INSTANCES DIFFERENCES. 452 00:13:06,800 --> 00:13:08,840 SO HERE IS A QUITE DIFFERENT 453 00:13:08,840 --> 00:13:10,280 LEVEL OF HEALTH SYSTEM AND 454 00:13:10,280 --> 00:13:12,480 POLICY PROGRESS TOWARDS CERVICAL 455 00:13:12,480 --> 00:13:14,080 CANCER ELIMINATION IN RWANDA. 456 00:13:14,080 --> 00:13:15,760 MANY OF YOU WILL KNOW THAT THE 457 00:13:15,760 --> 00:13:17,760 WHO HAS CALLED FOR CERVICAL 458 00:13:17,760 --> 00:13:19,120 CANCER ELIMINATION BY WHICH THEY 459 00:13:19,120 --> 00:13:20,520 MEAN A REDUCTION IN CERVICAL 460 00:13:20,520 --> 00:13:21,800 CANCER INCIDENCE WORLDWIDE TO A 461 00:13:21,800 --> 00:13:24,560 LEVEL LESS THAN 4 PER 100,000. 462 00:13:24,560 --> 00:13:26,080 BY THE WAY, WE HAVE NOT ACHIEVED 463 00:13:26,080 --> 00:13:27,560 THAT TARGET YET IN THE UNITED 464 00:13:27,560 --> 00:13:28,680 STATES, AND ACTUALLY ONE OF THE 465 00:13:28,680 --> 00:13:31,360 FIRST COUNTRIES WORLDWIDE TO 466 00:13:31,360 --> 00:13:33,880 ACCOMPLISH THIS, PERHAPS THE 467 00:13:33,880 --> 00:13:35,360 FIRST, MAY BE RWANDA. 468 00:13:35,360 --> 00:13:38,480 THIS IS A NEWSPAPER ARTICLE FROM 469 00:13:38,480 --> 00:13:40,680 THE GUARDIAN SEVERAL MONTHS AGO. 470 00:13:40,680 --> 00:13:42,400 RWANDA IS A LOW INCOME COUNTRY 471 00:13:42,400 --> 00:13:45,200 WITH A HIGH HIV PRESENCE AND LOW 472 00:13:45,200 --> 00:13:46,560 CERVICAL CANCER BURDEN, DESPITE 473 00:13:46,560 --> 00:13:49,920 THAT THEY'VE MADE REMARKABLE 474 00:13:49,920 --> 00:13:51,440 PROCESS TOWARDS THIS GOAL. 475 00:13:51,440 --> 00:13:52,720 SOME OF THE ENABLING FACTORS 476 00:13:52,720 --> 00:13:58,080 OUTLINED IN THIS ARTICLE ARE AN 477 00:13:58,080 --> 00:14:00,840 HPV VACCINATION EFFORT SINCE 478 00:14:00,840 --> 00:14:02,400 2011 WITH CONSISTENT MORE THAN 479 00:14:02,400 --> 00:14:04,040 90% COVERAGE FOR ELIGIBLE SCHOOL 480 00:14:04,040 --> 00:14:04,360 AGED GIRLS. 481 00:14:04,360 --> 00:14:05,920 I THINK IN MANY RESPECTS WE 482 00:14:05,920 --> 00:14:07,040 WOULD ENVY THIS IN SOME 483 00:14:07,040 --> 00:14:08,320 COMMUNITIES IN THE UNITED 484 00:14:08,320 --> 00:14:08,880 STATES. 485 00:14:08,880 --> 00:14:11,680 NATIONAL PROGRAMS TO IMPLEMENT 486 00:14:11,680 --> 00:14:13,880 HPV-BASED SCREENING FOR WOMEN 487 00:14:13,880 --> 00:14:14,800 ACROSS THE COUNTRY. 488 00:14:14,800 --> 00:14:16,120 TREATMENT BEING AVAILABLE FOR 489 00:14:16,120 --> 00:14:17,920 THOSE WHO ARE IDENTIFIED AS 490 00:14:17,920 --> 00:14:19,320 HAVING PRECANCER AND CANCER. 491 00:14:19,320 --> 00:14:20,400 TRAINING FOR PROVIDERS SO THEY 492 00:14:20,400 --> 00:14:22,560 CAN PROVIDE THESE SERVICES 493 00:14:22,560 --> 00:14:23,400 EFFECTIVELY. 494 00:14:23,400 --> 00:14:24,400 COMMUNITY EDUCATION BY TEACHERS 495 00:14:24,400 --> 00:14:27,160 AND HEALTH WORKERS, PARTICULARLY 496 00:14:27,160 --> 00:14:27,800 SINCE VACCINATION IS BEING 497 00:14:27,800 --> 00:14:28,600 OFFERED IN SCHOOLS. 498 00:14:28,600 --> 00:14:30,280 I THINK IT'S BEEN VERY CLEAR IN 499 00:14:30,280 --> 00:14:31,600 AFRICAN SETTINGS HOW IMPORTANT 500 00:14:31,600 --> 00:14:33,640 TEACHERS ARE FOR THAT -- FOR 501 00:14:33,640 --> 00:14:34,760 THOSE CONVERSATIONS TO CREATE 502 00:14:34,760 --> 00:14:38,600 THE NECESSARY DEMAND, 503 00:14:38,600 --> 00:14:40,480 DESTIGMATIZE CERVICAL CANCER, 504 00:14:40,480 --> 00:14:42,200 SUSTAINABLE FINANCING INCLUDING 505 00:14:42,200 --> 00:14:44,720 A NATIONAL HEALTH INSURANCE PLAN 506 00:14:44,720 --> 00:14:45,680 THAT HAS PROVIDED SUPPORT FOR 507 00:14:45,680 --> 00:14:48,000 ALL OF THESE EFFORTS, BOTH FROM 508 00:14:48,000 --> 00:14:49,480 RWANDAN GOVERNMENT AND ALSO FROM 509 00:14:49,480 --> 00:14:51,800 MANY INTERNATIONAL PARTNERS, AND 510 00:14:51,800 --> 00:14:52,840 THEN ENCASING ALL OF THIS WITHIN 511 00:14:52,840 --> 00:14:54,720 A BROADER WOMEN'S EMPOWERMENT 512 00:14:54,720 --> 00:14:59,760 AGENDA THAT HA IS REALLY LED FRM 513 00:14:59,760 --> 00:15:00,720 THE OFFICE OF THE PRESIDENT. 514 00:15:00,720 --> 00:15:02,160 SO I THINK THESE ENABLING 515 00:15:02,160 --> 00:15:03,440 FACTORS IN MANY RESPECTS HAVE 516 00:15:03,440 --> 00:15:04,480 ACHIEVED A LEVEL OF PROGRESS IN 517 00:15:04,480 --> 00:15:07,400 A LOW INCOME COUNTRY IN AFRICA 518 00:15:07,400 --> 00:15:09,800 WITH A HIGH HIV AND CERVICAL 519 00:15:09,800 --> 00:15:11,960 CANCER BURDEN THAN WE MIGHT ENVY 520 00:15:11,960 --> 00:15:13,720 IN THE UNITED STATES. 521 00:15:13,720 --> 00:15:14,680 TO ELABORATE ON THIS THEME A 522 00:15:14,680 --> 00:15:15,440 LITTLE BIT MORE, TALKING A 523 00:15:15,440 --> 00:15:16,240 LITTLE ABOUT SOME OF THE WORK 524 00:15:16,240 --> 00:15:17,840 THAT WE DID IN MALAWI, WHICH IS 525 00:15:17,840 --> 00:15:20,960 WHERE I LIVED AND WORKED AS AN 526 00:15:20,960 --> 00:15:22,040 NCI-SUPPORTED INVESTIGATOR 527 00:15:22,040 --> 00:15:23,040 BEFORE BEING RECRUITED TO THE 528 00:15:23,040 --> 00:15:24,560 NCI THREE YEARS AGO TO DIRECT 529 00:15:24,560 --> 00:15:25,680 THE CENTER FOR GLOBAL HEALTH, 530 00:15:25,680 --> 00:15:27,400 I'VE JUST INDICATED HERE WHERE 531 00:15:27,400 --> 00:15:28,520 MALAWI IS ON THE MAP AND ALSO 532 00:15:28,520 --> 00:15:31,640 PROVIDED SOME KIND OF 533 00:15:31,640 --> 00:15:33,280 SOCIOECONOMIC DEMOGRAPHIC 534 00:15:33,280 --> 00:15:34,440 CONTEXT FOR MALAWI. 535 00:15:34,440 --> 00:15:36,280 I THINK IMPORTANTLY FOR THIS 536 00:15:36,280 --> 00:15:36,920 CONVERSATION DURING THE PERIOD 537 00:15:36,920 --> 00:15:38,080 OF TIME I LIVED THERE, I WAS THE 538 00:15:38,080 --> 00:15:39,600 ONLY MEDICAL ONCOLOGIST IN THE 539 00:15:39,600 --> 00:15:42,200 COUNTRY OF 18 MILLION PEOPLE, 540 00:15:42,200 --> 00:15:44,200 AND ANNUAL HEALTH EXPENDITURE 541 00:15:44,200 --> 00:15:45,760 PER CAPITA, THAT IS WHAT THE 542 00:15:45,760 --> 00:15:48,040 GOVERNMENT SPENT PER PERSON PER 543 00:15:48,040 --> 00:15:49,440 HEALTH, FOR ALL HEALTH-RELATED 544 00:15:49,440 --> 00:15:51,320 NEEDS, WAS ON THE ORDER OF 35 545 00:15:51,320 --> 00:15:52,520 U.S. DOLLARS PER PERSON PER 546 00:15:52,520 --> 00:15:53,520 YEAR. 547 00:15:53,520 --> 00:15:54,720 SO I'M GOING TO AGAIN TALK A 548 00:15:54,720 --> 00:15:57,360 LITTLE BIT ABOUT THE NIMHD 549 00:15:57,360 --> 00:15:58,320 FRAMEWORK AND TRY TO TALK ABOUT 550 00:15:58,320 --> 00:15:59,560 SOME OF THE WORK THAT WE DID AND 551 00:15:59,560 --> 00:16:00,960 SOME OF THE SIMILARITIES AND 552 00:16:00,960 --> 00:16:02,120 DIFFERENCES THAT WE OBSERVED 553 00:16:02,120 --> 00:16:03,280 REALLY ACROSS THE FRAMEWORK. 554 00:16:03,280 --> 00:16:05,760 THIS IS INTENTIONALLY A LITTLE 555 00:16:05,760 --> 00:16:08,360 BIT KALEIDOSCOPEIC BECAUSE I 556 00:16:08,360 --> 00:16:10,840 WANTED TO TRY TO CAPTURE THE 557 00:16:10,840 --> 00:16:11,600 COMPLEXITY OF DISPARITIES AND 558 00:16:11,600 --> 00:16:14,400 HOW THEY PLAY OUT IN GLOBAL 559 00:16:14,400 --> 00:16:15,240 SETTINGS, RATHER THAN KIND OF 560 00:16:15,240 --> 00:16:17,840 DOING A SPECIFIC DEEP DIVE ON 561 00:16:17,840 --> 00:16:22,520 ANY PARTICULAR TOPIC. 562 00:16:22,520 --> 00:16:24,680 SO JUST TO START, WE OBSERVED 563 00:16:24,680 --> 00:16:26,680 QUITE DIFFERENT DIFFUSE LARGE B 564 00:16:26,680 --> 00:16:28,080 CELL LYMPHOMA BIOLOGY IN THE 565 00:16:28,080 --> 00:16:31,120 CONTEXT OF HIV IN MA LA MALAWI. 566 00:16:31,120 --> 00:16:32,400 THIS IS ORIENTED A LITTLE BIT 567 00:16:32,400 --> 00:16:34,720 FROM THE NIMHD FRAMEWORK, START 568 00:16:34,720 --> 00:16:35,720 AT THE UPPER LEFT, WHICH IS MORE 569 00:16:35,720 --> 00:16:37,160 OF THE CELLULAR ASPECTS OF 570 00:16:37,160 --> 00:16:38,080 DISPARITIES AND SORT OF OVER THE 571 00:16:38,080 --> 00:16:40,000 COURSE OF THE NEXT FEW SLIDES, 572 00:16:40,000 --> 00:16:40,640 WE'LL PROGRESS TOWARDS THE 573 00:16:40,640 --> 00:16:42,080 BOTTOM RIGHT, WHICH I THINK 574 00:16:42,080 --> 00:16:43,560 TOUCHES ON MORE OF THE SOCIETAL 575 00:16:43,560 --> 00:16:44,600 ASPECTS OF DISPARITIES. 576 00:16:44,600 --> 00:16:47,360 AND I THINK WE WERE CONSISTENTLY 577 00:16:47,360 --> 00:16:48,440 BOTH SURPRISED AT WHAT WAS THE 578 00:16:48,440 --> 00:16:49,800 SAME AND SURPRISED AT WHAT WAS 579 00:16:49,800 --> 00:16:50,160 DIFFERENT. 580 00:16:50,160 --> 00:16:52,720 I DON'T THINK THAT A PRIORI WE 581 00:16:52,720 --> 00:16:54,960 COULD HAVE AL ALWAYS PREDICTED T 582 00:16:54,960 --> 00:16:55,880 WOULD HAVE BEEN THE SAME AS THE 583 00:16:55,880 --> 00:16:57,560 U.S. AND WHAT WOULD HAVE BEEN 584 00:16:57,560 --> 00:16:58,280 DIFFERENT AND THAT'S SOME OF 585 00:16:58,280 --> 00:16:59,680 WHAT I WANT TO ILLUSTRATE OVER 586 00:16:59,680 --> 00:17:01,680 THE NEXT SEVERAL SLIDES. 587 00:17:01,680 --> 00:17:03,280 WE FOUND LYMPHOMA BIOLOGY WAS 588 00:17:03,280 --> 00:17:04,200 VERY DIFFERENT IN THE CONTEXT OF 589 00:17:04,200 --> 00:17:05,200 HIV IN MALAWI. 590 00:17:05,200 --> 00:17:07,120 THIS IS WORK WE ACTUALLY TRIED 591 00:17:07,120 --> 00:17:08,160 TO DO UNSUCCESSFULLY IN THE U.S. 592 00:17:08,160 --> 00:17:09,320 BUT FOR A WHOLE VARIETY OF 593 00:17:09,320 --> 00:17:09,760 REASONS. 594 00:17:09,760 --> 00:17:11,160 THIS IS DIFFICULT TO DO IN THE 595 00:17:11,160 --> 00:17:11,840 UNITED STATES. 596 00:17:11,840 --> 00:17:14,560 BUT IN A SETTING LIKE MALAWI, 597 00:17:14,560 --> 00:17:16,560 WHERE DIFFUSE LARGE B CELL 598 00:17:16,560 --> 00:17:18,720 LYMPHOMA, THE MOST COMMON 599 00:17:18,720 --> 00:17:20,400 AGGRESSIVE NON-HODGKIN'S 600 00:17:20,400 --> 00:17:21,960 LYMPHOMA AMONG ADULTS IS VERY 601 00:17:21,960 --> 00:17:22,920 HIGHLY HIV ASSOCIATED, IT 602 00:17:22,920 --> 00:17:24,880 ACTUALLY HAS, WE FOUND, A VERY 603 00:17:24,880 --> 00:17:27,280 DIFFERENT BIOLOGIC FEATURES THAN 604 00:17:27,280 --> 00:17:30,480 AS COMPARED WITH HIV NEGATIVE 605 00:17:30,480 --> 00:17:32,320 DLBCL IN A WAY THAT HAD REALLY 606 00:17:32,320 --> 00:17:34,920 NOT BEEN WELL DESCRIBED OR 607 00:17:34,920 --> 00:17:36,840 CHARACTERIZED AT A MOLECULAR 608 00:17:36,840 --> 00:17:37,720 LEVEL. 609 00:17:37,720 --> 00:17:39,680 HOWEVER, WE FOUND WHEN YOU APPLY 610 00:17:39,680 --> 00:17:40,720 TARGETED THERAPY, SO IN THIS 611 00:17:40,720 --> 00:17:44,960 INSTANCE, THIS IS RITUXIMAB, A 612 00:17:44,960 --> 00:17:46,560 MONOCLONAL ANTIBODY DIRECTED 613 00:17:46,560 --> 00:17:50,120 AGAINST CD20, WHICH ADDS 614 00:17:50,120 --> 00:17:51,960 SIGNIFICANT CURATIVE BENEFIT FOR 615 00:17:51,960 --> 00:17:54,240 MANY AGGRESSIVE B CELL LYMPHOMAS 616 00:17:54,240 --> 00:17:55,680 EXPRESSING CD20, THIS AGENT WAS 617 00:17:55,680 --> 00:17:58,640 APPROVED BY THE U.S. FDA IN 618 00:17:58,640 --> 00:18:00,200 1997, BUT HAD NEVER BEEN 619 00:18:00,200 --> 00:18:01,480 PROSPECTIVELY STUDIED IN AN 620 00:18:01,480 --> 00:18:06,280 AFRICAN AMEANAFRICAN CONTEXT ANS 621 00:18:06,280 --> 00:18:07,680 GENERALLY UNAVAILABLE THROUGHOUT 622 00:18:07,680 --> 00:18:08,840 THE DON'T TENT AS A RESULT OF 623 00:18:08,840 --> 00:18:09,880 ACCESS AND COST. 624 00:18:09,880 --> 00:18:11,520 EVEN SIMILAR AGENTS MADE IN 625 00:18:11,520 --> 00:18:14,120 INDIA ARE TYPICALLY $3,500, FOR 626 00:18:14,120 --> 00:18:15,880 EXAMPLE, FOR A TREATMENT COURSE, 627 00:18:15,880 --> 00:18:17,760 WHICH IS 100 FOLD HIGHER THAN 628 00:18:17,760 --> 00:18:19,800 THE ANNUAL PER CAPITA HEALTH 629 00:18:19,800 --> 00:18:21,360 EXPENDITURE IN A COUNTRY LIKE 630 00:18:21,360 --> 00:18:21,640 MALAWI. 631 00:18:21,640 --> 00:18:22,800 BUT NEVERTHELESS, WE FOUND THAT 632 00:18:22,800 --> 00:18:24,560 THERE WAS QUITE SIMILAR EFFICACY 633 00:18:24,560 --> 00:18:27,200 WHEN YOU APPLIED SOME OF THESE 634 00:18:27,200 --> 00:18:31,440 NEWER SPECIFIC CANCER TARGETING 635 00:18:31,440 --> 00:18:33,520 AGENTS FOR ADULTS WITH LARGE B 636 00:18:33,520 --> 00:18:36,120 CELL LYMPHOMA IN MALAWI, DESPITE 637 00:18:36,120 --> 00:18:37,840 THESE PATIENTS BEING LARGELY HIV 638 00:18:37,840 --> 00:18:39,360 AFFECTED WITH MANY FAIRLY 639 00:18:39,360 --> 00:18:40,200 ADVERSE DISEASE CHARACTERISTICS, 640 00:18:40,200 --> 00:18:43,080 SO WE ACCOMPLISHED A 55% 641 00:18:43,080 --> 00:18:43,800 TWO-YEAR OVERALL SURVIVAL, WHICH 642 00:18:43,800 --> 00:18:45,880 IS REALLY A PROXY FOR CURE FOR 643 00:18:45,880 --> 00:18:47,160 THIS POPULATION. 644 00:18:47,160 --> 00:18:50,080 AND FOR COMPARISON IN A U.S. 645 00:18:50,080 --> 00:18:52,040 COMPARABLE POPULATION, THE 646 00:18:52,040 --> 00:18:53,160 TWO-YEAR KIND OF SURVIVAL RATE 647 00:18:53,160 --> 00:18:55,760 WOULD BE SOMEWHERE ON THE ORDER 648 00:18:55,760 --> 00:18:56,760 OF 60 TO 70%. 649 00:18:56,760 --> 00:18:59,520 SO AGAIN, WITHOUT SORT OF 650 00:18:59,520 --> 00:19:00,800 A PRIORI KNOWING THIS WOULD WORK 651 00:19:00,800 --> 00:19:02,160 AS WELL AS IT DID, WE FOUND THAT 652 00:19:02,160 --> 00:19:03,880 INDEED IT DID, EVEN IN A SETTING 653 00:19:03,880 --> 00:19:06,160 WHERE THE HEALTH SYSTEM 654 00:19:06,160 --> 00:19:07,440 INFRASTRUCTURE TO SUPPORT CANCER 655 00:19:07,440 --> 00:19:08,240 TREATMENT IS QUITE A BIT 656 00:19:08,240 --> 00:19:09,640 DIFFERENT THAN WE ARE USED TO IN 657 00:19:09,640 --> 00:19:12,040 THE UNITED STATES. 658 00:19:12,040 --> 00:19:14,080 DIFFERENT -- SO WE FOUND QUITE 659 00:19:14,080 --> 00:19:15,400 DIFFERENT PATIENT-REPORTED 660 00:19:15,400 --> 00:19:17,040 EXPERIENCES FOR CHILDREN WITH 661 00:19:17,040 --> 00:19:18,120 LYMPHOMA IN MALAWI. 662 00:19:18,120 --> 00:19:20,520 SO THIS IS A LOT OF WORK THAT WE 663 00:19:20,520 --> 00:19:22,720 HAVE DONE TO REALLY I THINK 664 00:19:22,720 --> 00:19:26,120 AMONG THE FIRST TRANSLATIONS AND 665 00:19:26,120 --> 00:19:27,280 VALIDATIONS OF MANY OF THE 666 00:19:27,280 --> 00:19:28,320 CONTEMPORARY PRO INSTRUMENTS 667 00:19:28,320 --> 00:19:29,880 THAT WE'RE USING IN THE UNITED 668 00:19:29,880 --> 00:19:32,000 STATES ROUTINELY NOW IN NCTN 669 00:19:32,000 --> 00:19:32,400 TRIALS. 670 00:19:32,400 --> 00:19:33,800 WE SOUGHT TO TRANSLATE AND 671 00:19:33,800 --> 00:19:34,800 VALIDATE THESE TO CAPTURE 672 00:19:34,800 --> 00:19:37,080 PATIENT LEVEL EXPERIENCES IN 673 00:19:37,080 --> 00:19:37,440 MALAWI. 674 00:19:37,440 --> 00:19:39,640 THIS IS WORK DONE WITH CHILDREN 675 00:19:39,640 --> 00:19:42,720 WITH LYMPHOMA AND COMPARING THEM 676 00:19:42,720 --> 00:19:43,880 TO AVAILABLE DATA FOR CHILDREN 677 00:19:43,880 --> 00:19:44,960 WITH CANCER IN THE UNITED 678 00:19:44,960 --> 00:19:45,200 STATES. 679 00:19:45,200 --> 00:19:48,720 AND WHAT YOU'LL SEE IS 680 00:19:48,720 --> 00:19:49,840 THAT THE EXPERIENCE OF HAVING 681 00:19:49,840 --> 00:19:50,920 CANCER IS QUITE DIFFERENT. 682 00:19:50,920 --> 00:19:52,520 WHEN WE TRY TO CAPTURE QUALITY 683 00:19:52,520 --> 00:19:54,720 OF LIFE USING PATIENT-REPORTED 684 00:19:54,720 --> 00:19:56,560 OUT COME INSTRUMENT, CHILDREN IN 685 00:19:56,560 --> 00:19:57,800 MALAWI HAVE SIGNIFICANTLY WORSE 686 00:19:57,800 --> 00:19:59,440 QUALITY OF LIFE, THEY HAVE WORSE 687 00:19:59,440 --> 00:20:02,680 MOBILITY, HIGHER ANXIETY, HIGHER 688 00:20:02,680 --> 00:20:03,600 DEPRESSION, HIGHER FATIGUE AND 689 00:20:03,600 --> 00:20:06,080 HIGHER PAIN, ALL LARGELY AS A 690 00:20:06,080 --> 00:20:07,400 RESULT OF MORE ADVANCED DISEASE 691 00:20:07,400 --> 00:20:08,520 AT THE TIME THAT THEY'RE 692 00:20:08,520 --> 00:20:13,000 DIAGNOSED WITH CANCER. 693 00:20:13,000 --> 00:20:15,400 AND THAT IN SOME WAYS SEEMS 694 00:20:15,400 --> 00:20:16,440 OBVIOUS BUT TO US WAS REALLY 695 00:20:16,440 --> 00:20:17,320 IMPORTANT TO DEMONSTRATE BECAUSE 696 00:20:17,320 --> 00:20:19,280 I DON'T THINK THIS IS ALWAYS 697 00:20:19,280 --> 00:20:20,200 OBVIOUS WHEN YOU WALK THROUGH A 698 00:20:20,200 --> 00:20:21,960 CLINIC. 699 00:20:21,960 --> 00:20:24,320 YOU KNOW, PEOPLE IN AFRICAN 700 00:20:24,320 --> 00:20:26,920 HEALTH SYSTEMS ARE USED TO NOT 701 00:20:26,920 --> 00:20:28,920 EXPECTING AS MUCH FROM THEIR 702 00:20:28,920 --> 00:20:30,040 HEALTH SYSTEM AS WE COMMONLY DO 703 00:20:30,040 --> 00:20:31,240 IN THE U.S. SO THEY DON'T 704 00:20:31,240 --> 00:20:32,680 COMPLAIN IN THE WAY THAT I 705 00:20:32,680 --> 00:20:33,880 COMPLAIN WHEN I GO TO THE 706 00:20:33,880 --> 00:20:34,120 DOCTOR. 707 00:20:34,120 --> 00:20:35,160 SO I THINK THERE IS A 708 00:20:35,160 --> 00:20:36,320 SUPERFICIAL LEVEL OF STOICISM 709 00:20:36,320 --> 00:20:39,880 THAT CAN REALLY MASK THE AMGHT T 710 00:20:39,880 --> 00:20:41,320 OF IMMENSE SUFFERING THAT IS 711 00:20:41,320 --> 00:20:42,440 REALLY OCCURRING THAT I THINK IS 712 00:20:42,440 --> 00:20:44,440 IMPORTANT TO DOCUMENT, AND MORE 713 00:20:44,440 --> 00:20:45,080 IMPORTANTLY DEMONSTRATE THAT 714 00:20:45,080 --> 00:20:46,400 THESE ALL GET BETTER AS PATIENTS 715 00:20:46,400 --> 00:20:48,840 ARE TREATED EFFECTIVELY FOR 716 00:20:48,840 --> 00:20:49,280 THEIR CANCER. 717 00:20:49,280 --> 00:20:50,880 ONE THING WE WERE REALLY 718 00:20:50,880 --> 00:20:52,640 INTRIGUED BY IS THAT PEER 719 00:20:52,640 --> 00:20:53,840 RELATIONSHIPS WERE ACTUALLY 720 00:20:53,840 --> 00:20:56,080 BETTER IN MALAWI THAN FOR 721 00:20:56,080 --> 00:20:57,000 CHILDREN WITH CANCER IN THE 722 00:20:57,000 --> 00:20:57,480 UNITED STATES. 723 00:20:57,480 --> 00:20:58,920 THIS IS FASCINATING TO THINK 724 00:20:58,920 --> 00:20:59,120 ABOUT. 725 00:20:59,120 --> 00:21:00,720 IN THE UNITED STATES BEING A KID 726 00:21:00,720 --> 00:21:02,120 WITH CANCER IS INCREDIBLY 727 00:21:02,120 --> 00:21:02,800 SOCIALLY ISOLATING. 728 00:21:02,800 --> 00:21:04,320 YOU'RE TAKEN OUT OF SCHOOL, 729 00:21:04,320 --> 00:21:05,200 OFTEN KEPT IN THE HOSPITAL FOR 730 00:21:05,200 --> 00:21:06,960 LOCK PERIODS OF TIME UNDER 731 00:21:06,960 --> 00:21:07,800 STRICT INFECTION CONTROL 732 00:21:07,800 --> 00:21:09,000 MEASURES WHERE YOU'RE REALLY NOT 733 00:21:09,000 --> 00:21:11,360 ABLE TO IN ANY MEANINGFUL WAY 734 00:21:11,360 --> 00:21:12,000 INTERACT WITH OTHER CHILDREN OR 735 00:21:12,000 --> 00:21:13,920 HAVE A NORMAL KIDS LIFE. 736 00:21:13,920 --> 00:21:16,480 IN MALAWI, FOR BETTER OR WORSE 737 00:21:16,480 --> 00:21:18,160 CHILDREN ARE OFTEN CARED FOR IN 738 00:21:18,160 --> 00:21:20,040 AN OPEN WARD INTERACTING WITH 739 00:21:20,040 --> 00:21:21,320 OTHER KIDS WITH CAP SER, 740 00:21:21,320 --> 00:21:23,280 VILLAGES WILL KIND OF COALESCE 741 00:21:23,280 --> 00:21:25,080 AROUND A FAMILY THAT HAS A SICK 742 00:21:25,080 --> 00:21:26,080 CHILD SO IT'S INTERESTING TO 743 00:21:26,080 --> 00:21:27,280 THINK ABOUT THE WAYS IN WHICH 744 00:21:27,280 --> 00:21:28,600 THE EXPERIENCE OF HAVING CANCER 745 00:21:28,600 --> 00:21:30,200 MAY BE VERY CULTURALLY ENCODED 746 00:21:30,200 --> 00:21:32,080 AGAIN, IN WAYS THAT WE COULDN'T 747 00:21:32,080 --> 00:21:33,960 HAVE NECESSARILY ANTICIPATED 748 00:21:33,960 --> 00:21:34,920 WITHOUT BEING WILLING TO DO THIS 749 00:21:34,920 --> 00:21:45,200 KIND OF WORK. 750 00:21:54,800 --> 00:22:05,040 [PLEASE STAND BY] 751 00:22:30,680 --> 00:22:33,040 SO WE FOUND QUITE SIMILAR 752 00:22:33,040 --> 00:22:34,480 STRUCTURAL AND ENVIRONMENTAL 753 00:22:34,480 --> 00:22:35,800 FACTORS UNDERLYING PEDIATRIC 754 00:22:35,800 --> 00:22:37,000 LYMPHOMA TREATMENT 755 00:22:37,000 --> 00:22:38,480 NON-COMPLETION IN MALAWI SIMILAR 756 00:22:38,480 --> 00:22:39,720 TO WHAT WE SEE IN MANY 757 00:22:39,720 --> 00:22:40,720 COMMUNITIES AND SETTINGS IN THE 758 00:22:40,720 --> 00:22:41,040 UNITED STATES. 759 00:22:41,040 --> 00:22:42,800 SO THESE ARE CHILDREN WHO OFTEN 760 00:22:42,800 --> 00:22:44,360 HAVE TRAVELED WITH THEIR 761 00:22:44,360 --> 00:22:45,600 FAMILIES HALFWAY ACROSS THE 762 00:22:45,600 --> 00:22:47,760 COUNTRY TO RECEIVE A DIAGNOSIS 763 00:22:47,760 --> 00:22:49,160 AND INITIATE CARE, HAVE 764 00:22:49,160 --> 00:22:49,840 UNDERGONE SOME INITIAL 765 00:22:49,840 --> 00:22:51,480 COUNSELING WITH THE TREATMENT 766 00:22:51,480 --> 00:22:54,080 TEAM, AND DESPITE THAT, OFTEN 767 00:22:54,080 --> 00:22:55,520 DON'T COMPLETE TREATMENT IN THE 768 00:22:55,520 --> 00:22:58,320 WAY THAT WOULD BE RECOMMENDED. 769 00:22:58,320 --> 00:23:00,520 AND THIS IS DESPITE FOR THESE 770 00:23:00,520 --> 00:23:02,240 CANCERS IN PARTICULAR, THEY 771 00:23:02,240 --> 00:23:03,480 ARE -- THEY HAVE SIGNIFICANT 772 00:23:03,480 --> 00:23:04,920 CURATES, EVEN WITH RELATIVELY 773 00:23:04,920 --> 00:23:06,120 OLD GENERIC MEDICINES THAT ARE 774 00:23:06,120 --> 00:23:08,200 OFTEN AVAILABLE IN MOST AFRICAN 775 00:23:08,200 --> 00:23:08,480 SETTINGS. 776 00:23:08,480 --> 00:23:11,240 AND WE FOUND THAT LACK OF 777 00:23:11,240 --> 00:23:12,720 EDUCATION, FIREWOOD AS THE 778 00:23:12,720 --> 00:23:15,520 PRIMARY SOURCE OF ENERGY IN THE 779 00:23:15,520 --> 00:23:19,240 HOME, WHICH IS A PROXY FOR LOWER 780 00:23:19,240 --> 00:23:21,200 SOCIOECONOMIC STATUS IN THE 781 00:23:21,200 --> 00:23:23,560 MALAWIAN CONTEXT, LONG TRAVEL 782 00:23:23,560 --> 00:23:25,520 TIMES, AGAIN VERY SIMILAR TO 783 00:23:25,520 --> 00:23:27,040 WHAT FOR EXAMPLE MANY RURAL 784 00:23:27,040 --> 00:23:29,640 PATIENTS MIGHT FACE IN TRYING TO 785 00:23:29,640 --> 00:23:31,520 ACCESS HIGH QUALITY CANCER CARE 786 00:23:31,520 --> 00:23:35,360 AT AN NCI DESIGNATED CANCER 787 00:23:35,360 --> 00:23:36,160 CENTER AFFLICT PATIENTS TRYING 788 00:23:36,160 --> 00:23:37,960 TO RECEIVE CANCER TREATMENT IN 789 00:23:37,960 --> 00:23:40,400 MALAWI AS WELL. 790 00:23:40,400 --> 00:23:41,800 STIGMA IS COMMON, WE'RE QUITE 791 00:23:41,800 --> 00:23:43,080 USED TO STIGMA IN THE UNITED 792 00:23:43,080 --> 00:23:43,320 STATES. 793 00:23:43,320 --> 00:23:45,520 FOR EXAMPLE, TREATMENT RELATED 794 00:23:45,520 --> 00:23:46,520 ALOPECIA OR THE FEELING THAT 795 00:23:46,520 --> 00:23:48,600 WOMEN MAY HAVE FOLLOWING 796 00:23:48,600 --> 00:23:50,360 MASTECTOMY FOR BREAST CANCER, 797 00:23:50,360 --> 00:23:51,640 THE FEELING THAT PATIENTS WITH 798 00:23:51,640 --> 00:23:53,320 LUNG CANCER MAY EXPERIENCE WHEN 799 00:23:53,320 --> 00:23:55,640 THEY'RE ASSUMED TO HAVE BEEN A 800 00:23:55,640 --> 00:23:57,360 SMOKER AND PERHAPS DESERVE, 801 00:23:57,360 --> 00:23:58,320 QUOTE-UNQUOTE, THE CANCER THAT 802 00:23:58,320 --> 00:24:00,520 THEY GOT. 803 00:24:00,520 --> 00:24:02,640 SIMILARLY STIGMA IS A NEARLY 804 00:24:02,640 --> 00:24:03,760 UNIVERSAL EXPERIENCE WE FOUND IN 805 00:24:03,760 --> 00:24:05,040 MALAWI, BUT THE DRIVERS ARE 806 00:24:05,040 --> 00:24:05,880 QUITE DIFFERENT. 807 00:24:05,880 --> 00:24:08,160 AND IN PARTICULAR, BELIEFS 808 00:24:08,160 --> 00:24:09,560 AROUND CANCER ORIGIN, SO YOU CAN 809 00:24:09,560 --> 00:24:11,120 IMAGINE IN A SOCIETY WHERE THE 810 00:24:11,120 --> 00:24:13,480 KIND OF OPERATING PARADIGM FOR 811 00:24:13,480 --> 00:24:16,200 HEALTH FOR YEARS, DECADES, 812 00:24:16,200 --> 00:24:18,000 CENTURIES HAS BEEN ACUTE AND -- 813 00:24:18,000 --> 00:24:19,640 AN ACUTE INFECTIOUS PARADIGM 814 00:24:19,640 --> 00:24:22,720 THAT CANCER WOULD BE FELT TO BE 815 00:24:22,720 --> 00:24:24,320 INFECTIOUS, SO PATIENTS DESCRIBE 816 00:24:24,320 --> 00:24:25,800 OTHERS BEING UNWILLING TO SHARE 817 00:24:25,800 --> 00:24:26,480 FOOD WITH THEM BECAUSE THEY 818 00:24:26,480 --> 00:24:27,680 THOUGHT THEY COULD INFECT THEM 819 00:24:27,680 --> 00:24:28,360 WITH CANCER. 820 00:24:28,360 --> 00:24:30,920 CANCER IS OFTEN THOUGHT TO BE 821 00:24:30,920 --> 00:24:41,000 DUE TO BEWITCHMENT. 822 00:24:41,000 --> 00:24:43,240 NOT ALL -- MOST CANCER OCCURS IN 823 00:24:43,240 --> 00:24:44,840 HIV NEGATIVE PEOPLE, BUT DESPITE 824 00:24:44,840 --> 00:24:46,600 THAT, THERE'S A SOCIETAL 825 00:24:46,600 --> 00:24:48,440 PERCEPTION THAT HAVING CANCER 826 00:24:48,440 --> 00:24:50,320 ALSO MEANS THAT YOU HAVE HIV. 827 00:24:50,320 --> 00:24:53,040 AND SO I THINK UNPACKING THIS 828 00:24:53,040 --> 00:24:54,440 AND UNDERSTANDING IT IS, OF 829 00:24:54,440 --> 00:24:55,400 COURSE, IMPORTANT BECAUSE THESE 830 00:24:55,400 --> 00:24:57,840 CAN BE ADDRESSED AND SORT OF 831 00:24:57,840 --> 00:24:59,280 TAILORED IN SPECIFIC WAYS, AND 832 00:24:59,280 --> 00:25:00,560 IT'S ONLY BY KIND OF DOING THIS 833 00:25:00,560 --> 00:25:02,400 KIND OF WORK THAT PROVIDES THOSE 834 00:25:02,400 --> 00:25:03,760 OPPORTUNITIES. 835 00:25:03,760 --> 00:25:05,080 AND THEN JUST TO START KIND OF 836 00:25:05,080 --> 00:25:07,520 WRAPPING UP, YOU KNOW, FROM A 837 00:25:07,520 --> 00:25:10,800 POLICY MAKER PERSPECTIVE, WE 838 00:25:10,800 --> 00:25:12,560 KNOW AGAIN KIND OF AT THE BOTTOM 839 00:25:12,560 --> 00:25:15,440 RIGHT OF THE NIMHD FRAMEWORK 840 00:25:15,440 --> 00:25:17,040 FROM MORE OF THE SOCIETAL AND 841 00:25:17,040 --> 00:25:19,680 POLICY PERSPECTIVE, EVEN HAVING, 842 00:25:19,680 --> 00:25:21,240 FOR EXAMPLE, DONE CLINICAL 843 00:25:21,240 --> 00:25:23,040 TRIALS IN AN LMIC THAT 844 00:25:23,040 --> 00:25:24,080 DEMONSTRATED THE EFFECTIVENESS, 845 00:25:24,080 --> 00:25:27,320 SAFETY AND EFFICACY OF 846 00:25:27,320 --> 00:25:28,720 CONTEMPORARY CANCER THERAPIES, 847 00:25:28,720 --> 00:25:29,720 GOVERNMENT IN MALAWI AS I TOLD 848 00:25:29,720 --> 00:25:31,560 YOU HAS VERY DIFFERENT KIND OF 849 00:25:31,560 --> 00:25:32,760 COST-EFFECTIVENESS AND BUDGET 850 00:25:32,760 --> 00:25:34,120 IMPACT CONSIDERATIONS, RIGHT, IN 851 00:25:34,120 --> 00:25:36,960 A COUNTRY THAT, AGAIN, SPENDS 35 852 00:25:36,960 --> 00:25:38,280 TO 40 U.S. DOLLARS PER PERSON 853 00:25:38,280 --> 00:25:40,400 PER YEAR ON ALL OF THEIR 854 00:25:40,400 --> 00:25:41,600 HEALTH-RELATED NEEDS ASKING THEM 855 00:25:41,600 --> 00:25:43,480 TO SPEND WHAT THEY WOULD SPEND 856 00:25:43,480 --> 00:25:44,520 FOR 100 PEOPLE FOR A SINGLE 857 00:25:44,520 --> 00:25:47,840 INDIVIDUAL WITH CANCER IS 858 00:25:47,840 --> 00:25:48,600 INTUITIVELY -- DOESN'T MAKE ANY 859 00:25:48,600 --> 00:25:49,320 SENSE. 860 00:25:49,320 --> 00:25:51,080 THAT'S WHY THE KIND OF DATA 861 00:25:51,080 --> 00:25:51,680 GENERATION THAT WOULD HELP 862 00:25:51,680 --> 00:25:53,000 INFORM THAT DECISION-MAKING IS 863 00:25:53,000 --> 00:25:54,280 QUITE IMPORTANT AND NOT 864 00:25:54,280 --> 00:25:55,080 SURPRISINGLY WHEN YOU CONSIDER 865 00:25:55,080 --> 00:25:56,400 THAT THESE ARE GENERALLY YOUNG 866 00:25:56,400 --> 00:25:57,320 PATIENTS WHO HAVE THE 867 00:25:57,320 --> 00:25:59,120 OPPORTUNITY TO BE CURED WITH 868 00:25:59,120 --> 00:26:00,080 TIME-LIMITED THERAPY AND THEN 869 00:26:00,080 --> 00:26:01,960 HAVE POTENTIALLY DECADES OF 870 00:26:01,960 --> 00:26:03,320 EVENT-FREE SURVIVAL 871 00:26:03,320 --> 00:26:04,120 SUBSEQUENTLY, SPENDING MORE UP 872 00:26:04,120 --> 00:26:07,080 FRONT IS ACTUALLY EXTREMELY 873 00:26:07,080 --> 00:26:08,280 COST-EFFECTIVE, AND THE 874 00:26:08,280 --> 00:26:09,920 COST-EFFECTIVENESS METRICS 875 00:26:09,920 --> 00:26:10,800 COMPARE QUITE FAVORABLY TO OTHER 876 00:26:10,800 --> 00:26:12,200 THINGS THAT THE DEVELOPMENT 877 00:26:12,200 --> 00:26:15,200 COMMUNITY HAS WIDELY EMBRACED, 878 00:26:15,200 --> 00:26:17,160 LIKE ANTIRETROVIRAL THERAPY, 879 00:26:17,160 --> 00:26:18,600 LIKE HUMAN PAPILLOMAVIRUS 880 00:26:18,600 --> 00:26:19,000 VACCINATION. 881 00:26:19,000 --> 00:26:20,520 EVEN IF YOU GO BEYOND THE 882 00:26:20,520 --> 00:26:22,520 CONTEXTUAL FACTORS OF INDEXING 883 00:26:22,520 --> 00:26:23,960 COST-EFFECTIVENESS TO THE GDP OF 884 00:26:23,960 --> 00:26:25,240 THE COUNTRY IN WHICH A PATIENT 885 00:26:25,240 --> 00:26:27,080 WITH CANCER HAPPENS TO LIVE AND 886 00:26:27,080 --> 00:26:28,880 TAKE A MORE UNIVERSALIST VIEW 887 00:26:28,880 --> 00:26:31,520 THAT IS ALL LIVES ARE THE SAME 888 00:26:31,520 --> 00:26:33,320 AND EQUAL, WHICH IS SOMETHING WE 889 00:26:33,320 --> 00:26:36,080 SAY MUCH MORE THAN WE DO, THESE 890 00:26:36,080 --> 00:26:37,280 ARE KIND OF NO-BRAINERS. 891 00:26:37,280 --> 00:26:41,480 I MEAN, WE'RE TALKING ABOUT 892 00:26:41,480 --> 00:26:45,600 INVESTMENTS PER QALI OR DALI 893 00:26:45,600 --> 00:26:47,680 CONVERTED IN AN AFER CONTEXT AT 894 00:26:47,680 --> 00:26:49,080 LEAST 100 TO 150 FOLD LOWER THAN 895 00:26:49,080 --> 00:26:50,560 WHAT WE COMMONLY ACCEPT IN THE 896 00:26:50,560 --> 00:26:51,240 UNITED STATES FOR PEOPLE 897 00:26:51,240 --> 00:26:52,840 AFFECTED BY CANCER. 898 00:26:52,840 --> 00:26:53,440 THEN PERHAPS ONE OF THE THINGS 899 00:26:53,440 --> 00:26:55,280 WE WERE MOST SURPRISED AT WAS 900 00:26:55,280 --> 00:26:56,880 THAT WE REALLY HAD QUITE SIMILAR 901 00:26:56,880 --> 00:26:58,320 OPPORTUNITIES, I THINK, AS WITH 902 00:26:58,320 --> 00:26:59,960 THE DISPARITIES FIELD HERE IN 903 00:26:59,960 --> 00:27:01,280 THE UNITED STATES TO INCREASE 904 00:27:01,280 --> 00:27:02,920 DIVERSITY AND INCLUSION FOR 905 00:27:02,920 --> 00:27:04,080 CANCER RESEARCH IN MALAWI. 906 00:27:04,080 --> 00:27:05,520 MALAWI WAS REALLY A COUNTRY 907 00:27:05,520 --> 00:27:07,480 WITHOUT ANY MEANINGFUL TRACK 908 00:27:07,480 --> 00:27:08,720 RECORD OF CANCER RESEARCH, NOT A 909 00:27:08,720 --> 00:27:10,080 LOT OF INFRASTRUCTURE, NOT A LOT 910 00:27:10,080 --> 00:27:11,320 OF HISTORICAL PRECEDENT FOR 911 00:27:11,320 --> 00:27:14,080 PEOPLE DEVELOPING CAREERS AS 912 00:27:14,080 --> 00:27:15,360 INVESTIGATORS, BUT YOUNG PEOPLE 913 00:27:15,360 --> 00:27:16,600 IN MEDICAL SCHOOL, YOUNG PEOPLE 914 00:27:16,600 --> 00:27:18,000 IN THEIR SCHOOLS OF PUBLIC 915 00:27:18,000 --> 00:27:19,360 HEALTH KNOW THAT THIS IS A BIG 916 00:27:19,360 --> 00:27:20,400 PROBLEM IN THEIR COUNTRY, AND 917 00:27:20,400 --> 00:27:24,400 WHEN OFFERED OPPORTUNITIES TO 918 00:27:24,400 --> 00:27:26,160 DEVELOP CAREERS AND WORK ON THIS 919 00:27:26,160 --> 00:27:27,880 CRITICAL PUBLIC HEALTH NEED, 920 00:27:27,880 --> 00:27:29,240 PEOPLE JUST CAME OUT OF THE 921 00:27:29,240 --> 00:27:30,360 WOODWORK, REALLY, AND IT WAS 922 00:27:30,360 --> 00:27:33,080 REALLY WONDERFUL TO SEE SUCH 923 00:27:33,080 --> 00:27:34,920 AMAZING TALENT KIND OF ASSEMBLE 924 00:27:34,920 --> 00:27:39,480 AND COALESCE SO QUICKLY, WITH 925 00:27:39,480 --> 00:27:41,080 NCI SUPPORT AND BLESSING TO 926 00:27:41,080 --> 00:27:42,960 KEUND OF PURSUE CANCER RESEARCH 927 00:27:42,960 --> 00:27:44,200 CAREERS IN HE EVEN IN SOME OF 928 00:27:44,200 --> 00:27:45,360 THESE VERY CHALLENGING 929 00:27:45,360 --> 00:27:45,680 ENVIRONMENTS. 930 00:27:45,680 --> 00:27:46,760 I JUST WANTED TO MENTION, WE 931 00:27:46,760 --> 00:27:49,360 HAVE OUR OWN MEETING ONGOING 932 00:27:49,360 --> 00:27:50,560 THESE THREE DAYS, SO THIS IS A 933 00:27:50,560 --> 00:27:51,840 CONFLICT THAT WE WILL DEFINITELY 934 00:27:51,840 --> 00:27:52,400 AVOID NEXT YEAR. 935 00:27:52,400 --> 00:27:53,720 IT DID NOT OCCUR LAST YEAR. 936 00:27:53,720 --> 00:27:54,760 BUT I'M NOT SUGGESTING THAT YOU 937 00:27:54,760 --> 00:27:56,120 LEAVE THIS MEETING TO JOIN OUR 938 00:27:56,120 --> 00:27:59,880 MEETING TODAY. 939 00:27:59,880 --> 00:28:01,440 FOR THOSE OF YOU, WE DO HAVE 940 00:28:01,440 --> 00:28:02,120 ANOTHER THIRD DAY TOMORROW, SO 941 00:28:02,120 --> 00:28:03,040 FOR THOSE OF WHO YOU ARE 942 00:28:03,040 --> 00:28:03,960 INTERESTED, YOU CAN STILL 943 00:28:03,960 --> 00:28:05,520 REGISTER AND TUNE IN, AND WE 944 00:28:05,520 --> 00:28:07,120 LOOK FORWARD TO HAVING MORE 945 00:28:07,120 --> 00:28:08,440 DISPARITIES WORK AT OUR MEETING 946 00:28:08,440 --> 00:28:09,520 AND MORE GLOBAL WORK AT THIS 947 00:28:09,520 --> 00:28:10,080 MEETING. 948 00:28:10,080 --> 00:28:12,600 THEN I'LL JUST CLOSE BY SAYING, 949 00:28:12,600 --> 00:28:17,120 AGAIN I'VE JUST USED AN NIMHD 950 00:28:17,120 --> 00:28:18,800 FRAMEWORK AS AN ORGANIZE 951 00:28:18,800 --> 00:28:20,480 NIEDZING PRINCIPLE BUT I THINK 952 00:28:20,480 --> 00:28:22,240 SIMILAR PATTERNS AND IMPORTANT 953 00:28:22,240 --> 00:28:26,560 DIFFERENCES EXIST WORLDWIDE FOR 954 00:28:26,560 --> 00:28:29,400 EACH FRAMEWORK AND HAVING THE 955 00:28:29,400 --> 00:28:32,640 COURAGE, HUMILITY AND CURIOSITY 956 00:28:32,640 --> 00:28:34,680 I BELIEVE WILL MAKE THE GLOBAL 957 00:28:34,680 --> 00:28:36,120 DISPARITIES FIELD AND GLOBAL 958 00:28:36,120 --> 00:28:38,560 HEALTH FIELD AND INDEED CANCER 959 00:28:38,560 --> 00:28:39,760 RESEARCH VERY MUCH STRONGER, SO 960 00:28:39,760 --> 00:28:40,160 THANKS VERY MUCH. 961 00:28:40,160 --> 00:28:41,760 [APPLAUSE] 962 00:28:41,760 --> 00:28:45,320 >>THANK YOU SO MUCH FOR A VERY 963 00:28:45,320 --> 00:28:46,440 ACCESSIBLE TALK, I THINK TO A 964 00:28:46,440 --> 00:28:47,840 LOT OF OUR AUDIENCE MEMBERS WHO 965 00:28:47,840 --> 00:28:49,360 MAY NOT HAVE BEEN AS FAMILIAR 966 00:28:49,360 --> 00:28:50,240 WITH GLOBAL HEALTH OR THE 967 00:28:50,240 --> 00:28:51,360 PATTERNS OF RESEARCH IN GLOBAL 968 00:28:51,360 --> 00:28:51,640 HEALTH. 969 00:28:51,640 --> 00:28:52,920 DO WE HAVE ANY QUESTIONS FROM 970 00:28:52,920 --> 00:28:53,240 THE AUDIENCE? 971 00:28:53,240 --> 00:28:55,920 WE CAN TAKE, I THINK, ONE 972 00:28:55,920 --> 00:28:58,920 QUESTION. 973 00:28:58,920 --> 00:29:01,600 >>I HAVE A QUESTION. 974 00:29:01,600 --> 00:29:08,840 AND IT'S -- IT RELATES TO 975 00:29:08,840 --> 00:29:10,160 THERAPY. 976 00:29:10,160 --> 00:29:12,280 SO YOU TOLD US THAT CERTAIN 977 00:29:12,280 --> 00:29:13,280 THERAPIES MAY ACTUALLY WORK 978 00:29:13,280 --> 00:29:15,280 BETTER IN THESE POPULATIONS AND 979 00:29:15,280 --> 00:29:18,320 THEY DO WORK HERE, AND THEN 980 00:29:18,320 --> 00:29:19,560 COMES THE QUESTION, WHAT KIND OF 981 00:29:19,560 --> 00:29:23,560 THERAPIES CAN BE BROUGHT INTO 982 00:29:23,560 --> 00:29:25,280 AFRICA, FOR EXAMPLE, IMMUNE 983 00:29:25,280 --> 00:29:26,440 THERAPY, WOULD THAT WORK IN 984 00:29:26,440 --> 00:29:28,480 AFRICA OR IS IT JUST -- YOU 985 00:29:28,480 --> 00:29:30,920 KNOW, IS THE SETTING FOR IMMUNE 986 00:29:30,920 --> 00:29:31,960 THERAPY OR FOR SOME OTHER 987 00:29:31,960 --> 00:29:34,000 THERAPIES JUST NOT GIVEN IN 988 00:29:34,000 --> 00:29:36,360 AFRICA, IT'S NOT REALLY A MONEY 989 00:29:36,360 --> 00:29:39,440 QUESTION, SO IT'S MORE AN 990 00:29:39,440 --> 00:29:40,200 INFRASTRUCTURE QUESTION, CAN YOU 991 00:29:40,200 --> 00:29:41,440 TELL US A LITTLE BIT MORE ABOUT 992 00:29:41,440 --> 00:29:41,640 IT? 993 00:29:41,640 --> 00:29:42,400 >>SURE. 994 00:29:42,400 --> 00:29:45,040 I MEAN, I THINK -- I THINK MANY 995 00:29:45,040 --> 00:29:46,800 MORE THINGS CAN WORK THAN PEOPLE 996 00:29:46,800 --> 00:29:47,800 COMMONLY THINK. 997 00:29:47,800 --> 00:29:48,880 SO THAT'S THE FIRST POINT. 998 00:29:48,880 --> 00:29:52,520 I THINK THE SECOND POINT IS, ONE 999 00:29:52,520 --> 00:29:54,040 NEEDS TO GENERATE EVIDENCE THAT 1000 00:29:54,040 --> 00:29:55,160 WOULD SUPPORT THIS, RIGHT, AND 1001 00:29:55,160 --> 00:29:56,760 THAT INCLUDES POTENTIALLY 1002 00:29:56,760 --> 00:29:58,080 TAILORING TREATMENT PROTOCOLS, 1003 00:29:58,080 --> 00:29:59,680 ET CETERA, RIGHT? 1004 00:29:59,680 --> 00:30:01,160 THERE MAY NEED TO BE SOME 1005 00:30:01,160 --> 00:30:01,960 IMPORTANT MODIFICATIONS MADE 1006 00:30:01,960 --> 00:30:05,320 JUST AS WE DO ROUTINELY AT U.S. 1007 00:30:05,320 --> 00:30:06,560 NCI-DESIGNATED CANCER CENTERS, 1008 00:30:06,560 --> 00:30:08,240 BUT YOU KNOW, WHAT WOULD BE MUCH 1009 00:30:08,240 --> 00:30:10,160 BETTER IS TO DO THAT BASED ON 1010 00:30:10,160 --> 00:30:11,640 SOME EVIDENCE RATHER THAN WHAT 1011 00:30:11,640 --> 00:30:12,800 SORT OF PEOPLE THINK WITHOUT 1012 00:30:12,800 --> 00:30:13,200 DOING THAT. 1013 00:30:13,200 --> 00:30:16,440 AND AS YOU KNOW, HOW TO GENERATE 1014 00:30:16,440 --> 00:30:17,680 THE KIND OF EVIDENCE THAT WOULD 1015 00:30:17,680 --> 00:30:19,680 BE INFORMATIVE TO THESE BROADER 1016 00:30:19,680 --> 00:30:21,400 ACCESS QUESTIONS, FOR EXAMPLE, 1017 00:30:21,400 --> 00:30:22,000 WITH IMMUNOTHERAPY, THIS IS 1018 00:30:22,000 --> 00:30:22,960 SOMETHING THAT WE'RE THINKING A 1019 00:30:22,960 --> 00:30:25,440 GREAT DEAL ABOUT, AND INTEND TO 1020 00:30:25,440 --> 00:30:27,960 DO, I THINK, WORK IN THIS AREA 1021 00:30:27,960 --> 00:30:29,640 WITH NCI SUPPORT IN THE MONTHS 1022 00:30:29,640 --> 00:30:30,640 AND YEARS TO COME. 1023 00:30:30,640 --> 00:30:32,960 >>SO WHAT WE REALLY NEED IS AT 1024 00:30:32,960 --> 00:30:35,880 LEAST SMALL TRIALS OF THERAPIES 1025 00:30:35,880 --> 00:30:37,880 THAT WE'RE USING HERE, THEN 1026 00:30:37,880 --> 00:30:39,080 EVALUATING THEM IN AFRICA, DO 1027 00:30:39,080 --> 00:30:39,640 THEY WORK? 1028 00:30:39,640 --> 00:30:40,960 >>YEAH, AND JUST TO BACK UP A 1029 00:30:40,960 --> 00:30:42,240 LITTLE BIT, THERE IS A 1030 00:30:42,240 --> 00:30:43,640 HISTORICAL PRECEDENT FOR THIS 1031 00:30:43,640 --> 00:30:45,440 WITH HIV, SO LIKE IN THE 1032 00:30:45,440 --> 00:30:46,880 EARLY -- IN THE MID 1990s OR 1033 00:30:46,880 --> 00:30:48,280 THE EARLY 2000s, WE HAD 1034 00:30:48,280 --> 00:30:50,160 EXACTLY THE SAME CONVERSATION 1035 00:30:50,160 --> 00:30:51,880 FOR HIV, WHICH IS CAN WE PROVIDE 1036 00:30:51,880 --> 00:30:53,520 HIV TREATMENT, WHICH AT THE TIME 1037 00:30:53,520 --> 00:30:55,280 WAS ORAL PILLS GIVEN TO PEOPLE 1038 00:30:55,280 --> 00:30:56,480 AND YET WE STILL THOUGHT THAT 1039 00:30:56,480 --> 00:30:58,360 WAS NOT ABLE TO BE DONE IN AN 1040 00:30:58,360 --> 00:30:59,120 AFRICAN CONTEXT. 1041 00:30:59,120 --> 00:31:01,320 AND THERE WERE LEGITIMATE 1042 00:31:01,320 --> 00:31:04,600 ACADEMIC DEBATES ABOUT WHETHER 1043 00:31:04,600 --> 00:31:05,720 AFRICANS DIDN'T KNOW WHAT TIME 1044 00:31:05,720 --> 00:31:07,800 TO TAKE THEIR MEDICINES, YOU'RE 1045 00:31:07,800 --> 00:31:09,080 JUST -- IF YOU DO THIS WITHOUT 1046 00:31:09,080 --> 00:31:10,160 HIV VIRAL LOAD MONITORING, 1047 00:31:10,160 --> 00:31:11,320 YOU'RE JUST GOING TO GET 1048 00:31:11,320 --> 00:31:12,000 RESISTANCE AND YOU'RE GOING TO 1049 00:31:12,000 --> 00:31:13,600 MAKE THE EPIDEMIC WORSE, AND 1050 00:31:13,600 --> 00:31:14,960 THIS IS WHERE I THINK THE 1051 00:31:14,960 --> 00:31:16,200 SCIENTIFIC COMMUNITY CAN BE 1052 00:31:16,200 --> 00:31:17,240 UNIQUELY USEFUL, BECAUSE I THINK 1053 00:31:17,240 --> 00:31:19,200 THEY CAN STEP IN AND SEE IF IT 1054 00:31:19,200 --> 00:31:21,840 WORKS AND GENERATE EVIDENCE THAT 1055 00:31:21,840 --> 00:31:23,160 IS THEN INFORMATIVE TO SORT OF 1056 00:31:23,160 --> 00:31:24,800 POLICY MAKERS AND DEVELOPMENT 1057 00:31:24,800 --> 00:31:26,160 PARTNERS, ET CETERA, AND SO I 1058 00:31:26,160 --> 00:31:27,440 THINK THERE'S A REAL OPPORTUNITY 1059 00:31:27,440 --> 00:31:28,640 TO DO THAT FOR CANCER AS WELL. 1060 00:31:28,640 --> 00:31:30,080 WE HAVE LIVED THIS STORY BEFORE, 1061 00:31:30,080 --> 00:31:32,840 I THINK. 1062 00:31:32,840 --> 00:31:34,600 >>THANK YOU SO MUCH. 1063 00:31:34,600 --> 00:31:44,760 [APPLAUSE] 1064 00:31:54,040 --> 00:31:54,880 >>GOOD MORNING. 1065 00:31:54,880 --> 00:31:56,120 WE'RE THE FIRST PANEL. 1066 00:31:56,120 --> 00:31:57,720 HAPPY TO BE HERE TODAY. 1067 00:31:57,720 --> 00:31:59,120 MY NAME IS ANN GEIGER. 1068 00:31:59,120 --> 00:32:01,720 I AM THE SCIENTIFIC DIRECTOR OF 1069 00:32:01,720 --> 00:32:04,560 CANCER CARE DELIVERY RESEARCH IN 1070 00:32:04,560 --> 00:32:06,160 THE NCI COMMUNITY ONCOLOGY 1071 00:32:06,160 --> 00:32:07,320 RESEARCH PROGRAM, NCOR, WHICH 1072 00:32:07,320 --> 00:32:08,280 YOU HEARD A LITTLE BIT ABOUT 1073 00:32:08,280 --> 00:32:10,800 YESTERDAY. 1074 00:32:10,800 --> 00:32:13,400 WE HAVE THREE GREAT SPEAKERS. 1075 00:32:13,400 --> 00:32:15,480 WE HAVE DR. SARAH JACKSON, WHO 1076 00:32:15,480 --> 00:32:18,320 IS A FELLOW HERE IN OUR NCI 1077 00:32:18,320 --> 00:32:19,840 INTRAMURAL PROGRAM, WE HAVE 1078 00:32:19,840 --> 00:32:21,720 DR. ASH ALPERT, WHO IS CURRENTLY 1079 00:32:21,720 --> 00:32:23,200 A FELLOW AT BROWN BUT I'M HAPPY 1080 00:32:23,200 --> 00:32:25,280 TO SAY IS GOING TO YALE. 1081 00:32:25,280 --> 00:32:27,640 SO SHE IS SWITCHING IVY LEAGUE 1082 00:32:27,640 --> 00:32:28,720 SCHOOLS. 1083 00:32:28,720 --> 00:32:30,760 BY THE WAY, NEITHER OF WHICH I 1084 00:32:30,760 --> 00:32:31,120 SUPPORT. 1085 00:32:31,120 --> 00:32:32,840 I WENT TO A DIFFERENT IVY LEAGUE 1086 00:32:32,840 --> 00:32:33,280 SCHOOL. 1087 00:32:33,280 --> 00:32:35,200 BUT GOOD FOR HER. 1088 00:32:35,200 --> 00:32:36,880 AND THEN DR. MEGAN MULLINS, 1089 00:32:36,880 --> 00:32:38,600 WHO'S AN ASSISTANT PROFESSOR AT 1090 00:32:38,600 --> 00:32:40,800 THE UNIVERSITY OF TEXAS 1091 00:32:40,800 --> 00:32:42,400 SOUTHWESTERN, WHO DID A POSTDOC 1092 00:32:42,400 --> 00:32:43,560 AT THE UNIVERSITY OF MICHIGAN, 1093 00:32:43,560 --> 00:32:45,560 WHICH I HAPPEN TO BE AN ALUMNI 1094 00:32:45,560 --> 00:32:47,560 OF, SO GO BLUE. 1095 00:32:47,560 --> 00:32:48,920 THOSE ARE MY LITTLE FUN 1096 00:32:48,920 --> 00:32:50,880 COMMENTS. 1097 00:32:50,880 --> 00:32:53,600 I JUST WANTED TO MAKE A FEW 1098 00:32:53,600 --> 00:32:58,720 OPENING COMMENTS TODAY. 1099 00:32:58,720 --> 00:32:59,880 ONE OF THE THINGS I WANTED TO DO 1100 00:32:59,880 --> 00:33:00,880 IS TALK ABOUT TERMINOLOGY, 1101 00:33:00,880 --> 00:33:02,480 BECAUSE I THINK MANY OF US 1102 00:33:02,480 --> 00:33:04,360 STRUGGLE WITH WHAT ALL THESE 1103 00:33:04,360 --> 00:33:06,560 DIFFERENT TERMS ARE. 1104 00:33:06,560 --> 00:33:08,280 AND SO, YOU KNOW, I'M NOT GOING 1105 00:33:08,280 --> 00:33:10,040 TO READ THESE TO YOU, BUT YOU 1106 00:33:10,040 --> 00:33:13,960 CAN SEE THE LGBTQIA, WHICH IS A 1107 00:33:13,960 --> 00:33:15,320 COMMON -- YOU WILL SEE SOME 1108 00:33:15,320 --> 00:33:16,400 COMBINATION OF THOSE THINGS 1109 00:33:16,400 --> 00:33:19,360 FREQUENTLY. 1110 00:33:19,360 --> 00:33:20,920 HOW WE INDIVIDUALS REFER TO 1111 00:33:20,920 --> 00:33:23,640 OURSELF CAN BE REALLY VARIABLE. 1112 00:33:23,640 --> 00:33:25,840 I CALLED MYSELF GAY FOR A WHILE, 1113 00:33:25,840 --> 00:33:27,400 THEN I WAS LESBIAN, THEN I WAS 1114 00:33:27,400 --> 00:33:30,120 BACK TO GAY, NOW I'M KIND OF AT 1115 00:33:30,120 --> 00:33:30,560 QUEER. 1116 00:33:30,560 --> 00:33:31,240 IT CHANGES. 1117 00:33:31,240 --> 00:33:33,560 MY SPOUSE WAS LESBIAN, IS NOW 1118 00:33:33,560 --> 00:33:34,080 BISEXUAL. 1119 00:33:34,080 --> 00:33:37,000 SO IT'S FLUID, HOW WE IDENTIFY. 1120 00:33:37,000 --> 00:33:39,280 FOR ME PERSONALLY, IT'S OKAY TO 1121 00:33:39,280 --> 00:33:39,440 ASK. 1122 00:33:39,440 --> 00:33:41,280 I GIVE PEOPLE A LOT OF GRACE IF 1123 00:33:41,280 --> 00:33:43,760 THEY STUMBLE OVER THE 1124 00:33:43,760 --> 00:33:45,120 TERMINOLOGY, SO SEEING US IS 1125 00:33:45,120 --> 00:33:46,520 MORE IMPORTANT THAN GETTING IT 1126 00:33:46,520 --> 00:33:48,160 PERFECT. 1127 00:33:48,160 --> 00:33:49,760 BUT I ALSO WANT TO ADDRESS TWO 1128 00:33:49,760 --> 00:33:52,120 TERMS WE USE IN RESEARCH. 1129 00:33:52,120 --> 00:33:54,120 SO SGM, SEXUAL AND GENDER 1130 00:33:54,120 --> 00:33:54,640 MINORITIES. 1131 00:33:54,640 --> 00:33:57,360 THAT IS A RESEARCH USAGE. 1132 00:33:57,360 --> 00:33:59,800 OUR COMMUNITY IS NOT SGM 1133 00:33:59,800 --> 00:34:01,760 COMMUNITY AND WE AS INDIVIDUALS 1134 00:34:01,760 --> 00:34:02,800 ARE NOT SGM. 1135 00:34:02,800 --> 00:34:04,040 SO IF YOU WOULD PLEASE JUST KIND 1136 00:34:04,040 --> 00:34:06,240 OF KEEP THAT IN MIND. 1137 00:34:06,240 --> 00:34:08,880 AND THEN SOGI. 1138 00:34:08,880 --> 00:34:10,520 I HAVE RECENTLY BEEN CALLED 1139 00:34:10,520 --> 00:34:10,880 SOGI. 1140 00:34:10,880 --> 00:34:13,000 THAT IS A DEFINITE MISUSE. 1141 00:34:13,000 --> 00:34:17,080 THAT IS A DATA TERMINOLOGY. 1142 00:34:17,080 --> 00:34:18,640 DR. JACKSON IS ACTUALLY GOING TO 1143 00:34:18,640 --> 00:34:20,520 TALK A LITTLE BIT MORE ABOUT 1144 00:34:20,520 --> 00:34:22,920 SOGI DATA. 1145 00:34:22,920 --> 00:34:25,160 SO I WANTED TO MENTION THAT. 1146 00:34:25,160 --> 00:34:26,560 I ALSO WANTED TO MENTION 1147 00:34:26,560 --> 00:34:30,960 SOMETHING THAT I HAVE 1148 00:34:30,960 --> 00:34:31,800 EXPERIENCED AND OBSERVED, WHICH 1149 00:34:31,800 --> 00:34:33,040 IS THAT MEMBERS OF OUR COMMUNITY 1150 00:34:33,040 --> 00:34:34,240 AND THOSE INTERESTED IN DOING 1151 00:34:34,240 --> 00:34:37,600 RESEARCH WITH OUR COMMUNITY 1152 00:34:37,600 --> 00:34:38,520 DON'T ALWAYS RECOGNIZE 1153 00:34:38,520 --> 00:34:40,680 THEMSELVES AS BEING INCLUDED IN 1154 00:34:40,680 --> 00:34:42,880 THINGS LABELED WITH TERMS LIKE 1155 00:34:42,880 --> 00:34:44,560 DIVERSITY, DISPARITIES, 1156 00:34:44,560 --> 00:34:46,440 MINORITY, UNDERSERVED. 1157 00:34:46,440 --> 00:34:48,280 AND WE MAY FEEL EXCLUDED WHEN 1158 00:34:48,280 --> 00:34:51,400 TERMS LIKE THAT ARE USED AND WE 1159 00:34:51,400 --> 00:34:53,320 LOOK INTO IT AND IN FACT ARE NOT 1160 00:34:53,320 --> 00:34:54,120 PART OF THE ACTIVITY. 1161 00:34:54,120 --> 00:34:55,640 SO I JUST WANT TO PUT A PLEA OUT 1162 00:34:55,640 --> 00:34:59,000 THERE TO EVERYONE TO PLEASE BE 1163 00:34:59,000 --> 00:35:00,840 VERY SPECIFIC IN WHAT YOU'RE 1164 00:35:00,840 --> 00:35:02,200 DOING, AND IF YOU ARE LIMITING 1165 00:35:02,200 --> 00:35:06,000 YOUR DISPARITIES ACTIVITIES, FOR 1166 00:35:06,000 --> 00:35:08,920 EXAMPLE, TO RURAL, JUST SAY 1167 00:35:08,920 --> 00:35:09,880 RURAL, THIS IS A RURAL 1168 00:35:09,880 --> 00:35:10,600 DISPARITIES ACTIVITY. 1169 00:35:10,600 --> 00:35:11,640 I THINK THAT WOULD BE GOOD FOR 1170 00:35:11,640 --> 00:35:13,120 EVERYONE AND I THINK IT WOULD BE 1171 00:35:13,120 --> 00:35:13,840 HELPFUL FOR OUR COMMUNITY AS 1172 00:35:13,840 --> 00:35:17,760 WELL. 1173 00:35:17,760 --> 00:35:18,680 SO I'M NOT GOING TO SAY MUCH 1174 00:35:18,680 --> 00:35:20,160 BECAUSE I THINK OUR SPEAKERS ARE 1175 00:35:20,160 --> 00:35:23,160 GOING TO TALK ABOUT THIS. 1176 00:35:23,160 --> 00:35:25,760 OUR COMMUNITY EXPERIENCES 1177 00:35:25,760 --> 00:35:26,880 SUBSTANTIAL DISPARITIES IN 1178 00:35:26,880 --> 00:35:27,640 CANCER OUTCOMES. 1179 00:35:27,640 --> 00:35:30,640 HERE ARE A COUPLE OF THE REAPS 1180 00:35:30,640 --> 00:35:31,520 WHY. 1181 00:35:31,520 --> 00:35:33,760 WE EXPERIENCE GREATER 1182 00:35:33,760 --> 00:35:34,640 LIFESTYLE-BASED RISK FACTORS, 1183 00:35:34,640 --> 00:35:37,920 AND THERE ARE FEWER LIFESTYLE 1184 00:35:37,920 --> 00:35:38,760 PROGRAMS -- INTERVENTION 1185 00:35:38,760 --> 00:35:41,040 PROGRAMS TAILORED TO OUR NEEDS. 1186 00:35:41,040 --> 00:35:42,840 WE ARE LESS LIKELY TO BE 1187 00:35:42,840 --> 00:35:44,120 SCREENED, WE HAVE HIGHER RATES 1188 00:35:44,120 --> 00:35:46,320 OF CERTAIN CANCERS, WE ARE LESS 1189 00:35:46,320 --> 00:35:49,000 LIKELY TO SEEK TIMELY CANCER 1190 00:35:49,000 --> 00:35:49,760 CARE. 1191 00:35:49,760 --> 00:35:51,280 ROUGHLY A THIRD OF US, IF YOU 1192 00:35:51,280 --> 00:35:53,640 ASK, WILL REPORT A PRETTY 1193 00:35:53,640 --> 00:35:54,960 SERIOUS INCIDENCE OF HARASSMENT 1194 00:35:54,960 --> 00:35:56,280 IN THE MEDICAL CARE SYSTEM. 1195 00:35:56,280 --> 00:35:58,360 I WOULD INCLUDE MYSELF AMONG 1196 00:35:58,360 --> 00:36:00,080 THOSE THIRD. 1197 00:36:00,080 --> 00:36:02,520 OBVIOUSLY THAT PROVOKES A LOT OF 1198 00:36:02,520 --> 00:36:03,040 MISTRUST. 1199 00:36:03,040 --> 00:36:06,040 AND SURVIVORSHIP CARE IS NOT AS 1200 00:36:06,040 --> 00:36:06,520 GOOD. 1201 00:36:06,520 --> 00:36:07,840 I'M GOING TO BACK UP ONE SECOND 1202 00:36:07,840 --> 00:36:09,040 BECAUSE I FORGOT TO SAY 1203 00:36:09,040 --> 00:36:12,920 SOMETHING THAT'S VERY IMPORTANT. 1204 00:36:12,920 --> 00:36:14,160 WE HEARD A LITTLE BIT OF THIS 1205 00:36:14,160 --> 00:36:14,480 YESTERDAY. 1206 00:36:14,480 --> 00:36:16,600 NONE OF THESE MINORITIZED GROUPS 1207 00:36:16,600 --> 00:36:17,800 ARE MONOLITHS. 1208 00:36:17,800 --> 00:36:20,680 AND OUR GROUP IS NOT EITHER. 1209 00:36:20,680 --> 00:36:22,640 AND IF YOU LOOK AT THESE 1210 00:36:22,640 --> 00:36:24,040 DIFFERENT GROUPS, YOU WILL SEE 1211 00:36:24,040 --> 00:36:26,360 SOME REASONS WE MAY NOT HAVE 1212 00:36:26,360 --> 00:36:27,320 VERY MUCH IN COMMON AND SOME 1213 00:36:27,320 --> 00:36:28,440 THINGS THAT WE VERY MUCH HAVE IN 1214 00:36:28,440 --> 00:36:29,760 COMMON. 1215 00:36:29,760 --> 00:36:33,120 AND I ALSO WANTED TO MENTION 1216 00:36:33,120 --> 00:36:34,480 THAT INTERSECTIONALITY IS A VERY 1217 00:36:34,480 --> 00:36:35,240 IMPORTANT ISSUE FOR OUR 1218 00:36:35,240 --> 00:36:37,680 COMMUNITY. 1219 00:36:37,680 --> 00:36:39,360 UNFORTUNATELY, THE GAY AND 1220 00:36:39,360 --> 00:36:41,000 LESBIAN COMMUNITY HAS A LONG 1221 00:36:41,000 --> 00:36:46,200 HISTORY OF RACISM, SEXISM. 1222 00:36:46,200 --> 00:36:47,800 IF YOU'RE A RURAL MEMBER OF ONE 1223 00:36:47,800 --> 00:36:49,880 OF THESE GROUPS, YOU COULD HAVE 1224 00:36:49,880 --> 00:36:51,920 A VERY CHALLENGING LIFE. 1225 00:36:51,920 --> 00:36:53,320 NOT ALL OF US LIVE IN URBAN 1226 00:36:53,320 --> 00:36:53,640 AREAS. 1227 00:36:53,640 --> 00:36:54,720 SO ONE OF THE THINGS WE'RE GOING 1228 00:36:54,720 --> 00:36:55,840 TO DO TODAY WHEN WE HAVE OUR 1229 00:36:55,840 --> 00:36:57,720 PANEL IS TRY TO TALK ABOUT THAT 1230 00:36:57,720 --> 00:37:00,360 A LITTLE BIT, BUT I WANT TO 1231 00:37:00,360 --> 00:37:02,920 ACKNOWLEDGE THAT THAT IS 1232 00:37:02,920 --> 00:37:04,320 SOMETHING THAT WE ARE TRYING TO 1233 00:37:04,320 --> 00:37:07,600 BE VERY AWARE. 1234 00:37:07,600 --> 00:37:09,360 SO WOULD YOU LIKE TO GO AHEAD? 1235 00:37:09,360 --> 00:37:12,520 OKAY. 1236 00:37:12,520 --> 00:37:13,800 SO I'M NOT GOING TO INTRODUCE 1237 00:37:13,800 --> 00:37:14,560 THE SPEAKERS. 1238 00:37:14,560 --> 00:37:15,680 THEY'RE JUST GOING TO GO ONE BY 1239 00:37:15,680 --> 00:37:16,320 ONE. 1240 00:37:16,320 --> 00:37:17,640 BUT I WILL SAY THIS IS 1241 00:37:17,640 --> 00:37:27,840 DR. JACKSON. 1242 00:38:03,120 --> 00:38:04,240 >>THANK YOU, EVERYONE, AND 1243 00:38:04,240 --> 00:38:08,160 THANK YOU FOR THAT FIRST TALK. 1244 00:38:08,160 --> 00:38:11,840 I DO WANT TO SAY, TO ADD ON TO 1245 00:38:11,840 --> 00:38:12,920 WHAT ANN SAID, IS THAT I'M GOING 1246 00:38:12,920 --> 00:38:15,240 TO SHOW YOU A LOT OF DATA OR 1247 00:38:15,240 --> 00:38:16,640 SOME SCARCE MINIMAL DATA, AND I 1248 00:38:16,640 --> 00:38:18,720 WANT YOU TO TAKE IT WITH A GRAIN 1249 00:38:18,720 --> 00:38:19,280 OF SALT. 1250 00:38:19,280 --> 00:38:20,360 SOME OF THE DATA I'M GOING TO 1251 00:38:20,360 --> 00:38:22,520 SHOW YOU IS THE ONLY DATA WE 1252 00:38:22,520 --> 00:38:24,640 HAVE ON CANCER IN THESE 1253 00:38:24,640 --> 00:38:26,480 COMMUNITIES, AND SOME OF IT IS 1254 00:38:26,480 --> 00:38:27,000 STILL PROBLEMATIC. 1255 00:38:27,000 --> 00:38:31,000 SO PLEASE KEEP THAT IN MIND. 1256 00:38:31,000 --> 00:38:32,880 AS AN INTRODUCTION, MY NAME IS 1257 00:38:32,880 --> 00:38:33,720 DR. SARAH JACKSON. 1258 00:38:33,720 --> 00:38:36,840 MY PRONOUNS ARE SHE/HER/HERS. 1259 00:38:36,840 --> 00:38:38,600 I'M A RESEARCH FELLOW IN THE 1260 00:38:38,600 --> 00:38:40,360 INFECTIONS AND 1261 00:38:40,360 --> 00:38:41,680 IMMUNOEPIDEMIOLOGY BRANCH WITHIN 1262 00:38:41,680 --> 00:38:43,240 DCG AT NCI. 1263 00:38:43,240 --> 00:38:45,080 HERE MY RESEARCH FOCUSES MOSTLY 1264 00:38:45,080 --> 00:38:47,200 ON CANCER BURDEN IN TRANS 1265 00:38:47,200 --> 00:38:48,080 INDIVIDUALS, BUT I AM GOING TO 1266 00:38:48,080 --> 00:38:53,360 BE TALKING ABOUT THE LARGER 1267 00:38:53,360 --> 00:38:53,840 LGBTQ+ COMMUNITY TODAY. 1268 00:38:53,840 --> 00:38:55,120 SO BEFORE I GET INTO TALKING 1269 00:38:55,120 --> 00:38:58,400 ABOUT CANCER RISK AMONG LGBTQ+ 1270 00:38:58,400 --> 00:38:59,360 INDIVIDUALS, I WANT TO TALK 1271 00:38:59,360 --> 00:39:00,600 ABOUT HOW LARGE THE POPULATION 1272 00:39:00,600 --> 00:39:03,800 IS IN THE UNITED STATES. 1273 00:39:03,800 --> 00:39:07,160 SO THE U.S. CENSUS DOES NOT 1274 00:39:07,160 --> 00:39:08,600 COLLECT GENDER ORIENTATION OR 1275 00:39:08,600 --> 00:39:09,960 IDENTITY MAKING IT DIFFICULT TO 1276 00:39:09,960 --> 00:39:10,880 KNOW HOW LARGE THIS POPULATION 1277 00:39:10,880 --> 00:39:11,560 IS. 1278 00:39:11,560 --> 00:39:13,040 INSTEAD THESE DATA COME FROM A 1279 00:39:13,040 --> 00:39:15,880 2021 GALLOP POLL WHICH ESTIMATES 1280 00:39:15,880 --> 00:39:17,320 THAT 7.1% OF THE ADULT 1281 00:39:17,320 --> 00:39:20,760 POPULATION IN THE U.S. IS LGBT. 1282 00:39:20,760 --> 00:39:21,800 AND THEN THESE ARE THE GALLOP 1283 00:39:21,800 --> 00:39:23,840 POLL RESULTS BY GENERATION. 1284 00:39:23,840 --> 00:39:28,920 WHAT I FIND STRAI FIND STRIKINGE 1285 00:39:28,920 --> 00:39:30,920 PROPORTION OF PEOPLE IDENTIFYING 1286 00:39:30,920 --> 00:39:32,200 AS LGBT IS INCREASING WITH EACH 1287 00:39:32,200 --> 00:39:32,600 GENERATION. 1288 00:39:32,600 --> 00:39:34,240 SO THINK ABOUT HOW THE OLDEST 1289 00:39:34,240 --> 00:39:35,240 MILLENNIALS ARE NOW IN THEIR 1290 00:39:35,240 --> 00:39:36,720 40s SO WE HAVE ALMOST FOUR 1291 00:39:36,720 --> 00:39:38,840 GENERATIONS OF PEOPLE WHO ARE AT 1292 00:39:38,840 --> 00:39:40,400 AN AGE WHERE CANCER RISK IS 1293 00:39:40,400 --> 00:39:42,560 INCREASED, BUT WE HAVE NO GOOD 1294 00:39:42,560 --> 00:39:43,800 INFORMATION ON CANCER RISK 1295 00:39:43,800 --> 00:39:45,520 FACTORS, CANCER INCIDENCE OR 1296 00:39:45,520 --> 00:39:46,720 SURVIVAL FOR MEMBERS OF THIS 1297 00:39:46,720 --> 00:39:48,200 POPULATION. 1298 00:39:48,200 --> 00:39:51,800 AND THEN IF YOU LOOK AT GEN Z, 1299 00:39:51,800 --> 00:39:54,560 NEARLY 21% OF GEN Z CONSIDER 1300 00:39:54,560 --> 00:39:56,120 THEMSELVES TO BE LGBTQ+ WHICH 1301 00:39:56,120 --> 00:39:57,280 MEANS WE NEED TO START SETTING 1302 00:39:57,280 --> 00:40:00,760 STUDYINGTHIS POPULATION NOW SO N 1303 00:40:00,760 --> 00:40:06,560 PROVIDE THIS GENERATION WITH 1304 00:40:06,560 --> 00:40:08,200 CANCER RISK RELEVANT TO THEIR 1305 00:40:08,200 --> 00:40:09,000 BODIES AND EXPERIENCES. 1306 00:40:09,000 --> 00:40:10,720 I'M GOING TO USE THE TERM SOGI A 1307 00:40:10,720 --> 00:40:12,040 LOT, THANK YOU, ANN, FOR 1308 00:40:12,040 --> 00:40:12,960 INTRODUCING THIS. 1309 00:40:12,960 --> 00:40:14,480 IT STANDS AGAIN FOR SEXUAL 1310 00:40:14,480 --> 00:40:16,000 ORIENTATION IN GENDER IDENTITY. 1311 00:40:16,000 --> 00:40:17,480 SOGI IS NOT ROUTINELY COLLECTED 1312 00:40:17,480 --> 00:40:19,320 IN THE PLACES WHERE WE GO TO 1313 00:40:19,320 --> 00:40:21,160 LOOK FOR CANCER RISK FACTORS, 1314 00:40:21,160 --> 00:40:23,480 CANCER INCIDENCE OR SURVIVAL. 1315 00:40:23,480 --> 00:40:24,960 SO FOR INSTANCE, IT'S NOT 1316 00:40:24,960 --> 00:40:26,680 ROUTINELY COLLECTED IN MOST 1317 00:40:26,680 --> 00:40:30,400 POPULATION-BASED SURVEYS, 1318 00:40:30,400 --> 00:40:33,480 NHANES, NHIS COLLECTS SEXUAL OR 1319 00:40:33,480 --> 00:40:36,120 YEN TASTE, THE BRFSS COLLECTS 1320 00:40:36,120 --> 00:40:39,600 BOTH SO IT IS NOT WITHOUT ISSUE. 1321 00:40:39,600 --> 00:40:42,000 NOT IN CANCER REGISTRIES, COHORT 1322 00:40:42,000 --> 00:40:43,720 STUDIES NOT ROUTINELY THERE, NOT 1323 00:40:43,720 --> 00:40:44,840 COLLECTED IN PREVENTION AND 1324 00:40:44,840 --> 00:40:45,440 TREATMENT TRIALS EITHER. SO 1325 00:40:45,440 --> 00:40:47,800 THIS MEANS WE HAVE VERY LITTLE 1326 00:40:47,800 --> 00:40:49,440 DATA ON RISK FACTORS, INCIDENCE 1327 00:40:49,440 --> 00:40:50,760 AND SURVIVAL. 1328 00:40:50,760 --> 00:40:52,000 SO AGAIN I'M GOING TO REPEAT 1329 00:40:52,000 --> 00:40:53,480 THROUGHOUT THIS TALK THAT SOGI 1330 00:40:53,480 --> 00:40:54,920 ISN'T COLLECTED IN THESE MAJOR 1331 00:40:54,920 --> 00:40:57,080 DATA SOURCES, BUT FOR THOSE OF 1332 00:40:57,080 --> 00:40:58,720 YOU WHO ARE NOT EPIDEMIOLOGISTS, 1333 00:40:58,720 --> 00:41:00,080 YOU MAY WONDER WHY THIS IS SO 1334 00:41:00,080 --> 00:41:01,160 IMPORTANT. 1335 00:41:01,160 --> 00:41:02,400 SO ONE OF THE BASIC MEASURES 1336 00:41:02,400 --> 00:41:04,520 THAT WE USE TO ESTIMATE CANCER 1337 00:41:04,520 --> 00:41:06,720 RISK AND TO COMPARE POPULATIONS 1338 00:41:06,720 --> 00:41:07,960 IS INCIDENCE. 1339 00:41:07,960 --> 00:41:09,160 SO INCIDENCE IS THE NUMBER OF 1340 00:41:09,160 --> 00:41:11,880 NEW CASES IN A POPULATION 1341 00:41:11,880 --> 00:41:15,720 DIVIDED OVER THE TOTAL 1342 00:41:15,720 --> 00:41:16,040 POPULATION. 1343 00:41:16,040 --> 00:41:17,080 THEN WE USUALLY GET THE NUMBER 1344 00:41:17,080 --> 00:41:19,000 OF NEW CASES FROM CANCER 1345 00:41:19,000 --> 00:41:20,080 REGISTRIES AND THEN WE GET THE 1346 00:41:20,080 --> 00:41:22,400 TOTAL POPULATION FROM THE 1347 00:41:22,400 --> 00:41:22,640 CENSUS. 1348 00:41:22,640 --> 00:41:24,480 SO CANCER REGISTRIES DON'T 1349 00:41:24,480 --> 00:41:27,080 COLLECT SEXUAL ORIENTATION. 1350 00:41:27,080 --> 00:41:28,280 GENDER IDENTITY IS SORT OF 1351 00:41:28,280 --> 00:41:29,320 COLLECTED, THOUGH AGAIN, IT CAN 1352 00:41:29,320 --> 00:41:31,160 BE PROBLEMATIC. 1353 00:41:31,160 --> 00:41:32,840 SEXUAL ORIENTATION CAN SORT OF 1354 00:41:32,840 --> 00:41:35,320 BE COLLECTED IN THE CENSUS, SO 1355 00:41:35,320 --> 00:41:38,200 THE AMERICAN COMMUNITY SURVEY 1356 00:41:38,200 --> 00:41:40,400 ASKS ABOUT SAME SEX PARTNERSHIP 1357 00:41:40,400 --> 00:41:41,600 HOUSEHOLDS, BUT THAT DOESN'T 1358 00:41:41,600 --> 00:41:45,200 COLLECT THE ENTIRE LGBTQ+ 1359 00:41:45,200 --> 00:41:45,840 COMMUNITY, AND GENDER IDENTITY 1360 00:41:45,840 --> 00:41:47,120 IS NOT COLLECTED AT ALL IN THE 1361 00:41:47,120 --> 00:41:49,240 CENSUS. 1362 00:41:49,240 --> 00:41:50,800 SO I WANT TO MOVE ON TO SOME OF 1363 00:41:50,800 --> 00:41:53,440 THE RISK FACTORS FOR CANCER. 1364 00:41:53,440 --> 00:41:57,320 I AM IN THE INFECTIONS AND 1365 00:41:57,320 --> 00:41:58,360 IMMUNOEPI BRANCH SO I'M 1366 00:41:58,360 --> 00:41:59,280 PARTICULARLY FOCUSED ON 1367 00:41:59,280 --> 00:42:00,960 INFECTIONS THAT ARE RELATED TO 1368 00:42:00,960 --> 00:42:01,480 CANCER. 1369 00:42:01,480 --> 00:42:02,840 THERE'S NOT A LOT OF DATA ON THE 1370 00:42:02,840 --> 00:42:06,240 PREVALENCE OF THESE INFECTIONS, 1371 00:42:06,240 --> 00:42:08,280 HIV AND HPV IN SEXUAL AND GENDER 1372 00:42:08,280 --> 00:42:09,720 MINORITY PEOPLE IN THE UNITED 1373 00:42:09,720 --> 00:42:10,040 STATES. 1374 00:42:10,040 --> 00:42:11,480 AGAIN, THAT'S BECAUSE WE DON'T 1375 00:42:11,480 --> 00:42:13,760 COLLECT SOGI DATA. 1376 00:42:13,760 --> 00:42:17,440 BUT I HAVE -- I'M GOING TO 1377 00:42:17,440 --> 00:42:18,600 PROVIDE YOU WITH SOME ESTIMATES. 1378 00:42:18,600 --> 00:42:20,440 SO JUST A NOTE HERE THAT THE 1379 00:42:20,440 --> 00:42:22,040 HASH MARKING FOR TRANS WOMEN, 1380 00:42:22,040 --> 00:42:24,680 TRANS MEN, SEXUAL MINORITIES, 1381 00:42:24,680 --> 00:42:26,480 CIS WOMEN AND SEXUAL MINORITY 1382 00:42:26,480 --> 00:42:30,040 CIS MEN KIND OF -- I'M TRYING TO 1383 00:42:30,040 --> 00:42:31,120 INDICATE THE LEVEL OF EVIDENCE 1384 00:42:31,120 --> 00:42:32,440 SO THERE'S JUST NOT A LOT OF 1385 00:42:32,440 --> 00:42:33,680 EVIDENCE, THERE ARE NOT A LOT OF 1386 00:42:33,680 --> 00:42:35,000 LARGE SCALE STUDIES FOR THESE 1387 00:42:35,000 --> 00:42:36,440 COMMUNITIES. 1388 00:42:36,440 --> 00:42:39,160 AND THEN I USED THE GENERAL 1389 00:42:39,160 --> 00:42:43,200 POPULATION OF CISHET MEN AND 1390 00:42:43,200 --> 00:42:45,000 WOMEN TO KIND OF COMPARE. 1391 00:42:45,000 --> 00:42:48,560 SO THIS IS THE PREVALENCE OF HIV 1392 00:42:48,560 --> 00:42:53,080 IN THE POPULATION THAT WE KNOW. 1393 00:42:53,080 --> 00:42:54,560 SO IT'S ESTIMATED THAT 1394 00:42:54,560 --> 00:42:55,520 APPROXIMATELY 22% OF TRANS WOMEN 1395 00:42:55,520 --> 00:42:58,240 IN THE U.S. ARE LIVING WITH HIV. 1396 00:42:58,240 --> 00:43:01,920 2 TO 3% OF TRANS MEN HAVE HIV. 1397 00:43:01,920 --> 00:43:03,360 THE PREVALENCE OF HIV AMONG 1398 00:43:03,360 --> 00:43:06,640 SEXUAL MINORITY MEN IS AROUND 1399 00:43:06,640 --> 00:43:09,280 11% AND AROUND LESS THAN 1% FOR 1400 00:43:09,280 --> 00:43:10,960 CIS MEN AND CIS WOMEN IN THE 1401 00:43:10,960 --> 00:43:11,680 GENERAL POPULATION. 1402 00:43:11,680 --> 00:43:13,920 THE PREVALENCE OF HIV AMONG 1403 00:43:13,920 --> 00:43:15,200 SEXUAL MINORITY WOMEN IS THOUGHT 1404 00:43:15,200 --> 00:43:18,920 TO BE VERY LOW AND I'M NOT 1405 00:43:18,920 --> 00:43:20,120 ACTUALLY AWARE OF ANY PREVALENCE 1406 00:43:20,120 --> 00:43:20,880 ESTIMATES. 1407 00:43:20,880 --> 00:43:22,240 NEXT I'M GOING TO SHOW YOU 1408 00:43:22,240 --> 00:43:24,360 PREVALENCE ESTIMATES FOR HPV, 1409 00:43:24,360 --> 00:43:25,880 WHICH ALSO DEPEND ON ANATOMIC 1410 00:43:25,880 --> 00:43:27,320 SITE THAT WE'RE TALKING ABOUT. 1411 00:43:27,320 --> 00:43:28,720 SO FIRST LET'S TALK ABOUT HIGH 1412 00:43:28,720 --> 00:43:32,680 RISK ANAL HPV. 1413 00:43:32,680 --> 00:43:34,680 ONE STUDY ESTIMATED THAT TRANS 1414 00:43:34,680 --> 00:43:37,440 WOMEN HAVE 50% PREVALENCE OF 1415 00:43:37,440 --> 00:43:39,080 ANAL HPV, AND THAT SAME STUDY 1416 00:43:39,080 --> 00:43:43,080 ESTIMATED A 36% PREVALENCE IN 1417 00:43:43,080 --> 00:43:45,120 SEXUAL MINORITY MEN. 1418 00:43:45,120 --> 00:43:47,800 WHEN WE TURN NOW TO CERVIX AND 1419 00:43:47,800 --> 00:43:50,320 VAGINAL HPV, AND THIS IS HIGH 1420 00:43:50,320 --> 00:43:51,920 RISK HPV THAT I'M SHOWING YOU, 1421 00:43:51,920 --> 00:43:54,480 ANOTHER STUDY FOUND 20% 1422 00:43:54,480 --> 00:43:58,920 PREVALENCE OF HIGH RISK HPV IN 1423 00:43:58,920 --> 00:44:02,680 THE NEO VAGINA FOR TRANS WOMEN, 1424 00:44:02,680 --> 00:44:04,400 A VAGINA THAT IS CONSTRUCTED FOR 1425 00:44:04,400 --> 00:44:05,440 TRANS WOMEN. 1426 00:44:05,440 --> 00:44:07,560 IT'S USUALLY MADE OUT OF PENILE 1427 00:44:07,560 --> 00:44:08,960 SKIN OR SKIN USED FROM THE 1428 00:44:08,960 --> 00:44:09,240 COLON. 1429 00:44:09,240 --> 00:44:10,840 AT THIS TIME, IT'S NOT KNOWN 1430 00:44:10,840 --> 00:44:13,800 WHAT PERSISTENT HPV INFECTION IN 1431 00:44:13,800 --> 00:44:15,560 THE VAGINA OF TRANS WOMEN MEANS, 1432 00:44:15,560 --> 00:44:17,240 SO WE REALLY DO NEED TO STUDY 1433 00:44:17,240 --> 00:44:18,080 THIS FURTHER. 1434 00:44:18,080 --> 00:44:20,600 AND THEN I FOUND ESTIMATES OF 1435 00:44:20,600 --> 00:44:23,960 16% PREVALENCE FOR CERVICAL HPV 1436 00:44:23,960 --> 00:44:27,080 IN TRANS MASCULINE FOLKS. 1437 00:44:27,080 --> 00:44:29,960 13% PREVALENCE FOR SEXUAL 1438 00:44:29,960 --> 00:44:31,680 MINORITY WOMEN. 1439 00:44:31,680 --> 00:44:35,240 AND THEN 28% FOR CISHET WOMEN. 1440 00:44:35,240 --> 00:44:38,200 AND NOW TURNING TO ORAL HPV, WE 1441 00:44:38,200 --> 00:44:39,840 SEE THAT THE PREVALENCES ARE 1442 00:44:39,840 --> 00:44:43,440 PRETTY SIMILAR ACROSS GROUPS. 1443 00:44:43,440 --> 00:44:45,440 WITH CISHET WOMEN HAVING THE 1444 00:44:45,440 --> 00:44:48,760 LOWEST PREVALENCE OF ORAL HPV. 1445 00:44:48,760 --> 00:44:51,600 AND I WILL NOTE THAT WHAT IS 1446 00:44:51,600 --> 00:44:54,240 MISSING HERE IS ANY DATA ON ANAL 1447 00:44:54,240 --> 00:44:57,480 HPV IN TRANS MEN OR IN SEXUAL 1448 00:44:57,480 --> 00:44:58,880 MINORITY WOMEN, OR ORAL HPV IN 1449 00:44:58,880 --> 00:45:05,600 TRANS MEN. 1450 00:45:05,600 --> 00:45:07,640 SO I'M GOING TO GO NOW INTO THE 1451 00:45:07,640 --> 00:45:09,560 EVIDENCE OF WHY THESE INFECTIONS 1452 00:45:09,560 --> 00:45:10,760 ARE IMPORTANT FOR CANCER. 1453 00:45:10,760 --> 00:45:12,760 WHILE HPV ITSELF DOES NOT CAUSE 1454 00:45:12,760 --> 00:45:13,640 CANCER, IT IS ASSOCIATED WITH A 1455 00:45:13,640 --> 00:45:16,200 HIGHER NUMBER OF CANCERS DUE TO 1456 00:45:16,200 --> 00:45:16,800 IMMUNOSUPPRESSION, EVEN AMONG 1457 00:45:16,800 --> 00:45:18,040 THOSE WHO HAVE ACCESS TO 1458 00:45:18,040 --> 00:45:19,280 ANTIVIRAL THERAPY. 1459 00:45:19,280 --> 00:45:21,480 SO WORK DONE IN MY BRANCH HAS 1460 00:45:21,480 --> 00:45:24,040 SHOWN THAT THERE IS AN INCREASE 1461 00:45:24,040 --> 00:45:26,320 OF AIDS-DEFINING MALIGNANCIES 1462 00:45:26,320 --> 00:45:28,880 LIKE KAPOSI SARCOMA, 1463 00:45:28,880 --> 00:45:29,640 NON-HODGKIN'S LYMPHOMA AND 1464 00:45:29,640 --> 00:45:30,720 CERVICAL CANCER. 1465 00:45:30,720 --> 00:45:33,040 HIV CAN ALSO INCREASE THE RISK 1466 00:45:33,040 --> 00:45:35,160 OF NON-AIDS-DEFINING CANCERS 1467 00:45:35,160 --> 00:45:37,120 LIKE ANAL CANCER, HODGKIN'S 1468 00:45:37,120 --> 00:45:38,560 LYMPHOMA, LIVER CANCER AND LUNG 1469 00:45:38,560 --> 00:45:40,560 CANCER, AND THE CANCERS IN RED 1470 00:45:40,560 --> 00:45:42,080 HAVE AN INFECTIOUS ETIOLOGY, 1471 00:45:42,080 --> 00:45:43,400 MEANING THAT OTHER VIRAL 1472 00:45:43,400 --> 00:45:45,680 INFECTIONS LIKE HPV AND 1473 00:45:45,680 --> 00:45:46,840 HEPATITIS ARE IMPORTANT CANCER 1474 00:45:46,840 --> 00:45:49,960 RISK FACTORS FOR PEOPLE WITH H 1475 00:45:49,960 --> 00:45:50,680 HIV. 1476 00:45:50,680 --> 00:45:51,640 THERE HAVE ALSO BEEN STUDIES 1477 00:45:51,640 --> 00:45:54,360 THAT SHOW ELEVATED RISK OF THESE 1478 00:45:54,360 --> 00:45:55,480 CANCERS AMONG SEXUAL MINORITY 1479 00:45:55,480 --> 00:45:57,480 MEN AND HIV, BUT MISSING ARE 1480 00:45:57,480 --> 00:45:59,920 ESTIMATES THAT ARE SPECIFIC TO 1481 00:45:59,920 --> 00:46:01,760 SEXUAL MINORITY WOMEN OR TO 1482 00:46:01,760 --> 00:46:02,800 GENDER MINORITY PEOPLE. 1483 00:46:02,800 --> 00:46:05,960 AND I ALSO NOTE THAT HIV ALSO 1484 00:46:05,960 --> 00:46:07,080 INCREASES THE RISK OF CANCER 1485 00:46:07,080 --> 00:46:10,000 MORTALITY. 1486 00:46:10,000 --> 00:46:12,120 WITH REGARDS TO HPV, AN 1487 00:46:12,120 --> 00:46:13,440 IMPORTANT CANCER IS ANAL CANCER. 1488 00:46:13,440 --> 00:46:15,200 THIS GRAPHIC SHOWS YOU THE 1489 00:46:15,200 --> 00:46:16,800 INCIDENCE OF ANAL CANCER IN TWO 1490 00:46:16,800 --> 00:46:19,160 DIFFERENT POPULATIONS, SO THOSE 1491 00:46:19,160 --> 00:46:20,280 ASSIGNED MALE AT BIRTH WHO HAVE 1492 00:46:20,280 --> 00:46:23,640 SEX WITH MEN, MSM ON THE LEFT, 1493 00:46:23,640 --> 00:46:25,920 AND NON-MSM ON THE RIGHT. 1494 00:46:25,920 --> 00:46:28,080 SO HIV NEGATIVE MSM HAVE A 1495 00:46:28,080 --> 00:46:31,160 HIGHER RISK OF ANAL CANCER THAN 1496 00:46:31,160 --> 00:46:32,520 HIV NEGATIVE NON-MSM. 1497 00:46:32,520 --> 00:46:34,400 AND RISK OF ANAL CANCER THEN 1498 00:46:34,400 --> 00:46:35,240 INCREASES AMONG THOSE WHO ARE 1499 00:46:35,240 --> 00:46:36,920 LIVING WITH HIV. 1500 00:46:36,920 --> 00:46:39,680 SO AS YOU CAN SEE, FOR NON-MSM, 1501 00:46:39,680 --> 00:46:41,360 THE INCIDENCE IS AROUND 30 PER 1502 00:46:41,360 --> 00:46:43,520 100,000 MEN. 1503 00:46:43,520 --> 00:46:46,040 BUT THEN AMONG MSM WITH HIV, THE 1504 00:46:46,040 --> 00:46:48,120 RISK INCREASES DRAMATICALLY. 1505 00:46:48,120 --> 00:46:50,280 AND I THINK ANAL CANCER IS A 1506 00:46:50,280 --> 00:46:51,680 REALLY GREAT EXAMPLE OF WHY SOGI 1507 00:46:51,680 --> 00:46:53,280 MEASURES ARE NEEDED IN 1508 00:46:53,280 --> 00:46:55,320 POPULATION-BASED STUDIES, AND 1509 00:46:55,320 --> 00:46:55,880 CANCER REGISTRIES. 1510 00:46:55,880 --> 00:46:57,440 BECAUSE MSM HAVE A GREATER RISK 1511 00:46:57,440 --> 00:47:00,280 OF THIS CANCER. 1512 00:47:00,280 --> 00:47:01,720 SO ANAL CANCER ESTIMATES ARE 1513 00:47:01,720 --> 00:47:03,680 ALSO MISSING FOR SEXUAL MINORITY 1514 00:47:03,680 --> 00:47:05,760 WOMEN AND FOR TRANSGENDER AND 1515 00:47:05,760 --> 00:47:07,640 GENDER DIVERSE PEOPLE. 1516 00:47:07,640 --> 00:47:09,360 HPV IS ALSO RESPONSIBLE FOR 1517 00:47:09,360 --> 00:47:11,520 CERVICAL CANCER INCIDENCE AND WE 1518 00:47:11,520 --> 00:47:13,320 DON'T HAVE GREAT ESTIMATES OF 1519 00:47:13,320 --> 00:47:14,840 THIS CANCER AMONG SEXUAL 1520 00:47:14,840 --> 00:47:16,560 MINORITY WOMEN OR TRANS AND 1521 00:47:16,560 --> 00:47:17,360 GENDER DIVERSE PEOPLE. 1522 00:47:17,360 --> 00:47:19,360 IT'S ALSO RESPONSIBLE FOR ORAL 1523 00:47:19,360 --> 00:47:20,840 CANCER INCIDENCE AND I DON'T 1524 00:47:20,840 --> 00:47:24,960 THINK WE HAVE GREAT ESTIMATES 1525 00:47:24,960 --> 00:47:27,280 FOR SGM PEOPLE ALL TOGETHER. 1526 00:47:27,280 --> 00:47:29,040 SO I WANT TO MOVE ON TO RISK 1527 00:47:29,040 --> 00:47:30,800 FACTORS FOR SCREEN DETECTABLE 1528 00:47:30,800 --> 00:47:31,240 CANCERS. 1529 00:47:31,240 --> 00:47:33,560 SO SOME OF THESE RISK FACTORS 1530 00:47:33,560 --> 00:47:35,600 FOR THE CANCERS ARE ELEVATED IN 1531 00:47:35,600 --> 00:47:36,760 SGM POPULATIONS AND I'VE NOTED 1532 00:47:36,760 --> 00:47:39,840 THESE IN RED. 1533 00:47:39,840 --> 00:47:41,320 I'VE ALSO NOTED IF THE RISK 1534 00:47:41,320 --> 00:47:44,920 FACTOR WAS ELEVATED AND ONLY ONE 1535 00:47:44,920 --> 00:47:45,600 POPULATION. 1536 00:47:45,600 --> 00:47:48,960 SO FOR BREAST CAN CANCER, THE K 1537 00:47:48,960 --> 00:47:50,760 FACTORS ARE ALCOHOL USE, BEING 1538 00:47:50,760 --> 00:47:52,280 OVERWEIGHT OR OBESE, LACK OF 1539 00:47:52,280 --> 00:47:53,400 PHYSICAL ACTIVITY, NOT HAVING 1540 00:47:53,400 --> 00:47:54,520 CHILDREN OR HAVING CHILDREN 1541 00:47:54,520 --> 00:47:57,240 AFTER 30 YEARS OF AGE, BIRTH 1542 00:47:57,240 --> 00:47:58,120 CONTROL, MENOPAUSAL HORMONE 1543 00:47:58,120 --> 00:48:01,040 THERAPY AND GENETICS. 1544 00:48:01,040 --> 00:48:02,240 WE DON'T REALLY SEE A DIFFERENCE 1545 00:48:02,240 --> 00:48:03,400 IN SCREENING BETWEEN SEXUAL 1546 00:48:03,400 --> 00:48:04,920 MINORITY WOMEN AND NON-SEXUAL 1547 00:48:04,920 --> 00:48:06,440 MINORITY WOMEN. 1548 00:48:06,440 --> 00:48:08,480 THOUGH WE DO KNOW THAT 1549 00:48:08,480 --> 00:48:09,320 TRANSGENDER WOMEN ARE LESS 1550 00:48:09,320 --> 00:48:11,680 LIKELY TO BE SCREENED. 1551 00:48:11,680 --> 00:48:12,800 FOR LUNG CANCER, SMOKING IS A 1552 00:48:12,800 --> 00:48:15,080 BIG RISK FACTOR, AS IS GENETICS, 1553 00:48:15,080 --> 00:48:16,880 AND WE FIND THAT SGM PEOPLE ARE 1554 00:48:16,880 --> 00:48:18,160 MORE LIKELY TO BE ELIGIBLE FOR 1555 00:48:18,160 --> 00:48:19,520 THIS SCREENING BUT THEY'RE LESS 1556 00:48:19,520 --> 00:48:21,720 LIKELY TO BE SCREENED THAN 1557 00:48:21,720 --> 00:48:24,200 CISHET PEOPLE. 1558 00:48:24,200 --> 00:48:26,080 FOR COLORECTAL CANCER, ALCOHOL 1559 00:48:26,080 --> 00:48:28,400 USE, SMOKING, BEING OVERWEIGHT 1560 00:48:28,400 --> 00:48:30,520 OR OBESE, LACK OF PHYSICAL 1561 00:48:30,520 --> 00:48:31,880 ACTIVITY, RED MEAT AND GENETICS 1562 00:48:31,880 --> 00:48:33,400 ARE RISK FACTORS. 1563 00:48:33,400 --> 00:48:35,600 ONE STUDY DIDN'T FIND ANY 1564 00:48:35,600 --> 00:48:38,240 SCREENING DIFFERENCES BY SEXUAL 1565 00:48:38,240 --> 00:48:40,880 ORIENTATION, BUT THEY DID FIND 1566 00:48:40,880 --> 00:48:42,440 THAT TRANSGENDER AND GENDER 1567 00:48:42,440 --> 00:48:43,240 DIVERSE PEOPLE ARE LESS LIKELY 1568 00:48:43,240 --> 00:48:44,040 TO BE SCREENED. 1569 00:48:44,040 --> 00:48:46,640 SO I'M GOING TO SHOW YOU SOME 1570 00:48:46,640 --> 00:48:48,280 INCIDENT RATE RATIOS OF THESE 1571 00:48:48,280 --> 00:48:50,640 CANCERS AMONG SEXUAL MINORITY 1572 00:48:50,640 --> 00:48:50,840 WOMEN. 1573 00:48:50,840 --> 00:48:53,040 SO THE INCIDENCE RATE RATIO IS 1574 00:48:53,040 --> 00:48:54,360 CALCULATED BY TAKING THE RATIO 1575 00:48:54,360 --> 00:48:56,520 OF CANCER INCIDENCE IN ONE 1576 00:48:56,520 --> 00:48:58,760 POPULATION OVER THE OTHER. 1577 00:48:58,760 --> 00:49:00,320 SO ON THIS GRAPH, IS THE 1578 00:49:00,320 --> 00:49:01,200 ESTIMATE IS ABOVE ONE, THAT 1579 00:49:01,200 --> 00:49:02,640 MEANS THAT SEXUAL MINORITY WOMEN 1580 00:49:02,640 --> 00:49:04,000 HAVE A HIGHER INCIDENCE COMPARED 1581 00:49:04,000 --> 00:49:07,000 TO NON-SEXUAL MINORITY WOMEN. 1582 00:49:07,000 --> 00:49:08,040 YOU MIGHT THINK, WAIT A MINUTE, 1583 00:49:08,040 --> 00:49:09,400 YOU JUST TOLD ME THAT WE CAN'T 1584 00:49:09,400 --> 00:49:10,360 GET INCIDENCE RATES BECAUSE THE 1585 00:49:10,360 --> 00:49:12,760 DATA IS SO BAD. 1586 00:49:12,760 --> 00:49:15,880 SO THE AUTHORS OF THIS ANALYSIS 1587 00:49:15,880 --> 00:49:17,000 DID SOME REALLY INTERESTING WORK 1588 00:49:17,000 --> 00:49:19,320 WHERE THEY USED DATA FROM 1589 00:49:19,320 --> 00:49:20,800 CALIFORNIA WHICH COLLECTS SEXUAL 1590 00:49:20,800 --> 00:49:22,400 MINORITY STATUS IN THEIR HEALTH 1591 00:49:22,400 --> 00:49:23,280 INTERVIEW SURVEY. 1592 00:49:23,280 --> 00:49:24,480 STILL NOT ON THE CANCER 1593 00:49:24,480 --> 00:49:26,160 REGISTRY. 1594 00:49:26,160 --> 00:49:28,040 INSTEAD, THEY USE THESE DATA TO 1595 00:49:28,040 --> 00:49:29,880 ESTIMATE AGE-SPECIFIC POPULATION 1596 00:49:29,880 --> 00:49:31,640 DENSITY OF SEXUAL MINORITY 1597 00:49:31,640 --> 00:49:32,520 STATUS BY COUNTY. 1598 00:49:32,520 --> 00:49:35,640 SO THAT'S WHY INSTEAD OF SHOWING 1599 00:49:35,640 --> 00:49:37,040 YOU INCIDENCE RATE FOR LESBIAN 1600 00:49:37,040 --> 00:49:39,000 AND BISEXUAL WOMEN, I'M SHOWING 1601 00:49:39,000 --> 00:49:44,600 YOU LESBIAN POPULATION DENSITY. 1602 00:49:44,600 --> 00:49:47,240 AND I'M ACTUALLY GOING TO TRY TO 1603 00:49:47,240 --> 00:49:48,080 BREEZE THROUGH THIS BECAUSE I 1604 00:49:48,080 --> 00:49:50,080 ONLY HAVE 2 MINUTES. 1605 00:49:50,080 --> 00:49:51,880 BUT HERE IS WHAT WE KNOW ABOUT 1606 00:49:51,880 --> 00:49:53,800 BREAST LUNG AND COLORECTAL 1607 00:49:53,800 --> 00:49:55,320 CANCER IN THIS POPULATION. 1608 00:49:55,320 --> 00:49:57,120 AND THEN HERE IS WHAT WE KNOW 1609 00:49:57,120 --> 00:49:59,760 FOR LUNG AND COLORECTAL CANCER 1610 00:49:59,760 --> 00:50:02,080 INCIDENCE AMONG SEXUAL MINORITY 1611 00:50:02,080 --> 00:50:03,000 MEN. 1612 00:50:03,000 --> 00:50:04,960 THE EVIDENCE FOR THESE CANCERS 1613 00:50:04,960 --> 00:50:06,400 IN GENDER MINORITY ADULTS IS 1614 00:50:06,400 --> 00:50:07,600 ALSO SCARCE BUT THERE IS SOME 1615 00:50:07,600 --> 00:50:09,600 DATA THAT COMES FROM A COHORT IN 1616 00:50:09,600 --> 00:50:11,200 THE NETHERLANDS AND SO YOU CAN 1617 00:50:11,200 --> 00:50:13,240 SEE THAT COMPARED TO CISGENDER 1618 00:50:13,240 --> 00:50:14,600 WOMEN, BOTH TRANS WOMEN AND 1619 00:50:14,600 --> 00:50:16,920 TRANS MEN, HAVE A DECREASED 1620 00:50:16,920 --> 00:50:18,640 INCIDENCE OF BREAST CANCER, BUT 1621 00:50:18,640 --> 00:50:20,680 THEN COMPARED TO CISGENDER MEN, 1622 00:50:20,680 --> 00:50:22,400 THEY HAVE AN INCREASED RISK OF 1623 00:50:22,400 --> 00:50:25,480 BREAST CANCER. 1624 00:50:25,480 --> 00:50:26,600 THEN THE LAST CANCER I WANT TO 1625 00:50:26,600 --> 00:50:28,280 TALK ABOUT IS PROSTATE CANCER. 1626 00:50:28,280 --> 00:50:31,880 THE RISK FACTORS FOR THIS CANCER 1627 00:50:31,880 --> 00:50:34,800 ARE ON THE SCREEN, AND PSA IS 1628 00:50:34,800 --> 00:50:37,960 THE WAY THAT WE SCREEN FOR THIS 1629 00:50:37,960 --> 00:50:39,640 CANCER, AND SEXUAL MINORITY MEN 1630 00:50:39,640 --> 00:50:43,320 ARE MORE LIKELY THAN NON-SEXUAL 1631 00:50:43,320 --> 00:50:44,760 MINORITY MEN TO PARTICIPATE IN 1632 00:50:44,760 --> 00:50:45,400 PSA SCREENING. 1633 00:50:45,400 --> 00:50:46,520 AND TRANS WOMEN ARE LESS LIKELY 1634 00:50:46,520 --> 00:50:49,520 TO HAVE THIS TESTING DONE. 1635 00:50:49,520 --> 00:50:50,840 THEN THE ONLY EVIDENCE THAT WE 1636 00:50:50,840 --> 00:50:52,520 HAVE IN THESE POPULATIONS IS FOR 1637 00:50:52,520 --> 00:50:54,280 GENDER MINORITY ADULTS, WHERE WE 1638 00:50:54,280 --> 00:50:56,480 SEE THAT PROSTATE CANCER RISK IS 1639 00:50:56,480 --> 00:50:59,640 MUCH LOWER IN THESE INDIVIDUALS. 1640 00:50:59,640 --> 00:51:00,920 I WANT TO JUST LEAVE YOU WITH 1641 00:51:00,920 --> 00:51:02,280 SOME THOUGHTS ABOUT BARRIERS TO 1642 00:51:02,280 --> 00:51:04,040 CANCER PREVENTION FOR THIS 1643 00:51:04,040 --> 00:51:04,560 COMMUNITY. 1644 00:51:04,560 --> 00:51:06,000 SO SOME OF THESE INCLUDE THE 1645 00:51:06,000 --> 00:51:07,360 FACT THAT THE CLINICIANS LACK 1646 00:51:07,360 --> 00:51:09,000 KNOWLEDGE ABOUT SGM-SPECIFIC 1647 00:51:09,000 --> 00:51:11,320 NEED, SO A GREAT EXAMPLE IS THAT 1648 00:51:11,320 --> 00:51:12,440 SOME PEOPLE BELIEVE THAT SEXUAL 1649 00:51:12,440 --> 00:51:14,000 MINORITY WOMEN ARE NOT AT RISK 1650 00:51:14,000 --> 00:51:16,520 FOR HPV. 1651 00:51:16,520 --> 00:51:17,920 LACK OF SGM SPECIFIC SCREENING 1652 00:51:17,920 --> 00:51:20,280 GUIDELINES FOR CANCER, LACK OF 1653 00:51:20,280 --> 00:51:21,560 SCREENING MODALITIES THAT TAKE 1654 00:51:21,560 --> 00:51:26,080 INTO ACCOUNT THE PATIENT 1655 00:51:26,080 --> 00:51:27,520 EXPERIENCE, AND CLINICIANS ARE 1656 00:51:27,520 --> 00:51:28,960 OFTEN UNCOMFORTABLE ASKING ABOUT 1657 00:51:28,960 --> 00:51:31,560 SEXUAL ORIENTATION, GENDER 1658 00:51:31,560 --> 00:51:32,600 IDENTITY AND SECRETARIES YOU'LL 1659 00:51:32,600 --> 00:51:35,160 BEHAVIOR. 1660 00:51:35,160 --> 00:51:38,520 AND SEXUAL BEHAVIOR. 1661 00:51:38,520 --> 00:51:41,400 THESE STATISTICS, THAT 28% OF 1662 00:51:41,400 --> 00:51:42,520 TRANSGENDER INDIVIDUALS REPORT 1663 00:51:42,520 --> 00:51:43,720 HARASSMENT AND VIOLENCE IN 1664 00:51:43,720 --> 00:51:44,920 MEDICAL SETTINGS SHOULD BE VERY 1665 00:51:44,920 --> 00:51:47,600 UPSETTING TO US ALL. 1666 00:51:47,600 --> 00:51:48,680 AND FINALLY, I WOULD LIKE TO 1667 00:51:48,680 --> 00:51:51,080 LEAVE YOU WITH THIS CALL TO 1668 00:51:51,080 --> 00:51:51,320 ACTION. 1669 00:51:51,320 --> 00:51:53,000 PLEASE START COLLECTING DATA ON 1670 00:51:53,000 --> 00:51:55,840 SEXUAL ORIENTATION AND GENDER 1671 00:51:55,840 --> 00:51:56,120 IDENTITY. 1672 00:51:56,120 --> 00:51:57,680 WE CANNOT STUDY POPULATIONS THAT 1673 00:51:57,680 --> 00:51:58,840 WE CANNOT SEE. 1674 00:51:58,840 --> 00:51:59,720 AND WITH THAT, THANK YOU VERY 1675 00:51:59,720 --> 00:52:00,080 MUCH. 1676 00:52:00,080 --> 00:52:10,280 [APPLAUSE] 1677 00:52:25,640 --> 00:52:26,600 >>HI, EVERYBODY. 1678 00:52:26,600 --> 00:52:28,800 MY NAME IS ASH. 1679 00:52:28,800 --> 00:52:31,640 I'M A HEMATOLOGIST AND MEDICAL 1680 00:52:31,640 --> 00:52:33,280 ONCOLOGIST, AND I'M QUEER AND 1681 00:52:33,280 --> 00:52:34,600 NON-BINARY AND MY WORK FOCUSES 1682 00:52:34,600 --> 00:52:36,720 ON IMPROVING EXPERIENCES AND 1683 00:52:36,720 --> 00:52:37,840 OUTCOMES FOR TRANSGENDER PEOPLE 1684 00:52:37,840 --> 00:52:39,240 WITH CANCER. 1685 00:52:39,240 --> 00:52:40,320 I'M HONORED TO HAVE THE 1686 00:52:40,320 --> 00:52:41,320 OPPORTUNITY TO SPEAK WITH YOU 1687 00:52:41,320 --> 00:52:42,920 TODAY ABOUT IMPROVING DATA 1688 00:52:42,920 --> 00:52:44,560 ACCURACY AND MITIGATING BARRIERS 1689 00:52:44,560 --> 00:52:46,480 TO CANCER CLINICAL TRIALS FOR 1690 00:52:46,480 --> 00:52:48,640 TRANSGENDER PEOPLE. 1691 00:52:48,640 --> 00:52:50,320 BASICALLY WHAT I'LL BE TALKING 1692 00:52:50,320 --> 00:52:52,440 ABOUT IS THIS, TRYING TO DEBUNK 1693 00:52:52,440 --> 00:52:55,000 THE IDEA THAT SEX IS AN I 1694 00:52:55,000 --> 00:52:56,360 MUTABLE FACT OF THE BODY AND TO 1695 00:52:56,360 --> 00:52:58,160 TRY TO DISENTANGLE SEX AND 1696 00:52:58,160 --> 00:53:02,040 GENDER. 1697 00:53:02,040 --> 00:53:03,400 SO BEFORE I START, I WANT TO 1698 00:53:03,400 --> 00:53:04,600 ACKNOWLEDGE THE COMMUNITY 1699 00:53:04,600 --> 00:53:05,840 ADVISORY BOARD OF TRANSGENDER 1700 00:53:05,840 --> 00:53:07,120 PEOPLE WITH CANCER WITH WHOM 1701 00:53:07,120 --> 00:53:08,080 I'VE HAD THE PRIVILEGE TO WORK 1702 00:53:08,080 --> 00:53:09,840 FOR THE LAST FOUR YEARS. 1703 00:53:09,840 --> 00:53:12,760 AND I'D LIKE TO PAY A TRIBUTE TO 1704 00:53:12,760 --> 00:53:18,520 MY FRIEND LAX, WHO'S RIGHT 1705 00:53:18,520 --> 00:53:23,560 THERE, WHO DIED OF MELANOMA 1706 00:53:23,560 --> 00:53:24,080 ABOUT A YEAR AGO. 1707 00:53:24,080 --> 00:53:25,760 SHE PUBLISHED AN ARTICLE IN THE 1708 00:53:25,760 --> 00:53:27,000 "L.A. TIMES" IN WHICH SHE 1709 00:53:27,000 --> 00:53:28,000 DESCRIBED HER EXPERIENCES AND 1710 00:53:28,000 --> 00:53:30,040 I'LL JUST READ A SHORT SEGMENT 1711 00:53:30,040 --> 00:53:30,640 FROM THAT. 1712 00:53:30,640 --> 00:53:32,520 SHE WROTE, WHEN I WAS FIRST 1713 00:53:32,520 --> 00:53:33,400 DIAGNOSED, I THOUGHT THE WORST 1714 00:53:33,400 --> 00:53:35,480 PART OF HAVING CANCER WOULD BE 1715 00:53:35,480 --> 00:53:37,160 THE ANXIETY, UNCERTAINTY AND 1716 00:53:37,160 --> 00:53:38,840 FEAR ASSOCIATED WITH TREATMENT 1717 00:53:38,840 --> 00:53:40,480 AND PROGNOSIS. 1718 00:53:40,480 --> 00:53:42,360 INSTEAD I FOUND MYSELF WORRIED 1719 00:53:42,360 --> 00:53:44,440 ABOUT THE STIGMA, HARASSMENT AND 1720 00:53:44,440 --> 00:53:46,160 STRUCTURAL VIOLENCE PERPETRATED 1721 00:53:46,160 --> 00:53:47,320 BY THE MEDICAL SYSTEM I HAD TO 1722 00:53:47,320 --> 00:53:48,800 TAKE PART IN TO RECEIVE 1723 00:53:48,800 --> 00:53:49,160 TREATMENT. 1724 00:53:49,160 --> 00:53:51,040 I FACED DILEMMAS RECEIVING CARE 1725 00:53:51,040 --> 00:53:52,800 BECAUSE OF RESPONSES TO BOTH MY 1726 00:53:52,800 --> 00:53:55,640 CANCER AND MY TRANSNESS. 1727 00:53:55,640 --> 00:53:57,040 PANIC AT THE C WORD BARRED ME 1728 00:53:57,040 --> 00:53:59,160 FROM ACCESS TO 1729 00:53:59,160 --> 00:53:59,640 TRANSITION-RELATED CARE. 1730 00:53:59,640 --> 00:54:01,120 ONCE THEY LEARNED I HAD CANCER, 1731 00:54:01,120 --> 00:54:02,680 SOME PROVIDERS SUGGESTED 1732 00:54:02,680 --> 00:54:04,360 DISCONTINUING MY HORMONE THERAPY 1733 00:54:04,360 --> 00:54:06,480 WITHOUT OFFERING ANY MEDICAL 1734 00:54:06,480 --> 00:54:08,400 JUSTIFICATION. 1735 00:54:08,400 --> 00:54:09,560 OTHER PROVIDERS WHO WERE 1736 00:54:09,560 --> 00:54:10,760 FAMILIAR AND COMFORTABLE 1737 00:54:10,760 --> 00:54:12,080 TREATING CANCER HAD NO IDEA HOW 1738 00:54:12,080 --> 00:54:14,200 TO INTERACT WITH ME AS A 1739 00:54:14,200 --> 00:54:14,960 TRANSGENDER PATIENT. 1740 00:54:14,960 --> 00:54:16,560 THE DISCOMFORT AND HOSTILITY 1741 00:54:16,560 --> 00:54:20,120 CAME FROM NOT JUST DOCTORS BUT 1742 00:54:20,120 --> 00:54:22,080 ALSO NURSES AND OTHER HEALTH 1743 00:54:22,080 --> 00:54:23,120 PROFESSIONALS WHO PARTICIPATED 1744 00:54:23,120 --> 00:54:24,440 IN MY CARE. 1745 00:54:24,440 --> 00:54:25,880 THE DEHUMANIZING DISCRIMINATION 1746 00:54:25,880 --> 00:54:27,960 I DEALT WITH INCLUDING HAVING MY 1747 00:54:27,960 --> 00:54:30,440 CLOTHES TUGGED ON AND BEING TOLD 1748 00:54:30,440 --> 00:54:31,760 I WAS DRESSING INAPPROPRIATELY 1749 00:54:31,760 --> 00:54:33,200 FOR WEARING A SKIRT. 1750 00:54:33,200 --> 00:54:37,480 AND I CAN TELL YOU THAT KNOWING 1751 00:54:37,480 --> 00:54:38,680 LAX IS LIKE A DAY-TO-DAY 1752 00:54:38,680 --> 00:54:39,120 EXPERIENCE FOR HER. 1753 00:54:39,120 --> 00:54:41,240 SO I WANTED TO GROUND MY TALK 1754 00:54:41,240 --> 00:54:44,600 WITH HER COMMENTS, AND TO TELL 1755 00:54:44,600 --> 00:54:47,400 YOU THAT HER COMMENTS AND THE 1756 00:54:47,400 --> 00:54:48,280 THEORIZING OF THE COMMUNITY 1757 00:54:48,280 --> 00:54:49,360 ADVISORY BOARD IN GENERAL IS 1758 00:54:49,360 --> 00:54:50,480 WHAT BROUGHT ME TO THE IDEAS 1759 00:54:50,480 --> 00:54:55,160 THAT I'LL BE PRESENTING TODAY. 1760 00:54:55,160 --> 00:54:58,480 SO MY OBJE OBJECTIVES ARE TO DEE 1761 00:54:58,480 --> 00:55:00,600 THE WAY GENDER SEX ASSIGNED AT 1762 00:55:00,600 --> 00:55:01,640 BIRTH ANTIOTHER BIOLOGICAL 1763 00:55:01,640 --> 00:55:05,560 FACTORS HAVE BEEN CONFLATED IN 1764 00:55:05,560 --> 00:55:06,600 MEDICINE GENERALLY IN THE WAYS 1765 00:55:06,600 --> 00:55:08,080 THIS LEADS TO CANCER CLINICAL 1766 00:55:08,080 --> 00:55:09,360 TRIALS TO EXCLUDE TRANSGENDER 1767 00:55:09,360 --> 00:55:10,920 PEOPLE AND ALSO LEADS TO POOR 1768 00:55:10,920 --> 00:55:12,240 QUALITY DATA. 1769 00:55:12,240 --> 00:55:13,600 AND TO SUGGEST SOME SIMPLE 1770 00:55:13,600 --> 00:55:15,040 STRATEGIES TO IMPROVE TRIAL 1771 00:55:15,040 --> 00:55:16,000 ACCESSIBILITY AND IMPROVE THE 1772 00:55:16,000 --> 00:55:20,280 QUALITY OF OUR DATA. 1773 00:55:20,280 --> 00:55:22,000 SO I'LL START WITH SOME SIMPLE 1774 00:55:22,000 --> 00:55:22,440 CONCEPTS. 1775 00:55:22,440 --> 00:55:24,960 THESE MAY SEEM VERY BASIC BUT I 1776 00:55:24,960 --> 00:55:26,520 THINK IN SOME WAYS THEY'RE STILL 1777 00:55:26,520 --> 00:55:28,160 VERY CONFUSING TO US AS A FIELD. 1778 00:55:28,160 --> 00:55:30,280 SO SEX ASSIGNED AT BIRTH IS THE 1779 00:55:30,280 --> 00:55:32,360 DESIGNATION MADE BY A PHYSICIAN, 1780 00:55:32,360 --> 00:55:35,520 A DOULA, A NURSE OR A MIDWIFE BY 1781 00:55:35,520 --> 00:55:36,720 LOOKING AT THE EXTERNAL 1782 00:55:36,720 --> 00:55:38,800 GENITALIA OF A BABY. 1783 00:55:38,800 --> 00:55:40,920 SO GENDER IS SOMEONE'S SENSE OF 1784 00:55:40,920 --> 00:55:42,400 THEMSELVES AS A MAN, WOMAN, 1785 00:55:42,400 --> 00:55:43,240 MASCULINE, FEMININE, ONE OF 1786 00:55:43,240 --> 00:55:44,440 THOSE OR MORE THAN ONE OF THEM, 1787 00:55:44,440 --> 00:55:45,760 AND THEN ANATOMY ARE THE 1788 00:55:45,760 --> 00:55:47,040 INTERNAL AND EXTERNAL STRUCTURES 1789 00:55:47,040 --> 00:55:48,120 OF THE BODY. 1790 00:55:48,120 --> 00:55:49,840 SO ALTHOUGH THESE ARE OBVIOUSLY 1791 00:55:49,840 --> 00:55:52,160 VERY DISTINCT CONCEPTS, SEX 1792 00:55:52,160 --> 00:55:53,800 ASSIGNED AT BIRTH AND GENDER ARE 1793 00:55:53,800 --> 00:55:56,640 OFTEN MISTAKENLY USED 1794 00:55:56,640 --> 00:55:57,680 INTERCHANGEABLY THROUGHOUT OUR 1795 00:55:57,680 --> 00:55:59,240 ONCOLOGY LITERATURE, AND 1796 00:55:59,240 --> 00:56:01,960 INAPPROPRIATELY USED TO MAKE 1797 00:56:01,960 --> 00:56:06,360 ASSUMPTIONS ABOUT ANATOMY, 1798 00:56:06,360 --> 00:56:10,440 HORMONAL MILIEU, KARYOTYPE AND 1799 00:56:10,440 --> 00:56:11,560 OTHER OBJECTIVE FACTORS. 1800 00:56:11,560 --> 00:56:13,200 SO LOOKING AT THE BODY OF A BABY 1801 00:56:13,200 --> 00:56:14,760 WE MAKE A LOT OUT OF WHERE I 1802 00:56:14,760 --> 00:56:16,600 THINK IN SOME WAYS SEX ASSIGNED 1803 00:56:16,600 --> 00:56:17,880 AT BIRTH CAN'T HOLD ALL OF THOSE 1804 00:56:17,880 --> 00:56:18,440 CONCEPTS. 1805 00:56:18,440 --> 00:56:20,240 SO I'LL GIVE YOU THE EXAMPLE OF 1806 00:56:20,240 --> 00:56:23,640 HOW THIS COMES UP IN ELIGIBILITY 1807 00:56:23,640 --> 00:56:25,800 CRITERIA IN ONCOLOGY TRIALS AND 1808 00:56:25,800 --> 00:56:27,200 THE WAY THIS LEADS TO EXCLUSION 1809 00:56:27,200 --> 00:56:27,680 OF TRANSGENDER PEOPLE. 1810 00:56:27,680 --> 00:56:29,920 SO THESE ARE REAL INCLUSION AND 1811 00:56:29,920 --> 00:56:31,240 EXCLUSION CRITERIA FROM A 1812 00:56:31,240 --> 00:56:33,560 PROSTATE CANCER TRIAL AVAILABLE 1813 00:56:33,560 --> 00:56:35,360 IN CLINICALTRIALS.GOV. 1814 00:56:35,360 --> 00:56:37,680 YOU CAN SEE ONE OF THE INCLUSION 1815 00:56:37,680 --> 00:56:39,760 TRY CAREER NA IS BEING MALE. 1816 00:56:39,760 --> 00:56:41,160 SO THAT WORD MALE CAN MEAN 1817 00:56:41,160 --> 00:56:42,160 DIFFERENT THINGS TO DIFFERENT 1818 00:56:42,160 --> 00:56:42,360 PEOPLE. 1819 00:56:42,360 --> 00:56:44,120 IT CAN MEAN GENDER, SEX ASSIGNED 1820 00:56:44,120 --> 00:56:46,720 AT BIRTH, BUT I CAN IMAGINE IF I 1821 00:56:46,720 --> 00:56:47,800 WERE A TRANSGENDER WOMAN LOOKING 1822 00:56:47,800 --> 00:56:49,320 AT THIS CRITERIA, I WOULD 1823 00:56:49,320 --> 00:56:50,720 RIGHTLY OR WRONGLY THINK THIS 1824 00:56:50,720 --> 00:56:52,160 TRIAL IS NOT A TRIAL I WAS 1825 00:56:52,160 --> 00:56:59,680 ELIGIBLE FOR. 1826 00:56:59,680 --> 00:57:02,000 RELATEDLY THIS COMMENT, 1827 00:57:02,000 --> 00:57:03,720 PARTICIPANTS MUST AGREE TO USE A 1828 00:57:03,720 --> 00:57:05,280 CONDOM IF HAVING SEX WITH A 1829 00:57:05,280 --> 00:57:07,520 WOMAN OF CHILD BEARING POTENTIAL 1830 00:57:07,520 --> 00:57:08,520 MAY SIGNAL THAT THAT WE WERE NOT 1831 00:57:08,520 --> 00:57:09,920 IN THE INVESTIGATOR'S MIND WHEN 1832 00:57:09,920 --> 00:57:12,280 THEY WERE WRITING THEIR TRIAL 1833 00:57:12,280 --> 00:57:13,560 CRITERIA BECAUSE THERE ARE 1834 00:57:13,560 --> 00:57:14,560 CERTAIN ASSUMPTIONS ASSOCIATED 1835 00:57:14,560 --> 00:57:15,680 WITH THE WORD SEX AND ALSO THE 1836 00:57:15,680 --> 00:57:16,800 WORD WOMAN THAT PROBABLY DON'T 1837 00:57:16,800 --> 00:57:19,360 APPLY TO MANY OF US. 1838 00:57:19,360 --> 00:57:21,880 AND THEN THESE TWO EXCLUSION 1839 00:57:21,880 --> 00:57:23,800 CRITERIA ALSO MAY INADVERTENTLY 1840 00:57:23,800 --> 00:57:25,240 EXCLUDE MANY TRANSGENDER PEOPLE, 1841 00:57:25,240 --> 00:57:26,760 SO THERE'S AN EXCLUSION FOR 1842 00:57:26,760 --> 00:57:28,480 PRIOR HORMONE THERAPY FOR 1843 00:57:28,480 --> 00:57:29,440 PROSTATE CANCER, BUT I CAN 1844 00:57:29,440 --> 00:57:31,000 IMAGINE THAT IF I WERE AN 1845 00:57:31,000 --> 00:57:32,040 ONCOLOGIST TAKING CARE OF A 1846 00:57:32,040 --> 00:57:33,840 TRANSGENDER WOMAN ON ESTROGEN 1847 00:57:33,840 --> 00:57:35,000 THERAPY FOR TRANSITION, I 1848 00:57:35,000 --> 00:57:36,280 WOULDN'T KNOW WHETHER SHE WAS 1849 00:57:36,280 --> 00:57:37,920 ELIGIBLE OR INELIGIBLE FOR THE 1850 00:57:37,920 --> 00:57:39,280 TRIAL, AND IF I WERE A TRANS 1851 00:57:39,280 --> 00:57:43,200 WOMAN LOOKING AT THESE CRITERIA, 1852 00:57:43,200 --> 00:57:44,720 I MIGHT FEEL VERY UNCOMFORTABLE 1853 00:57:44,720 --> 00:57:45,040 ASKING. 1854 00:57:45,040 --> 00:57:47,120 THEN AS DR. JACKSON TALKED 1855 00:57:47,120 --> 00:57:48,720 ABOUT, BLANKET EXCLUSIONS FOR 1856 00:57:48,720 --> 00:57:50,560 HIV NECESSARILY EXCLUDE MANY 1857 00:57:50,560 --> 00:57:53,640 TRANSGENDER PEOPLE AS 1 IN 10 1858 00:57:53,640 --> 00:57:54,280 TRANSGENDER PEOPLE IN THE U.S. 1859 00:57:54,280 --> 00:57:57,560 IS LIVING WITH HIV. 1860 00:57:57,560 --> 00:57:59,000 BEYOND ACCESSIBILITY TO CLINICAL 1861 00:57:59,000 --> 00:58:01,280 TRIALS, ANOTHER ISSUE TO CONTEND 1862 00:58:01,280 --> 00:58:02,800 WITH IS THAT TRIALS THAT 1863 00:58:02,800 --> 00:58:05,720 CONFLATE SEX, GENDER AND OTHER 1864 00:58:05,720 --> 00:58:06,360 BIOLOGICAL FACTORS PRODUCE DATA 1865 00:58:06,360 --> 00:58:08,280 THAT ARE UNINTERPRETABLE. 1866 00:58:08,280 --> 00:58:09,560 SO FOR EXAMPLE, IF I'M 1867 00:58:09,560 --> 00:58:11,160 DESCRIBING A MACHINE LEARNING 1868 00:58:11,160 --> 00:58:14,120 ALGORITHM TO DETECT RESIDUAL 1869 00:58:14,120 --> 00:58:15,240 TUMOR AFTER NEOADJUVANT 1870 00:58:15,240 --> 00:58:16,240 CHEMOTHERAPY IN WOMEN WITH 1871 00:58:16,240 --> 00:58:17,600 BREAST CANCER, WHAT DO I MEAN 1872 00:58:17,600 --> 00:58:18,600 EXACTLY? 1873 00:58:18,600 --> 00:58:20,000 DO I MEAN THAT THIS ALGORITHM 1874 00:58:20,000 --> 00:58:21,360 CAN BE USED IN PEOPLE WHO 1875 00:58:21,360 --> 00:58:22,880 DESCRIBE THEIR GENDER AS A 1876 00:58:22,880 --> 00:58:24,560 WOMAN, OR DO I MEAN PEOPLE WITH 1877 00:58:24,560 --> 00:58:26,160 SEX ASSIGNED AT BIRTH FEMALE, OR 1878 00:58:26,160 --> 00:58:27,840 DO I MEAN PEOPLE WHO AT SOME 1879 00:58:27,840 --> 00:58:28,760 POINT HAD BREAST TISSUE AS A 1880 00:58:28,760 --> 00:58:30,880 RESULT OF ENDOGENOUS ESTROGEN? 1881 00:58:30,880 --> 00:58:32,480 COULD THIS ALGORITHM BE APPLIED 1882 00:58:32,480 --> 00:58:33,920 TO SOMEONE WITH BREAST 1883 00:58:33,920 --> 00:58:34,920 AUGMENTATION? 1884 00:58:34,920 --> 00:58:37,200 WHAT ABOUT SOMEONE WHOSE SEX 1885 00:58:37,200 --> 00:58:39,720 ASSIGNED AT BIRTH WAS MALE WHO'S 1886 00:58:39,720 --> 00:58:40,800 BEEN ON ESTROGEN THERAPY? 1887 00:58:40,800 --> 00:58:42,200 WHAT ABOUT A TRANSGENDER MEN 1888 00:58:42,200 --> 00:58:44,640 WHO'S EITHER HAD OR NOT HAD 1889 00:58:44,640 --> 00:58:45,680 SURGERY? 1890 00:58:45,680 --> 00:58:46,880 I DON'T KNOW ABOUT YOU BUT I 1891 00:58:46,880 --> 00:58:48,040 FIND THIS VERY CONFUSING. 1892 00:58:48,040 --> 00:58:49,200 RECENTLY A STUDY WAS PUBLISHED 1893 00:58:49,200 --> 00:58:50,840 IN THE JOURNAL OF THE NATIONAL 1894 00:58:50,840 --> 00:58:52,120 CANCER INSTITUTE THAT ASSESSED 1895 00:58:52,120 --> 00:58:53,080 ANTICANCER THERAPIES THAT 1896 00:58:53,080 --> 00:58:54,600 RECEIVED FDA APPROVAL BETWEEN 1897 00:58:54,600 --> 00:58:56,840 2012 AND 2019. 1898 00:58:56,840 --> 00:58:58,280 AND NONE OF THE STUDIES, NOT A 1899 00:58:58,280 --> 00:59:00,840 SINGLE ONE OF THE STUDIES, 1900 00:59:00,840 --> 00:59:02,080 DESCRIBED HOW THEIR VARIABLE SEX 1901 00:59:02,080 --> 00:59:03,320 AND GENDER WERE COLLECTED. 1902 00:59:03,320 --> 00:59:04,320 IN OTHER WORDS, WHO GETS TO 1903 00:59:04,320 --> 00:59:06,120 DECIDE WHAT THE SEX OR GENDER OF 1904 00:59:06,120 --> 00:59:08,680 THE PARTICIPANTS WERE. 1905 00:59:08,680 --> 00:59:10,640 AND THREE QUARTERS OF THOSE 1906 00:59:10,640 --> 00:59:13,280 STUDIES USED THE TERMS SEX AND 1907 00:59:13,280 --> 00:59:15,320 GENDER INTERCHANGEABLY OR 1908 00:59:15,320 --> 00:59:16,200 INCONSISTENTLY, SO FOR A FIELD 1909 00:59:16,200 --> 00:59:18,480 THAT'S VERY FOCUSED ON PRECISION 1910 00:59:18,480 --> 00:59:19,960 MEDICINE, THIS IS ONE AREA IN 1911 00:59:19,960 --> 00:59:21,920 WHICH WE'RE BEING QUITE 1912 00:59:21,920 --> 00:59:22,800 IMPRECISE AND IT'S LEADING TO 1913 00:59:22,800 --> 00:59:24,440 VERY DIFFICULT TO INTERPRET 1914 00:59:24,440 --> 00:59:25,680 DATA. 1915 00:59:25,680 --> 00:59:27,480 BEYOND THE QUESTION OF 1916 00:59:27,480 --> 00:59:28,360 CONFLATING SEX AND GENDER, 1917 00:59:28,360 --> 00:59:30,000 THERE'S ALSO THE QUESTION OF 1918 00:59:30,000 --> 00:59:32,440 WHAT DOES SEX TELL US EXACTLY. 1919 00:59:32,440 --> 00:59:34,360 SO SEX IS OFTEN CONSIDERED TO BE 1920 00:59:34,360 --> 00:59:35,640 A FACT OF THE BODY. 1921 00:59:35,640 --> 00:59:37,280 BY THIS, WE OFTEN MEAN THE SEX 1922 00:59:37,280 --> 00:59:38,520 ONE WAS ASSIGNED AT BIRTH AND 1923 00:59:38,520 --> 00:59:40,000 WHAT WE, THEREFORE, ASSUME ABOUT 1924 00:59:40,000 --> 00:59:42,520 THEIR ANATOMY, HORMONES AND 1925 00:59:42,520 --> 00:59:43,640 KARYOTYPE. 1926 00:59:43,640 --> 00:59:44,640 HOWEVER, 1% OF THE POPULATION IS 1927 00:59:44,640 --> 00:59:47,640 BORN WITH OR DEVELOPS ANATOMY OR 1928 00:59:47,640 --> 00:59:49,480 A HORMONAL MILIEU THAT DOES NOT 1929 00:59:49,480 --> 00:59:50,720 CORRESPOND TO WHAT WAS PRESUMED 1930 00:59:50,720 --> 00:59:51,880 BASED ON THEIR SEX ASSIGNED AT 1931 00:59:51,880 --> 00:59:53,640 BIRTH AND MANY PEOPLE UNDERGO 1932 00:59:53,640 --> 00:59:55,520 CHANGES TO THEIR ANATOMY OR 1933 00:59:55,520 --> 00:59:56,720 HORMONES THROUGHOUT THEIR LIVES. 1934 00:59:56,720 --> 00:59:58,880 SO WHEN WE COLLECT DATA ABOUT 1935 00:59:58,880 --> 01:00:01,400 SEX, AND ASSESS ASSOCIATIONS 1936 01:00:01,400 --> 01:00:02,400 BETWEEN SEX AND DISEASE, WE'RE 1937 01:00:02,400 --> 01:00:05,320 USING SEX AS A PROXY FOR OTHER 1938 01:00:05,320 --> 01:00:06,960 FACTORS INCLUDING STIGMA, 1939 01:00:06,960 --> 01:00:08,560 HORMONES, ANATOMY AND BODY SIZE, 1940 01:00:08,560 --> 01:00:09,720 AND WITHOUT MORE SPECIFIC DATA, 1941 01:00:09,720 --> 01:00:11,200 WE DON'T KNOW WHAT WE'RE 1942 01:00:11,200 --> 01:00:13,080 ACTUALLY ASSESSING. 1943 01:00:13,080 --> 01:00:15,040 SO WHEN WE COLLECT CONFLATED 1944 01:00:15,040 --> 01:00:16,400 VARIABLES ON OUR TRIALS, WE 1945 01:00:16,400 --> 01:00:17,960 DEVELOP DATA THAT'S DIFFICULT TO 1946 01:00:17,960 --> 01:00:19,000 INTERPRET, AND THEN WE'RE FORCED 1947 01:00:19,000 --> 01:00:22,280 TO DEVELOP ONCOLOGY GUIDELINES, 1948 01:00:22,280 --> 01:00:23,360 LABORATORY REFERENCE RANGES, AND 1949 01:00:23,360 --> 01:00:25,440 DRUG DOSING BASED ON THESE 1950 01:00:25,440 --> 01:00:27,520 CONFLATED VARIABLES THAT WE 1951 01:00:27,520 --> 01:00:29,520 CAN'T EX-TR EXTRAPOLATE TO TRANS 1952 01:00:29,520 --> 01:00:31,440 PEOPLE BUT I THINK ARE ALSO 1953 01:00:31,440 --> 01:00:32,320 IMPRECISE FOR EVERYBODY. 1954 01:00:32,320 --> 01:00:34,520 SO FOR EXAMPLE, LABORATORY 1955 01:00:34,520 --> 01:00:36,520 REFERENCE RANGES ARE DETERMINED 1956 01:00:36,520 --> 01:00:38,520 BASED ON LARGE PROBABILITY 1957 01:00:38,520 --> 01:00:41,800 STUDIES OF PEOPLE ASSUMED TO BE 1958 01:00:41,800 --> 01:00:42,880 CISGENDER WOMEN. 1959 01:00:42,880 --> 01:00:43,880 SO THEY'RE AVERAGES. 1960 01:00:43,880 --> 01:00:45,920 THEY DON'T TELL US WHAT'S 1961 01:00:45,920 --> 01:00:48,040 NORMALLY PATHOLOGIC, JUST WHAT'S 1962 01:00:48,040 --> 01:00:48,600 AVERAGE. 1963 01:00:48,600 --> 01:00:50,440 SO FOR EXAMPLE, WE KNOW IN THESE 1964 01:00:50,440 --> 01:00:51,440 STUDIES AND OUR REFERENCE RANGES 1965 01:00:51,440 --> 01:00:53,440 ARE BASED ON THEM, THAT 1966 01:00:53,440 --> 01:00:55,880 CISGENDER WOMEN AND OTHER 1967 01:00:55,880 --> 01:00:56,920 NON-TRANSGENDER WOMEN HAVE A 1968 01:00:56,920 --> 01:00:58,680 LOWER HEMOGLOBIN THAN CISGENDER 1969 01:00:58,680 --> 01:00:59,960 MEN. 1970 01:00:59,960 --> 01:01:01,200 BUT WE DON'T KNOW IF THAT'S 1971 01:01:01,200 --> 01:01:03,920 NORMAL OR NOT NORMAL, SO FOR 1972 01:01:03,920 --> 01:01:05,720 EXAMPLE, MAYBE THE REASON THAT 1973 01:01:05,720 --> 01:01:07,360 CISGENDER WOMEN HAVE A LOWER 1974 01:01:07,360 --> 01:01:08,760 HEMOGLOBIN THAN CISGENDER MEN IS 1975 01:01:08,760 --> 01:01:10,160 BECAUSE A LOT OF PEOPLE WHO ARE 1976 01:01:10,160 --> 01:01:11,520 CISGENDER WOMEN ARE 1977 01:01:11,520 --> 01:01:11,920 IRON-DEFICIENT. 1978 01:01:11,920 --> 01:01:14,080 AND SO WHEN WE'RE COMPARING A 1979 01:01:14,080 --> 01:01:15,280 PATIENT WHO COMES IN TO OUR 1980 01:01:15,280 --> 01:01:17,160 OFFICE TO THESE REFERENCE 1981 01:01:17,160 --> 01:01:18,840 RANGES, WE MAY JUST BE MISSING 1982 01:01:18,840 --> 01:01:21,160 IRON DEFICIENCY IN A LARGE 1983 01:01:21,160 --> 01:01:25,000 POPULATION OF CISGENDER WOMEN. 1984 01:01:25,000 --> 01:01:26,360 ALSO, TRANSGENDER PEOPLE OFTEN 1985 01:01:26,360 --> 01:01:27,680 HAVE LABORATORY REFERENCE RANGES 1986 01:01:27,680 --> 01:01:30,880 THAT FALL OUTSIDE OF THOSE 1987 01:01:30,880 --> 01:01:31,680 CATEGORIZED AS NORMAL FOR 1988 01:01:31,680 --> 01:01:32,880 CISGENDER MEN OR WOMEN, SO TRANS 1989 01:01:32,880 --> 01:01:35,480 PEOPLE OFTEN HAVE LABS THAT ARE 1990 01:01:35,480 --> 01:01:37,000 PERSISTENTLY FLAGGED AS 1991 01:01:37,000 --> 01:01:38,240 ABNORMAL, WHICH THEY MAY OR MAY 1992 01:01:38,240 --> 01:01:39,800 NOT BE. 1993 01:01:39,800 --> 01:01:41,400 SO FOR EXAMPLE, A TRANSGENDER 1994 01:01:41,400 --> 01:01:43,120 MAN IN ONE OF OUR QUALITATIVE 1995 01:01:43,120 --> 01:01:45,360 STUDIES SAID THEY HAVE ME LISTED 1996 01:01:45,360 --> 01:01:47,120 AS A FEMALE FOR MY LAB LEVELS SO 1997 01:01:47,120 --> 01:01:48,600 THEY'RE ALWAYS A LITTLE BIT OFF. 1998 01:01:48,600 --> 01:01:50,400 AND I'M LIKE, IS THIS NORMAL? 1999 01:01:50,400 --> 01:01:52,520 AND HE DOESN'T KNOW AND PROBABLY 2000 01:01:52,520 --> 01:01:54,640 HIS CLINICIAN OFTEN DOESN'T KNOW 2001 01:01:54,640 --> 01:01:54,840 EITHER. 2002 01:01:54,840 --> 01:01:56,280 SO ALSO AN AREA OF GREAT CONCERN 2003 01:01:56,280 --> 01:01:59,440 IS THAT THERE ARE SOME 2004 01:01:59,440 --> 01:02:00,440 CHEMOTHERAPEUTIC AGENTS WE DOSE 2005 01:02:00,440 --> 01:02:01,880 BASED ON CREATININE CLEARANCE 2006 01:02:01,880 --> 01:02:03,480 WHICH IS BASED ON A SEX OR 2007 01:02:03,480 --> 01:02:05,440 GENDER MARKER AND WE DO NOT HAVE 2008 01:02:05,440 --> 01:02:07,680 ROBUST DATA ABOUT HOW THESE 2009 01:02:07,680 --> 01:02:08,760 ALGORITHMS APPLY OR DON'T APPLY 2010 01:02:08,760 --> 01:02:11,000 TO TRANSGENDER PEOPLE ON OR OFF 2011 01:02:11,000 --> 01:02:11,360 HORMONE THERAPY. 2012 01:02:11,360 --> 01:02:17,760 SO WE MAY BE UNDER OR OVERDOSING 2013 01:02:17,760 --> 01:02:18,720 CARBOPLATIN IN MANY TRANSGENDER 2014 01:02:18,720 --> 01:02:19,840 PEOPLE. 2015 01:02:19,840 --> 01:02:21,400 SO HOW CAN WE DO THINGS 2016 01:02:21,400 --> 01:02:22,000 DIFFERENTLY? 2017 01:02:22,000 --> 01:02:23,080 SO THERE'S SOME REALLY SIMPLE 2018 01:02:23,080 --> 01:02:26,000 THINGS WE CAN DO. 2019 01:02:26,000 --> 01:02:27,640 SO FOR ONE THING, OFTEN THE 2020 01:02:27,640 --> 01:02:29,880 WORDS MALE AND FEMALE, MEN AND 2021 01:02:29,880 --> 01:02:31,880 WOMEN, CAN BE JUST TAKEN OUT OF 2022 01:02:31,880 --> 01:02:33,920 ELIGIBILITY CRITERIA AND 2023 01:02:33,920 --> 01:02:34,840 ONCOLOGY GUIDELINES AS WELL AND 2024 01:02:34,840 --> 01:02:38,280 JUST BE REPLACED WITH THE WORD 2025 01:02:38,280 --> 01:02:38,560 "PEOPLE." 2026 01:02:38,560 --> 01:02:40,160 IN ADDITION, WE CAN REPLACE 2027 01:02:40,160 --> 01:02:41,400 WORDS THAT CONTAIN A LOT OF 2028 01:02:41,400 --> 01:02:42,880 ASSUMPTIONS WITH MORE PRECISE 2029 01:02:42,880 --> 01:02:44,120 LANGUAGE, SO IF WE'RE TALKING 2030 01:02:44,120 --> 01:02:45,600 ABOUT SEX THAT COULD RESULT IN A 2031 01:02:45,600 --> 01:02:47,040 PREGNANCY, WE CAN JUST SAY SEX 2032 01:02:47,040 --> 01:02:48,280 THAT COULD RESULT IN A PREGNANCY 2033 01:02:48,280 --> 01:02:49,560 AND WE CAN TAKE GENDER OUT OF 2034 01:02:49,560 --> 01:02:52,400 THE EQUATION ENTIRELY. 2035 01:02:52,400 --> 01:02:54,240 IF WE HAVE EXCLUSIONS IN OUR 2036 01:02:54,240 --> 01:02:56,280 TRIALS FOR HORMONE THERAPY, WE 2037 01:02:56,280 --> 01:02:58,560 CAN BE EXPLICIT ABOUT WHETHER OR 2038 01:02:58,560 --> 01:02:59,440 NOT HORMONE THERAPY FOR THE 2039 01:02:59,440 --> 01:03:02,120 PURPOSES OF GENDER TRANSITION IS 2040 01:03:02,120 --> 01:03:02,440 RELEVANT. 2041 01:03:02,440 --> 01:03:03,800 AND INSTEAD OF BLANKET 2042 01:03:03,800 --> 01:03:05,280 EXCLUSIONS FOR HIV, WE CAN 2043 01:03:05,280 --> 01:03:07,120 EXCLUDE BASED ON THINGS THAT 2044 01:03:07,120 --> 01:03:08,760 WE'RE ACTUALLY WORRIED ABOUT, 2045 01:03:08,760 --> 01:03:10,160 LIKE IMMUNOSUPPRESSION OR 2046 01:03:10,160 --> 01:03:12,280 DRUG-DRUG INTERACTIONS. 2047 01:03:12,280 --> 01:03:13,880 WE CAN BEGIN TO COLLECT 2048 01:03:13,880 --> 01:03:15,520 MEANINGFUL DATA, SO INSTEAD OF 2049 01:03:15,520 --> 01:03:17,720 OR IN ADDITION TO SEX AND GENDER 2050 01:03:17,720 --> 01:03:19,640 DATA, WE CAN COLLECT DATA ABOUT 2051 01:03:19,640 --> 01:03:22,360 BODY SURFACE AREA, MUSCLE MASS, 2052 01:03:22,360 --> 01:03:24,960 ANATOMY, HORMONE LEVELS, AND 2053 01:03:24,960 --> 01:03:26,120 CHROMOSOMES, AND WE CAN DEVELOP 2054 01:03:26,120 --> 01:03:29,160 REFERENCE RANGES AND OTHER 2055 01:03:29,160 --> 01:03:29,800 IMPORTANT INFORMATION BASED ON 2056 01:03:29,800 --> 01:03:32,400 THINGS THAT WE CAN MEASURE IN A 2057 01:03:32,400 --> 01:03:33,720 VARIETY OF PEOPLE, INCLUDING 2058 01:03:33,720 --> 01:03:35,640 TRANSGENDER PEOPLE. 2059 01:03:35,640 --> 01:03:37,560 WE ALSO WANT TO ENSURE THAT OUR 2060 01:03:37,560 --> 01:03:38,720 CANCER CLINICAL TRIALS ARE 2061 01:03:38,720 --> 01:03:40,160 ACCESSIBLE TO TRANSGENDER 2062 01:03:40,160 --> 01:03:41,240 PEOPLE, AND THE BEST WAY TO DO 2063 01:03:41,240 --> 01:03:45,720 THAT IS TO MEET THE NIE NEEDS OF 2064 01:03:45,720 --> 01:03:47,480 TRANSGENDER, SO QUALITATIVE DATA 2065 01:03:47,480 --> 01:03:48,520 WITH TRANSGENDER SUGGESTS WE'RE 2066 01:03:48,520 --> 01:03:50,400 MORE LIKELY TO PARTICIPATE IN 2067 01:03:50,400 --> 01:03:51,400 CLINICAL TRIALS WHEN THERE ARE 2068 01:03:51,400 --> 01:03:52,320 TRANS INVESTIGATORS OR 2069 01:03:52,320 --> 01:03:53,480 TRANSGENDER RESEARCH STAFF, WHEN 2070 01:03:53,480 --> 01:03:55,400 THERE'S A CLEAR BENEFIT TO TRANS 2071 01:03:55,400 --> 01:03:57,760 COMMUNITIES, WHEN RESOURCES ARE 2072 01:03:57,760 --> 01:04:00,120 PROVIDED LIKE TRANSPORTATION AND 2073 01:04:00,120 --> 01:04:00,400 HOUSING. 2074 01:04:00,400 --> 01:04:01,760 AND WHEN TRIALS ARE INTEGRATED 2075 01:04:01,760 --> 01:04:03,280 INTO THE HEALTHCARE THAT WE'RE 2076 01:04:03,280 --> 01:04:05,960 ALREADY RECEIVING. 2077 01:04:05,960 --> 01:04:07,600 COMMUNITY-BASED PARTICIPATORY 2078 01:04:07,600 --> 01:04:08,840 RESEARCH, RECRUITMENT OF 2079 01:04:08,840 --> 01:04:10,880 TRANSGENDER PEOPLE AT 2080 01:04:10,880 --> 01:04:12,200 TRANS-SERVING AGENCIES AND USING 2081 01:04:12,200 --> 01:04:13,240 ONLINE RECRUITMENT HAVE ALSO 2082 01:04:13,240 --> 01:04:14,880 BEEN EFFECTIVE MEANS OF ENGAGING 2083 01:04:14,880 --> 01:04:17,600 TRANS PEOPLE IN CLINICAL TRIALS. 2084 01:04:17,600 --> 01:04:20,320 SO IN CONCLUSION, LET'S ALL 2085 01:04:20,320 --> 01:04:22,640 THINK ABOUT HOW WE CAN 2086 01:04:22,640 --> 01:04:23,480 DISENTANGLE SEX, GENDER AND 2087 01:04:23,480 --> 01:04:26,520 OTHER BIOLOGICAL FACTORS, ENSURE 2088 01:04:26,520 --> 01:04:28,520 ACCESSIBLE ELIGIBILITY CRITERIA, 2089 01:04:28,520 --> 01:04:29,880 COLLECT MEANINGFUL DATA, AND 2090 01:04:29,880 --> 01:04:30,520 ENGAGE TRANSGENDER COMMUNITIES. 2091 01:04:30,520 --> 01:04:31,480 THANK YOU SO MUCH FOR YOUR 2092 01:04:31,480 --> 01:04:31,800 ATTENTION. 2093 01:04:31,800 --> 01:04:42,000 [APPLAUSE] 2094 01:04:54,000 --> 01:04:54,640 >>HELLO. 2095 01:04:54,640 --> 01:04:57,600 MY NAME IS MEGAN MULLINS AND MY 2096 01:04:57,600 --> 01:04:58,560 PRONOUNS ARE SHE/HER. 2097 01:04:58,560 --> 01:04:59,800 I'M HAPPY TO BE HERE WITH YOU 2098 01:04:59,800 --> 01:05:01,120 ALL TODAY TO TALK A LITTLE BIT 2099 01:05:01,120 --> 01:05:02,880 ABOUT CANCER CARE IN SEXUAL AND 2100 01:05:02,880 --> 01:05:04,440 GENDER MINORITY POPULATIONS 2101 01:05:04,440 --> 01:05:05,800 LOOKING BOTH AT WHERE WE ARE 2102 01:05:05,800 --> 01:05:06,600 CURRENTLY AND WHERE WE MIGHT BE 2103 01:05:06,600 --> 01:05:08,080 ABLE TO GO. 2104 01:05:08,080 --> 01:05:09,600 SO IN MY TALK TODAY, I'LL 2105 01:05:09,600 --> 01:05:11,160 DESCRIBE SOME KNOWN DISPARITIES 2106 01:05:11,160 --> 01:05:13,200 IN CANCER CARE, SUMMARIZE SOME 2107 01:05:13,200 --> 01:05:15,240 OF THE DRIVERS OF CARE 2108 01:05:15,240 --> 01:05:16,560 INEQUITIES FOR SEXUAL AND GENDER 2109 01:05:16,560 --> 01:05:17,440 MINORITY INDIVIDUALS, AND 2110 01:05:17,440 --> 01:05:19,320 PROPOSE SOME POTENTIAL SOLUTIONS 2111 01:05:19,320 --> 01:05:20,880 TO IMPROVING INCLUSIVENESS AND 2112 01:05:20,880 --> 01:05:23,600 QUALITY OF CANCER CARE. 2113 01:05:23,600 --> 01:05:25,240 SO YOU KNOW, WHEN WE THINK ABOUT 2114 01:05:25,240 --> 01:05:26,480 THE INCREASINGLY COMPLEX 2115 01:05:26,480 --> 01:05:28,720 LANDSCAPE OF CANCER CARE 2116 01:05:28,720 --> 01:05:30,920 DELIVERY, ALONGSIDE THE 2117 01:05:30,920 --> 01:05:32,440 INCREASINGLY COMPLEX POLITICAL 2118 01:05:32,440 --> 01:05:34,560 LANDSCAPE THAT SEXUAL AND GENDER 2119 01:05:34,560 --> 01:05:35,160 MINORITY INDIVIDUALS FACE, I 2120 01:05:35,160 --> 01:05:37,320 THINK IT'S A CRITICAL TIME TO BE 2121 01:05:37,320 --> 01:05:38,960 ASKING WHERE ARE WE IN OUR 2122 01:05:38,960 --> 01:05:40,800 ABILITY TO PROVIDE HIGH QUALITY 2123 01:05:40,800 --> 01:05:41,600 CANCER CARE TO THESE 2124 01:05:41,600 --> 01:05:43,600 POPULATIONS. 2125 01:05:43,600 --> 01:05:46,280 AND AS MY CO-PANELISTS HAVE 2126 01:05:46,280 --> 01:05:48,000 EMPHASIZED, I THINK WE ARE 2127 01:05:48,000 --> 01:05:49,040 REALLY IN A PLACE WHERE IT'S 2128 01:05:49,040 --> 01:05:50,800 DIFFICULT TO ANSWER THAT 2129 01:05:50,800 --> 01:05:51,440 QUESTION. 2130 01:05:51,440 --> 01:05:52,800 WHEN WE LOOK AT THE LITERATURE, 2131 01:05:52,800 --> 01:05:55,400 WE SEE THAT MOST STUDIES OF 2132 01:05:55,400 --> 01:05:56,680 CANCER AND SEXUAL AND GENDER 2133 01:05:56,680 --> 01:06:00,200 MINORITIES ARE FOCUSED ON BREAST 2134 01:06:00,200 --> 01:06:02,800 AND PROSTATE CANCER, THEY'RE 2135 01:06:02,800 --> 01:06:03,560 OVERWHELMINGLY CONDUCTED IN 2136 01:06:03,560 --> 01:06:05,160 CISGENDER POPULATIONS, AND THOSE 2137 01:06:05,160 --> 01:06:06,320 POPULATIONS ARE OVERWHELMINGLY 2138 01:06:06,320 --> 01:06:06,520 WHITE. 2139 01:06:06,520 --> 01:06:08,480 SO WE HAVE HUGE GAPS IN THE 2140 01:06:08,480 --> 01:06:09,800 LITERATURE IN TERMS OF OTHER 2141 01:06:09,800 --> 01:06:12,960 TYPES OF CANCER, INTERSECTIONAL 2142 01:06:12,960 --> 01:06:14,200 IDENTITIES AND HOW ALL OF THESE 2143 01:06:14,200 --> 01:06:16,000 COME TOGETHER TO IMPACT PEOPLE'S 2144 01:06:16,000 --> 01:06:19,640 EXPERIENCES OF CANCER CARE. 2145 01:06:19,640 --> 01:06:21,440 REALLY THE MAJOR DRIVER FOR WHY 2146 01:06:21,440 --> 01:06:22,720 OUR LITERATURE IS LIMITED IS 2147 01:06:22,720 --> 01:06:25,400 THAT WE ARE NOT COLLECTING SOGI 2148 01:06:25,400 --> 01:06:25,720 DATA. 2149 01:06:25,720 --> 01:06:28,480 I'M GOING TO KEEP BEATING ON 2150 01:06:28,480 --> 01:06:28,920 THAT POINT. 2151 01:06:28,920 --> 01:06:30,600 IF WE LOOK AT THE NCI'S 2152 01:06:30,600 --> 01:06:32,560 COMMUNITY ONCOLOGY RESEARCH 2153 01:06:32,560 --> 01:06:34,640 PROGRAM, LESS THAN 20% OF 2154 01:06:34,640 --> 01:06:35,800 PRACTICE GROUPS REPORTED 2155 01:06:35,800 --> 01:06:38,680 COLLECTING SOGI DATA IN THE 2017 2156 01:06:38,680 --> 01:06:39,800 LANDMARK SURVEY. 2157 01:06:39,800 --> 01:06:41,680 AND THIS WAS PARTICULARLY 2158 01:06:41,680 --> 01:06:43,160 STRIKING TO ME BECAUSE THE 2159 01:06:43,160 --> 01:06:44,800 MAJORITY OF CANCER CARE IN THE 2160 01:06:44,800 --> 01:06:46,560 UNITED STATES IS DELIVERED IN 2161 01:06:46,560 --> 01:06:48,520 COMMUNITY ONCOLOGY SETTINGS, YET 2162 01:06:48,520 --> 01:06:50,200 MOST OF THE RESEARCH THAT WE'RE 2163 01:06:50,200 --> 01:06:52,120 DOING IN SEXUAL AND GENDER 2164 01:06:52,120 --> 01:06:53,720 MINORITY COMMUNITIES ARE 2165 01:06:53,720 --> 01:06:55,200 HAPPENING AT ACADEMIC MEDICAL 2166 01:06:55,200 --> 01:06:55,840 CENTERS. 2167 01:06:55,840 --> 01:06:57,880 AND SO IT WAS IMPORTANT TO ME TO 2168 01:06:57,880 --> 01:07:00,000 TRY TO FIGURE OUT SOME OF WHAT 2169 01:07:00,000 --> 01:07:03,840 WAS DRIVING THE LOW DATA 2170 01:07:03,840 --> 01:07:05,600 COLLECTION RATES OR THE NCOR, 2171 01:07:05,600 --> 01:07:08,640 AND SO WORKING WITH NRG 2172 01:07:08,640 --> 01:07:09,960 ONCOLOGY, I CONDUCTED A PILOT 2173 01:07:09,960 --> 01:07:12,400 STUDY TO EVALUATE BARRIERS TO 2174 01:07:12,400 --> 01:07:13,080 SOGI DATA COLLECTION. 2175 01:07:13,080 --> 01:07:15,680 WE DID QUALITATIVE INTERVIEWS 2176 01:07:15,680 --> 01:07:19,560 WITH ONCOLOGY PHYSICIANS, 2177 01:07:19,560 --> 01:07:20,360 ADVANCE PRACTICE PROVIDERS AND 2178 01:07:20,360 --> 01:07:21,720 MEMBERS OF THEIR STAFF INVOLVED 2179 01:07:21,720 --> 01:07:23,240 IN DEMOGRAPHICS COLLECTION, AND 2180 01:07:23,240 --> 01:07:25,680 BASED ON OUR THEMATIC ANALYSIS, 2181 01:07:25,680 --> 01:07:28,680 THIS DIAGRAM SHOWS HOW WE SEE 2182 01:07:28,680 --> 01:07:29,960 MANY OF THE IMPORTANT THEMES 2183 01:07:29,960 --> 01:07:32,480 RELATING TOGETHER. 2184 01:07:32,480 --> 01:07:33,880 SO UNDERLYING OUR FAILURE TO 2185 01:07:33,880 --> 01:07:35,280 COLLECT SOGI DATA IS REALLY A 2186 01:07:35,280 --> 01:07:37,240 LACK OF UNDERSTANDING OF HOW 2187 01:07:37,240 --> 01:07:39,720 SEXUAL ORIENTATION AND GENDER 2188 01:07:39,720 --> 01:07:41,800 IDENTITY RELATE TO HIGH QUALITY 2189 01:07:41,800 --> 01:07:43,680 ONCOLOGY CARE. 2190 01:07:43,680 --> 01:07:45,360 MOST OF THE PHYSICIANS THAT I 2191 01:07:45,360 --> 01:07:47,760 SPOKE TO WERE INSISTENT THAT 2192 01:07:47,760 --> 01:07:49,120 KNOWING SOMEONE'S SEXUAL 2193 01:07:49,120 --> 01:07:51,320 ORIENTATION WOULD NOT CHANGE THE 2194 01:07:51,320 --> 01:07:52,520 CARE THEY PROVIDED, AND SO THEY 2195 01:07:52,520 --> 01:07:55,240 DIDN'T NEED TO KNOW IT. 2196 01:07:55,240 --> 01:07:57,000 THEY WERE A LITTLE BIT MORE 2197 01:07:57,000 --> 01:07:58,280 FLEXIBLE ON GENDER IDENTITY 2198 01:07:58,280 --> 01:08:00,000 BECAUSE THAT WOULD LET THEM KNOW 2199 01:08:00,000 --> 01:08:01,480 THE CORRECT PRONOUNCE TO USE AND 2200 01:08:01,480 --> 01:08:03,040 EVERYONE WANTED TO BE RESPECTFUL 2201 01:08:03,040 --> 01:08:04,040 OF THEIR PATIENTS. 2202 01:08:04,040 --> 01:08:08,040 BUT THAT SEPARATION OF PATIENT 2203 01:08:08,040 --> 01:08:10,760 IDENTITY FROM PROVISION OF CARE 2204 01:08:10,760 --> 01:08:14,080 IS PERPETUATING A CULTURE OF CIS 2205 01:08:14,080 --> 01:08:15,560 HETERONORMTIVITY IN OUR CLINICAL 2206 01:08:15,560 --> 01:08:15,800 SPACES. 2207 01:08:15,800 --> 01:08:16,720 BASICALLY MEANING THAT WE'RE 2208 01:08:16,720 --> 01:08:18,800 ASSUMING THAT MOST PEOPLE WHO 2209 01:08:18,800 --> 01:08:21,560 COME THROUGH ARE CISGENDER AND 2210 01:08:21,560 --> 01:08:23,160 HETEROSEXUAL, AND WE FAIL TO 2211 01:08:23,160 --> 01:08:25,960 ACCOUNT FOR DIFFERENT IDENTITIES 2212 01:08:25,960 --> 01:08:27,640 THAT MAY PRESENT. 2213 01:08:27,640 --> 01:08:29,800 SO MOST OF MY INTERVIEW 2214 01:08:29,800 --> 01:08:30,720 PARTICIPANTS DESCRIBE SITUATIONS 2215 01:08:30,720 --> 01:08:32,600 WHERE THEY HAD THAT ONE PERSON 2216 01:08:32,600 --> 01:08:35,440 THAT STOOD OUT IN THEIR MEMORY 2217 01:08:35,440 --> 01:08:37,400 WHO WAS TRANSGENDER THAT PERHAPS 2218 01:08:37,400 --> 01:08:39,240 SHOWED UP TO A GYNECOLOGIC 2219 01:08:39,240 --> 01:08:40,960 ONCOLOGY CLINIC, AND IT TOOK 2220 01:08:40,960 --> 01:08:43,400 GREAT LENGTHS TO NAVIGATE THEM 2221 01:08:43,400 --> 01:08:45,320 TO THE CARE THAT THEY NEEDED AND 2222 01:08:45,320 --> 01:08:46,800 MAKE SURE THAT THEY WERE TREATED 2223 01:08:46,800 --> 01:08:48,320 RESPECTFULLY. 2224 01:08:48,320 --> 01:08:50,560 AND SO THIS TYPE OF CULTURE 2225 01:08:50,560 --> 01:08:52,120 REALLY CONTRIBUTES TO SEVERAL 2226 01:08:52,120 --> 01:08:54,480 THINGS SPECIFIC TO SOGI DATA 2227 01:08:54,480 --> 01:08:55,280 COLLECTION. 2228 01:08:55,280 --> 01:08:58,360 ONE BEING THAT MANY PLACES STILL 2229 01:08:58,360 --> 01:08:59,760 DO NOT HAVE DISCRETE FIELDS IN 2230 01:08:59,760 --> 01:09:02,160 THE EMR TO COLLECT THIS DATA. 2231 01:09:02,160 --> 01:09:04,720 FOR THOSE THAT DO HAVE DISCRETE 2232 01:09:04,720 --> 01:09:05,960 FIELDS, MOST PEOPLE COULD NOT 2233 01:09:05,960 --> 01:09:09,040 TELL ME WHERE THEY WERE, AND SO 2234 01:09:09,040 --> 01:09:10,840 EVEN IN PLACES WHERE A CLINICAL 2235 01:09:10,840 --> 01:09:12,640 STAFF MEMBER MAY HAVE BEEN VERY 2236 01:09:12,640 --> 01:09:14,200 EXCITED THAT THEY WERE DOING 2237 01:09:14,200 --> 01:09:15,880 THIS GREAT SOGI DATA COLLECTION, 2238 01:09:15,880 --> 01:09:17,600 WHEN I TALKED TO THE ONCOLOGIST, 2239 01:09:17,600 --> 01:09:19,680 THEY DIDN'T KNOW WHERE THAT 2240 01:09:19,680 --> 01:09:21,360 INFORMATION WAS IN THE EMR TO BE 2241 01:09:21,360 --> 01:09:23,160 ABLE TO USE IT IN THEIR CLINIC 2242 01:09:23,160 --> 01:09:25,760 VISIT. 2243 01:09:25,760 --> 01:09:26,560 SIMILARLY THERE'S A LOW PRIORITY 2244 01:09:26,560 --> 01:09:28,840 FOR THIS INFORMATION, SO PEOPLE 2245 01:09:28,840 --> 01:09:32,160 ARE NOT BEING ASKED TO COLLECT 2246 01:09:32,160 --> 01:09:33,880 THE FIELD IN THE EMR EVEN WHEN 2247 01:09:33,880 --> 01:09:36,400 THEY ARE PRESENT, AND THERE'S AN 2248 01:09:36,400 --> 01:09:38,240 UNDERLYING DISCOMFORT OF 2249 01:09:38,240 --> 01:09:39,440 ENGAGING BOTH WITH DATA 2250 01:09:39,440 --> 01:09:41,480 COLLECTION AND I THINK THESE 2251 01:09:41,480 --> 01:09:42,680 TERMS MORE BROADLY. 2252 01:09:42,680 --> 01:09:44,360 AND I THINK THAT REALLY CAME 2253 01:09:44,360 --> 01:09:46,200 FROM TWO PLACES. 2254 01:09:46,200 --> 01:09:50,280 SO ONE IS, WHEN WE DECOUPLE 2255 01:09:50,280 --> 01:09:52,080 IDENTITY FROM PROVIDING CARE, 2256 01:09:52,080 --> 01:09:53,520 THEN THERE'S THE SENSE THAT 2257 01:09:53,520 --> 01:09:54,720 ASKING THESE QUESTIONS ARE 2258 01:09:54,720 --> 01:09:56,520 REALLY INTRUSIVE AND 2259 01:09:56,520 --> 01:09:57,720 UNNECESSARY, WHICH CREATES 2260 01:09:57,720 --> 01:09:58,720 DISCOMFORT. 2261 01:09:58,720 --> 01:10:00,600 THE OTHER IS THAT REALLY 2262 01:10:00,600 --> 01:10:01,760 SOMEBODY DESCRIBED IT AS A 2263 01:10:01,760 --> 01:10:03,240 MUSCLE THAT PEOPLE ARE NOT USED 2264 01:10:03,240 --> 01:10:04,480 TO FLEXING. 2265 01:10:04,480 --> 01:10:06,760 SO FOR MANY PEOPLE, THESE TERMS 2266 01:10:06,760 --> 01:10:09,520 ARE DIFFERENT, DOING THINGS LIKE 2267 01:10:09,520 --> 01:10:10,840 OFFERING YOUR PRONOUNCE IS NEW, 2268 01:10:10,840 --> 01:10:12,280 AND IT'S NOT SOMETHING THAT 2269 01:10:12,280 --> 01:10:16,520 THEY'RE USED TO PRACTICING. 2270 01:10:16,520 --> 01:10:17,520 AND SO IT'S SOMETHING THAT WE 2271 01:10:17,520 --> 01:10:20,000 CAN NORMALIZE IN PRACTICE AND 2272 01:10:20,000 --> 01:10:21,880 USE TO PROMOTE SOGI DATA 2273 01:10:21,880 --> 01:10:23,280 COLLECTION. 2274 01:10:23,280 --> 01:10:26,040 SO I WALK THROUGH THESE THINGS 2275 01:10:26,040 --> 01:10:27,920 TODAY NOT TO MAKE YOU ALL EXPERT 2276 01:10:27,920 --> 01:10:29,840 SOGI DATA COLLECTORS, ALTHOUGH I 2277 01:10:29,840 --> 01:10:31,680 HOPE AFTER OUR PANEL, YOU ALL 2278 01:10:31,680 --> 01:10:32,120 WILL BE. 2279 01:10:32,120 --> 01:10:35,360 BUT REALLY, BECAUSE I THINK THE 2280 01:10:35,360 --> 01:10:36,800 SAME TYPES OF THINGS ARE 2281 01:10:36,800 --> 01:10:37,800 UNDERLYING THE DISPARITIES THAT 2282 01:10:37,800 --> 01:10:41,960 WE SEE IN PROVISION OF CARE. 2283 01:10:41,960 --> 01:10:43,280 SO WHEN WE LOOK AT KNOWN 2284 01:10:43,280 --> 01:10:45,360 DISPARITIES, THERE'S A LACK OF 2285 01:10:45,360 --> 01:10:46,640 CULTURALLY COMPETENT CARE FOR 2286 01:10:46,640 --> 01:10:48,080 SEXUAL AND GENDER MINORITY. 2287 01:10:48,080 --> 01:10:50,160 ONE EXAMPLE IS UNADDRESSED 2288 01:10:50,160 --> 01:10:53,400 SEXUAL HEALTH CONCERNS. 2289 01:10:53,400 --> 01:10:57,920 SO THIS IS NOT UNIQUE TO SEXUAL 2290 01:10:57,920 --> 01:10:58,600 AND GENDER MINORITY POPULATIONS. 2291 01:10:58,600 --> 01:11:00,040 LESS THAN 10% OF CANCER 2292 01:11:00,040 --> 01:11:00,720 SURVIVORS IN THE UNITED STATES 2293 01:11:00,720 --> 01:11:03,120 ARE ASKED ABOUT THEIR SEXUAL 2294 01:11:03,120 --> 01:11:05,120 HEALTH NEEDS, SO THIS IS A 2295 01:11:05,120 --> 01:11:06,920 GLARING GAP IN OUR PROVISION OF 2296 01:11:06,920 --> 01:11:11,040 CON KONCOLOGY CARE, AND I'M HOPL 2297 01:11:11,040 --> 01:11:13,160 THAT AS WE NORMALIZE THINGS LIKE 2298 01:11:13,160 --> 01:11:14,400 SOGI DATA COLLECTION AND CREATE 2299 01:11:14,400 --> 01:11:16,280 MORE SPACE FOR PEOPLE TO BRING 2300 01:11:16,280 --> 01:11:17,560 THEIR WHOLE SELVES INTO THEIR 2301 01:11:17,560 --> 01:11:19,640 CANCER CARE EXPERIENCE, WE CAN 2302 01:11:19,640 --> 01:11:21,440 ALSO IMPROVE COMFORTABILITY OF 2303 01:11:21,440 --> 01:11:23,400 TALKING ABOUT SEXUALITY AT ALL 2304 01:11:23,400 --> 01:11:25,400 IN ONCOLOGY SETTINGS. 2305 01:11:25,400 --> 01:11:27,840 BUT WHAT IS UNIQUE HERE IS THAT 2306 01:11:27,840 --> 01:11:28,840 PARTICULARLY FOR MEN WHO HAVE 2307 01:11:28,840 --> 01:11:31,880 SEX WITH MEN, THERE ARE HIGHER 2308 01:11:31,880 --> 01:11:33,320 RATES OF UNADDRESSED SEXUAL 2309 01:11:33,320 --> 01:11:34,640 HEALTH CONCERNS, LARGELY BECAUSE 2310 01:11:34,640 --> 01:11:36,760 IF THEY GO TO THEIR PROVIDER AND 2311 01:11:36,760 --> 01:11:39,840 ATTEMPT TO TALK ABOUT THEIR 2312 01:11:39,840 --> 01:11:40,840 CONCERNS OR UNIQUE NEEDS, 2313 01:11:40,840 --> 01:11:43,320 THEY'RE MET WITH DISCOMFORT OR 2314 01:11:43,320 --> 01:11:46,120 PEOPLE WHO CANNOT HAVE A 2315 01:11:46,120 --> 01:11:46,960 CONVERSATION OR PROVIDE 2316 01:11:46,960 --> 01:11:48,520 RESOURCES. 2317 01:11:48,520 --> 01:11:51,400 OFTEN MANY OF THE PATIENT-FACING 2318 01:11:51,400 --> 01:11:52,240 EDUCATIONAL MATERIALS ARE 2319 01:11:52,240 --> 01:11:53,560 WRITTEN TOWARDS AN AUDIENCE OF 2320 01:11:53,560 --> 01:11:55,240 MEN WHO HAVE SEX WITH WOMEN. 2321 01:11:55,240 --> 01:11:58,800 SO I THINK THIS IS AN IMPORTANT 2322 01:11:58,800 --> 01:12:00,120 PLACE WHERE WE COULD USE 2323 01:12:00,120 --> 01:12:01,280 TAILORED RESOURCES THAT COULD 2324 01:12:01,280 --> 01:12:03,280 REALLY PROVIDE A LOT OF BENEFIT 2325 01:12:03,280 --> 01:12:04,720 FOR PEOPLE IN BEING ABLE TO 2326 01:12:04,720 --> 01:12:05,840 ADDRESS THEIR CONCERNS. 2327 01:12:05,840 --> 01:12:09,040 AND I WILL NOTE FOR PROSTATE 2328 01:12:09,040 --> 01:12:09,720 CANCER, THERE ARE GUIDELINES 2329 01:12:09,720 --> 01:12:11,680 THAT HAVE COME OUT RELATED TO 2330 01:12:11,680 --> 01:12:12,680 SEXUAL HEALTH AND THEY DO 2331 01:12:12,680 --> 01:12:13,800 INCLUDE RECOMMENDATIONS FOR 2332 01:12:13,800 --> 01:12:15,120 SEXUAL AND GENDER MINORITIES, SO 2333 01:12:15,120 --> 01:12:17,920 THAT'S A GREAT RESOURCE TO HAVE. 2334 01:12:17,920 --> 01:12:22,000 AND THEN AS DR. ALPERT MENTIONED 2335 01:12:22,000 --> 01:12:24,760 WITH TRIALS, SIMILARLY IN 2336 01:12:24,760 --> 01:12:26,640 CLINICAL PLACE, WE HAVE GENDERED 2337 01:12:26,640 --> 01:12:28,280 AND HETERONORMATIVE LANGUAGE, 2338 01:12:28,280 --> 01:12:29,040 ASSUMPTIONS ABOUT HOW PATIENTS 2339 01:12:29,040 --> 01:12:33,720 MAY BE RELATED TO THE PERSON 2340 01:12:33,720 --> 01:12:34,600 THAT'S ON THE VISIT WITH THEM IN 2341 01:12:34,600 --> 01:12:39,040 THE ROOM, AND ASKING WHO HAVE 2342 01:12:39,040 --> 01:12:40,080 YOU BROUGHT WITH YOU TODAY, HOW 2343 01:12:40,080 --> 01:12:41,360 WOULD YOU LIKE ME TO ADDRESS 2344 01:12:41,360 --> 01:12:42,720 THEM, RATHER THAN ASSUMING A 2345 01:12:42,720 --> 01:12:43,320 PARTICULAR RELATIONSHIP. 2346 01:12:43,320 --> 01:12:44,920 THEN FINALLY, WE KNOW THERE ARE 2347 01:12:44,920 --> 01:12:46,080 KNOWLEDGE GAPS. 2348 01:12:46,080 --> 01:12:49,160 SO SURVEYS OF CLINICAL CARE 2349 01:12:49,160 --> 01:12:51,120 PROVIDERS INCLUDING NURSES, 2350 01:12:51,120 --> 01:12:53,040 ADVANCED PRACTICE PROVIDERS, AND 2351 01:12:53,040 --> 01:12:55,320 PHYSICIANS, ALL INDICATE THAT 2352 01:12:55,320 --> 01:12:56,560 WHILE PEOPLE ARE COMFORTABLE 2353 01:12:56,560 --> 01:12:57,880 PROVIDING CARE FOR SEXUAL AND 2354 01:12:57,880 --> 01:12:59,800 GENDER MINORITIES, THEY DON'T 2355 01:12:59,800 --> 01:13:03,040 KNOW AS MUCH AS THEY WOULD LIKE 2356 01:13:03,040 --> 01:13:04,520 TO, AND THEY STATE A WILLINGNESS 2357 01:13:04,520 --> 01:13:05,080 TO LEARN MORE. 2358 01:13:05,080 --> 01:13:07,080 SO I THINK THAT'S AN IMPORTANT 2359 01:13:07,080 --> 01:13:09,920 OPPORTUNITY FOR US TO PROVIDE 2360 01:13:09,920 --> 01:13:12,320 EDUCATION WHEN WE CONSIDER THAT 2361 01:13:12,320 --> 01:13:13,800 IN U.S. MEDICAL CURRICULUM, I 2362 01:13:13,800 --> 01:13:17,120 THINK THE MEDIAN IS ZERO TO 2363 01:13:17,120 --> 01:13:18,800 5 HOURS AROUND LGBT HEALTH, AND 2364 01:13:18,800 --> 01:13:21,440 33% OF MEDICAL SCHOOLS SAID OF 2365 01:13:21,440 --> 01:13:23,160 THOSE HOURS, ZERO OF THEM WERE 2366 01:13:23,160 --> 01:13:26,000 CLINICAL HOURS. 2367 01:13:26,000 --> 01:13:28,880 THEN FINALLY, WE DO HAVE A 2368 01:13:28,880 --> 01:13:31,560 ROBUST LITERATURE SHOWING POORER 2369 01:13:31,560 --> 01:13:34,440 MENTAL HEALTH OUTCOMES AROUND -- 2370 01:13:34,440 --> 01:13:35,840 IN SEXUAL AND GENDER MINORITY 2371 01:13:35,840 --> 01:13:37,160 CANCER SURVIVORS COMPARED TO 2372 01:13:37,160 --> 01:13:38,600 THEIR CISGENDERRED AND 2373 01:13:38,600 --> 01:13:39,800 HETEROSEXUAL COUNTERPARTS. 2374 01:13:39,800 --> 01:13:43,520 AND I THINK THIS MENTAL HEALTH 2375 01:13:43,520 --> 01:13:44,240 EXAMPLE IS AN IMPORTANT 2376 01:13:44,240 --> 01:13:47,200 OPPORTUNITY TO REALLY STRESS THE 2377 01:13:47,200 --> 01:13:48,720 IMPORTANCE OF DEAGGREGATING 2378 01:13:48,720 --> 01:13:52,280 THESE GROUPS WHENEVER POSSIBLE. 2379 01:13:52,280 --> 01:13:53,320 SO WE KNOW THAT WOMEN WHO HAVE 2380 01:13:53,320 --> 01:13:54,560 SEX WITH WOMEN ARE MORE LIKELY 2381 01:13:54,560 --> 01:13:56,360 TO BE IN PARTNERED RELATIONSHIPS 2382 01:13:56,360 --> 01:13:57,800 THAT CAN PROVIDE SOURCES OF 2383 01:13:57,800 --> 01:14:00,560 COMFORT AND RESILIENCE THROUGH 2384 01:14:00,560 --> 01:14:03,280 SOMEONE'S CANCER TREATMENT 2385 01:14:03,280 --> 01:14:03,680 EXPERIENCE. 2386 01:14:03,680 --> 01:14:04,800 THAT'S VERY DIFFERENT FROM MEN 2387 01:14:04,800 --> 01:14:06,160 WHO HAVE SEX WITH MEN WHO ARE 2388 01:14:06,160 --> 01:14:08,000 MORE COMMONLY NOT PARTNERED AND 2389 01:14:08,000 --> 01:14:09,640 EXPERIENCE HIGHER RATES OF 2390 01:14:09,640 --> 01:14:14,080 SOCIAL ISOLATION AND DEPRESSION. 2391 01:14:14,080 --> 01:14:15,840 THEN WHEN WE LOOK AT DISTRESS, 2392 01:14:15,840 --> 01:14:16,760 WHILE SEXUAL AND GENDER 2393 01:14:16,760 --> 01:14:18,240 MINORITIES HAVE DISTRESS LEVELS 2394 01:14:18,240 --> 01:14:19,680 THAT ARE 3 TO 6 TIMES HIGHER 2395 01:14:19,680 --> 01:14:22,080 THAN THEIR CISGENDERED 2396 01:14:22,080 --> 01:14:24,160 HETEROSEXUAL COUNTERPARTS, IF WE 2397 01:14:24,160 --> 01:14:25,600 COMPARE TRANS INDIVIDUALS TO 2398 01:14:25,600 --> 01:14:27,480 THEIR SEXUAL MINORITY 2399 01:14:27,480 --> 01:14:29,240 CISGENDERED COUNTERPARTS, WE SEE 2400 01:14:29,240 --> 01:14:30,480 HIGHER DISTRESS AMONG TRANS 2401 01:14:30,480 --> 01:14:30,960 FOLKS. 2402 01:14:30,960 --> 01:14:35,840 AND SO I THINK RECOGNIZING THAT 2403 01:14:35,840 --> 01:14:38,440 ALL OF THESE GROUPS HAVE 2404 01:14:38,440 --> 01:14:39,360 DIFFERENT CHARACTERISTICS THAT 2405 01:14:39,360 --> 01:14:41,080 WE NEED TO CONSIDER AS WE MOVE 2406 01:14:41,080 --> 01:14:43,040 THIS RESEARCH FORWARD IS 2407 01:14:43,040 --> 01:14:44,240 CRITICAL. 2408 01:14:44,240 --> 01:14:45,840 AND REALLY MUCH OF THE MENTAL 2409 01:14:45,840 --> 01:14:47,680 HEALTH OUTCOMES COME FROM THE 2410 01:14:47,680 --> 01:14:49,480 EXPERIENCES OF DISCRIMINATION 2411 01:14:49,480 --> 01:14:50,680 AND STIGMA THAT HAVE BEEN 2412 01:14:50,680 --> 01:14:52,320 MENTIONED THROUGHOUT THIS PANEL 2413 01:14:52,320 --> 01:14:53,040 TODAY. 2414 01:14:53,040 --> 01:14:55,200 AND SO I THINK THAT REALLY 2415 01:14:55,200 --> 01:14:58,280 CREATES A PRESSING NEED TO 2416 01:14:58,280 --> 01:15:00,320 CONSIDER THE ROLE OF HEALTHCARE 2417 01:15:00,320 --> 01:15:01,880 IN DEVELOPING A TRUSTWORTHY 2418 01:15:01,880 --> 01:15:05,280 ENVIRONMENT FOR PEOPLE, 2419 01:15:05,280 --> 01:15:06,360 PARTICULARLY IN ONCOLOGY. 2420 01:15:06,360 --> 01:15:07,400 AND I THINK ONE WAY TO DO THAT 2421 01:15:07,400 --> 01:15:09,640 IS TO REALLY BRIDGE THIS GAP 2422 01:15:09,640 --> 01:15:12,600 BETWEEN PATIENT IDENTITIES AND 2423 01:15:12,600 --> 01:15:14,040 ONCOLOGY CARE. 2424 01:15:14,040 --> 01:15:16,840 SO IN THE GREEN BOX, THIS IS A 2425 01:15:16,840 --> 01:15:18,400 QUOTE FROM MY STUDY, WHERE AN 2426 01:15:18,400 --> 01:15:19,440 ONCOLOGIST TOLD ME, YOU KNOW, I 2427 01:15:19,440 --> 01:15:21,360 HAVE TO ADMIT I DON'T ROUTINELY 2428 01:15:21,360 --> 01:15:22,560 ADDRESS SEXUAL ORIENTATION 2429 01:15:22,560 --> 01:15:25,120 DURING MY VISITS, BECAUSE 2430 01:15:25,120 --> 01:15:27,280 USUALLY I'M SEEING, I'M KIND OF 2431 01:15:27,280 --> 01:15:28,280 FOCUSED ON THE CANCER ISSUE. 2432 01:15:28,280 --> 01:15:31,160 SO THERE'S A CLEAR DELINEATION 2433 01:15:31,160 --> 01:15:32,520 THERE BETWEEN THE PATIENT'S 2434 01:15:32,520 --> 01:15:33,440 IDENTITY AND WHAT NEEDS TO 2435 01:15:33,440 --> 01:15:35,560 HAPPEN IN THIS VISIT, BUT THAT'S 2436 01:15:35,560 --> 01:15:37,000 IN DIRECT CONTRAST TO WHAT WE 2437 01:15:37,000 --> 01:15:39,360 SEE IN THE PATIENT LITERATURE. 2438 01:15:39,360 --> 01:15:40,760 THIS QUOTE IS FROM A STUDY THAT 2439 01:15:40,760 --> 01:15:46,280 WAS DONE BY KATZ IN 2009 OF 2440 01:15:46,280 --> 01:15:48,520 INTERVIEWS OF MINORITY CANCER 2441 01:15:48,520 --> 01:15:49,480 SURVIVORS, WHERE EVERY 2442 01:15:49,480 --> 01:15:50,200 PARTICIPANT SAID IT WAS VERY 2443 01:15:50,200 --> 01:15:51,480 IMPORTANT THAT THEIR ONCOLOGY 2444 01:15:51,480 --> 01:15:53,320 PROVIDER KNOW THEIR SEXUAL 2445 01:15:53,320 --> 01:15:54,440 ORIENTATION BECAUSE IT WAS 2446 01:15:54,440 --> 01:15:56,920 INTEGRAL TO WHO THEY WERE, AND I 2447 01:15:56,920 --> 01:15:58,720 THINK THIS QUOTE ILLUSTRATES 2448 01:15:58,720 --> 01:15:59,280 THAT. 2449 01:15:59,280 --> 01:16:01,320 A WOMAN SAID, IT WAS IMPORTANT 2450 01:16:01,320 --> 01:16:03,120 "TO NOT BE DANCING AROUND WITH 2451 01:16:03,120 --> 01:16:04,640 WHO I AM AS A PERSON AND WHO MY 2452 01:16:04,640 --> 01:16:06,520 SUPPORT PEOPLE ARE." 2453 01:16:06,520 --> 01:16:08,920 AND SO I THINK PATIENTS WANT TO 2454 01:16:08,920 --> 01:16:12,240 HAVE A SAFE SPACE TO BE 2455 01:16:12,240 --> 01:16:13,840 THEMSELVES IN THEIR VISITS. 2456 01:16:13,840 --> 01:16:17,000 AND TO HAVE THEIR RELATIONSHIPS 2457 01:16:17,000 --> 01:16:19,000 RESPECTED THE WAY THAT OTHER 2458 01:16:19,000 --> 01:16:19,640 HETEROSEXUAL RELATIONSHIPS MIGHT 2459 01:16:19,640 --> 01:16:20,560 BE. 2460 01:16:20,560 --> 01:16:22,720 AND I THINK THAT WHEN WE -- WE 2461 01:16:22,720 --> 01:16:24,680 CAN DO THAT, WE SEE THAT THERE 2462 01:16:24,680 --> 01:16:26,720 ARE BETTER OUTCOMES FOR THE 2463 01:16:26,720 --> 01:16:28,160 CANCER AS WELL. 2464 01:16:28,160 --> 01:16:30,480 SO DISCLOSING A SEXUAL AND 2465 01:16:30,480 --> 01:16:32,280 GENDER MINORITY IDENTITY IN A 2466 01:16:32,280 --> 01:16:33,640 CULTURALLY COMPETENT ENVIRONMENT 2467 01:16:33,640 --> 01:16:35,640 IS ASSOCIATED WITH IMPROVED 2468 01:16:35,640 --> 01:16:37,880 OUTCOMES INCLUDING BETTER MENTAL 2469 01:16:37,880 --> 01:16:40,040 HEALTH, LESS ANXIETY, AND LESS 2470 01:16:40,040 --> 01:16:40,840 ILLNESS INTRUSIVENESS. 2471 01:16:40,840 --> 01:16:43,120 IT'S ALSO BEEN ASSOCIATED WITH 2472 01:16:43,120 --> 01:16:44,920 SATISFACTION WITH CARE, AND WE 2473 01:16:44,920 --> 01:16:47,480 ALSO KNOW THAT CANCER SURVIVORS 2474 01:16:47,480 --> 01:16:50,800 WHO REPORT PROVIDERS THAT ARE 2475 01:16:50,800 --> 01:16:52,280 LESS LGBT-COMPETENT HAVE MORE 2476 01:16:52,280 --> 01:16:53,800 UNMET SURVIVORSHIP NEEDS AND 2477 01:16:53,800 --> 01:16:55,400 HIGHER RATES OF PTSD ASSOCIATED 2478 01:16:55,400 --> 01:16:59,880 WITH THEIR CANCER. 2479 01:16:59,880 --> 01:17:02,520 SO WHEN WE TAKE ALL OF THIS 2480 01:17:02,520 --> 01:17:04,000 TOGETHER, WHERE CAN WE GO? 2481 01:17:04,000 --> 01:17:05,520 I THINK MAYBE THE QUESTION IS 2482 01:17:05,520 --> 01:17:08,040 REALLY WHERE SHOULD WE GO. 2483 01:17:08,040 --> 01:17:09,360 I WOULD SAY THE FIRST STEP IS 2484 01:17:09,360 --> 01:17:11,320 REALLY SOGI DATA COLLECTION. 2485 01:17:11,320 --> 01:17:13,400 IT'S NOT AS SIMPLE AS JUST 2486 01:17:13,400 --> 01:17:16,040 SLAPPING THESE QUESTIONS ON YOUR 2487 01:17:16,040 --> 01:17:18,360 STUDY OR ON YOUR INTAKE FORMS, 2488 01:17:18,360 --> 01:17:20,040 BUT IT'S REALLY CRITICAL THAT WE 2489 01:17:20,040 --> 01:17:21,400 HAVE LEADERSHIP SUPPORT, 2490 01:17:21,400 --> 01:17:22,760 TRAINING, AND A SAFE ENVIRONMENT 2491 01:17:22,760 --> 01:17:24,600 BEFORE WE ASK PEOPLE TO DISCLOSE 2492 01:17:24,600 --> 01:17:27,120 THEIR IDENTITIES. 2493 01:17:27,120 --> 01:17:29,120 IF WE DON'T DO THIS, I THINK 2494 01:17:29,120 --> 01:17:29,800 WE'LL RUN INTO A SITUATION WHERE 2495 01:17:29,800 --> 01:17:31,280 WE'RE GETTING DATA THAT'S NOT 2496 01:17:31,280 --> 01:17:34,280 VERY MEANINGFUL AND LOTS OF 2497 01:17:34,280 --> 01:17:35,480 CHOOSE NOT TO DISCLOSE 2498 01:17:35,480 --> 01:17:36,320 RESPONSES. 2499 01:17:36,320 --> 01:17:39,200 SO THERE ARE SEVERAL WAYS TO 2500 01:17:39,200 --> 01:17:40,440 SUPPORT THIS. 2501 01:17:40,440 --> 01:17:43,280 THERE ARE MANY OPTIONS FOR 2502 01:17:43,280 --> 01:17:44,120 TRAINING REFLECTING LGBT 2503 01:17:44,120 --> 01:17:45,200 CULTURAL COMPETENCE, BUT I THINK 2504 01:17:45,200 --> 01:17:47,640 WHAT'S PROBABLY MORE IMPORTANT 2505 01:17:47,640 --> 01:17:52,040 IS TRAINING AND A GENERAL SHIFT 2506 01:17:52,040 --> 01:17:53,320 TOWARDS CULTURAL HUMILITY, WHICH 2507 01:17:53,320 --> 01:17:54,800 REALLY ENTAILS LOOKING AT OUR 2508 01:17:54,800 --> 01:17:56,600 OWN BIASES AND HOW THEY MIGHT 2509 01:17:56,600 --> 01:17:57,440 IMPACT INTERACTIONS IN THE 2510 01:17:57,440 --> 01:17:59,320 CLINICAL CARE SETTING, AND 2511 01:17:59,320 --> 01:18:01,480 MAINTAINING A SPIRIT OF 2512 01:18:01,480 --> 01:18:03,000 CURIOSITY ABOUT PATIENTS AND 2513 01:18:03,000 --> 01:18:04,360 THEIR IDENTITIES AND THEIR 2514 01:18:04,360 --> 01:18:05,880 PREFERENCES. 2515 01:18:05,880 --> 01:18:08,280 AND IT'S MY HOPE THAT IF WE CAN 2516 01:18:08,280 --> 01:18:09,880 GROW THAT TYPE OF CULTURE, IT 2517 01:18:09,880 --> 01:18:11,320 WILL IMPROVE CLINICAL CARE NOT 2518 01:18:11,320 --> 01:18:13,480 ONLY FOR SEXUAL AND GENDER 2519 01:18:13,480 --> 01:18:15,560 MINORITIES, BUT OTHER PEOPLE WHO 2520 01:18:15,560 --> 01:18:17,680 HAVE DIFFERENCES THAT MATTER TO 2521 01:18:17,680 --> 01:18:19,000 THEIR CARE THAT THEY WANT TO 2522 01:18:19,000 --> 01:18:20,320 SHARE WITH THEIR CLINICAL 2523 01:18:20,320 --> 01:18:21,440 PROVIDERS, AND I THINK THAT 2524 01:18:21,440 --> 01:18:23,320 WOULD OPEN THE DOOR FOR ALL OF 2525 01:18:23,320 --> 01:18:26,160 US TO MOVE TOWARDS MORE PATIENT 2526 01:18:26,160 --> 01:18:28,560 PATIENT-CENTERED CARE IN 2527 01:18:28,560 --> 01:18:29,360 ONCOLOGY. 2528 01:18:29,360 --> 01:18:35,480 [APPLAUSE] 2529 01:18:35,480 --> 01:18:38,800 >>SO FOR THE VIRTUAL AUDIENCE, 2530 01:18:38,800 --> 01:18:40,160 PLEASE SUBMIT YOUR QUESTIONS FOR 2531 01:18:40,160 --> 01:18:48,880 THE PODIUM DISCUSSION. 2532 01:18:48,880 --> 01:18:53,360 >>WE HAVE ABOUT 20 MINUTES FOR 2533 01:18:53,360 --> 01:18:54,200 THE PANEL, 25 MINUTES. 2534 01:18:54,200 --> 01:18:55,960 WE'VE HEARD A LOT ABOUT SOGI 2535 01:18:55,960 --> 01:18:56,960 DATA COLLECTION AND SO I JUST 2536 01:18:56,960 --> 01:19:01,720 WANT TO MENTION THAT NIH 2537 01:19:01,720 --> 01:19:02,400 COMMISSIONED THE NATIONAL 2538 01:19:02,400 --> 01:19:04,000 ACADEMY OF SCIENCES, ENGINEERING 2539 01:19:04,000 --> 01:19:06,720 AND MEDICINE TO DO A REPORT ON 2540 01:19:06,720 --> 01:19:08,160 WHAT KINDS OF ITEMS SHOULD BE 2541 01:19:08,160 --> 01:19:10,640 USED IN RESEARCH, AND IF YOU'RE 2542 01:19:10,640 --> 01:19:12,760 THINKING ABOUT MEASURING SOGI IN 2543 01:19:12,760 --> 01:19:13,960 RESEARCH, I ENCOURAGE YOU TO 2544 01:19:13,960 --> 01:19:15,720 LOOK AT THAT REPORT. 2545 01:19:15,720 --> 01:19:19,400 THE ITEMS ARE NOT PERFECT, BUT 2546 01:19:19,400 --> 01:19:20,960 UNFORTUNATELY, WE NEED TO 2547 01:19:20,960 --> 01:19:22,240 STANDARDIZE THE ITEMS A LITTLE 2548 01:19:22,240 --> 01:19:24,600 BIT TO START GATHERING A VOLUME 2549 01:19:24,600 --> 01:19:25,840 OF DATA, SO I THINK THE 2550 01:19:25,840 --> 01:19:31,560 QUESTIONS ARE EVOLVING, BUT THE 2551 01:19:31,560 --> 01:19:33,280 NASEM REPORT INVOLVES SOME 2552 01:19:33,280 --> 01:19:34,480 STANDARDISH ITEMS THAT WE REALLY 2553 01:19:34,480 --> 01:19:35,600 ENCOURAGE PEOPLE TO LOOK AT. 2554 01:19:35,600 --> 01:19:36,960 AND I HAVE SOME QUESTIONS FOR 2555 01:19:36,960 --> 01:19:40,840 THE PANELISTS BUT I SEE PEOPLE 2556 01:19:40,840 --> 01:19:41,960 STANDING IN FRONT OF ME SO I'M 2557 01:19:41,960 --> 01:19:43,040 GOING TO START WITH THE PERSON 2558 01:19:43,040 --> 01:19:43,480 UP HERE. 2559 01:19:43,480 --> 01:19:44,800 AND IF YOU COULD SAY YOUR NAME 2560 01:19:44,800 --> 01:19:45,440 AND WHERE YOU'RE FROM, THAT 2561 01:19:45,440 --> 01:19:47,360 WOULD BE TERRIFIC. 2562 01:19:47,360 --> 01:19:49,440 >>JASMINE MCDONALD, COLUMBIA 2563 01:19:49,440 --> 01:19:49,720 UNIVERSITY. 2564 01:19:49,720 --> 01:19:51,440 I HAD A QUESTION KIND OF 2565 01:19:51,440 --> 01:19:54,880 REFLECTING OFF OF YESTERDAY'S 2566 01:19:54,880 --> 01:19:57,520 SESSION ON PERSISTENT POVERTY 2567 01:19:57,520 --> 01:20:02,360 AREAS AND THEN DR. MA CAN THE TT 2568 01:20:02,360 --> 01:20:03,200 PLACE AND RACE. 2569 01:20:03,200 --> 01:20:04,600 SO WONDERED IF THERE'S BEST 2570 01:20:04,600 --> 01:20:05,960 PRACTICES NOT JUST BASED OFF OF 2571 01:20:05,960 --> 01:20:09,480 SOGI, BUT THE INTERSECTIONAL 2572 01:20:09,480 --> 01:20:10,240 IDENTITY WITHIN SOGI. 2573 01:20:10,240 --> 01:20:12,800 AND I IMAGINE THAT SOMEONE 2574 01:20:12,800 --> 01:20:17,880 COMING IN WITH A, I GUESS, NOT A 2575 01:20:17,880 --> 01:20:19,240 NORMATIVE IDENTITY BUT ALSO 2576 01:20:19,240 --> 01:20:21,280 BEING OF ORIGINAL ETHNIC OR 2577 01:20:21,280 --> 01:20:23,000 BEING RURAL COMMUNITIES, SO ARE 2578 01:20:23,000 --> 01:20:25,680 THERE BEST PRACTICES RELATED TO 2579 01:20:25,680 --> 01:20:28,640 THAT INTERSECTIONALITY FOR THE 2580 01:20:28,640 --> 01:20:36,560 POPULATION IN GENERAL? 2581 01:20:36,560 --> 01:20:38,560 >>SO THIS IS A VERY GENERAL 2582 01:20:38,560 --> 01:20:40,760 ANSWER, I GUESS, IN SOME WAYS, 2583 01:20:40,760 --> 01:20:43,000 BUT I THINK WHAT IT MAKES ME 2584 01:20:43,000 --> 01:20:47,320 THINK OF IS JUST I THINK THAT A 2585 01:20:47,320 --> 01:20:50,040 THING TO REMIND US ALL -- 2586 01:20:50,040 --> 01:20:50,760 ESPECIALLY WHEN WE'RE TALKING 2587 01:20:50,760 --> 01:20:52,240 ABOUT SOGI DATA COLLECTION, IS 2588 01:20:52,240 --> 01:20:53,440 THAT TRANS PEOPLE IN PARTICULAR, 2589 01:20:53,440 --> 01:20:55,800 TRANS PEOPLE OF COLOR IN 2590 01:20:55,800 --> 01:20:56,960 PARTICULAR ARE FACING A HUGE 2591 01:20:56,960 --> 01:20:59,320 BURDEN OF VIOLENCE, INCLUDING A 2592 01:20:59,320 --> 01:21:01,520 LACK OF SAFETY IN MEDICAL 2593 01:21:01,520 --> 01:21:02,200 SETTINGS. 2594 01:21:02,200 --> 01:21:04,520 SO I THINK IT'S -- I MEAN, I 2595 01:21:04,520 --> 01:21:06,080 THINK DR. MULLINS TALKED ABOUT, 2596 01:21:06,080 --> 01:21:07,680 YOU KNOW, INTRODUCING YOURSELF 2597 01:21:07,680 --> 01:21:10,440 AND SAYING, LIKE, HI, I'M 2598 01:21:10,440 --> 01:21:11,560 DR. SO-AND-SO, MY PRONOUNCE ARE 2599 01:21:11,560 --> 01:21:12,560 SUCH AND SUCH, HOW WOULD YOU 2600 01:21:12,560 --> 01:21:14,760 LIKE ME TO REFER TO YOU AND WHAT 2601 01:21:14,760 --> 01:21:16,320 ARE YOUR PRONOUNCE, AND 2602 01:21:16,320 --> 01:21:16,960 UNDERSTANDING THAT PEOPLE ARE 2603 01:21:16,960 --> 01:21:18,200 GOING TO HAVE REALLY DIFFERENT 2604 01:21:18,200 --> 01:21:19,880 LANGUAGE ABOUT HOW THEY DESCRIBE 2605 01:21:19,880 --> 01:21:21,400 THEMSELVES. 2606 01:21:21,400 --> 01:21:24,520 AND A DIFFERENT AMOUNT OF NEED 2607 01:21:24,520 --> 01:21:26,480 TO TALK ABOUT OR NOT TALK ABOUT 2608 01:21:26,480 --> 01:21:30,680 THAT, SO RECENTLY WE DID A 2609 01:21:30,680 --> 01:21:32,480 QUALITATIVE STUDY AND WE LOOKED 2610 01:21:32,480 --> 01:21:34,520 AT PEOPLE'S EXPERIENCES SHARING 2611 01:21:34,520 --> 01:21:37,360 BEING TRANS WITH CLINICIANS, 2612 01:21:37,360 --> 01:21:39,200 EITHER JUST TELLING CLINICIANS 2613 01:21:39,200 --> 01:21:40,160 THAT THEY WERE TRANS OR TELLING 2614 01:21:40,160 --> 01:21:41,640 THEM THEY WERE ON HORMONES OR 2615 01:21:41,640 --> 01:21:42,880 TELLING THEM THEY HAD HAD 2616 01:21:42,880 --> 01:21:44,360 SURGERIES, AND PEOPLE OFTEN HAD 2617 01:21:44,360 --> 01:21:50,560 REALLY POOR EXPERIENCES AFTER 2618 01:21:50,560 --> 01:21:52,120 EXPRESSING THESE THINGS TO THEIR 2619 01:21:52,120 --> 01:21:53,040 CLINICIANS OR JUST HAVING THEM 2620 01:21:53,040 --> 01:21:53,600 IN THEIR CHARTS. 2621 01:21:53,600 --> 01:21:55,600 SO I THINK THERE'S A BALANCE 2622 01:21:55,600 --> 01:21:57,360 WHEN -- WE REALLY NEED DATA 2623 01:21:57,360 --> 01:21:58,880 ABOUT SEXUAL AND GENDER MINORITY 2624 01:21:58,880 --> 01:22:02,640 COMMUNITIES, BUT WE ALSO REALLY 2625 01:22:02,640 --> 01:22:03,640 NEED TO THINK FIRST AND FOREMOST 2626 01:22:03,640 --> 01:22:04,320 ABOUT THE SAFETY OF OUR 2627 01:22:04,320 --> 01:22:07,280 PATIENTS. 2628 01:22:07,280 --> 01:22:09,240 SO I THINK THAT IS AN ASPECT OF 2629 01:22:09,240 --> 01:22:10,200 THINKING ABOUT 2630 01:22:10,200 --> 01:22:10,840 INTERSECTIONALITY, IS THINKING 2631 01:22:10,840 --> 01:22:16,800 ABOUT SAFETY. 2632 01:22:16,800 --> 01:22:18,400 >>SO THIS IS A REALLY TOUGH 2633 01:22:18,400 --> 01:22:20,040 QUESTION, AND WHAT I'M GOING TO 2634 01:22:20,040 --> 01:22:21,480 SAY IS, IF YOU WOULD PLEASE COME 2635 01:22:21,480 --> 01:22:24,040 TALK TO ME BETWEEN SESSIONS, 2636 01:22:24,040 --> 01:22:26,520 THERE WAS ACTUALLY A RECENT 2637 01:22:26,520 --> 01:22:28,200 PRESENTATION THAT ADDRESSED THIS 2638 01:22:28,200 --> 01:22:29,480 AT ANOTHER CONFERENCE, AND I'D 2639 01:22:29,480 --> 01:22:31,040 BE HAPPY TO FIGURE THAT OUT FOR 2640 01:22:31,040 --> 01:22:34,320 YOU AND GET YOU -- THE WOMAN 2641 01:22:34,320 --> 01:22:36,080 WAS, I BELIEVE, AT UCLA. 2642 01:22:36,080 --> 01:22:37,440 SO I CAN GET YOU HER CONTACT 2643 01:22:37,440 --> 01:22:38,640 INFORMATION. 2644 01:22:38,640 --> 01:22:40,120 UNFORTUNATELY, WHAT SHE SAID IN 2645 01:22:40,120 --> 01:22:43,160 ESSENCE IS, GREAT QUESTION, 2646 01:22:43,160 --> 01:22:46,160 TRYING TO FIGURE IT OUT, THANKS. 2647 01:22:46,160 --> 01:22:48,400 BUT SHE WAS VERY ARTICULATE AND 2648 01:22:48,400 --> 01:22:50,560 THOUGHTFUL, SO I'D BE HAPPY TO 2649 01:22:50,560 --> 01:22:51,360 LOOK THAT UP AND GET THAT TO 2650 01:22:51,360 --> 01:22:52,200 YOU. 2651 01:22:52,200 --> 01:22:53,960 I'M GOING TO GO TO THE BACK 2652 01:22:53,960 --> 01:22:55,000 THERE, BECAUSE YOU HAVE BEEN 2653 01:22:55,000 --> 01:22:58,400 WAITING AS WELL. 2654 01:22:58,400 --> 01:23:02,520 >>UIC. 2655 01:23:02,520 --> 01:23:03,880 UNAPOLOGETICALLY 2656 01:23:03,880 --> 01:23:04,240 THEY/THEIR/THEM. 2657 01:23:04,240 --> 01:23:05,000 WAIT A MINUTE TO THANK THE PANEL 2658 01:23:05,000 --> 01:23:05,960 FOR BEING HERE BECAUSE I THINK 2659 01:23:05,960 --> 01:23:07,040 FOR ME AND OTHERS IN THIS ROOM, 2660 01:23:07,040 --> 01:23:09,400 IT'S REALLY IMPORTANT TO HAVE 2661 01:23:09,400 --> 01:23:11,040 THIS PANEL AND HAVE THIS SPACE. 2662 01:23:11,040 --> 01:23:12,720 I WANT TO ACKNOWLEDGE THAT WE 2663 01:23:12,720 --> 01:23:15,080 HAVE BEEN DOING QUEER 101 FOR A 2664 01:23:15,080 --> 01:23:17,400 COUPLE OF DECADES IN THESE 2665 01:23:17,400 --> 01:23:18,680 CONFERENCES AND I THANK YOU ALL 2666 01:23:18,680 --> 01:23:20,600 FOR PUSHING THE NEEDLE ON THAT. 2667 01:23:20,600 --> 01:23:22,880 I WANTED TO HAVE A COMMENT MORE 2668 01:23:22,880 --> 01:23:24,240 THAN ANYTHING AND THAT IS JUST 2669 01:23:24,240 --> 01:23:27,480 TO REFLECT THAT I THINK IN 2670 01:23:27,480 --> 01:23:28,840 ADDITION TO ASKING PEOPLE TO 2671 01:23:28,840 --> 01:23:30,520 COLLECT THE DATA, THERE NEEDS TO 2672 01:23:30,520 --> 01:23:31,880 BE A MANDATE, AND THAT NEEDS TO 2673 01:23:31,880 --> 01:23:32,960 COME FROM OUR FUNDERS, THAT 2674 01:23:32,960 --> 01:23:34,200 NEEDS TO COME FROM OUR JOURNALS 2675 01:23:34,200 --> 01:23:35,440 AND OUR EDITORS. 2676 01:23:35,440 --> 01:23:37,120 THIS IS A CRITICAL PRIORITY FOR 2677 01:23:37,120 --> 01:23:38,320 ALL SCIENCE, NOT ONLY SCIENCE 2678 01:23:38,320 --> 01:23:40,200 THAT IS FOCUSED ON SEXUAL AND 2679 01:23:40,200 --> 01:23:41,480 GENDER MINORITIES. 2680 01:23:41,480 --> 01:23:43,760 AND WE HAVE EXISTING CRITERIA 2681 01:23:43,760 --> 01:23:45,400 THAT MANDATE SCIENTISTS REPORT 2682 01:23:45,400 --> 01:23:47,160 ON DEMOGRAPHIC CHARACTERISTICS, 2683 01:23:47,160 --> 01:23:49,560 SO WHAT IF WE WERE TO BEYOND THE 2684 01:23:49,560 --> 01:23:51,120 BINARY WHEN ASKING ABOUT 2685 01:23:51,120 --> 01:23:52,120 BIOLOGICAL SEX OR GENDER, WHAT 2686 01:23:52,120 --> 01:23:55,080 IF WE WERE TO JUST BE MORE 2687 01:23:55,080 --> 01:23:55,840 COMPREHENSIVE? 2688 01:23:55,840 --> 01:23:56,760 ISN'T THAT WHAT WE ALL WANT? 2689 01:23:56,760 --> 01:24:00,280 SO I WILL -- AND I'LL GIVE AN 2690 01:24:00,280 --> 01:24:03,120 EXAMPLE IN TERMS OF 2691 01:24:03,120 --> 01:24:03,840 INTERSECTIONALITY, FOR ALL 2692 01:24:03,840 --> 01:24:06,320 CANCER RESEARCH, SO I HAVE 2693 01:24:06,320 --> 01:24:06,720 PREVIOUSLY THROUGH 2694 01:24:06,720 --> 01:24:07,800 INTERSECTIONALITY WITH RACE AND 2695 01:24:07,800 --> 01:24:10,640 ETHNICITY, SOME OF THE WORK THAT 2696 01:24:10,640 --> 01:24:11,640 I'VE SHOWN IS THAT AFRICAN 2697 01:24:11,640 --> 01:24:15,000 AMERICAN SEXUAL MINORITY WOMEN 2698 01:24:15,000 --> 01:24:19,000 HAVE GREATER RISKS OF NEEDS, 2699 01:24:19,000 --> 01:24:20,400 HYPERTENSION, LESS ABLE TO DO 2700 01:24:20,400 --> 01:24:21,600 PHYSICAL ACTIVITY TO RECOMMENDED 2701 01:24:21,600 --> 01:24:23,320 GUIDELINES THAN THEIR WHITE 2702 01:24:23,320 --> 01:24:23,760 COUNTERPARTS. 2703 01:24:23,760 --> 01:24:27,080 THEY ARE ALSO SIMULTANEOUSLY 2704 01:24:27,080 --> 01:24:28,960 COMPARED TO AFRICAN AMERICAN 2705 01:24:28,960 --> 01:24:31,040 HETEROSEXUAL POPULATIONS MORE 2706 01:24:31,040 --> 01:24:32,320 LIKELY TO USE TOBACCO, MORE 2707 01:24:32,320 --> 01:24:35,000 LIKELY TO BE EXPOSED TO ALCOHOL 2708 01:24:35,000 --> 01:24:35,480 USE AND DO THAT. 2709 01:24:35,480 --> 01:24:38,880 SO WE HAVE A -- SITUATION HERE 2710 01:24:38,880 --> 01:24:41,040 AND HAVING SOGI DATA, HAVING 2711 01:24:41,040 --> 01:24:45,720 ACCESS TO THAT DATA, ACCESS TO 2712 01:24:45,720 --> 01:24:46,720 AGE, OTHER THINGS CRITICAL IN 2713 01:24:46,720 --> 01:24:48,200 OUR BASELINE MODEL KS REALLY 2714 01:24:48,200 --> 01:24:51,680 HELP US UNDERSTANDING WHERE THAT 2715 01:24:51,680 --> 01:24:55,360 VARIATION IS AND YE YET WE DON'O 2716 01:24:55,360 --> 01:24:55,840 IT. 2717 01:24:55,840 --> 01:24:57,480 ACTUALLY IT SHOULD BE A PART OF 2718 01:24:57,480 --> 01:24:58,760 EVERYONE'S TABLE 1, JUST IN 2719 01:24:58,760 --> 01:24:59,000 GENERAL. 2720 01:24:59,000 --> 01:25:00,000 THANK YOU. 2721 01:25:00,000 --> 01:25:01,760 >>I DON'T THINK ANYBODY ON THIS 2722 01:25:01,760 --> 01:25:03,680 PANEL IS GOING TO DISAGREE WITH 2723 01:25:03,680 --> 01:25:03,840 YOU. 2724 01:25:03,840 --> 01:25:07,760 THANK YOU FOR YOUR COMMENTS. 2725 01:25:07,760 --> 01:25:09,440 YES. 2726 01:25:09,440 --> 01:25:13,160 THAT'S WHAT I'LL SAY ABOUT THAT. 2727 01:25:13,160 --> 01:25:14,280 YES, WE HAVE SOMEBODY HERE AT 2728 01:25:14,280 --> 01:25:15,640 THE FRONT AND THEN I'M GOING TO 2729 01:25:15,640 --> 01:25:18,360 GO TO A COUPLE QUESTIONS HERE 2730 01:25:18,360 --> 01:25:20,040 FROM SLIDO AND MAYBE PUT A FEW 2731 01:25:20,040 --> 01:25:21,480 OF MY OWN QUESTIONS IN. 2732 01:25:21,480 --> 01:25:22,960 >>GOOD MORNING. 2733 01:25:22,960 --> 01:25:24,320 TERESA GILLESPIE FROM EMORY 2734 01:25:24,320 --> 01:25:25,000 UNIVERSITY. 2735 01:25:25,000 --> 01:25:26,760 FIRST THANK YOU ALL FOR THOSE 2736 01:25:26,760 --> 01:25:28,840 EXCEPTIONAL PRESENTATIONS. 2737 01:25:28,840 --> 01:25:30,520 I'M GLAD TO HEAR THAT THE 2738 01:25:30,520 --> 01:25:31,560 NATIONAL ACADEMIES ARE LOOKING 2739 01:25:31,560 --> 01:25:34,680 AT DATA COLLECTION, AND I THINK 2740 01:25:34,680 --> 01:25:38,840 WHEN WE THINK ABOUT HOW CHANGE 2741 01:25:38,840 --> 01:25:40,000 COMES, OFTEN REQUIREMENTS SORT 2742 01:25:40,000 --> 01:25:40,800 OF DRIVE THOSE CHANGES. 2743 01:25:40,800 --> 01:25:43,240 SO IF YOU LOOK AT THE NIH FORM 2744 01:25:43,240 --> 01:25:46,640 THAT IS USED FOR ENROLLMENT OF 2745 01:25:46,640 --> 01:25:49,360 HUMAN SUBJECTS FOR ANY GRANT 2746 01:25:49,360 --> 01:25:50,840 PROPOSAL, THEY ONLY OFFER TWO 2747 01:25:50,840 --> 01:25:52,240 OPTIONS, FEMALE AND MALE. 2748 01:25:52,240 --> 01:25:53,760 HOWEVER, FOR THE ACTUAL 2749 01:25:53,760 --> 01:25:55,960 ENROLLMENT, YOU GET TO HAVE 2750 01:25:55,960 --> 01:25:58,560 FEMALE, MALE, OR UNKNOWN OR 2751 01:25:58,560 --> 01:25:59,400 UNDOCUMENTED. 2752 01:25:59,400 --> 01:26:00,280 SO MY QUESTION IS WHETHER THERE 2753 01:26:00,280 --> 01:26:01,920 HAVE BEEN CONVERSATIONS AT THE 2754 01:26:01,920 --> 01:26:02,880 NIH THAT MAYBE -- BECAUSE WHEN 2755 01:26:02,880 --> 01:26:04,800 WE TRY TO IMPLEMENT THESE IN OUR 2756 01:26:04,800 --> 01:26:06,720 OWN CENTERS, THERE'S OFTEN 2757 01:26:06,720 --> 01:26:07,800 PUSHBACK THAT, LIKE, WELL, WHO 2758 01:26:07,800 --> 01:26:09,560 NEEDS TO KNOW THIS, BUT I THINK 2759 01:26:09,560 --> 01:26:12,720 IF THE NIH REQUIRED THAT, IT 2760 01:26:12,720 --> 01:26:14,120 WOULD REALLY FACILITATE THAT 2761 01:26:14,120 --> 01:26:15,160 DATA COLLECTION PROCESS. 2762 01:26:15,160 --> 01:26:16,840 SO I JUST WONDER IF THERE HAVE 2763 01:26:16,840 --> 01:26:18,200 BEEN CONVERSATIONS. 2764 01:26:18,200 --> 01:26:24,600 >>I AM A LOWLY EMPLOYEE HERE T 2765 01:26:24,600 --> 01:26:25,640 NCI AND CAN'T REALLY ANSWER THAT 2766 01:26:25,640 --> 01:26:26,040 QUESTION. 2767 01:26:26,040 --> 01:26:28,280 WHAT I CAN TELL YOU IS, I HEAR 2768 01:26:28,280 --> 01:26:30,720 THAT QUESTION ALL THE TIME. 2769 01:26:30,720 --> 01:26:34,920 I THINK THERE ARE A NUMBER OF 2770 01:26:34,920 --> 01:26:35,800 DATA POINTS THAT PEOPLE THINK 2771 01:26:35,800 --> 01:26:38,280 SHOULD BE REQUIRED, THIS BEING 2772 01:26:38,280 --> 01:26:42,960 ONE OF THEM. 2773 01:26:42,960 --> 01:26:44,960 THIS IS GOING TO SOUND LIKE AN 2774 01:26:44,960 --> 01:26:49,800 EXCUSE, BUT THE LEVEL OF 2775 01:26:49,800 --> 01:26:51,320 POLICYMAKING, THE AMOUNT OF 2776 01:26:51,320 --> 01:26:52,000 PERMISSIONS THAT WOULD HAVE TO 2777 01:26:52,000 --> 01:26:54,400 BE GOTTEN, THE AMOUNT OF MONEY 2778 01:26:54,400 --> 01:26:55,960 IT WOULD COST TO CHANGE ALL OF 2779 01:26:55,960 --> 01:27:01,400 OUR I.T. SYSTEMS, IT'S DAUNTING. 2780 01:27:01,400 --> 01:27:03,760 AND SO I THINK WITH TIME, MAYBE 2781 01:27:03,760 --> 01:27:06,280 THERE WILL BE A GROUNDSWELL OF 2782 01:27:06,280 --> 01:27:06,520 SUPPORT. 2783 01:27:06,520 --> 01:27:07,680 AND I DO THINK THESE 2784 01:27:07,680 --> 01:27:11,920 CONVERSATIONS ARE GOING ON, BUT 2785 01:27:11,920 --> 01:27:15,680 IT'S TOUGH, AND IT DOESN'T SEEM 2786 01:27:15,680 --> 01:27:17,680 LIKE A BIG DEAL BUT IT'S REALLY 2787 01:27:17,680 --> 01:27:21,800 A SUPER BIG DEAL FROM A SYSTEMS 2788 01:27:21,800 --> 01:27:26,120 AND AGENCY WHERE WE ARE SUBJECT 2789 01:27:26,120 --> 01:27:27,600 TO CONGRESSIONAL OVERSIGHT. 2790 01:27:27,600 --> 01:27:29,480 SO, YOU KNOW, I ENCOURAGE ALL OF 2791 01:27:29,480 --> 01:27:30,880 YOU TO TALK ABOUT THIS AS MUCH 2792 01:27:30,880 --> 01:27:32,080 AS YOU CAN. 2793 01:27:32,080 --> 01:27:33,440 BECAUSE I THINK IT IS GOING TO 2794 01:27:33,440 --> 01:27:36,800 NEED TO BE A GROUNDSWELL FROM 2795 01:27:36,800 --> 01:27:39,360 THE COMMUNITY. 2796 01:27:39,360 --> 01:27:41,960 I'M GOING TO TAKE THE LIBERTY OF 2797 01:27:41,960 --> 01:27:43,080 ASKING ONE QUESTION OF MEGAN 2798 01:27:43,080 --> 01:27:44,000 ACTUALLY, AND THEN WE'LL COME 2799 01:27:44,000 --> 01:27:45,840 BACK TO THE QUESTIONS THAT HAVE 2800 01:27:45,840 --> 01:27:46,520 COME IN. 2801 01:27:46,520 --> 01:27:48,400 SO MEGAN, YOU KNOW, I HEAR ALL 2802 01:27:48,400 --> 01:27:50,680 THE TIME WHEN I RECOMMEND PEOPLE 2803 01:27:50,680 --> 01:27:53,600 COLLECT SOGI DATA THAT WE CAN'T 2804 01:27:53,600 --> 01:27:54,600 COLLECT THOSE DATA BECAUSE 2805 01:27:54,600 --> 01:27:55,680 THEY'RE GOING TO OFFEND 2806 01:27:55,680 --> 01:27:58,200 SOMEBODY. 2807 01:27:58,200 --> 01:27:59,920 AND WE DON'T WANT TO OFFEND 2808 01:27:59,920 --> 01:28:00,240 ANYBODY. 2809 01:28:00,240 --> 01:28:03,720 SO CAN YOU COMMENT ON HOW MUCH 2810 01:28:03,720 --> 01:28:07,640 THAT IS A CONCERN? 2811 01:28:07,640 --> 01:28:08,040 >>YES. 2812 01:28:08,040 --> 01:28:09,520 SO I HEAR THAT ALL THE TIME. 2813 01:28:09,520 --> 01:28:10,480 AND FIRST I WOULD ENCOURAGE 2814 01:28:10,480 --> 01:28:12,120 PEOPLE TO THINK ABOUT HOW 2815 01:28:12,120 --> 01:28:13,760 OFFENDED THEY FEEL WHEN THEY 2816 01:28:13,760 --> 01:28:15,880 FILL OUT RACE AND ETHNICITY IN A 2817 01:28:15,880 --> 01:28:16,720 CLINICAL SPACE. 2818 01:28:16,720 --> 01:28:19,120 BECAUSE I THINK MANY OF THE SAME 2819 01:28:19,120 --> 01:28:20,360 ARGUMENTS WERE MADE THE SAME 2820 01:28:20,360 --> 01:28:22,360 WAY, LIKE, BACK AROUND 2008, 2821 01:28:22,360 --> 01:28:24,360 WHEN THERE WAS A PUSH TO COLLECT 2822 01:28:24,360 --> 01:28:25,920 MORE RACE AND ETHNICITY DIRECTLY 2823 01:28:25,920 --> 01:28:27,280 FROM PATIENTS. 2824 01:28:27,280 --> 01:28:28,840 SO THAT'S ONE. 2825 01:28:28,840 --> 01:28:31,200 TWO IS THAT THE LITERATURE DOES 2826 01:28:31,200 --> 01:28:32,640 NOT SHOW THAT PEOPLE ARE 2827 01:28:32,640 --> 01:28:34,600 UNCOMFORTABLE WITH THESE 2828 01:28:34,600 --> 01:28:36,560 QUESTIONS, OVERWHELMINGLY. 2829 01:28:36,560 --> 01:28:41,480 AND SAMPLE WITH A WIDE RANGE OF 2830 01:28:41,480 --> 01:28:42,720 AGES, VETERANS ACROSS THE BOARD 2831 01:28:42,720 --> 01:28:44,320 ARE GENERALLY BETTER FOR THOSE 2832 01:28:44,320 --> 01:28:45,120 THAN INCOME QUESTIONS. 2833 01:28:45,120 --> 01:28:47,760 SO PEOPLE ARE NOT OVERWHELMINGLY 2834 01:28:47,760 --> 01:28:48,400 OFFENDED. 2835 01:28:48,400 --> 01:28:49,880 GENERALLY WHAT I'VE HEARD IN MY 2836 01:28:49,880 --> 01:28:52,240 WORK IS THAT IT'S MOSTLY OLDER 2837 01:28:52,240 --> 01:28:54,040 PEOPLE WHO ARE LIKE, WHY ARE YOU 2838 01:28:54,040 --> 01:28:55,320 ASKING ME THIS? 2839 01:28:55,320 --> 01:28:56,920 I'M 80 YEARS OLD. 2840 01:28:56,920 --> 01:29:00,120 AND I THINK IF YOU HAVE A 2841 01:29:00,120 --> 01:29:01,320 RESPONSE, SOMETHING LIKE, YOU 2842 01:29:01,320 --> 01:29:02,280 KNOW, WE KNOW PEOPLE HAVE 2843 01:29:02,280 --> 01:29:03,760 DIFFERENT NEEDS IN THEIR CARE, 2844 01:29:03,760 --> 01:29:04,920 SOME PEOPLE AREN'T GETTING THE 2845 01:29:04,920 --> 01:29:06,600 CARE THAT THEY NEED, AND WE WANT 2846 01:29:06,600 --> 01:29:09,600 TO KEEP TRACK OF THAT, USUALLY 2847 01:29:09,600 --> 01:29:10,680 THAT'S ALL IT TAKES. 2848 01:29:10,680 --> 01:29:12,640 PEOPLE JUST DON'T UNDERSTAND 2849 01:29:12,640 --> 01:29:13,560 WHERE THIS QUESTION CAME FROM. 2850 01:29:13,560 --> 01:29:15,640 SO I THINK WAYS TO COMBAT THAT 2851 01:29:15,640 --> 01:29:18,920 ARE SITUATING THE QUESTIONS IN 2852 01:29:18,920 --> 01:29:20,920 DEMOGRAPHICS, AND NORMALIZING 2853 01:29:20,920 --> 01:29:21,280 IT. 2854 01:29:21,280 --> 01:29:22,960 IF WE ASK THIS MORE AND MORE, 2855 01:29:22,960 --> 01:29:24,520 IT'S GOING TO BECOME MORE 2856 01:29:24,520 --> 01:29:26,680 ROUTINE, AND IT IS REALLY A 2857 01:29:26,680 --> 01:29:30,560 DEMOGRAPHIC QUESTION. 2858 01:29:30,560 --> 01:29:31,360 >>OKAY. 2859 01:29:31,360 --> 01:29:33,480 I'M GOING TO TAKE ONE QUESTION 2860 01:29:33,480 --> 01:29:37,200 FROM THE CHAT HERE. 2861 01:29:37,200 --> 01:29:39,280 AND I THINK, ASH, I'M GULF COAST 2862 01:29:39,280 --> 01:29:40,200 TO SERVE THIS ONE TO YOU. 2863 01:29:40,200 --> 01:29:44,040 IS IT IMPORTANT FOR A PERSON'S 2864 01:29:44,040 --> 01:29:44,680 HEALTHCARE TO DISTINGUISH WHERE 2865 01:29:44,680 --> 01:29:46,120 A TRANS PERSON IS IN THEIR 2866 01:29:46,120 --> 01:29:52,400 TRANSITION? 2867 01:29:52,400 --> 01:29:53,880 >>SO I GUESS WHAT I WOULD SAY 2868 01:29:53,880 --> 01:29:57,120 TO THAT QUESTION IS, YOU KNOW, 2869 01:29:57,120 --> 01:29:58,960 DIFFERENT TRANS AND NON-BINARY 2870 01:29:58,960 --> 01:30:00,760 PEOPLE HAVE DIFFERENT MEDICAL 2871 01:30:00,760 --> 01:30:02,280 INTERVENTIONS TO CHANGE OUR 2872 01:30:02,280 --> 01:30:04,280 BODIES TO ALIGN BETTER WITH OUR 2873 01:30:04,280 --> 01:30:04,680 GENDER. 2874 01:30:04,680 --> 01:30:08,800 SOME OF US DON'T GO ON HORMONES 2875 01:30:08,800 --> 01:30:10,120 OR HAVE SURGERIES AND SOME OF US 2876 01:30:10,120 --> 01:30:10,320 DO. 2877 01:30:10,320 --> 01:30:11,600 SO JUST LIKE YOU WOULD WANT TO 2878 01:30:11,600 --> 01:30:13,360 KNOW THE MEDICATIONS FOR ANY 2879 01:30:13,360 --> 01:30:14,760 PATIENT AND THE SURGICAL AND 2880 01:30:14,760 --> 01:30:16,840 MEDICAL HISTORY FOR ANY PATIENT, 2881 01:30:16,840 --> 01:30:18,040 IT LIKELY ALSO IMPORTANT TO KNOW 2882 01:30:18,040 --> 01:30:19,800 THOSE THINGS FOR YOUR TRANS 2883 01:30:19,800 --> 01:30:24,160 PATIENTS AS WELL. 2884 01:30:24,160 --> 01:30:24,920 >>OKAY. 2885 01:30:24,920 --> 01:30:26,560 HERE IN THE ROOM, NAME AND WHERE 2886 01:30:26,560 --> 01:30:31,520 YOU'RE FROM, PLEASE. 2887 01:30:31,520 --> 01:30:33,720 >> -- FIRST OF ALL, I REALLY 2888 01:30:33,720 --> 01:30:34,440 WANT TO THANK YOU FROM THE 2889 01:30:34,440 --> 01:30:40,360 BOTTOM OF MY HEART FOR YOUR 2890 01:30:40,360 --> 01:30:43,240 COURAGE, YOUR SINCERITY, AND 2891 01:30:43,240 --> 01:30:46,400 WHAT IT TAKES TO DO THIS PANEL 2892 01:30:46,400 --> 01:30:48,760 AT THE LEVEL THAT YOU HAVE DONE 2893 01:30:48,760 --> 01:30:49,160 IT. 2894 01:30:49,160 --> 01:30:53,640 I REALLY AM DEEPLY GRATEFUL AND 2895 01:30:53,640 --> 01:30:56,840 IMPRESSED. 2896 01:30:56,840 --> 01:30:59,400 SECOND, AS I WAS LISTENING TO 2897 01:30:59,400 --> 01:31:05,720 ALL OF YOU HERE, ONE THING THAT 2898 01:31:05,720 --> 01:31:10,960 FELT -- CAME OUT VERY STRONG TO 2899 01:31:10,960 --> 01:31:12,400 ME, AND I'VE ALSO OBSERVED IN 2900 01:31:12,400 --> 01:31:16,640 OTHER TYPES OF MINORITIES, 2901 01:31:16,640 --> 01:31:18,120 ESPECIALLY IN WHAT YOU ARE 2902 01:31:18,120 --> 01:31:20,200 DESCRIBING AS THE LACK OF 2903 01:31:20,200 --> 01:31:24,120 SAFETY. 2904 01:31:24,120 --> 01:31:24,760 AND ONE OF THE THINGS THAT I 2905 01:31:24,760 --> 01:31:25,960 HAVE BEEN THINKING AND I WOULD 2906 01:31:25,960 --> 01:31:28,160 LIKE TO HEAR WHAT YOU THINK OF 2907 01:31:28,160 --> 01:31:30,960 THIS IS THAT, YOU KNOW, WE ARE 2908 01:31:30,960 --> 01:31:32,360 TALKING -- WE ARE HAVING THIS 2909 01:31:32,360 --> 01:31:36,320 CONVERSATION HERE WITHIN THE 2910 01:31:36,320 --> 01:31:40,080 CONTEXT OF -- DISPARITIES, BUT 2911 01:31:40,080 --> 01:31:41,520 REALLY WHEN I'M SPEAKING TO 2912 01:31:41,520 --> 01:31:43,680 PATIENTS, IT'S REALLY -- IT 2913 01:31:43,680 --> 01:31:46,560 SHOULD REALLY BE PART OF PATIENT 2914 01:31:46,560 --> 01:31:47,200 SAFETY. 2915 01:31:47,200 --> 01:31:49,000 WE LOOK AT SAFETY AS GUIDANCE, 2916 01:31:49,000 --> 01:31:53,240 YOU KNOW, TO PROTECT PATIENTS 2917 01:31:53,240 --> 01:31:55,920 FROM INFECTIONS, INJURIES AND 2918 01:31:55,920 --> 01:32:01,280 MEDICAL ERRORS, BUT MINORITY 2919 01:32:01,280 --> 01:32:02,200 PATIENTS OF ALL KINDS ARE NOT 2920 01:32:02,200 --> 01:32:05,520 SAFE IN HEALTHCARE, AND WHAT YOU 2921 01:32:05,520 --> 01:32:08,240 ARE DESCRIBING TODAY WAS 2922 01:32:08,240 --> 01:32:13,720 REALLY -- IT WAS STRIKING AT THE 2923 01:32:13,720 --> 01:32:14,840 VERY -- LEVEL AND YOU HAVE THE 2924 01:32:14,840 --> 01:32:16,680 CREDIBILITY OF BEING IN A 2925 01:32:16,680 --> 01:32:18,920 MINORITY GROUP THAT ALSO THE 2926 01:32:18,920 --> 01:32:21,800 CREDIBILITY OF BEING LEADERS IN 2927 01:32:21,800 --> 01:32:24,800 MEDICINE, AND YOU KNOW, THAT WAS 2928 01:32:24,800 --> 01:32:27,000 VERY POWERFUL. 2929 01:32:27,000 --> 01:32:28,560 AND WHAT DO YOU THINK AND WHAT 2930 01:32:28,560 --> 01:32:32,480 CAN WE DO TO RAISE EMOTIONAL 2931 01:32:32,480 --> 01:32:35,080 SAFETY OF PATIENTS AT THE LEVEL 2932 01:32:35,080 --> 01:32:37,840 OF PATIENT SAFETY TO ADDRESS 2933 01:32:37,840 --> 01:32:41,160 INEQUITIES IN HEALTHCARE? 2934 01:32:41,160 --> 01:32:42,760 >>MEGAN, SARAH, WOULD EITHER OF 2935 01:32:42,760 --> 01:32:46,520 YOU LIKE TO DO A RESPONSE TO 2936 01:32:46,520 --> 01:32:46,800 THAT ONE? 2937 01:32:46,800 --> 01:32:49,320 >>I WOULD SAY YES, ABSOLUTELY, 2938 01:32:49,320 --> 01:32:50,800 SAFETY IS PARAMOUNT, WHICH IS 2939 01:32:50,800 --> 01:32:53,400 WHY I THINK BEFORE ANYBODY 2940 01:32:53,400 --> 01:32:54,960 STARTS SOGI DATA COLLECTION, 2941 01:32:54,960 --> 01:32:56,520 THERE ARE THOSE KEY PIECES THAT 2942 01:32:56,520 --> 01:32:58,160 NEED TO HAPPEN. 2943 01:32:58,160 --> 01:33:00,880 AND THAT INCLUDES PATIENT 2944 01:33:00,880 --> 01:33:01,800 PROTECTIONS LIKE PATIENT BILLS 2945 01:33:01,800 --> 01:33:05,240 OF RIGHTS OR NON-DISCRIMINATION 2946 01:33:05,240 --> 01:33:06,560 POLICIES THAT EXPLICITLY INCLUDE 2947 01:33:06,560 --> 01:33:07,920 SEXUAL ORIENTATION AND GENDER 2948 01:33:07,920 --> 01:33:09,400 IDENTITY AS A START. 2949 01:33:09,400 --> 01:33:12,600 BUT I THINK THE LEADERSHIP 2950 01:33:12,600 --> 01:33:13,600 COMPONENT, I MENTIONED THAT 2951 01:33:13,600 --> 01:33:15,320 LEADERSHIP COMMITMENT IS 2952 01:33:15,320 --> 01:33:16,560 NECESSARY, AND THAT'S REALLY TO 2953 01:33:16,560 --> 01:33:19,080 SET A CULTURE FROM THE TOP-DOWN 2954 01:33:19,080 --> 01:33:20,640 OF HOW WE HANDLE THIS 2955 01:33:20,640 --> 01:33:22,440 INFORMATION AND HOW WE WANT TO 2956 01:33:22,440 --> 01:33:27,680 BEHAVE AND TREAT PATIENTS TH, TT 2957 01:33:27,680 --> 01:33:31,120 RESPECT ISNES NECESSARY AND WE L 2958 01:33:31,120 --> 01:33:32,200 DO OUR BEST WITH THAT, I THINK 2959 01:33:32,200 --> 01:33:34,240 THAT'S WHERE THE LEADERSHIP 2960 01:33:34,240 --> 01:33:35,440 PIECE COMES IN, AS WELL AS THE 2961 01:33:35,440 --> 01:33:39,400 TRAINING, MAYBE MA MAKING SURE E 2962 01:33:39,400 --> 01:33:41,760 HEAR THE INFORMATION 2963 01:33:41,760 --> 01:33:43,560 RESPECTFULLY AND DISCLOSE IN A 2964 01:33:43,560 --> 01:33:45,280 WAY THAT DOESN'T FURTHER 2965 01:33:45,280 --> 01:33:45,720 TRAUMATIZE PATIENTS. 2966 01:33:45,720 --> 01:33:48,240 >>THE ONLY OTHER THING I WOULD 2967 01:33:48,240 --> 01:33:49,640 ADD TO THAT FANTASTIC ANSWER IS 2968 01:33:49,640 --> 01:33:52,320 I THINK IT ALSO HAS TO INVOLVE 2969 01:33:52,320 --> 01:33:52,920 ABSOLUTELY EVERYBODY. 2970 01:33:52,920 --> 01:33:54,600 SO IT CAN'T JUST BE THE 2971 01:33:54,600 --> 01:33:56,280 CLINICIAN, IT NEEDS TO BE THE 2972 01:33:56,280 --> 01:33:57,400 FRONT DESK PERSON WHO ISN'T 2973 01:33:57,400 --> 01:33:59,760 GOING TO PUSH BACK WHEN NAMES ON 2974 01:33:59,760 --> 01:34:01,360 INSURANCE DOESN'T MATCH THE NAME 2975 01:34:01,360 --> 01:34:05,800 THAT GIVEN AND USES THE CORRECT 2976 01:34:05,800 --> 01:34:07,240 PRONOUNCE AND THAT YOUR CLINIC 2977 01:34:07,240 --> 01:34:08,640 HAS GENDER NEUTRAL BATHROOMS. 2978 01:34:08,640 --> 01:34:09,960 I THINK WE JUST NEED TO THINK 2979 01:34:09,960 --> 01:34:11,240 ABOUT IT, EVERYBODY IN THE CARE 2980 01:34:11,240 --> 01:34:12,320 TEAM, EVERYBODY ALSO ON THE 2981 01:34:12,320 --> 01:34:14,920 RESEARCH TEAM, THAT WE SPEAK 2982 01:34:14,920 --> 01:34:16,080 RESPECTFULLY ABOUT PEOPLE WHEN 2983 01:34:16,080 --> 01:34:17,640 WE WRITE ABOUT THEM AND WHEN WE 2984 01:34:17,640 --> 01:34:20,320 RESEARCH THEM AS WELL. 2985 01:34:20,320 --> 01:34:22,320 >>I'M JUST GOING TO ADD A 2986 01:34:22,320 --> 01:34:25,240 COUPLE RESOURCES. 2987 01:34:25,240 --> 01:34:27,120 IF YOU GO TO THE FENWAY 2988 01:34:27,120 --> 01:34:28,320 INSTITUTE, THEY HAVE RESOURCES 2989 01:34:28,320 --> 01:34:31,880 ABOUT TRAINING AND ENVIRONMENTAL 2990 01:34:31,880 --> 01:34:32,640 THINGS. 2991 01:34:32,640 --> 01:34:33,600 ALSO THE HUMAN RIGHTS CAMPAIGN 2992 01:34:33,600 --> 01:34:34,760 HAS A HEALTH AND AGING PROGRAM 2993 01:34:34,760 --> 01:34:38,000 THAT ACTUALLY INVITES HOSPITALS 2994 01:34:38,000 --> 01:34:40,040 PRIMARILY, BUT INCREASINGLY 2995 01:34:40,040 --> 01:34:42,640 LONG-TERM CARE FACILITIES, TO 2996 01:34:42,640 --> 01:34:46,600 KIND OF QUALIFY AND BECOME 2997 01:34:46,600 --> 01:34:50,840 DESIGNATED LEADERS IN LGBTQ 2998 01:34:50,840 --> 01:34:53,800 CARE, AND IT'S INTERESTING, AN 2999 01:34:53,800 --> 01:34:54,960 INCREASING NUMBER OF FACILITIES 3000 01:34:54,960 --> 01:34:56,360 DO THAT BECAUSE THEY GET A 3001 01:34:56,360 --> 01:34:58,120 LITTLE LOGO THEY CAN USE. 3002 01:34:58,120 --> 01:34:59,920 AND IT BECOMES A MARKETING 3003 01:34:59,920 --> 01:35:02,120 ISSUE, AND I HATE TO SAY THAT -- 3004 01:35:02,120 --> 01:35:03,360 I MEAN, I'M ACTUALLY HAPPY TO 3005 01:35:03,360 --> 01:35:06,400 SAY THAT OUR COMMUNITY IS WORTH 3006 01:35:06,400 --> 01:35:08,600 MARKETING TO, BUT SOME OF THIS 3007 01:35:08,600 --> 01:35:10,440 IS JUST REALISTICALLY DRIVEN BY 3008 01:35:10,440 --> 01:35:10,960 MONEY. 3009 01:35:10,960 --> 01:35:13,640 I THINK A LOT OF WHAT WE TALKED 3010 01:35:13,640 --> 01:35:15,080 ABOUT YESTERDAY, THERE'S ALWAYS 3011 01:35:15,080 --> 01:35:18,160 THAT MONEY ELEMENT THERE, POWER 3012 01:35:18,160 --> 01:35:18,440 ELEMENT. 3013 01:35:18,440 --> 01:35:19,640 ANY OTHER QUESTIONS IN THE ROOM? 3014 01:35:19,640 --> 01:35:23,680 I'M GOING TO REVERT TO MY 3015 01:35:23,680 --> 01:35:25,960 QUESTIONS HERE AND I'M GOING TO 3016 01:35:25,960 --> 01:35:27,400 ASK ASH A QUESTION -- OH, WE 3017 01:35:27,400 --> 01:35:28,400 HAVE SOMEBODY COMING UP. 3018 01:35:28,400 --> 01:35:29,720 OH, WE HAVE TWO SOMEBODIES. 3019 01:35:29,720 --> 01:35:30,320 GO AHEAD. 3020 01:35:30,320 --> 01:35:31,800 I THINK THE GENTLEMAN IN THE 3021 01:35:31,800 --> 01:35:34,080 BACK BEAT YOU THERE. 3022 01:35:34,080 --> 01:35:35,600 >>HI. 3023 01:35:35,600 --> 01:35:36,480 KAREEM WATSON, NIH ALL-OF-US 3024 01:35:36,480 --> 01:35:37,000 RESEARCH PROGRAM. 3025 01:35:37,000 --> 01:35:39,280 I HAD A QUICK QUESTION ABOUT 3026 01:35:39,280 --> 01:35:40,280 THE -- I LOVE THE CONVERSATION 3027 01:35:40,280 --> 01:35:41,000 THAT WE'RE HAVING. 3028 01:35:41,000 --> 01:35:42,800 I WONDER HOW ARE WE UTILIZING 3029 01:35:42,800 --> 01:35:44,280 AND LEVERAGING THE LEADERSHIP OF 3030 01:35:44,280 --> 01:35:46,280 OUR CANCER CENTERS AS WELL AS 3031 01:35:46,280 --> 01:35:46,680 NIH? 3032 01:35:46,680 --> 01:35:49,160 I LOVE WHAT WE'RE SEEING WITH 3033 01:35:49,160 --> 01:35:50,440 COEs, SECTIONS, AND THEN ALSO 3034 01:35:50,440 --> 01:35:52,120 THE FACT THAT WE NOW HAVE 3035 01:35:52,120 --> 01:35:53,640 EQUITY, DIVERSITY AND INCLUSION 3036 01:35:53,640 --> 01:35:54,760 PRIORITIES WITHIN CANCER 3037 01:35:54,760 --> 01:35:55,680 CENTERS, AND I WOULD LOVE TO 3038 01:35:55,680 --> 01:35:58,240 HEAR IF ANY OF YOU ALL HAVE 3039 01:35:58,240 --> 01:35:59,800 LEVERAGED THAT SENIOR LEADERSHIP 3040 01:35:59,800 --> 01:36:01,080 TO PROMOTE SOME OF THOSE 3041 01:36:01,080 --> 01:36:01,560 PRIORITIES. 3042 01:36:01,560 --> 01:36:02,520 I KNOW I WAS FORTUNATE WHEN I 3043 01:36:02,520 --> 01:36:05,720 WAS IN THE CANCER CENTER AT USC 3044 01:36:05,720 --> 01:36:07,800 WE HAD SOME PILOT FUNDING TO DO 3045 01:36:07,800 --> 01:36:11,120 SOME INITIAL FUNDING, SO HAVING 3046 01:36:11,120 --> 01:36:12,840 THIS FROM SENIOR LEADERSHIP CAN 3047 01:36:12,840 --> 01:36:15,560 BE IMPORTANT, CURIOUS IF YOU 3048 01:36:15,560 --> 01:36:18,120 HAVE LEVERAGE WITH THE COE OR -- 3049 01:36:18,120 --> 01:36:19,160 >>ABSOLUTELY. 3050 01:36:19,160 --> 01:36:20,320 SO I THINK WE'RE IN A REALLY 3051 01:36:20,320 --> 01:36:22,080 EXCITING TIME RIGHT NOW. 3052 01:36:22,080 --> 01:36:24,640 MY COLLEAGUE AT THE NATIONAL 3053 01:36:24,640 --> 01:36:26,000 LGBT CANCER NETWORK MENTIONED 3054 01:36:26,000 --> 01:36:27,640 THAT I BELIEVE 30% OF 3055 01:36:27,640 --> 01:36:29,000 COMPREHENSIVE CANCER CENTERS ARE 3056 01:36:29,000 --> 01:36:31,720 NOW ACTIVELY WORKING ON SOGI 3057 01:36:31,720 --> 01:36:32,320 IMPLEMENTATION. 3058 01:36:32,320 --> 01:36:34,080 I KNOW THE FOUR COMPREHENSIVE 3059 01:36:34,080 --> 01:36:35,840 CANCER CENTERS IN TEXAS ARE ALL 3060 01:36:35,840 --> 01:36:36,840 WORKING ON IT. 3061 01:36:36,840 --> 01:36:39,240 TWO OF US ARE DOING IT WITH OUR 3062 01:36:39,240 --> 01:36:40,480 OWN INTERNAL FUNDS. 3063 01:36:40,480 --> 01:36:42,320 BECAUSE WE DID GO TO CANCER 3064 01:36:42,320 --> 01:36:43,520 CENTER LEADERSHIP AND SAY THIS 3065 01:36:43,520 --> 01:36:47,000 IS WHERE THE FUTURE IS HEADED. 3066 01:36:47,000 --> 01:36:48,400 WE HAVE THESE PEOPLE IN OUR 3067 01:36:48,400 --> 01:36:49,600 CATCHMENT AREA AND WE NEED TO 3068 01:36:49,600 --> 01:36:50,720 DOCUMENT HOW WE'RE SERVING THEM 3069 01:36:50,720 --> 01:36:52,960 OR NOT, SO THAT HAS BEEN A VERY 3070 01:36:52,960 --> 01:36:56,360 SUCCESSFUL APPROACH AT MY OWN 3071 01:36:56,360 --> 01:36:56,640 INSTITUTION. 3072 01:36:56,640 --> 01:36:59,200 >>I WANT TO PUT A PLUG IN FOR 3073 01:36:59,200 --> 01:36:59,440 PRIDENET. 3074 01:36:59,440 --> 01:37:00,520 >>I WAS GOING TO SAY, IF YOU 3075 01:37:00,520 --> 01:37:01,880 DON'T DO A PLUG FOR ALL-OF-US 3076 01:37:01,880 --> 01:37:03,240 AND THE EFFORTS YOU'VE MADE, I'M 3077 01:37:03,240 --> 01:37:04,280 GOING TO DO ONE FOR YOU. 3078 01:37:04,280 --> 01:37:06,280 >>YEAH, NO, I'VE BEEN THANKFUL 3079 01:37:06,280 --> 01:37:07,320 WHAT WE'VE BEEN ABLE TO DO. 3080 01:37:07,320 --> 01:37:08,960 WE'VE BEEN ABLE TO PARTNER WITH 3081 01:37:08,960 --> 01:37:12,720 MITCH LINE AND PRIDENET AT 3082 01:37:12,720 --> 01:37:13,680 STANFORD UNIVERSITY, TO COLLECT 3083 01:37:13,680 --> 01:37:20,760 SOME OF THE MOST AMAZING -- 3084 01:37:20,760 --> 01:37:22,040 10% -- LOOKING AT THAT 3085 01:37:22,040 --> 01:37:22,640 INTERSECTIONALITY DATA, WHAT 3086 01:37:22,640 --> 01:37:24,400 WE'RE SEEING RIGHT NOW IS 3087 01:37:24,400 --> 01:37:26,560 LOOKING AT POPULATION BUT OUR 3088 01:37:26,560 --> 01:37:29,200 ESTIMATE POPULATION -- OVER THE 3089 01:37:29,200 --> 01:37:31,520 MISSING MARK, SO AGAIN I LOVE 3090 01:37:31,520 --> 01:37:33,360 THAT QUESTION -- ABOUT 3091 01:37:33,360 --> 01:37:34,160 INTERSECTIONALITY BECAUSE WHAT 3092 01:37:34,160 --> 01:37:35,440 WE'RE MISSING OUT ON IS BOTH 3093 01:37:35,440 --> 01:37:38,880 LOWER SES POPULATIONS, RACIAL 3094 01:37:38,880 --> 01:37:41,040 ETHNIC MINORITIES AND SEXUAL AND 3095 01:37:41,040 --> 01:37:41,440 GENDER MINORITIES. 3096 01:37:41,440 --> 01:37:43,560 WE'RE DOING A GOOD JOB OF 3097 01:37:43,560 --> 01:37:45,320 GETTING SGM IN SO KUDOS TO US 3098 01:37:45,320 --> 01:37:47,240 FOR THAT BUT WE'VE GOT TO DO 3099 01:37:47,240 --> 01:37:48,240 MORE ON INTERSECTIONALITIES. 3100 01:37:48,240 --> 01:37:50,360 >>I'LL ALSO GOING TO THANK YOU 3101 01:37:50,360 --> 01:37:52,760 FOR INCLUDING SEXUAL AND GENDER 3102 01:37:52,760 --> 01:37:56,200 MINORITY EXPLICITLY IN 3103 01:37:56,200 --> 01:37:57,600 DISPARITIES OPPORTUNITIES FOR 3104 01:37:57,600 --> 01:37:59,720 WORKFORCE DEVELOPMENT. 3105 01:37:59,720 --> 01:38:01,320 THIS IS AN AREA THAT HAS BEEN 3106 01:38:01,320 --> 01:38:04,240 REALLY LACKING THAT I WAS 3107 01:38:04,240 --> 01:38:05,440 REALLY, REALLY PLEASED TO SEE 3108 01:38:05,440 --> 01:38:07,160 THAT YOU HAD EMPHASIZED THAT. 3109 01:38:07,160 --> 01:38:09,680 I'M GOING TO GIVE A LITTLE NCI 3110 01:38:09,680 --> 01:38:12,840 PLUG HERE, SELFISHLY. 3111 01:38:12,840 --> 01:38:13,960 SOME OF THE WORK MEGAN IS 3112 01:38:13,960 --> 01:38:15,920 REFERRING TO, SHE SAID INTERNAL 3113 01:38:15,920 --> 01:38:17,160 FUNDS. 3114 01:38:17,160 --> 01:38:18,520 NCI, A COUPLE MONTHS AGO, I 3115 01:38:18,520 --> 01:38:21,600 THINK, FUNDED 12 OR 14 CANCER 3116 01:38:21,600 --> 01:38:24,160 CENTERS TO HELP SUPPORT THEIR 3117 01:38:24,160 --> 01:38:26,760 EFFORTS TO EITHER INITIATE OR 3118 01:38:26,760 --> 01:38:29,840 ENHANCE SOGI DATA COLLECTION. 3119 01:38:29,840 --> 01:38:34,480 NCI IS NOW SIGNED ON TO SEVERAL 3120 01:38:34,480 --> 01:38:35,440 NOSIs TO INDICATE OUR INTEREST 3121 01:38:35,440 --> 01:38:36,840 IN THIS AREA OF RESEARCH, AND WE 3122 01:38:36,840 --> 01:38:39,400 HAVE AN ADMINISTRATIVE 3123 01:38:39,400 --> 01:38:40,400 SUPPLEMENT CALLOUT WITH 3124 01:38:40,400 --> 01:38:42,040 APPLICATIONS DUAL LATER THIS 3125 01:38:42,040 --> 01:38:42,240 MONTH. 3126 01:38:42,240 --> 01:38:44,880 SO THERE IS ACTIVE INTEREST HERE 3127 01:38:44,880 --> 01:38:46,800 IN PROMOTING THIS AREA OF 3128 01:38:46,800 --> 01:38:49,080 RESEARCH. 3129 01:38:49,080 --> 01:38:50,680 SO PERSON IN THE FRONT HERE. 3130 01:38:50,680 --> 01:38:53,120 >>HI. 3131 01:38:53,120 --> 01:38:57,760 MY NAME IS -- I'M A PRIMARY CARE 3132 01:38:57,760 --> 01:38:58,800 PHYSICIAN, REALLY GREAT SESSION. 3133 01:38:58,800 --> 01:39:00,160 THANK YOU SO MUCH. 3134 01:39:00,160 --> 01:39:01,280 ONE OF THE QUESTIONS I HAD WHICH 3135 01:39:01,280 --> 01:39:04,880 MIGHT BE SLIGHTLY -- IS, ONE OF 3136 01:39:04,880 --> 01:39:07,280 THE KEY THINGS THAT WE SEE IS 3137 01:39:07,280 --> 01:39:08,480 OBVIOUSLY BEING REPRESENTATIVE 3138 01:39:08,480 --> 01:39:09,280 AS HEALTHCARE PROFESSIONALS IN 3139 01:39:09,280 --> 01:39:10,440 THE COMMUNITY WE SERVE. 3140 01:39:10,440 --> 01:39:11,320 AND ONE OF THE THINGS THAT 3141 01:39:11,320 --> 01:39:13,600 REALLY STRUCK ME ABOUT YOUR 3142 01:39:13,600 --> 01:39:16,440 PRESENTATION WAS AROUND VIOLENCE 3143 01:39:16,440 --> 01:39:17,880 FOR PATIENTS WITHIN THESE 3144 01:39:17,880 --> 01:39:18,560 COMMUNITIES IN THE HEALTHCARE 3145 01:39:18,560 --> 01:39:19,480 SETTING. 3146 01:39:19,480 --> 01:39:20,840 I WAS REALLY CURIOUS IF THERE'S 3147 01:39:20,840 --> 01:39:23,280 ANY KIND OF UNDERSTANDING OF HOW 3148 01:39:23,280 --> 01:39:24,720 HEALTHCARE PROFESSIONALS FROM 3149 01:39:24,720 --> 01:39:26,080 THESE COMMUNITIES FEEL AND HOW 3150 01:39:26,080 --> 01:39:29,240 THEY ARE BEING TREATED TO, FOR 3151 01:39:29,240 --> 01:39:30,960 INSTANCE, ARE THEY SAFE IN A 3152 01:39:30,960 --> 01:39:32,160 SAFE ENVIRONMENT TO THEN CARE 3153 01:39:32,160 --> 01:39:33,440 FOR PATIENTS TO MAKE THEM FEEL 3154 01:39:33,440 --> 01:39:34,960 SAFE IN THIS ENVIRONMENT. 3155 01:39:34,960 --> 01:39:36,240 AND I WAS REALLY CURIOUS ABOUT 3156 01:39:36,240 --> 01:39:38,000 IF THERE IS ANY DATA FROM THAT, 3157 01:39:38,000 --> 01:39:40,000 AND WHAT MORE WE CAN DO AS 3158 01:39:40,000 --> 01:39:41,480 HEALTHCARE PROFESSIONALS TO 3159 01:39:41,480 --> 01:39:42,640 CREATE MORE INCLUSIVE SETTING 3160 01:39:42,640 --> 01:39:44,000 FOR THESE HEALTHCARE 3161 01:39:44,000 --> 01:39:51,720 PROFESSIONALS AS WELL. 3162 01:39:51,720 --> 01:39:54,680 >>THE ONLY DATA I KNOW ABOUT 3163 01:39:54,680 --> 01:39:56,680 ARE PRETTY OLD, AND I MEAN, ARE 3164 01:39:56,680 --> 01:39:59,440 KIND OF LIKE WHAT YOU WOULD 3165 01:39:59,440 --> 01:40:00,720 EXPECT THE LGBT PHYSICIANS AND 3166 01:40:00,720 --> 01:40:04,760 OTHER MEDICAL TRAINEES 3167 01:40:04,760 --> 01:40:05,160 EXPERIENCE STIGMA 3168 01:40:05,160 --> 01:40:05,680 DISCRIMINATION. 3169 01:40:05,680 --> 01:40:07,600 AND I KNOW FROM TALKING TO MANY 3170 01:40:07,600 --> 01:40:09,360 TRANSGENDER MEDICAL TRAINEES, IT 3171 01:40:09,360 --> 01:40:10,960 CAN BE VERY DIFFICULT TO DECIDE 3172 01:40:10,960 --> 01:40:13,840 WHETHER TO BE OUT AND IN 3173 01:40:13,840 --> 01:40:14,560 INTERVIEWS, APPLICATIONS OR 3174 01:40:14,560 --> 01:40:17,040 OTHER SETTINGS, AND THEN DEALING 3175 01:40:17,040 --> 01:40:19,600 WITH NAME CHANGES AND PRONOUNS 3176 01:40:19,600 --> 01:40:21,200 IN CLINICAL SETTINGS, I THINK 3177 01:40:21,200 --> 01:40:24,480 CAN BE VERY CHALLENGING. 3178 01:40:24,480 --> 01:40:26,000 SO THERE IS A GROUP OF TRANS 3179 01:40:26,000 --> 01:40:29,080 TRAINEES THAT WE'VE CREATED, SO 3180 01:40:29,080 --> 01:40:30,240 IF ANYONE IS INTERESTED IN THAT, 3181 01:40:30,240 --> 01:40:32,200 THEY CAN EMAIL ME ABOUT IT. 3182 01:40:32,200 --> 01:40:33,640 BUT I DO THINK IT AN IMPORTANT 3183 01:40:33,640 --> 01:40:35,640 AREA TO KEEP THINKING ABOUT, 3184 01:40:35,640 --> 01:40:36,880 DOING MORE RESEARCH AND WORK, 3185 01:40:36,880 --> 01:40:39,240 BECAUSE I THINK THAT, YOU KNOW, 3186 01:40:39,240 --> 01:40:40,960 I CAN JUST SAY FOR MYSELF THAT 3187 01:40:40,960 --> 01:40:43,320 IT'S VERY STRESSFUL TO BE LIKE 3188 01:40:43,320 --> 01:40:44,160 MISGENDERED OVER AND OVER AGAIN 3189 01:40:44,160 --> 01:40:47,560 IN A VARIETY OF SETTINGS AND 3190 01:40:47,560 --> 01:40:48,800 CLINICAL SETTINGS AND IT CAN BE 3191 01:40:48,800 --> 01:40:51,200 VERY DISTRACTING INTER FROM DOIG 3192 01:40:51,200 --> 01:40:51,560 WORK. 3193 01:40:51,560 --> 01:40:53,040 SO I REALLY APPRECIATE YOUR 3194 01:40:53,040 --> 01:40:57,280 QUESTION AND YOUR CONCERN. 3195 01:40:57,280 --> 01:40:59,680 >>AND I WILL SAY THAT NIH 3196 01:40:59,680 --> 01:41:02,040 SPONSORED A GENDER-AFFIRMING 3197 01:41:02,040 --> 01:41:04,320 CARE WORKSHOP LAST WEEK, I 3198 01:41:04,320 --> 01:41:05,480 BELIEVE MONDAY AND TUESDAY, AND 3199 01:41:05,480 --> 01:41:07,520 I HAD THE PRIVILEGE OF BEING 3200 01:41:07,520 --> 01:41:09,600 PART OF THOSE DISCUSSIONS. 3201 01:41:09,600 --> 01:41:12,080 AND UNFORTUNATELY, A MAJOR PART 3202 01:41:12,080 --> 01:41:13,560 OF THE DISCUSSION WAS WHETHER WE 3203 01:41:13,560 --> 01:41:16,320 COULD MAKE THIS PUBLIC OR NOT. 3204 01:41:16,320 --> 01:41:18,200 BECAUSE OF THE RISK THAT 3205 01:41:18,200 --> 01:41:19,360 QUESTIONS WOULD BE ASKED OR 3206 01:41:19,360 --> 01:41:22,640 COMMENTS WOULD BE MADE THAT WERE 3207 01:41:22,640 --> 01:41:24,240 HOSTILE, AND FRANKLY, THAT THE 3208 01:41:24,240 --> 01:41:26,440 PRESENTERS MIGHT FACE HOSTILITY 3209 01:41:26,440 --> 01:41:28,000 UP TO AND INCLUDING PHYSICAL 3210 01:41:28,000 --> 01:41:30,160 HARM WHEN RETURNING -- WE 3211 01:41:30,160 --> 01:41:32,520 WEREN'T IN PERSON, BUT AT THEIR 3212 01:41:32,520 --> 01:41:32,880 INSTITUTIONS. 3213 01:41:32,880 --> 01:41:34,680 SO I THINK THIS IS A GREAT 3214 01:41:34,680 --> 01:41:36,920 QUESTION, AND IT'S VERY REAL 3215 01:41:36,920 --> 01:41:41,720 RIGHT NOW, AND PEOPLE'S CAREER 3216 01:41:41,720 --> 01:41:43,320 AND WELL-BEING ARE BOTH BEING 3217 01:41:43,320 --> 01:41:44,360 THREATENED BY SOME OF THE THINGS 3218 01:41:44,360 --> 01:41:45,520 THAT ARE GOING ON. 3219 01:41:45,520 --> 01:41:48,040 SO I'M GOING TO HOPE THE PERSON 3220 01:41:48,040 --> 01:41:50,240 IN THE BACK HAS A MORE UPLIFTING 3221 01:41:50,240 --> 01:41:53,440 QUESTION THAT WE CAN WRAP UP ON? 3222 01:41:53,440 --> 01:41:55,600 IF NOT, I'LL MAKE SOMETHING UP. 3223 01:41:55,600 --> 01:41:55,880 [LAUGHTER] 3224 01:41:55,880 --> 01:41:58,720 >>I DO. 3225 01:41:58,720 --> 01:42:01,640 ZUL SARANI FROM CEDARS-SINAI 3226 01:42:01,640 --> 01:42:03,600 CANCER IN LOS ANGELES. 3227 01:42:03,600 --> 01:42:04,720 LOS ANGELES HAS THE SECOND 3228 01:42:04,720 --> 01:42:06,680 LARGEST POSSIBLY THE MOST 3229 01:42:06,680 --> 01:42:08,720 DIVERSE LGBTQ+ POPULATION IN THE 3230 01:42:08,720 --> 01:42:09,120 COUNTRY. 3231 01:42:09,120 --> 01:42:15,680 AND YOU KNOW, JUST BUILDING UPON 3232 01:42:15,680 --> 01:42:16,560 WHAT THE PERSON THAT TALKED 3233 01:42:16,560 --> 01:42:18,160 EARLIER SAID THAT, YOU KNOW, WE 3234 01:42:18,160 --> 01:42:20,240 ACTUALLY LEVERAGED OUR COMMUNITY 3235 01:42:20,240 --> 01:42:22,720 OUTREACH AND ENGAGEMENT TO 3236 01:42:22,720 --> 01:42:25,080 REALLY, YOU KNOW, CREATE CHANGE 3237 01:42:25,080 --> 01:42:29,040 IN OUR INSTITUTION AND REALLY 3238 01:42:29,040 --> 01:42:29,840 CATALYZE RESEARCH. 3239 01:42:29,840 --> 01:42:32,520 SO WE BUILT A TRANSGENDER 3240 01:42:32,520 --> 01:42:34,400 RESEARCH ADVISORY COMMITTEE, WE 3241 01:42:34,400 --> 01:42:36,080 BROUGHT IN LGBTQ COMMUNITY 3242 01:42:36,080 --> 01:42:38,240 MEMBERS TO TALK TO OUR 3243 01:42:38,240 --> 01:42:40,280 RESEARCHERS AND YOU KNOW, A LOT 3244 01:42:40,280 --> 01:42:44,120 HAS COME OUT OF IT, A CAMPAIGN 3245 01:42:44,120 --> 01:42:46,760 ON HOW TO IMPROVE HPV 3246 01:42:46,760 --> 01:42:47,960 VACCINATIONS, THINKING ABOUT A 3247 01:42:47,960 --> 01:42:49,960 DIFFERENT APPROACH TO TALKING 3248 01:42:49,960 --> 01:42:53,080 ABOUT CANCER SCREENING, A GENDER 3249 01:42:53,080 --> 01:42:55,360 NEUTRAL APPROACH. 3250 01:42:55,360 --> 01:42:58,360 WE DEVELOPED A SURVEY WHERE WE 3251 01:42:58,360 --> 01:43:02,520 COLLECTED -- 700 SURVEYS THAT WE 3252 01:43:02,520 --> 01:43:03,640 RECENTLY COMPLETED AND WANT TO 3253 01:43:03,640 --> 01:43:05,400 CONTINUE COMPLETING IT THIS YEAR 3254 01:43:05,400 --> 01:43:08,440 AS WELL, AND MANY OTHER RESEARCH 3255 01:43:08,440 --> 01:43:09,960 STUDIES THAT HAVE EMERGED 3256 01:43:09,960 --> 01:43:10,880 BECAUSE OF THAT. 3257 01:43:10,880 --> 01:43:13,600 SO I GUESS THIS IS UP TO YOU 3258 01:43:13,600 --> 01:43:16,280 FOLKS IN CANCER CENTERS TO 3259 01:43:16,280 --> 01:43:19,640 MEREREALLY BUILD YOUR COMMUNITY 3260 01:43:19,640 --> 01:43:20,560 MOVEMENT TO CREATE THIS CHANGE. 3261 01:43:20,560 --> 01:43:21,400 SO THANK YOU. 3262 01:43:21,400 --> 01:43:22,680 AND THANK YOU SO MUCH TO THE 3263 01:43:22,680 --> 01:43:22,880 PANEL. 3264 01:43:22,880 --> 01:43:23,320 EXCELLENT. 3265 01:43:23,320 --> 01:43:25,120 >>YOU'RE VERY WELCOME. 3266 01:43:25,120 --> 01:43:26,560 EVERYTHING YOU HEARD YESTERDAY 3267 01:43:26,560 --> 01:43:28,640 AND MAY HEAR TODAY ABOUT 3268 01:43:28,640 --> 01:43:29,600 ENGAGING WITH COMMUNITIES WHEN 3269 01:43:29,600 --> 01:43:34,320 YOU DO RESEARCH, PLEASE, HERE IN 3270 01:43:34,320 --> 01:43:36,040 MY WORLD, WE HAVE A SAYING WHICH 3271 01:43:36,040 --> 01:43:38,280 IS NOTHING ABOUT US WITHOUT US. 3272 01:43:38,280 --> 01:43:40,440 AND SO I THINK THAT'S WHERE I'LL 3273 01:43:40,440 --> 01:43:41,560 LEAVE IT TODAY. 3274 01:43:41,560 --> 01:43:43,120 AND WE APPRECIATE VERY MUCH ALL 3275 01:43:43,120 --> 01:43:44,880 OF YOUR KIND WORDS AND 3276 01:43:44,880 --> 01:43:48,680 THOUGHTFUL QUESTIONS. 3277 01:43:48,680 --> 01:43:50,680 SO STEFFAN, I'M GOING TO TURN IT 3278 01:43:50,680 --> 01:43:51,320 BACK TO YOU. 3279 01:43:51,320 --> 01:43:52,920 I THINK IT'S BREAK TIME. 3280 01:43:52,920 --> 01:44:01,480 [APPLAUSE] 3281 01:44:01,480 --> 01:44:04,160 >>IT'S BREAK TIME. 3282 01:44:04,160 --> 01:44:05,360 I WANT TO SAY SOMETHING ABOUT 3283 01:44:05,360 --> 01:44:09,800 POSPOSTER PRESENTERS. 3284 01:44:09,800 --> 01:44:11,480 PLEASE PUT UP YOUR POSTERS ON 3285 01:44:11,480 --> 01:44:12,040 THE BREAK. 3286 01:44:12,040 --> 01:44:13,040 WE'RE ACTUALLY ON TIME. 3287 01:44:13,040 --> 01:44:14,240 IT'S GOOD, IT'S GOOD. 3288 01:44:14,240 --> 01:44:17,440 IT WAS GOOD YESTERDAY. 3289 01:44:17,440 --> 01:44:17,880 NO CRITICISM. 3290 01:44:17,880 --> 01:44:20,360 AND I ALSO WOULD LIKE TO THANK 3291 01:44:20,360 --> 01:44:22,640 EVERYBODY THIS MORNING FOR THESE 3292 01:44:22,640 --> 01:44:24,800 GREAT PRESENTATIONS AND WE HAD A 3293 01:44:24,800 --> 01:44:25,400 GREAT START. 3294 01:44:25,400 --> 01:44:29,320 THANK YOU SO MUCH. 3295 01:44:29,320 --> 01:44:33,320 MY NAME IS ALEXANDRIA HARRIS, 3296 01:44:33,320 --> 01:44:35,360 ALSO THE DIVISION OF CANCER 3297 01:44:35,360 --> 01:44:36,520 EPIDEMIOLOGY AND GENETICS. 3298 01:44:36,520 --> 01:44:38,320 TODAY IT'S MY IMMENSE HONOR TO 3299 01:44:38,320 --> 01:44:39,800 CHAIR THIS FIRST DEDICATED 3300 01:44:39,800 --> 01:44:42,280 SESSION ON CANCER DISPARITY 3301 01:44:42,280 --> 01:44:43,600 RESEARCH IN THE NCI INTRAMURAL 3302 01:44:43,600 --> 01:44:46,200 PROGRAM. 3303 01:44:46,200 --> 01:44:47,480 AS YOU'LL HEAR TODAY, THERE'S 3304 01:44:47,480 --> 01:44:49,240 MANY EXCITING EFFORTS UNDER WAY 3305 01:44:49,240 --> 01:44:51,880 WITHIN THE IRP WHICH SPAN ACROSS 3306 01:44:51,880 --> 01:44:53,240 DISCIPLINES AND DIVISIONS, MANY 3307 01:44:53,240 --> 01:44:54,440 OF WHICH ARE TRAINEE-LED. 3308 01:44:54,440 --> 01:44:59,120 IN FACT, ALL THEE SPE ALL THREEE 3309 01:44:59,120 --> 01:45:00,240 CURRENT CANCER PREVENTION 3310 01:45:00,240 --> 01:45:01,320 FELLOWS AND I THINK THIS 3311 01:45:01,320 --> 01:45:02,320 SHOWCASES THE PASSION AND 3312 01:45:02,320 --> 01:45:03,200 COMMITMENT OF THE NEXT 3313 01:45:03,200 --> 01:45:04,680 GENERATION OF SCIENTISTS IN 3314 01:45:04,680 --> 01:45:05,560 MOVING THE FIELD FORWARD. 3315 01:45:05,560 --> 01:45:07,280 SO WITH THAT, I'D LIKE TO 3316 01:45:07,280 --> 01:45:09,160 INTRODUCE THE FIRST SPEAKER, DR. 3317 01:45:09,160 --> 01:45:10,680 DR. LORD IS A CANCER PREVENTION 3318 01:45:10,680 --> 01:45:12,280 FELLOW IN BOTH THE CENTER FOR 3319 01:45:12,280 --> 01:45:14,280 CANCER RESEARCH AND THE DIVISION 3320 01:45:14,280 --> 01:45:16,040 OF CANCER EPIDEMIOLOGY AND 3321 01:45:16,040 --> 01:45:17,000 GENETICS. 3322 01:45:17,000 --> 01:45:18,800 PLEASE HELP ME IN WELCOMING 3323 01:45:18,800 --> 01:45:19,080 DR. LORD. 3324 01:45:19,080 --> 01:45:22,440 [APPLAUSE] 3325 01:45:22,440 --> 01:45:25,600 >>THANK YOU SO MUCH, 3326 01:45:25,600 --> 01:45:25,880 DR. HARRIS. 3327 01:45:25,880 --> 01:45:26,760 I'M VERY EXCITED TO BE ABLE TO 3328 01:45:26,760 --> 01:45:27,560 PRESENT SOME OF MY WORK HERE 3329 01:45:27,560 --> 01:45:28,040 TODAY. 3330 01:45:28,040 --> 01:45:29,960 SO I'M GOING TO TALK ABOUT BOTH 3331 01:45:29,960 --> 01:45:31,880 SOCIAL AND ENVIRONMENTAL FACTORS 3332 01:45:31,880 --> 01:45:32,880 INCLUDING NEIGHBORHOOD LEVEL 3333 01:45:32,880 --> 01:45:34,560 FACTORS THAT IMPACT TUMOR 3334 01:45:34,560 --> 01:45:36,920 BIOLOGY AND MORE SPECIFICALLY 3335 01:45:36,920 --> 01:45:38,400 DNA METHYLATION AND HOW THAT 3336 01:45:38,400 --> 01:45:41,440 IMPACTS BREAST CANCER 3337 01:45:41,440 --> 01:45:42,720 DISPARITIES. 3338 01:45:42,720 --> 01:45:44,440 I HAVE NO FINANCIAL DISCLOSURES. 3339 01:45:44,440 --> 01:45:45,760 SO I WANT TO START MY TALK TODAY 3340 01:45:45,760 --> 01:45:47,360 WITH THIS DIAGRAM THAT SHOWS 3341 01:45:47,360 --> 01:45:49,160 SOME OF THE SYSTEMIC AS WELL AS 3342 01:45:49,160 --> 01:45:50,360 INDIVIDUAL LEVEL DRIVERS THAT 3343 01:45:50,360 --> 01:45:51,560 ARE CONTRIBUTING TO THE RACIAL 3344 01:45:51,560 --> 01:45:55,400 AND ETHNIC DISPARITIES WE SEE IN 3345 01:45:55,400 --> 01:45:56,520 CERTAIN POPULATION GROUPS. 3346 01:45:56,520 --> 01:45:58,240 OF COURSE THIS IS NOT AN 3347 01:45:58,240 --> 01:45:59,760 EXHAUSTIVE LIST OF RISK FACTORS 3348 01:45:59,760 --> 01:46:01,000 BY ANY MEANS BUT IT INCLUDES 3349 01:46:01,000 --> 01:46:02,360 VERY IMPORTANT ETIOLOGIC 3350 01:46:02,360 --> 01:46:04,640 CONTRIBUTORS TO THE WORST 3351 01:46:04,640 --> 01:46:05,880 OUTCOMES WE SEE FOR BLACK MEN 3352 01:46:05,880 --> 01:46:06,960 AND WOMEN IN THE UNITED STATES 3353 01:46:06,960 --> 01:46:09,040 WITH CANCER, AS WELL AS THE MORE 3354 01:46:09,040 --> 01:46:10,320 AGGRESSIVE TUMOR BIOLOGY THAT 3355 01:46:10,320 --> 01:46:13,840 THESE POPULATIONS EXPERIENCE. 3356 01:46:13,840 --> 01:46:15,800 SO ON A SYSTEMIC LEVEL, WE SEE 3357 01:46:15,800 --> 01:46:17,320 DIFFERENCES IN ACCESS TO 3358 01:46:17,320 --> 01:46:18,400 HEALTHCARE, ACCESS TO HEALTHY 3359 01:46:18,400 --> 01:46:20,560 FOODS AS WELL AS GREEN SPACE FOR 3360 01:46:20,560 --> 01:46:22,520 PHYSICAL ACTIVITY, THESE HAVE 3361 01:46:22,520 --> 01:46:24,840 ALL BEEN SHOWN TO IMPACT CANCER 3362 01:46:24,840 --> 01:46:25,400 DISPARITIES AS WELL AS 3363 01:46:25,400 --> 01:46:26,520 NEIGHBORHOOD AND ENVIRONMENTAL 3364 01:46:26,520 --> 01:46:28,680 LEVEL FACTORS, INCLUDING AIR AND 3365 01:46:28,680 --> 01:46:30,640 GROUND POLLUTION, AS WELL AS 3366 01:46:30,640 --> 01:46:33,080 EXPOSURE TO CANCER-CAUSING 3367 01:46:33,080 --> 01:46:34,120 CHEMICALS, WHETHER 3368 01:46:34,120 --> 01:46:34,760 OCCUPATIONALLY OR IN THE 3369 01:46:34,760 --> 01:46:37,240 HOUSEHOLD. 3370 01:46:37,240 --> 01:46:39,320 THESE GROUPS ALSO EXPERIENCE 3371 01:46:39,320 --> 01:46:41,600 DIFFERENCES IN RESOURCES AND 3372 01:46:41,600 --> 01:46:42,520 OPPORTUNITIES, AND RESEARCH HAS 3373 01:46:42,520 --> 01:46:44,920 SHOWN THAT INCOME IS A HUGE 3374 01:46:44,920 --> 01:46:46,400 DRIVER OF CANCER RISK AND CANCER 3375 01:46:46,400 --> 01:46:48,080 DISPARITIES IN THIS COUNTRY, AND 3376 01:46:48,080 --> 01:46:53,760 A LACK OF INCOME CAN IMPACT -- 3377 01:46:53,760 --> 01:46:55,360 LACK OF INCOME AND/OR HEALTH 3378 01:46:55,360 --> 01:46:57,680 INSURANCE CAN IMPACT ACCESS TO 3379 01:46:57,680 --> 01:46:58,360 CANCER TREATMENT AS WELL AS 3380 01:46:58,360 --> 01:47:00,560 CANCER SURVIVAL AND OUTCOMES. 3381 01:47:00,560 --> 01:47:04,320 ON AN INDIVIDUAL LEVEL FACTOR, 3382 01:47:04,320 --> 01:47:06,240 WE CAN SEE THAT OUR GENETICS AS 3383 01:47:06,240 --> 01:47:08,880 WELL AS OUR INDIVIDUAL GENETIC 3384 01:47:08,880 --> 01:47:11,120 PROFILES CAN CONTRIBUTE TO 3385 01:47:11,120 --> 01:47:13,720 CANCER DISPARITIES IN RACIAL 3386 01:47:13,720 --> 01:47:14,480 POPULATIONS, ESPECIALLY WHEN 3387 01:47:14,480 --> 01:47:15,760 THESE VARIANTS OR THESE 3388 01:47:15,760 --> 01:47:17,720 MUTATIONS ARE 3389 01:47:17,720 --> 01:47:18,920 POPULATION-SPECIFIC. 3390 01:47:18,920 --> 01:47:20,560 ADDITIONALLY, WE SEE THAT 3391 01:47:20,560 --> 01:47:22,080 INDIVIDUAL-LEVEL BEHAVIORS LIKE 3392 01:47:22,080 --> 01:47:23,960 DIETARY CHOICES, SMOKING TOBACCO 3393 01:47:23,960 --> 01:47:26,160 OR DRINKING ALCOHOL, ARE ALSO 3394 01:47:26,160 --> 01:47:28,800 ALL IMPORTANT CONTRIBUTORS. 3395 01:47:28,800 --> 01:47:30,400 AND THEN FINALLY, INDIVIDUAL 3396 01:47:30,400 --> 01:47:31,920 LEVEL SOCIAL EXPERIENCES 3397 01:47:31,920 --> 01:47:33,880 INCLUDING SOCIAL ISOLATION OR 3398 01:47:33,880 --> 01:47:35,200 EXPERIENCES OF RACISM OR 3399 01:47:35,200 --> 01:47:36,440 DISCRIMINATION IN THESE GROUPS 3400 01:47:36,440 --> 01:47:39,080 CAN ALSO IMPACT OUTCOMES. 3401 01:47:39,080 --> 01:47:40,760 SO FOR MY TALK, I'LL FOCUS FIRST 3402 01:47:40,760 --> 01:47:42,600 ON GENETIC FACTORS AND HOW THEY 3403 01:47:42,600 --> 01:47:43,560 CONTRIBUTE TO CANCER 3404 01:47:43,560 --> 01:47:44,720 DISPARITIES, WHICH WE HEARD A 3405 01:47:44,720 --> 01:47:46,400 BIT ABOUT IN THE LATTER SESSIONS 3406 01:47:46,400 --> 01:47:47,880 YESTERDAY. 3407 01:47:47,880 --> 01:47:49,960 I'LL ALSO DISCUSS 3408 01:47:49,960 --> 01:47:50,880 NEIGHBORHOOD-LEVEL ENVIRONMENTAL 3409 01:47:50,880 --> 01:47:52,280 AND SOCIAL CONTRIBUTORS TO 3410 01:47:52,280 --> 01:47:53,920 DIFFERENCES IN TUMOR BIOLOGY, 3411 01:47:53,920 --> 01:47:55,840 SPECIFICALLY FOR BLACK 3412 01:47:55,840 --> 01:47:58,000 POPULATIONS. 3413 01:47:58,000 --> 01:47:59,360 IN THINKING ABOUT THE USE OF 3414 01:47:59,360 --> 01:48:00,840 GENETIC ANCESTRY VERSUS 3415 01:48:00,840 --> 01:48:01,560 SELF-REPORTED RACE, IT'S 3416 01:48:01,560 --> 01:48:03,160 IMPORTANT TO GET SOME CONTEXT AS 3417 01:48:03,160 --> 01:48:05,240 TO WHY THIS DISTINCTION IS 3418 01:48:05,240 --> 01:48:06,560 IMPORTANT. 3419 01:48:06,560 --> 01:48:07,760 SO AS WE'VE HEARD, OVERALL 3420 01:48:07,760 --> 01:48:09,600 CANCER STUDIES HAVE BEEN 3421 01:48:09,600 --> 01:48:12,160 HISTORICALLY AND LARGELY EURO 3422 01:48:12,160 --> 01:48:12,640 CENTRIC. 3423 01:48:12,640 --> 01:48:13,560 WE HEARD IN THE OPENING SESSION 3424 01:48:13,560 --> 01:48:14,800 YESTERDAY ABOUT THE LACK OF 3425 01:48:14,800 --> 01:48:16,440 DIVERSITY IN CLINICAL CANCER 3426 01:48:16,440 --> 01:48:17,640 TRIALS, WHICH HAS BEEN FAIRLY 3427 01:48:17,640 --> 01:48:19,720 SLOW TO IMPROVE, BUT I ALSO 3428 01:48:19,720 --> 01:48:20,760 WANTED TO POINT OUT THAT THERE 3429 01:48:20,760 --> 01:48:24,120 IS A SEVERE LACK OF DIVERSITY IN 3430 01:48:24,120 --> 01:48:24,840 GENOME-WIDE ASSOCIATION STUDIES, 3431 01:48:24,840 --> 01:48:28,080 WHICH ARE REALLY IMPORTANT IN 3432 01:48:28,080 --> 01:48:29,680 IDENTIFYING IMPORTANT DISEASE 3433 01:48:29,680 --> 01:48:31,360 LOCI THAT ARE ASSOCIATED WITH 3434 01:48:31,360 --> 01:48:33,760 RISK. 3435 01:48:33,760 --> 01:48:36,200 IT BEEN WELL DOCUMENTED THAT THE 3436 01:48:36,200 --> 01:48:37,320 LIMITED RISK ALLELES THAT HAVE 3437 01:48:37,320 --> 01:48:38,880 BEEN IDENTIFIED IN EUROPEAN 3438 01:48:38,880 --> 01:48:39,800 POPULATIONS DO NOT TRANSLATE 3439 01:48:39,800 --> 01:48:43,400 WELL TO NON-WHITE OR ADMIXED 3440 01:48:43,400 --> 01:48:43,760 POPULATIONS. 3441 01:48:43,760 --> 01:48:45,760 SO AS YOU MAY IMAGINE, A FAILURE 3442 01:48:45,760 --> 01:48:47,440 TO APPLY GWAS FINDINGS OUTSIDE 3443 01:48:47,440 --> 01:48:49,320 OF EUROPEAN POPULATIONS 3444 01:48:49,320 --> 01:48:50,920 INCREASES THE DIFFICULTY OF US 3445 01:48:50,920 --> 01:48:52,800 TO CREATE ACCURATE POLYGENIC 3446 01:48:52,800 --> 01:48:55,280 RISK SCORE MODELS, SPECIFICALLY 3447 01:48:55,280 --> 01:48:57,160 FOR ADMIXED POPULATIONS, WHICH 3448 01:48:57,160 --> 01:48:58,400 WILL REDUCE THE CLINICAL UTILITY 3449 01:48:58,400 --> 01:49:02,840 OF PRS MODELS IN THE CLINIC. 3450 01:49:02,840 --> 01:49:04,200 SO IF THESE STUDIES ARE NOW 3451 01:49:04,200 --> 01:49:07,160 BEING DONE IN GREAT ENOUGH 3452 01:49:07,160 --> 01:49:09,840 NUMBERS IN THESE NON-WHITE POP 3453 01:49:09,840 --> 01:49:10,360 POPULATIONS THEN THESE 3454 01:49:10,360 --> 01:49:11,400 INDIVIDUALS WILL ALWAYS 3455 01:49:11,400 --> 01:49:13,600 EXPERIENCE THESE BARRIERS IN 3456 01:49:13,600 --> 01:49:15,120 UNDERSTANDING THEIR GENETIC 3457 01:49:15,120 --> 01:49:17,520 CONTRIBUTORS ESPECIALLY WHEN 3458 01:49:17,520 --> 01:49:20,480 THESE ARE ANCESTRALLY 3459 01:49:20,480 --> 01:49:20,800 INFORMATIVE. 3460 01:49:20,800 --> 01:49:22,000 SO THE SECOND PART IS KIND OF 3461 01:49:22,000 --> 01:49:23,200 THINKING ABOUT THE USE OF 3462 01:49:23,200 --> 01:49:24,600 SELF-REPORTED RACE VERSUS 3463 01:49:24,600 --> 01:49:26,280 GENETIC ANCESTRY IN CANCER 3464 01:49:26,280 --> 01:49:26,920 DISPARITIES AND IT TOUCHES MORE 3465 01:49:26,920 --> 01:49:33,520 ON WHAT WE HEARD YESTERDAY, 3466 01:49:33,520 --> 01:49:34,120 WHERE ANCESTRY-ASSOCIATED GENE 3467 01:49:34,120 --> 01:49:35,120 SIGNATURES ARE TRANSLATING TO 3468 01:49:35,120 --> 01:49:36,120 DIFFERENTIAL TUMOR BIOLOGY IN 3469 01:49:36,120 --> 01:49:38,440 CERTAIN POPULATIONS. 3470 01:49:38,440 --> 01:49:40,800 SO WHEN WE ARE ABLE TO USE 3471 01:49:40,800 --> 01:49:43,400 QUANTIFIED GENETIC ANCESTRY 3472 01:49:43,400 --> 01:49:44,640 ESTIMATES OVER SELF-REPORTED 3473 01:49:44,640 --> 01:49:46,040 RACE, WE HAVE A BETTER 3474 01:49:46,040 --> 01:49:47,000 UNDERSTANDING OF THE GENETIC 3475 01:49:47,000 --> 01:49:48,240 DIFFERENCES THAT WILL CONTRIBUTE 3476 01:49:48,240 --> 01:49:50,200 TO BETTER GENE EXPRESSION 3477 01:49:50,200 --> 01:49:51,920 PREDICTION MODELS AS WELL AS 3478 01:49:51,920 --> 01:49:53,440 IMPROVED MAPPING OF FUNCTIONAL 3479 01:49:53,440 --> 01:49:57,680 ALEGALS THAALLELES THAT MAY CONO 3480 01:49:57,680 --> 01:49:58,720 DISEASE RISK. 3481 01:49:58,720 --> 01:50:00,280 SO WE DID SEE THIS FIGURE 3482 01:50:00,280 --> 01:50:01,600 BRIEFLY YESTERDAY, BUT I WANTED 3483 01:50:01,600 --> 01:50:02,880 TO DIVE IN A BIT MORE JUST 3484 01:50:02,880 --> 01:50:05,960 BECAUSE THE MESSAGE IS REALLY 3485 01:50:05,960 --> 01:50:07,080 IMPORTANT HERE. 3486 01:50:07,080 --> 01:50:12,200 I WAS ACTUALLY TALKING TO MAYAS 3487 01:50:12,200 --> 01:50:13,640 ROBSON YESTERDAY, IT ILLUSTRATES 3488 01:50:13,640 --> 01:50:15,560 OUR WORK IN BETTER UNDERSTANDING 3489 01:50:15,560 --> 01:50:16,960 HOW BOTH BIOLOGICAL DETERMINANTS 3490 01:50:16,960 --> 01:50:18,000 OF HEALTH AS WELL AS THE SOCIAL 3491 01:50:18,000 --> 01:50:19,000 DETERMINANTS OF HEALTH THAT 3492 01:50:19,000 --> 01:50:20,280 IMPACT CANCER DISPARITIES CAN 3493 01:50:20,280 --> 01:50:23,840 AND SHOULD BE DONE IN PARALLEL. 3494 01:50:23,840 --> 01:50:25,800 SO ON THE BIOLOGICAL SIDE, THIS 3495 01:50:25,800 --> 01:50:27,440 INCLUDES EMPLOYING DIVERSITY 3496 01:50:27,440 --> 01:50:30,160 COMPETENT RESEARCH SUCH AS 3497 01:50:30,160 --> 01:50:31,920 QUANTIFIED GENETIC ANCESTRY, 3498 01:50:31,920 --> 01:50:33,240 INCLUDING MORE MINORITIZED 3499 01:50:33,240 --> 01:50:36,760 POPULATIONS IN YOUR STUDIES, AS 3500 01:50:36,760 --> 01:50:38,680 WELL AS DIVERSIFYING GENOME-WIDE 3501 01:50:38,680 --> 01:50:40,040 ASSOCIATION STUDIES TO 3502 01:50:40,040 --> 01:50:41,320 MULTIETHNIC POPULATIONS. 3503 01:50:41,320 --> 01:50:43,040 AND THEN ON THE SOCIAL SIDE, 3504 01:50:43,040 --> 01:50:44,200 RECOGNIZING THAT STRUCTURAL 3505 01:50:44,200 --> 01:50:45,520 RACISM IS AN IMPORTANT RISK 3506 01:50:45,520 --> 01:50:49,240 FACTOR FOR ILLNESS IN GENERAL, 3507 01:50:49,240 --> 01:50:51,120 AND PUTTING MORE FUNDING TOWARDS 3508 01:50:51,120 --> 01:50:53,560 UNDERSTANDING THE WAYS WE CAN 3509 01:50:53,560 --> 01:50:56,400 MEASURE AND MITIGATE THE IMPACTS 3510 01:50:56,400 --> 01:50:57,000 OF DISPARITIES. 3511 01:50:57,000 --> 01:51:00,240 SO ALL OF THIS WILL LEAD TO MORE 3512 01:51:00,240 --> 01:51:01,120 DIVERSITY-COMPETENT RESEARCH AND 3513 01:51:01,120 --> 01:51:02,240 HOPEFULLY OVERALL WILL LEAD TO 3514 01:51:02,240 --> 01:51:10,000 HEALTH JUSTICE FOR EVERYONE. 3515 01:51:10,000 --> 01:51:11,640 QAWND FIED GENETIC ANCESTRY HAS 3516 01:51:11,640 --> 01:51:12,760 EXPANDED OUR KNOWLEDGE OF CANCER 3517 01:51:12,760 --> 01:51:13,960 BEYOND SELF-REPORTED RACE BUT 3518 01:51:13,960 --> 01:51:16,840 IT'S VERY IMPORTANT THAT WE 3519 01:51:16,840 --> 01:51:18,800 STUDY QUANTIFIED GENETIC 3520 01:51:18,800 --> 01:51:19,840 ANCESTRY IN THE CONTEXT OF 3521 01:51:19,840 --> 01:51:24,760 SOCIAL DETERMINANTS. 3522 01:51:24,760 --> 01:51:26,160 NEXT I WANT TO GO INTO THINKING 3523 01:51:26,160 --> 01:51:27,400 ABOUT HOW SOCIAL AND 3524 01:51:27,400 --> 01:51:28,480 ENVIRONMENTAL FACTORS CAN IMPACT 3525 01:51:28,480 --> 01:51:31,840 CANCER BIOLOGY FOR BLACK 3526 01:51:31,840 --> 01:51:32,840 AMERICANS. 3527 01:51:32,840 --> 01:51:35,960 THIS IS A REVIEW DONE WITH 3528 01:51:35,960 --> 01:51:38,160 DR. HARRIS AND DR. ANN SITTING 3529 01:51:38,160 --> 01:51:40,040 UP HERE AND IN OUR REVIEW, WE 3530 01:51:40,040 --> 01:51:41,400 HAD SPECIFIC STUDIES THAT HAVE 3531 01:51:41,400 --> 01:51:42,720 CAPTURED THE BIOLOGICAL EFFECTS 3532 01:51:42,720 --> 01:51:44,560 OF BOTH ENVIRONMENTAL AND SOCIAL 3533 01:51:44,560 --> 01:51:46,080 CONTRIBUTORS TO ADVERSE CANCER 3534 01:51:46,080 --> 01:51:47,400 OUTCOMES FOR BLACK MEN AND 3535 01:51:47,400 --> 01:51:49,120 WOMEN. 3536 01:51:49,120 --> 01:51:50,520 SO TWO MAJOR CONTRIBUTING 3537 01:51:50,520 --> 01:51:51,240 ENVIRONMENTAL FACTORS THAT HAVE 3538 01:51:51,240 --> 01:51:52,360 AN IMPACT ON HEALTH AND 3539 01:51:52,360 --> 01:51:54,680 SPECIFICALLY CANCER BIOLOGY ARE 3540 01:51:54,680 --> 01:51:55,960 AIR POLLUTION AS WELL AS 3541 01:51:55,960 --> 01:51:59,320 NEIGHBORHOOD DEPRIVATION. 3542 01:51:59,320 --> 01:52:00,040 SO IN ADDITION TO DISCUSSING THE 3543 01:52:00,040 --> 01:52:01,160 IMPACT OF ENVIRONMENTAL RACISM 3544 01:52:01,160 --> 01:52:02,480 ON HEALTH, WE DISCUSSED THE 3545 01:52:02,480 --> 01:52:05,720 EFFECTS OF AIR POLLUTION WHICH 3546 01:52:05,720 --> 01:52:06,240 DISPROPORTIONATELY IMPACTS 3547 01:52:06,240 --> 01:52:07,440 COMMUNITIES OF COLOR IN THE 3548 01:52:07,440 --> 01:52:10,240 UNITED STATES. 3549 01:52:10,240 --> 01:52:11,080 SO BIOLOGICALLY AIR POLLUTION 3550 01:52:11,080 --> 01:52:13,200 ENCOURAGES THE FORMATION OF DNA 3551 01:52:13,200 --> 01:52:14,600 ADDUCTS, WHICH ARE A FORM OF DNA 3552 01:52:14,600 --> 01:52:16,280 DAMAGE THAT CAN LEAD TO 3553 01:52:16,280 --> 01:52:17,320 MUTATIONS AS WELL AS THE 3554 01:52:17,320 --> 01:52:19,320 INITIATION OF CANCER. 3555 01:52:19,320 --> 01:52:21,040 AIR POLLUTION CAN ALSO 3556 01:52:21,040 --> 01:52:22,880 CONTRIBUTE TO THE EPIGENETIC 3557 01:52:22,880 --> 01:52:24,840 SILENCING OF TP53, WHICH IS A 3558 01:52:24,840 --> 01:52:26,680 TUMOR SUPPRESSOR GENE, AND CAN 3559 01:52:26,680 --> 01:52:29,120 ALSO HAVE IMPLICATIONS IN LOW 3560 01:52:29,120 --> 01:52:32,040 GRADE INFORMATION AND O OXIDATIE 3561 01:52:32,040 --> 01:52:32,680 STRESS. 3562 01:52:32,680 --> 01:52:34,360 THEN ADDITIONALLY, LIVING IN AN 3563 01:52:34,360 --> 01:52:36,880 ECONOMICALLY DISADVANTAGED 3564 01:52:36,880 --> 01:52:39,200 NEIGHBORHOOD CAN LEAD TO 3565 01:52:39,200 --> 01:52:40,640 ACCELERATED AGING VIA ATTRITION 3566 01:52:40,640 --> 01:52:42,040 OR SHORTENING OF TELOMERES. 3567 01:52:42,040 --> 01:52:43,240 THERE'S BEEN A GOOD AMOUNT OF 3568 01:52:43,240 --> 01:52:44,400 WORK DONE IN THAT AREA. 3569 01:52:44,400 --> 01:52:46,040 AS WELL AS INCREASED ALLOSTATIC 3570 01:52:46,040 --> 01:52:48,880 LOAD, WHICH YOU HEARD A BIT 3571 01:52:48,880 --> 01:52:50,320 ABOUT YESTERDAY, AS WELL AS 3572 01:52:50,320 --> 01:52:53,600 CHRONIC INFLAMMATION. 3573 01:52:53,600 --> 01:52:55,680 FOR SOCIAL CONTRIBUTORS, WE 3574 01:52:55,680 --> 01:52:57,280 INVESTIGATED SOCIAL ISOLATION AS 3575 01:52:57,280 --> 01:52:58,680 A RISK FACTOR FOR CANCER. 3576 01:52:58,680 --> 01:53:01,760 THIS INCLUDES BIOLOGICALLY 3577 01:53:01,760 --> 01:53:04,440 ELEVATED STRESS INDUCED 3578 01:53:04,440 --> 01:53:06,000 HORMONES, DECREASED OXYTOCIN 3579 01:53:06,000 --> 01:53:07,760 WHICH IS YOUR LOVE HORMONE, AND 3580 01:53:07,760 --> 01:53:10,640 THEN ACCELERATED EPIGENETIC 3581 01:53:10,640 --> 01:53:12,640 AGING, THEN SIMILARLY, WHEN 3582 01:53:12,640 --> 01:53:14,960 THINKING ABOUT HOW RACISM AND 3583 01:53:14,960 --> 01:53:16,280 DISCRIMINATION IS IMPACTING 3584 01:53:16,280 --> 01:53:18,400 TUMOR BIOLOGY, WE SEE THE SAME 3585 01:53:18,400 --> 01:53:20,360 KIND OF BIOLOGICAL EFFECT, SO 3586 01:53:20,360 --> 01:53:24,200 AIN CREAANINCREASE IN STRESS AND 3587 01:53:24,200 --> 01:53:25,480 DEPRESSION AS WELL AS 3588 01:53:25,480 --> 01:53:25,960 ACCELERATED AGING. 3589 01:53:25,960 --> 01:53:27,600 SO TAKEN TOGETHER, THESE FACTORS 3590 01:53:27,600 --> 01:53:29,040 ALL LEAD TO DISPARATE OUTCOMES 3591 01:53:29,040 --> 01:53:30,880 FOR THE INDIVIDUALS WHO 3592 01:53:30,880 --> 01:53:33,600 EXPERIENCE THESE RISK FACTORS 3593 01:53:33,600 --> 01:53:34,960 MORE FREQUENTLY. 3594 01:53:34,960 --> 01:53:36,760 THIS INCLUDES INCREASED CANCER 3595 01:53:36,760 --> 01:53:40,960 RISK, MORE AGGRESSIVE TEU NOR TR 3596 01:53:40,960 --> 01:53:41,800 SUBTYPES AS WELL AS A DECREASE 3597 01:53:41,800 --> 01:53:42,720 IN SURVIVAL. 3598 01:53:42,720 --> 01:53:44,600 SO FROM THIS REVIEW, WE SAW THAT 3599 01:53:44,600 --> 01:53:46,680 SOCIAL AND ENVIRONMENTAL FACTORS 3600 01:53:46,680 --> 01:53:48,440 CAN DRIVE DIFFERENCES IN TUMOR 3601 01:53:48,440 --> 01:53:50,160 BIOLOGY AS WELL AS OUTCOMES 3602 01:53:50,160 --> 01:53:51,480 BETWEEN DIFFERENT POPULATION 3603 01:53:51,480 --> 01:53:55,560 GROUPS. 3604 01:53:55,560 --> 01:53:57,840 BUILDING ON THAT IDEA, I WANT TO 3605 01:53:57,840 --> 01:53:59,760 NEXT DISCUSS OUR STUDY ON HOW 3606 01:53:59,760 --> 01:54:01,360 NEIGHBORHOOD DEPRIVATION IMPACTS 3607 01:54:01,360 --> 01:54:04,600 DNA METHYLATION AS WELL AS GENE 3608 01:54:04,600 --> 01:54:06,760 EXPRESSION. 3609 01:54:06,760 --> 01:54:08,200 AS WE HAVEN'T HAD ANY TALKS YET 3610 01:54:08,200 --> 01:54:09,800 ON DNA METHYLATION, I THOUGHT I 3611 01:54:09,800 --> 01:54:11,200 WOULD START WITH JUST A BIT OF A 3612 01:54:11,200 --> 01:54:11,880 PRIMER. 3613 01:54:11,880 --> 01:54:13,400 DNA METHYLATION IS THE 3614 01:54:13,400 --> 01:54:15,360 BIOLOGICAL PROCESS OF ADDING A 3615 01:54:15,360 --> 01:54:18,960 METHYL GROUP TO A DNA MOLECULE. 3616 01:54:18,960 --> 01:54:20,560 IT'S BEEN MOST STUDIED IN THE 3617 01:54:20,560 --> 01:54:22,480 REGULATION OF GENE EXPRESSION 3618 01:54:22,480 --> 01:54:24,560 BUT IT ALSO HAS IMPLICATIONS IN 3619 01:54:24,560 --> 01:54:25,160 HUMAN DEVELOPMENT, AS WELL AS 3620 01:54:25,160 --> 01:54:26,320 DIFFERENT DISEASE PROCESSES 3621 01:54:26,320 --> 01:54:27,800 INCLUDING CANCER. 3622 01:54:27,800 --> 01:54:30,720 SO THIS IS A SCHEMATIC OF A GENE 3623 01:54:30,720 --> 01:54:31,960 SHOWING THE DIFFERENT REGIONS 3624 01:54:31,960 --> 01:54:34,600 WHERE MYTH LAI METHYLATION CAN . 3625 01:54:34,600 --> 01:54:37,160 THE EFFECTS OF METHYLATION ON 3626 01:54:37,160 --> 01:54:38,480 GENE EXPRESSION ARE 3627 01:54:38,480 --> 01:54:39,360 LOCATION-DEPENDENT. 3628 01:54:39,360 --> 01:54:40,440 SO GENERALLY METHYLATION IS 3629 01:54:40,440 --> 01:54:41,880 STUDIED IN THE CONTEXT OF THE 3630 01:54:41,880 --> 01:54:43,080 PROMOTER REGION OR THE 3631 01:54:43,080 --> 01:54:44,720 TRANSCRIPTION START SITE. 3632 01:54:44,720 --> 01:54:45,560 AND METHYLATION IN THIS AREA 3633 01:54:45,560 --> 01:54:49,360 ACTUALLY LEADS TO GENETIC 3634 01:54:49,360 --> 01:54:52,000 SILENCING OR DECREASE IN 3635 01:54:52,000 --> 01:54:54,600 TRANSCRIPTION. 3636 01:54:54,600 --> 01:54:55,600 INTERESTINGLY ENOUGH IN THE GENE 3637 01:54:55,600 --> 01:54:56,680 BODY REGION LESS STUDIED IN THE 3638 01:54:56,680 --> 01:54:57,760 CONTEXT OF METHYLATION AND 3639 01:54:57,760 --> 01:55:00,960 INCLUDES OUR INTRONS AND OUR 3640 01:55:00,960 --> 01:55:03,520 EXONS, METHYLATION IS ACTUALLY 3641 01:55:03,520 --> 01:55:04,640 STRONGLY CORRELATED WITH GENE 3642 01:55:04,640 --> 01:55:05,600 EXPRESSION AND GENE' LON 3643 01:55:05,600 --> 01:55:09,480 GAITION. 3644 01:55:09,480 --> 01:55:10,960 GENE ELONGATION. 3645 01:55:10,960 --> 01:55:14,200 IN CANCER THE GENE BODY REGIONS 3646 01:55:14,200 --> 01:55:15,920 HAVE BEEN SHOWN TO LOSE DNA 3647 01:55:15,920 --> 01:55:19,720 METHYLATION AND THAT LEADS TO 3648 01:55:19,720 --> 01:55:21,160 DECREASED GENE EXPRESSION 3649 01:55:21,160 --> 01:55:22,640 COMPARED TO WHAT WE SEE IN 3650 01:55:22,640 --> 01:55:23,240 NON-CANCER CELLS. 3651 01:55:23,240 --> 01:55:25,400 AND I REALLY LOVE THIS SCHEMATIC 3652 01:55:25,400 --> 01:55:27,440 FROM THE EPA FROM 2015. 3653 01:55:27,440 --> 01:55:29,320 I THINK IT DOES A GREAT JOB 3654 01:55:29,320 --> 01:55:31,040 DESCRIBING HOW DNA METHYLATION 3655 01:55:31,040 --> 01:55:32,280 PROFILES CAN DIFFER BY 3656 01:55:32,280 --> 01:55:34,760 NEIGHBORHOOD DEPRIVATION. 3657 01:55:34,760 --> 01:55:36,240 SO WE CONSIDER THAT INDIVIDUALS 3658 01:55:36,240 --> 01:55:37,600 FROM DISADVANTAGED NEIGHBORHOODS 3659 01:55:37,600 --> 01:55:40,760 ARE EXPERIENCING A 3660 01:55:40,760 --> 01:55:41,520 DISPROPORTIONATE AMOUNT OF 3661 01:55:41,520 --> 01:55:43,680 CHEMICAL STRESSORS AS WELL AS 3662 01:55:43,680 --> 01:55:44,360 NON-CHEMICAL STRESSORS, WHICH 3663 01:55:44,360 --> 01:55:46,480 WILL HAVE IMPLICATIONS IN THE 3664 01:55:46,480 --> 01:55:46,720 GENOME. 3665 01:55:46,720 --> 01:55:49,000 AND STUDIES HAVE SHOWN THAT 3666 01:55:49,000 --> 01:55:50,400 THESE INCLUDE EPIGENETIC 3667 01:55:50,400 --> 01:55:52,720 ALTERATIONS INCLUDING HISTONE 3668 01:55:52,720 --> 01:55:54,600 MOD NATIONS, CHANGES TO ABERRANT 3669 01:55:54,600 --> 01:55:55,920 DNA METHYLATION, AS WELL AS 3670 01:55:55,920 --> 01:55:59,480 SHORT NON-CODING RNAs. 3671 01:55:59,480 --> 01:56:01,480 OVER TIME, THESE CHANGES WILL 3672 01:56:01,480 --> 01:56:03,720 EVENTUALLY LEAD TO DIFFERENTIAL 3673 01:56:03,720 --> 01:56:04,880 EPIGENETIC PROFILES BETWEEN 3674 01:56:04,880 --> 01:56:07,400 INDIVIDUALS FROM ADVANTAGED 3675 01:56:07,400 --> 01:56:07,960 VERSUS DISADVANTAGED 3676 01:56:07,960 --> 01:56:09,680 NEIGHBORHOODS AND CAN HAVE 3677 01:56:09,680 --> 01:56:10,480 IMPLICATIONS, LONG STANDING 3678 01:56:10,480 --> 01:56:11,960 IMPLICATIONS IN CANCER RISK AND 3679 01:56:11,960 --> 01:56:13,400 PROGRESSION, AND THIS CAN EVEN 3680 01:56:13,400 --> 01:56:14,200 SPAN ACROSS DIFFERENT 3681 01:56:14,200 --> 01:56:19,200 GENERATIONS. 3682 01:56:19,200 --> 01:56:20,360 WE WANTED TO INVESTIGATE THIS 3683 01:56:20,360 --> 01:56:21,520 CONCEPT FURTHER AND OUR STUDY 3684 01:56:21,520 --> 01:56:22,960 GOAL WAS TO INVESTIGATE IF DNA 3685 01:56:22,960 --> 01:56:24,920 METHYLATION IS LINKED TO 3686 01:56:24,920 --> 01:56:25,880 NEIGHBORHOOD SOCIOECONOMIC 3687 01:56:25,880 --> 01:56:27,360 DEPRIVATION, AND TO A DNA 3688 01:56:27,360 --> 01:56:28,560 PROFILE THAT'S MORE ASSOCIATED 3689 01:56:28,560 --> 01:56:30,400 WITH CANCER AND/OR IMMUNE-ROW 3690 01:56:30,400 --> 01:56:33,280 LATED PATHWAY 3691 01:56:33,280 --> 01:56:34,200 IMMUNE-RELATED PATHWAYS. 3692 01:56:34,200 --> 01:56:36,240 WE'RE USING TISSUE FROM THE NCI 3693 01:56:36,240 --> 01:56:37,600 MAYOR LEFT-HAND BREAST CANCER 3694 01:56:37,600 --> 01:56:37,960 COHORT. 3695 01:56:37,960 --> 01:56:39,240 THIS IS A LONG-STANDING 3696 01:56:39,240 --> 01:56:39,960 COLLABORATION BETWEEN NCI AND 3697 01:56:39,960 --> 01:56:42,640 THE UNIVERSITY OF MARYLAND. 3698 01:56:42,640 --> 01:56:45,440 THE WOMEN IN THE STUDY COMPLETED 3699 01:56:45,440 --> 01:56:46,480 A QUESTIONNAIRE AND THEY ALSO 3700 01:56:46,480 --> 01:56:47,520 DONATED THEIR -- EITHER THEIR 3701 01:56:47,520 --> 01:56:52,600 TUMOR TISSUE OR -- NORMAL TISSUE 3702 01:56:52,600 --> 01:56:56,800 FROM REDUCTION MAMMOMRS. TEES. 3703 01:56:56,800 --> 01:56:58,600 WE HAD 289 WOMEN IN THE STUDY, 3704 01:56:58,600 --> 01:56:59,600 MAJORITY OF WHICH ARE BLACK 3705 01:56:59,600 --> 01:57:00,240 WOMEN. 3706 01:57:00,240 --> 01:57:01,240 WE EXTRACTED DNA FROM TISSUES 3707 01:57:01,240 --> 01:57:03,760 AND USED THE EPIC 850K 3708 01:57:03,760 --> 01:57:05,920 METHYLATION ARRAY TO COLLECT OUR 3709 01:57:05,920 --> 01:57:08,000 METHYLATION DATA. 3710 01:57:08,000 --> 01:57:09,480 I JUST WANTED TO TALK A LITTLE 3711 01:57:09,480 --> 01:57:11,120 BIT MORE ABOUT OUR EXPOSURE 3712 01:57:11,120 --> 01:57:14,560 HERE, WHICH IS NEIGHBORHOOD 3713 01:57:14,560 --> 01:57:15,560 DEPRIVATION. 3714 01:57:15,560 --> 01:57:18,000 SO IN ORDER IN OUR COHORT TO 3715 01:57:18,000 --> 01:57:18,840 MEASURE SOCIOECONOMIC 3716 01:57:18,840 --> 01:57:20,640 DEPRIVATION, WE USED THE 3717 01:57:20,640 --> 01:57:21,280 NEIGHBORHOOD DEPRIVATION INDEX. 3718 01:57:21,280 --> 01:57:24,800 OURS WAS ADAPTED FROM THE NDI IN 3719 01:57:24,800 --> 01:57:25,000 2006. 3720 01:57:25,000 --> 01:57:27,440 FOR THIS INDEX, WE COLLECTED 3721 01:57:27,440 --> 01:57:29,520 CENSUS TRACT LEVEL DATA FROM THE 3722 01:57:29,520 --> 01:57:31,320 2000 CENSUS USING THE ADDRESSES 3723 01:57:31,320 --> 01:57:32,480 OF OUR PARTICIPANTS. 3724 01:57:32,480 --> 01:57:34,200 THIS IS AN EXAMPLE OF A CENSUS 3725 01:57:34,200 --> 01:57:35,920 TRACT MAP FOR MARYLAND, WHERE WE 3726 01:57:35,920 --> 01:57:39,600 CAN SEE THAT ESPECIALLY IN THE 3727 01:57:39,600 --> 01:57:41,640 BALTIMORE AREA, THERE'S A HIGHER 3728 01:57:41,640 --> 01:57:42,560 PERCENT POVERTY COMPARED TO THE 3729 01:57:42,560 --> 01:57:43,440 REST OF THE STATE AND THAT'S 3730 01:57:43,440 --> 01:57:45,680 WHERE A NUMBER OF OUR 3731 01:57:45,680 --> 01:57:50,400 PARTICIPANTS LIVE. 3732 01:57:50,400 --> 01:57:51,760 SO A BIT MORE INFORMATION ABOUT 3733 01:57:51,760 --> 01:57:52,240 THE NDI. 3734 01:57:52,240 --> 01:57:55,320 WE STARTED WITH 20 DIFFERENT 3735 01:57:55,320 --> 01:57:56,960 CENSUS TRACT LEVEL VARIOUS, WE 3736 01:57:56,960 --> 01:58:01,040 USED THE PRINCIPAL COMPONENT -- 3737 01:58:01,040 --> 01:58:02,920 BETWEEN THOSE 20 INDICATORS AND 3738 01:58:02,920 --> 01:58:04,840 THEN VARIABLES THAT HAD A PCA 3739 01:58:04,840 --> 01:58:06,760 LOADING ABOVE 0.25 WERE RETAINED 3740 01:58:06,760 --> 01:58:09,000 IN OUR NDI AND INCLUDED THESE 3741 01:58:09,000 --> 01:58:10,840 SIX VARIABLES HERE. 3742 01:58:10,840 --> 01:58:13,080 AND THEN OVERALL, LOWER NDI 3743 01:58:13,080 --> 01:58:14,760 VALUES INDICATE LESS 3744 01:58:14,760 --> 01:58:17,240 DEPRIVATION, HIGHER NDI VALUES 3745 01:58:17,240 --> 01:58:21,400 INDICATE GREATER DEPRIVATION. 3746 01:58:21,400 --> 01:58:22,640 TO BETTER UNDERSTAND THE 3747 01:58:22,640 --> 01:58:23,720 NEIGHBORHOOD DEPRIVATION IN OUR 3748 01:58:23,720 --> 01:58:25,680 COHORT, WE STARTED BY JUST 3749 01:58:25,680 --> 01:58:27,120 CHARACTERIZING IT, SO LOOKING AT 3750 01:58:27,120 --> 01:58:28,880 NDI ON A CONTINUOUS SCALE AND 3751 01:58:28,880 --> 01:58:31,160 BREAKING THAT DOWN BY RACE AS 3752 01:58:31,160 --> 01:58:32,480 WELL AS SAMPLE TYPE. 3753 01:58:32,480 --> 01:58:34,960 SO WE CAN SEE VERY CLEARLY THAT 3754 01:58:34,960 --> 01:58:37,160 BLACK PARTICIPANTS IN OUR COHORT 3755 01:58:37,160 --> 01:58:39,320 ACTUALLY HAD THE HIGHEST -- I'M 3756 01:58:39,320 --> 01:58:40,840 SORRY SH BLACK PARTICIPANTS HAVE 3757 01:58:40,840 --> 01:58:41,800 SIGNIFICANTLY HIGHER DEPRIVATION 3758 01:58:41,800 --> 01:58:42,840 LEVELS COMPARED TO THE WHITE 3759 01:58:42,840 --> 01:58:43,960 PARTICIPANTS IN OUR COHORT. 3760 01:58:43,960 --> 01:58:45,760 WE SAW THIS REGARDLESS OF TISSUE 3761 01:58:45,760 --> 01:58:46,640 TYPE. 3762 01:58:46,640 --> 01:58:49,520 WE CAN ALSO SEE THAT THE BLACK 3763 01:58:49,520 --> 01:58:51,080 PARTICIPANTS IN OUR STUDY THAT 3764 01:58:51,080 --> 01:58:51,840 HAVE BREAST CANCER ACTUALLY HAD 3765 01:58:51,840 --> 01:58:54,520 THE HIGHEST MEDIAN NDI IN OUR 3766 01:58:54,520 --> 01:58:56,080 COHORT, ALTHOUGH IT WAS NOT 3767 01:58:56,080 --> 01:58:58,360 SIGNIFICANTLY DIFFERENT THAN THE 3768 01:58:58,360 --> 01:59:01,120 BLACK WOMEN WITHOUT BREAST 3769 01:59:01,120 --> 01:59:01,600 CANCER. 3770 01:59:01,600 --> 01:59:03,480 WHEN WE CONSIDERED MOLECULAR 3771 01:59:03,480 --> 01:59:05,720 BREAST CANCER SUBTYPES INCLUDING 3772 01:59:05,720 --> 01:59:10,680 HORMONE RECEPTOR POSITIVE, HER-2 3773 01:59:10,680 --> 01:59:14,200 POSITIVE AND TRIPLE NEGATIVE, 3774 01:59:14,200 --> 01:59:15,680 THOSE WITH TRIPLE NEGATIVELY 3775 01:59:15,680 --> 01:59:16,840 WERE THE HIGHEST PROPORTION OF 3776 01:59:16,840 --> 01:59:18,280 WOMEN WITH HIGH NDI COMPARED TO 3777 01:59:18,280 --> 01:59:19,840 ANY OF THE OTHER MOLECULAR 3778 01:59:19,840 --> 01:59:23,560 SUBTYPES, AND THIS WAS SLIGHTLY 3779 01:59:23,560 --> 01:59:28,760 OVER SIGNIFICANCE AT -- WE NEXT 3780 01:59:28,760 --> 01:59:30,760 WANTED TO IDENTIFY SPECIFIC CPG 3781 01:59:30,760 --> 01:59:32,560 SITES THAT WERE ASSOCIATED WITH 3782 01:59:32,560 --> 01:59:33,800 A PATIENT'S NEIGHBORHOOD 3783 01:59:33,800 --> 01:59:34,920 DEPRIVATION STATUS. 3784 01:59:34,920 --> 01:59:36,560 INCLUDING HOW THEY MAY RELATE TO 3785 01:59:36,560 --> 01:59:39,560 CANCER DRIVER GENES. 3786 01:59:39,560 --> 01:59:42,160 THIS IS A VOLCANO PLOT OF OUR 3787 01:59:42,160 --> 01:59:43,920 PROBES FROM THE METHYLATION 3788 01:59:43,920 --> 01:59:45,000 ANALYSIS, AND THIS WAS ONLY DONE 3789 01:59:45,000 --> 01:59:46,680 IN TUMOR TISSUE. 3790 01:59:46,680 --> 01:59:48,560 ON THE Y AXIS, WE HAVE THE 3791 01:59:48,560 --> 01:59:50,400 NEGATIVE LOG OF THE UNADJUSTED P 3792 01:59:50,400 --> 01:59:52,240 VALUE FOR EACH CPG SITE. 3793 01:59:52,240 --> 01:59:53,920 THE X AXIS SHOWS THE AVERAGE 3794 01:59:53,920 --> 01:59:55,840 DIFFERENCE IN BETA VALUES 3795 01:59:55,840 --> 01:59:58,240 BETWEEN NDI HIGH PATIENTS VERSUS 3796 01:59:58,240 --> 01:59:59,360 NDI LOW PATIENTS. 3797 01:59:59,360 --> 02:00:02,400 SO IN THIS ANALYSIS, THERE WERE 3798 02:00:02,400 --> 02:00:04,280 FIVE CPG SITES THAT WERE 3799 02:00:04,280 --> 02:00:05,920 SIGNIFICANTLY HYPOMETHYLATED IN 3800 02:00:05,920 --> 02:00:06,640 THE NDI HIGH GROUP. 3801 02:00:06,640 --> 02:00:12,440 THIS IS USING A BONVERONI 3802 02:00:12,440 --> 02:00:12,920 CORRECTED VALUE. 3803 02:00:12,920 --> 02:00:14,200 YOU CAN SEE THE GENES ASSOCIATED 3804 02:00:14,200 --> 02:00:16,560 WITH THOSE CPGs. 3805 02:00:16,560 --> 02:00:17,800 MOST OF THIS IS OCCURRING WITHIN 3806 02:00:17,800 --> 02:00:19,200 THE GENE BODY REGION, 3807 02:00:19,200 --> 02:00:21,800 INTERESTINGLY ENOUGH. 3808 02:00:21,800 --> 02:00:24,720 AND I WANTED TO POINT OUT TWO OF 3809 02:00:24,720 --> 02:00:28,040 THESE GENES IN MORE DETAIL. 3810 02:00:28,040 --> 02:00:29,680 LRIG1 IS A TUMOR SUPPRESSOR 3811 02:00:29,680 --> 02:00:29,880 GENE. 3812 02:00:29,880 --> 02:00:32,840 IT HAS IMPLICATIONS IN SQUAMOUS 3813 02:00:32,840 --> 02:00:37,520 CELL CARCINOMAS AS WELL AS 3814 02:00:37,520 --> 02:00:38,720 ADENOCARCINOMAS AND WWX ACTS AS 3815 02:00:38,720 --> 02:00:42,680 A TUMOR SP SUPPRESSOR GENE AS W. 3816 02:00:42,680 --> 02:00:43,360 VERY INTERESTING THAT THOSE TWO 3817 02:00:43,360 --> 02:00:45,040 CAME OUT OF THIS ANALYSIS. 3818 02:00:45,040 --> 02:00:51,960 A BIT MORE ABOUT LRG1, IT'S A 3819 02:00:51,960 --> 02:00:52,600 TUMOR SUPPRESSOR AND THERE'S 3820 02:00:52,600 --> 02:00:56,560 BEEN A LOT OF WORK ON LRIG1 IN 3821 02:00:56,560 --> 02:00:57,960 BREAST CANCER AND IT'S ACTUALLY 3822 02:00:57,960 --> 02:00:59,360 BEEN SHOWN THAT LOWER EXPRESSION 3823 02:00:59,360 --> 02:01:01,600 OF THIS GENE IS AN INDEPENDENT 3824 02:01:01,600 --> 02:01:03,960 RISK FACTOR FOR BREAST CANCER 3825 02:01:03,960 --> 02:01:05,400 METASTASIS AND DEATH. 3826 02:01:05,400 --> 02:01:08,800 IN TWO EXAMPLES WE SUE DECREASED 3827 02:01:08,800 --> 02:01:12,840 OR HYPOMETMETHYLATION OF THE SIE 3828 02:01:12,840 --> 02:01:13,920 AS NEIGHBORHOOD DEPRIVATION 3829 02:01:13,920 --> 02:01:15,320 VALUES ARE INCREASING. 3830 02:01:15,320 --> 02:01:16,960 WE CAN SEE THAT AS WELL IN OUR 3831 02:01:16,960 --> 02:01:17,560 QUARTILES. 3832 02:01:17,560 --> 02:01:19,320 AND SINCE THIS CPG IS LOCATED IN 3833 02:01:19,320 --> 02:01:21,640 THE GENE BODY REGION, THIS MIGHT 3834 02:01:21,640 --> 02:01:23,880 ACTUALLY RESULT IN DECREASED 3835 02:01:23,880 --> 02:01:24,880 TRANSCRIPTION OF THIS TUMOR 3836 02:01:24,880 --> 02:01:26,400 SUPPRESSOR IN OUR NDI HIGH 3837 02:01:26,400 --> 02:01:29,520 GROUP. 3838 02:01:29,520 --> 02:01:34,120 WE DID HAVE A LIMITED NUMBER OF 3839 02:01:34,120 --> 02:01:38,040 RNA SEQ TUMOR SANL PEL S SAMPLEE 3840 02:01:38,040 --> 02:01:39,880 ABLE TO LOOK DIRECTLY AT GENE 3841 02:01:39,880 --> 02:01:41,400 EXPRESSION AND WE SEE THE SAME 3842 02:01:41,400 --> 02:01:42,120 NEGATIVE CORRELATION AS WE DID 3843 02:01:42,120 --> 02:01:44,720 WITH THE METHYLATION DATA, 3844 02:01:44,720 --> 02:01:48,720 INDICATING AN OVERALL LOSS OF 3845 02:01:48,720 --> 02:01:49,760 LRID1 GENE EXPRESSION FOR THOSE 3846 02:01:49,760 --> 02:01:53,480 INDIVIDUALS WITH HIGH NDI. 3847 02:01:53,480 --> 02:01:56,960 I ALSO LOOKED AT SURVIVAL FROM 3848 02:01:56,960 --> 02:01:59,320 TCGA DATA SPECIFICALLY FOR 3849 02:01:59,320 --> 02:02:02,200 LRIG1, AND AS EXPECTED, WE CAN 3850 02:02:02,200 --> 02:02:05,280 SEE THAT LOW GENE EXPRESSION OF 3851 02:02:05,280 --> 02:02:07,440 LRIG1 IS ASSOCIATED WITH 3852 02:02:07,440 --> 02:02:08,120 SIGNIFICANTLY DECREASED 3853 02:02:08,120 --> 02:02:09,280 SURVIVAL. 3854 02:02:09,280 --> 02:02:11,520 IN LOOKING AT WWOX, WHICH ALSO 3855 02:02:11,520 --> 02:02:13,720 SERVES AS A TUMOR SUPPRESSOR, 3856 02:02:13,720 --> 02:02:15,200 DELETIONS IN THE CODING SEQUENCE 3857 02:02:15,200 --> 02:02:16,560 OF THIS GENE ARE COMMONLY SEEN 3858 02:02:16,560 --> 02:02:17,600 IN BREAST CANCER CASES. 3859 02:02:17,600 --> 02:02:21,400 I THINK IT'S AROUND 80%. 3860 02:02:21,400 --> 02:02:22,680 AND DECREASED GENE EXPRESSION 3861 02:02:22,680 --> 02:02:24,560 HERE IS ALSO ASSOCIATED WITH THE 3862 02:02:24,560 --> 02:02:25,560 WORST PROGNOSIS AND HIGHER 3863 02:02:25,560 --> 02:02:26,120 MORTALITY. 3864 02:02:26,120 --> 02:02:28,880 SO SIMILAR TO LRIG1, WE SAW THIS 3865 02:02:28,880 --> 02:02:31,600 DECREASE IN METHYLATION IN THE 3866 02:02:31,600 --> 02:02:34,000 CPG ASSOCIATED WITH WWOX, AND 3867 02:02:34,000 --> 02:02:35,600 AGAIN, THIS WAS LOCATED IN THE 3868 02:02:35,600 --> 02:02:38,400 GENE BODY. 3869 02:02:38,400 --> 02:02:40,280 SO FOR THE HIGHER NDI GROUPS, 3870 02:02:40,280 --> 02:02:41,320 THIS RESULTS IN LOWER 3871 02:02:41,320 --> 02:02:42,760 TRANSCRIPTIONAL ACTIVITY FOR 3872 02:02:42,760 --> 02:02:45,320 THIS TUMOR SUPPRESSOR GENE. 3873 02:02:45,320 --> 02:02:46,840 THEN ONCE AGAIN FROM THE RNA SEQ 3874 02:02:46,840 --> 02:02:48,120 DATA, WE SEE SIMILAR RESULTS AS 3875 02:02:48,120 --> 02:02:52,320 WE DID WITH LRIG1. 3876 02:02:52,320 --> 02:02:54,520 OVERALL FROM THIS ANALYSIS, WE 3877 02:02:54,520 --> 02:02:55,480 CAN CONCLUDE THAT HIGHER 3878 02:02:55,480 --> 02:02:57,320 NEIGHBORHOOD DEPRIVATION IS 3879 02:02:57,320 --> 02:02:58,160 ASSOCIATED WITH HIGHER 3880 02:02:58,160 --> 02:02:59,080 METHYLATION OF BREAST TUMORS AND 3881 02:02:59,080 --> 02:03:00,760 THIS MAY HAVE A ROLE IN 3882 02:03:00,760 --> 02:03:01,840 IMPACTING TUMOR SUPPRESSOR 3883 02:03:01,840 --> 02:03:04,400 GENES. 3884 02:03:04,400 --> 02:03:06,000 THEN OUR FINAL TAKE-HOME MESSAGE 3885 02:03:06,000 --> 02:03:07,280 FROM THE STUDY, WE SEE THAT 3886 02:03:07,280 --> 02:03:08,640 NEIGHBORHOOD ENVIRONMENTS CAN 3887 02:03:08,640 --> 02:03:09,640 INDEED IMPACT OUR EPIGENETICS, 3888 02:03:09,640 --> 02:03:11,040 WHICH CAN POTENTIALLY INCREASE 3889 02:03:11,040 --> 02:03:14,720 OUR CANCER RISK AND EXACERBATE 3890 02:03:14,720 --> 02:03:18,360 CANCER DISPARITIES. 3891 02:03:18,360 --> 02:03:20,040 I JUST WANT TO ACKNOWLEDGE THE 3892 02:03:20,040 --> 02:03:23,640 WONDERFUL MEMBERS OF BOTH OF MY 3893 02:03:23,640 --> 02:03:29,480 LABS IN DCEG, AND ACKNOWLEDGE MY 3894 02:03:29,480 --> 02:03:30,080 COLLABORATORS, DR. MARTINI, AS 3895 02:03:30,080 --> 02:03:31,600 WELL AS DR. MELISSA DAVIS. 3896 02:03:31,600 --> 02:03:32,800 THANK YOU SO MUCH FOR ATTENDING. 3897 02:03:32,800 --> 02:03:40,320 [APPLAUSE] 3898 02:03:40,320 --> 02:03:42,480 >>THANK YOU, BRITTANY, AND 3899 02:03:42,480 --> 02:03:44,600 DR. LORD, FOR A WONDERFUL TALK. 3900 02:03:44,600 --> 02:03:46,440 WE'LL TAKE QUESTIONS NOW. 3901 02:03:46,440 --> 02:03:47,960 FROM THE AUDIENCE AND ALSO IF 3902 02:03:47,960 --> 02:03:50,280 YOU'RE TUNING IN ONLINE, PLEASE 3903 02:03:50,280 --> 02:03:55,040 SEND THEM VIA SLIDO. 3904 02:03:55,040 --> 02:03:55,520 >>HI. 3905 02:03:55,520 --> 02:03:56,280 VERY INTERESTING. 3906 02:03:56,280 --> 02:03:56,720 >>THANK YOU. 3907 02:03:56,720 --> 02:03:57,960 >>IS THIS WORKING? 3908 02:03:57,960 --> 02:03:59,520 YES? 3909 02:03:59,520 --> 02:04:01,280 OKAY. 3910 02:04:01,280 --> 02:04:05,240 SO MAYBE I MISSED HOW YOU DID 3911 02:04:05,240 --> 02:04:09,160 THIS, BUT I WAS INTRIGUED BY THE 3912 02:04:09,160 --> 02:04:16,960 NDI HIGH VERSUS LOW ANALYSIS, 3913 02:04:16,960 --> 02:04:19,320 BECAUSE DUE TO THAT REALLY 3914 02:04:19,320 --> 02:04:20,440 STRIKING DIFFERENCE WITHIN RACE, 3915 02:04:20,440 --> 02:04:22,280 I WOULD EXPECT THAT THAT 3916 02:04:22,280 --> 02:04:24,880 ANALYSIS WOULD BE CONFOUNDED BY 3917 02:04:24,880 --> 02:04:25,240 RACE. 3918 02:04:25,240 --> 02:04:26,440 SO HOW DO YOU TACKLE THAT? 3919 02:04:26,440 --> 02:04:29,280 >>YES, ABSOLUTELY. 3920 02:04:29,280 --> 02:04:33,320 SO AS YOU SAY -- AND NDI ARE 3921 02:04:33,320 --> 02:04:34,160 VERY TIGHTLY CORRELATED. 3922 02:04:34,160 --> 02:04:37,800 WE WERE ABLE TO LOOK AT WWOX AND 3923 02:04:37,800 --> 02:04:38,800 LRIG1 METHYLATION AND GENE 3924 02:04:38,800 --> 02:04:40,640 EXPRESSION STRATIFIED BY RACE, 3925 02:04:40,640 --> 02:04:43,680 AND WE DO STILL SEE SIGNIFICANT 3926 02:04:43,680 --> 02:04:44,720 ASSOCIATIONS SPECIFICALLY IN 3927 02:04:44,720 --> 02:04:47,000 AFRICAN AMERICAN WOMEN WITH 3928 02:04:47,000 --> 02:04:49,760 THESE TUMOR SUPPRESSORS. 3929 02:04:49,760 --> 02:04:51,880 SO IT CONFOUNDED BY RACE BUT 3930 02:04:51,880 --> 02:04:55,360 WHEN WE SEPARATE BY RACE, WE 3931 02:04:55,360 --> 02:04:56,480 STILL SEE THE SIGNIFICANT 3932 02:04:56,480 --> 02:05:01,680 ASSOCIATIONS FOR BLACK WOMEN. 3933 02:05:01,680 --> 02:05:03,240 >>GO AHEAD AND BACK. 3934 02:05:03,240 --> 02:05:05,600 >>HI, GREAT TALK. 3935 02:05:05,600 --> 02:05:07,960 SO METHYLATION CHANGES ARE 3936 02:05:07,960 --> 02:05:10,360 ASSOCIATED WITH AGING. 3937 02:05:10,360 --> 02:05:10,600 >>YES. 3938 02:05:10,600 --> 02:05:12,120 >>I WAS WONDERING WHETHER, IN 3939 02:05:12,120 --> 02:05:14,400 YOUR WORK, YOU'VE BEEN ABLE TO 3940 02:05:14,400 --> 02:05:17,200 LOOK AT WHETHER SOME OF THESE 3941 02:05:17,200 --> 02:05:20,040 POPULATIONS HAVE AXILLARY -- 3942 02:05:20,040 --> 02:05:22,400 AGING OR ANYTHING RELATED TO 3943 02:05:22,400 --> 02:05:22,600 AGING? 3944 02:05:22,600 --> 02:05:23,840 >>GREAT QUESTION. 3945 02:05:23,840 --> 02:05:26,920 SO AS I DISCUSSED BEFORE, 3946 02:05:26,920 --> 02:05:29,080 EPIGENETIC OR CELLULAR AGING IS 3947 02:05:29,080 --> 02:05:29,840 VERY COMMON, ESPECIALLY WITH 3948 02:05:29,840 --> 02:05:31,240 THESE RISK FACTORS THAT WE'RE 3949 02:05:31,240 --> 02:05:31,560 INVESTIGATING. 3950 02:05:31,560 --> 02:05:33,560 WE ACTUALLY HAVEN'T BEEN ABLE TO 3951 02:05:33,560 --> 02:05:34,040 LOOK YET. 3952 02:05:34,040 --> 02:05:35,720 THERE'S A WAY TO LINK 3953 02:05:35,720 --> 02:05:38,840 METHYLATION DATA WITH EPIGENETIC 3954 02:05:38,840 --> 02:05:39,400 CLOCKS TO LOOK AT CELLULAR 3955 02:05:39,400 --> 02:05:39,720 AGING. 3956 02:05:39,720 --> 02:05:41,360 WE HAVEN'T DONE THAT YET, BUT IT 3957 02:05:41,360 --> 02:05:42,880 WOULD BE INTERESTING TO SEE HOW 3958 02:05:42,880 --> 02:05:44,640 THAT CORRELATES WITH 3959 02:05:44,640 --> 02:05:46,720 NEIGHBORHOOD DEPRIVATION FOR 3960 02:05:46,720 --> 02:05:48,240 SURE. 3961 02:05:48,240 --> 02:05:49,560 >>AND WE ALSO HAVE A QUESTION 3962 02:05:49,560 --> 02:05:50,240 FROM ONLINE. 3963 02:05:50,240 --> 02:05:51,320 IT SAYS GREAT TALK, WERE YOU 3964 02:05:51,320 --> 02:05:53,120 ABLE TO ADJUST FOR CONFOUNDERS 3965 02:05:53,120 --> 02:05:56,640 SUCH AS BODY SIZE AND PARITY? 3966 02:05:56,640 --> 02:05:58,640 >>INTERESTING. 3967 02:05:58,640 --> 02:06:00,640 SO IN LOOKING AT DIFFERENCES IN 3968 02:06:00,640 --> 02:06:02,640 THE NDI HIGH AND LOW POPULATION, 3969 02:06:02,640 --> 02:06:04,120 WE ACTUALLY DIDN'T SEE 3970 02:06:04,120 --> 02:06:10,120 DIFFERENCES IN PARITY BETWEEN 3971 02:06:10,120 --> 02:06:11,000 THE TWO GROUPS. 3972 02:06:11,000 --> 02:06:12,360 I BELIEVE THERE WERE SIGNIFICANT 3973 02:06:12,360 --> 02:06:15,240 DIFFERENCES IN BMI, BUT FOR THIS 3974 02:06:15,240 --> 02:06:16,760 ANALYSIS, WE FOCUSED ON AGE AND 3975 02:06:16,760 --> 02:06:18,320 WE FOCUSED ON ADJUSTING FOR 3976 02:06:18,320 --> 02:06:18,800 RACE. 3977 02:06:18,800 --> 02:06:22,440 JUST BECAUSE THOSE TWO WERE SO 3978 02:06:22,440 --> 02:06:24,600 IMPACTFUL IN THE NDI ITSELF. 3979 02:06:24,600 --> 02:06:27,800 SO WE DIDN'T ADJUST FOR BMI, BUT 3980 02:06:27,800 --> 02:06:28,960 IT WOULD BE INTERESTING TO GO 3981 02:06:28,960 --> 02:06:29,640 BACK AND LOOK AND SEE. 3982 02:06:29,640 --> 02:06:31,040 >>PLEASE GO AHEAD IN THE BACK. 3983 02:06:31,040 --> 02:06:31,480 >>HI. 3984 02:06:31,480 --> 02:06:33,360 MY NAME IS LEA. 3985 02:06:33,360 --> 02:06:36,240 I'M FROM MOUNT SINAI. 3986 02:06:36,240 --> 02:06:37,320 YEAH, THANK YOU FOR THIS 3987 02:06:37,320 --> 02:06:40,600 WONDERFUL TALK, AND I WANTED TO 3988 02:06:40,600 --> 02:06:41,520 ASK IN OUR WORK SOMETHING WE'VE 3989 02:06:41,520 --> 02:06:43,200 BEEN TALKING A LOT ABOUT SORT OF 3990 02:06:43,200 --> 02:06:44,080 RELATED TO WHAT YOU WERE SAYING 3991 02:06:44,080 --> 02:06:45,200 ABOUT RACE CONSCIOUS MEDICINE 3992 02:06:45,200 --> 02:06:47,880 AND KIND OF LIKE GOING -- 3993 02:06:47,880 --> 02:06:50,280 LOOKING AT RACE AS LIKE THIS 3994 02:06:50,280 --> 02:06:52,120 INHERENT THING AND SEEING IT 3995 02:06:52,120 --> 02:06:56,720 MORE AS LIKE THE -- STRUCTURAL 3996 02:06:56,720 --> 02:07:00,000 RACISM AND ANCESTRY. 3997 02:07:00,000 --> 02:07:01,200 SPECIFICALLY FOR GUIDELINES AND 3998 02:07:01,200 --> 02:07:03,880 RECOMMENDATIONS FOR SCREENING, 3999 02:07:03,880 --> 02:07:05,640 KIND OF LIKE IN BREAST CANCER, 4000 02:07:05,640 --> 02:07:06,440 PROSTATE CANCER, STUFF LIKE 4001 02:07:06,440 --> 02:07:08,040 THAT, I WAS WONDERING IF YOU HAD 4002 02:07:08,040 --> 02:07:09,240 ANY THOUGHTS ABOUT -- OBVIOUSLY 4003 02:07:09,240 --> 02:07:10,920 WE NEED TO BE ADDRESSING THE 4004 02:07:10,920 --> 02:07:13,440 STRUCTURAL AND LIKE, YOU KNOW, 4005 02:07:13,440 --> 02:07:15,880 KIND OF UPSTREAM DETERMINANTS, 4006 02:07:15,880 --> 02:07:18,040 BUT LIKE KIND OF HOW TO TALK 4007 02:07:18,040 --> 02:07:20,560 ABOUT RISK IN A WAY THAT DOESN'T 4008 02:07:20,560 --> 02:07:22,840 FURTHER ENTRENCH IDEAS OF RACE 4009 02:07:22,840 --> 02:07:24,520 IS BIOLOGICAL BUT THEN TO SORT 4010 02:07:24,520 --> 02:07:25,560 OF LIKE, YOU KNOW, MAKE SURE 4011 02:07:25,560 --> 02:07:28,320 THAT PEOPLE ARE GETTING SCREENED 4012 02:07:28,320 --> 02:07:28,760 TOO. 4013 02:07:28,760 --> 02:07:29,440 >>YEAH. 4014 02:07:29,440 --> 02:07:33,040 SO GREAT QUESTION. 4015 02:07:33,040 --> 02:07:35,760 I THINK SELF-REPORTED RACE HAS A 4016 02:07:35,760 --> 02:07:37,080 PLACE IN DISPARITIES RESEARCH. 4017 02:07:37,080 --> 02:07:39,960 I THINK IF YOU'RE DOING SOCIAL, 4018 02:07:39,960 --> 02:07:41,800 SOCIALLY CONSCIOUS WORK, 4019 02:07:41,800 --> 02:07:43,000 ENVIRONMENTAL WORK, YOU KNOW, 4020 02:07:43,000 --> 02:07:44,080 RACE IS A SOCIAL CONSTRUCT. 4021 02:07:44,080 --> 02:07:45,320 SO IT WOULD MAKE SENSE TO USE 4022 02:07:45,320 --> 02:07:45,960 IT. 4023 02:07:45,960 --> 02:07:48,680 WHICH IS WHY I USED IT IN THIS 4024 02:07:48,680 --> 02:07:48,960 ANALYSIS. 4025 02:07:48,960 --> 02:07:51,520 BUT IF YOU CAN COLLECT 4026 02:07:51,520 --> 02:07:52,960 QUANTIFIED GENETIC ANCESTRY 4027 02:07:52,960 --> 02:07:54,440 DATA, THAT'S EVEN BETTER TO HAVE 4028 02:07:54,440 --> 02:07:55,800 BOTH. 4029 02:07:55,800 --> 02:07:58,720 AS FAR AS RISK IS CONCERNED, I 4030 02:07:58,720 --> 02:08:02,760 THINK JUST BEING CONSCIOUS OF 4031 02:08:02,760 --> 02:08:06,480 THE FACT THAT NOT ALL 4032 02:08:06,480 --> 02:08:08,400 INDIVIDUALS IDENTIFY IN ONE 4033 02:08:08,400 --> 02:08:09,960 PARTICULAR RACIAL GROUP, SO WE 4034 02:08:09,960 --> 02:08:11,720 USE THE TERM BLACK IN THIS 4035 02:08:11,720 --> 02:08:12,760 COUNTRY, BUT WHAT DOES THAT 4036 02:08:12,760 --> 02:08:14,600 ACTUALLY MEAN? 4037 02:08:14,600 --> 02:08:16,560 SO WE SAW YESTERDAY, 4038 02:08:16,560 --> 02:08:18,240 DR. MARTINI'S TALK, THERE'S 4039 02:08:18,240 --> 02:08:19,560 INCREDIBLE GENETIC HETEROGENEITY 4040 02:08:19,560 --> 02:08:21,080 AND THAT'S GOING TO IMPACT THE 4041 02:08:21,080 --> 02:08:22,280 RISK OF THESE PARTICULAR 4042 02:08:22,280 --> 02:08:23,040 POPULATIONS. 4043 02:08:23,040 --> 02:08:24,520 SO JUST BEING AWARE OF THAT AND 4044 02:08:24,520 --> 02:08:25,920 BEING CONSCIOUS OF THAT WHEN 4045 02:08:25,920 --> 02:08:27,160 WE'RE THINKING ABOUT SCREENING 4046 02:08:27,160 --> 02:08:28,520 AND THINGS LIKE THAT, I THINK IS 4047 02:08:28,520 --> 02:08:30,680 REALLY IMPORTANT. 4048 02:08:30,680 --> 02:08:32,640 YEAH. 4049 02:08:32,640 --> 02:08:33,600 >>ALL RIGHT. 4050 02:08:33,600 --> 02:08:37,560 WELL, THANK YOU, DR. LORD. 4051 02:08:37,560 --> 02:08:38,160 >>THANK YOU. 4052 02:08:38,160 --> 02:08:48,320 [APPLAUSE] 4053 02:08:57,120 --> 02:08:57,200 s 4054 02:08:57,200 --> 02:08:58,160 >>ALL RIGHT. 4055 02:08:58,160 --> 02:08:59,720 WHILE WE GET OUR NEXT SPEAKER'S 4056 02:08:59,720 --> 02:09:04,480 PRESENTATION UP, I'D LIKE TO 4057 02:09:04,480 --> 02:09:08,120 INTRODUCE DR. JENNIFER 4058 02:09:08,120 --> 02:09:08,960 MCGEE-AVILA, PLEASE BEAR WITH US 4059 02:09:08,960 --> 02:09:10,800 FOR ANY TECHNICAL ISSUES, BUT 4060 02:09:10,800 --> 02:09:12,560 DR. MCGEE-AVILA IS ALSO A CANCER 4061 02:09:12,560 --> 02:09:13,080 PREVENTION FELLOW IN THE 4062 02:09:13,080 --> 02:09:15,840 DIVISION OF CANCER EPIDEMIOLOGY 4063 02:09:15,840 --> 02:09:26,080 AND GENETICS. 4064 02:09:27,680 --> 02:09:29,240 ALL RIGHT, DR. MCGEE-AVILA, YOU 4065 02:09:29,240 --> 02:09:30,440 ARE GOOD TO GO. 4066 02:09:30,440 --> 02:09:32,680 >>CAN YOU HEAR ME, DR. HARRIS? 4067 02:09:32,680 --> 02:09:34,160 >>YES, WE CAN HEAR YOU. 4068 02:09:34,160 --> 02:09:35,160 >>OKAY. 4069 02:09:35,160 --> 02:09:35,400 PERFECT. 4070 02:09:35,400 --> 02:09:36,160 THANK YOU. 4071 02:09:36,160 --> 02:09:37,160 AND YOU'RE SEEING THE CORRECT 4072 02:09:37,160 --> 02:09:38,760 VERSION OF MY SLIDES? 4073 02:09:38,760 --> 02:09:41,320 >>YES, WE ARE. 4074 02:09:41,320 --> 02:09:41,560 >>GREAT. 4075 02:09:41,560 --> 02:09:42,000 THANK YOU. 4076 02:09:42,000 --> 02:09:43,280 GOOD MORNING, EVERYONE. 4077 02:09:43,280 --> 02:09:44,880 I APOLOGIZE FOR BEING UNABLE TO 4078 02:09:44,880 --> 02:09:46,360 BE WITH YOU ALL TODAY IN PERSON. 4079 02:09:46,360 --> 02:09:48,360 MY NAME IS JEN MCGEE-AVILA. 4080 02:09:48,360 --> 02:09:49,600 MY PRONOUNS ARE SHE AND HER. 4081 02:09:49,600 --> 02:09:51,800 I'M A CURRENT CANCER PREVENTION 4082 02:09:51,800 --> 02:09:53,440 POSTDOC FELLOW AND TODAY I'LL BE 4083 02:09:53,440 --> 02:09:55,480 PRESENTING SOME WORK ON CANCER 4084 02:09:55,480 --> 02:09:57,200 TREATMENT INEQUITIES IN PEOPLE 4085 02:09:57,200 --> 02:09:59,600 WITH HIV IN THE U.S. DURING THE 4086 02:09:59,600 --> 02:10:04,040 YEARS OF 2001 TO 2019. 4087 02:10:04,040 --> 02:10:05,440 SO I'D LIKE TO START MY TALK 4088 02:10:05,440 --> 02:10:06,880 WITH JUST A QUICK CENTERING ON 4089 02:10:06,880 --> 02:10:08,120 THE UNIQUE RELATIONSHIP BETWEEN 4090 02:10:08,120 --> 02:10:09,320 HIV AND CANCER. 4091 02:10:09,320 --> 02:10:11,160 HIV CAN CAUSE PERSONS TO HAVE AN 4092 02:10:11,160 --> 02:10:13,560 ELEVATED RISK OF CANCER 4093 02:10:13,560 --> 02:10:16,800 DEVELOPMENT, AND HAVING HIV, WE 4094 02:10:16,800 --> 02:10:18,240 WEAKENS THE IMMUNE SYSTEM AND 4095 02:10:18,240 --> 02:10:20,200 REDUCES THE BODY TO FIGHT VIRAL 4096 02:10:20,200 --> 02:10:21,280 INFECTIONS THAT ALSO MAY LEAD TO 4097 02:10:21,280 --> 02:10:21,600 CANCER. 4098 02:10:21,600 --> 02:10:22,600 THERE ARE SEVERAL VIRUSES THAT 4099 02:10:22,600 --> 02:10:24,240 ARE MORE LIKELY TO CAUSE CANCER 4100 02:10:24,240 --> 02:10:26,080 IN PEOPLE WITH HIV. 4101 02:10:26,080 --> 02:10:29,040 AND IN ADDITION, PEOPLE WITH HIV 4102 02:10:29,040 --> 02:10:30,560 ARE MORE LIKELY TO HAVE THESE 4103 02:10:30,560 --> 02:10:31,600 ADDITIONAL VIRUSES THAN PEOPLE 4104 02:10:31,600 --> 02:10:37,400 IN THE GENERAL POPULATION. 4105 02:10:37,400 --> 02:10:38,720 SO CANCER RISK IS ELEVATED IN 4106 02:10:38,720 --> 02:10:42,280 PERSONS WITH HIV, AND 4107 02:10:42,280 --> 02:10:43,680 TRADITIONALLY CANCERS HAVE BEEN 4108 02:10:43,680 --> 02:10:45,600 CATEGORIZED AS EITHER 4109 02:10:45,600 --> 02:10:47,560 NON-AIDS-DEFINING CANCERS AND 4110 02:10:47,560 --> 02:10:49,000 AIDS-DEFINING CANCERS, WHICH 4111 02:10:49,000 --> 02:10:50,320 MEANS IMMUNOSUPPRESSION HAS 4112 02:10:50,320 --> 02:10:51,280 PROGRESSED TO AIDS. 4113 02:10:51,280 --> 02:10:54,000 AND HERE I'VE LISTED THREE 4114 02:10:54,000 --> 02:10:54,800 AIDS-DEFINING CANCERS IN 4115 02:10:54,800 --> 02:10:59,360 PARTICULAR. 4116 02:10:59,360 --> 02:11:03,720 AND KAPOSI SARCOMA IS MOST 4117 02:11:03,720 --> 02:11:05,080 CLOSELY ASSOCIATED WITH HIV 4118 02:11:05,080 --> 02:11:06,200 SINCE RATES ARE SO MUCH MORE 4119 02:11:06,200 --> 02:11:07,760 ELEVATED IN PERSONS WITH HIV. 4120 02:11:07,760 --> 02:11:10,200 AND FOR NON-AIDS-DEFINING 4121 02:11:10,200 --> 02:11:12,320 CANCERS, THESE ARE SOME OF THE 4122 02:11:12,320 --> 02:11:14,120 MORE COMMON CANCERS BUT BY NO 4123 02:11:14,120 --> 02:11:15,920 MEANS IS THIS AN EXHAUSTIVE 4124 02:11:15,920 --> 02:11:18,960 LIST, AND SO IN ADDITION, THE 4125 02:11:18,960 --> 02:11:20,280 PREVALENCE OF SOME TRADITIONAL 4126 02:11:20,280 --> 02:11:22,880 RISK FACTORS FOR CANCERS, FOR 4127 02:11:22,880 --> 02:11:24,240 EXAMPLE, SMOKING AND HEAVY 4128 02:11:24,240 --> 02:11:27,160 ALCOHOL USE, IS ALSO HIGHER 4129 02:11:27,160 --> 02:11:32,040 AMONGST PEOPLE WITH HIV. 4130 02:11:32,040 --> 02:11:34,120 SO THE CENTRAL QUESTION THAT 4131 02:11:34,120 --> 02:11:34,720 THIS RESEARCH PROJECT REALLY 4132 02:11:34,720 --> 02:11:37,280 SOUGHT TO ANSWER WAS HOW 4133 02:11:37,280 --> 02:11:39,200 INEQUITIES IN CANCER TREATMENT 4134 02:11:39,200 --> 02:11:42,480 FOR PEOPLE WITH HIV IMPROVED. 4135 02:11:42,480 --> 02:11:44,640 SO TO ANSWER THAT, WE REALLY 4136 02:11:44,640 --> 02:11:45,720 NEED TO UNDERSTAND PEOPLE WITH 4137 02:11:45,720 --> 02:11:48,880 HIV AND CANCER EXPERIENCE HIGHER 4138 02:11:48,880 --> 02:11:50,640 CANCER-SPECIFIC MORTALITY THAN 4139 02:11:50,640 --> 02:11:53,360 PEOPLE WITHOUT HIV. 4140 02:11:53,360 --> 02:11:57,360 AND IN WORK DONE BY ANNA COGHILL 4141 02:11:57,360 --> 02:11:58,480 AND COLLEAGUES, THEY REPORTED 4142 02:11:58,480 --> 02:12:00,760 THE ROLE OF HIV ON 4143 02:12:00,760 --> 02:12:01,400 CANCER-SPECIFIC MORTALITY RATES, 4144 02:12:01,400 --> 02:12:03,080 AND AS YOU CAN SEE, THEY ARE ALL 4145 02:12:03,080 --> 02:12:05,080 ELEVATED FOR THE CANCER SITES 4146 02:12:05,080 --> 02:12:06,560 LISTED HERE, AND ONE 4147 02:12:06,560 --> 02:12:09,080 HYPOTHESIZED REASON FOR ELEVATED 4148 02:12:09,080 --> 02:12:11,200 MORTALITY RATES IS DUE TO 4149 02:12:11,200 --> 02:12:12,200 DISPARITIES ALSO IN THE RECEIPT 4150 02:12:12,200 --> 02:12:17,160 OF CANCER TREATMENT. 4151 02:12:17,160 --> 02:12:19,160 SO DISPARITIES EXIST ALONG THE 4152 02:12:19,160 --> 02:12:20,960 CANCER CARE CONTINUUM, AND 4153 02:12:20,960 --> 02:12:23,960 PEOPLE WITH HIV HAVE POORER 4154 02:12:23,960 --> 02:12:25,360 SURVIVAL RATES, HIGHER 4155 02:12:25,360 --> 02:12:26,720 CANCER-SPECIFIC MORTALITY AND 4156 02:12:26,720 --> 02:12:27,680 ARE LESS LIKELY TO RECEIVE 4157 02:12:27,680 --> 02:12:28,760 CANCER TREATMENT. 4158 02:12:28,760 --> 02:12:30,600 AND IN ADDITION, THERE ARE 4159 02:12:30,600 --> 02:12:32,800 DISPARITIES OF QUALITY OF CANCER 4160 02:12:32,800 --> 02:12:34,600 TREATMENT RECEIVED RELATED TO 4161 02:12:34,600 --> 02:12:35,920 TREATMENT DELAY, LOWER DOSE OF 4162 02:12:35,920 --> 02:12:37,280 TREATMENT RECEIVED, AND NOT 4163 02:12:37,280 --> 02:12:39,760 RECEIVING GUIDELINE-CONCORDANT 4164 02:12:39,760 --> 02:12:40,040 CARE. 4165 02:12:40,040 --> 02:12:42,160 AND INTERESTINGLY ENOUGH, IN 4166 02:12:42,160 --> 02:12:46,440 WORK DONE BY JESSICA AND 4167 02:12:46,440 --> 02:12:47,840 COLLEAGUES, PEOPLE WITH HIV ARE 4168 02:12:47,840 --> 02:12:50,320 ACTUALLY MORE LIKELY TO RECEIVE 4169 02:12:50,320 --> 02:12:52,320 PALLIATIVE CARE IN LIEU OF KEEM 4170 02:12:52,320 --> 02:12:53,720 THEIR WHEN DIAGNOSED WITH STAGE 4171 02:12:53,720 --> 02:12:55,520 I, 2 OR 3 CANCER, YET THEY ARE 4172 02:12:55,520 --> 02:12:56,960 LESS LIKELY TO RECEIVE 4173 02:12:56,960 --> 02:12:59,680 PALLIATIVE CARE FOR STAGE IV 4174 02:12:59,680 --> 02:13:00,760 CANCER. 4175 02:13:00,760 --> 02:13:05,560 SOMSOME SOME OF THE REALLY FOUL 4176 02:13:05,560 --> 02:13:06,600 WORK SHOWN IN THIS AREA HAS 4177 02:13:06,600 --> 02:13:08,200 SHOWN THAT HIV STATUS HAS BEEN 4178 02:13:08,200 --> 02:13:09,400 ASSOCIATED WITH NON-RECEIPT OF 4179 02:13:09,400 --> 02:13:12,840 STANDARD OF CARE TREATMENT FOR 4180 02:13:12,840 --> 02:13:15,120 LOCAL STAGED CANCERS, WHICH IS 4181 02:13:15,120 --> 02:13:16,560 REALLY IMPORTANT SINCE THAT'S A 4182 02:13:16,560 --> 02:13:19,760 MISSED OPPORTUNITY. 4183 02:13:19,760 --> 02:13:21,440 SO CANCER TREATMENT DISPARITIES 4184 02:13:21,440 --> 02:13:24,040 ARE MULTILEVEL AND 4185 02:13:24,040 --> 02:13:25,320 MULTIFACTORIAL, AND IN WORK 4186 02:13:25,320 --> 02:13:28,440 ADAPTED BY THE SAME ONCOLOGIST, 4187 02:13:28,440 --> 02:13:29,120 SHE HIGHLIGHTS SEVERAL REASONS 4188 02:13:29,120 --> 02:13:31,720 FOR TREATMENT DISPARITIES AT THE 4189 02:13:31,720 --> 02:13:33,960 PATIENT, PROVIDER AND HEALTHCARE 4190 02:13:33,960 --> 02:13:35,360 SYSTEM LEVELS. 4191 02:13:35,360 --> 02:13:37,000 AND AN EXAMPLE OF A PATIENT 4192 02:13:37,000 --> 02:13:38,600 LEVEL DRIVER IS THE DUAL BURDEN 4193 02:13:38,600 --> 02:13:41,480 OF TWO CHRONIC CONDITIONS, AND 4194 02:13:41,480 --> 02:13:42,440 HERE'S AN EXAMPLE QUOTE THAT'S 4195 02:13:42,440 --> 02:13:43,640 PULLED FROM SOME QUALITATIVE 4196 02:13:43,640 --> 02:13:45,040 WORK IN WHICH THE PERSON STATED, 4197 02:13:45,040 --> 02:13:47,360 IT MADE ME FEEL LIKE SERIOUSLY, 4198 02:13:47,360 --> 02:13:48,240 WHAT NEXT? 4199 02:13:48,240 --> 02:13:52,200 NOW YOU GOT TWO DOZEN DIAGNOSES? 4200 02:13:52,200 --> 02:13:54,560 DEALING WITH BOTH IS A DOUBLE 4201 02:13:54,560 --> 02:13:55,120 BULLET. 4202 02:13:55,120 --> 02:13:57,920 AN EXAMPLE OF A PHYSICIAN-LEVEL 4203 02:13:57,920 --> 02:14:00,320 DRIVER HAS BEEN HYPOTHESIZED AS 4204 02:14:00,320 --> 02:14:01,520 LACK OF INTERDISCIPLINARY 4205 02:14:01,520 --> 02:14:02,280 COLLABORATIONS, AND 4206 02:14:02,280 --> 02:14:03,960 UNFORTUNATELY WE DON'T HAVE 4207 02:14:03,960 --> 02:14:05,920 GREAT DATA ABOUT THE CARE TEAM 4208 02:14:05,920 --> 02:14:07,560 COMPOSITION OF PEOPLE WITH HIV 4209 02:14:07,560 --> 02:14:08,640 OR FIRST DIAGNOSED WITH CANCER, 4210 02:14:08,640 --> 02:14:10,800 HOWEVER, WE CANNOT UNDERSCORE 4211 02:14:10,800 --> 02:14:11,920 THE IMPORTANCE OF CARE 4212 02:14:11,920 --> 02:14:13,200 COORDINATION BETWEEN INFECTIOUS 4213 02:14:13,200 --> 02:14:16,680 DISEASE AND ONCOLOGY DOCS. 4214 02:14:16,680 --> 02:14:18,800 AN EXAMPLE OF SYSTEMS LEVEL 4215 02:14:18,800 --> 02:14:20,720 BARRIER HAS BEEN POOR HEALTHCARE 4216 02:14:20,720 --> 02:14:21,400 ACCESSIBILITY WITH PEOPLE WITH 4217 02:14:21,400 --> 02:14:22,840 HIV BEING MORE LIKELY TO EITHER 4218 02:14:22,840 --> 02:14:28,880 BE UNINSURED OR UNDERINSURED. 4219 02:14:28,880 --> 02:14:31,360 SO WE WANTED TO UPDATE A PRIOR 4220 02:14:31,360 --> 02:14:33,280 ANALYSIS THAT EXAMINED CANCER 4221 02:14:33,280 --> 02:14:34,920 TREATMENT DISPARITIES IN PEOPLE 4222 02:14:34,920 --> 02:14:36,800 WITH HIV AND WE HAD TWO 4223 02:14:36,800 --> 02:14:37,600 OVERARCHING AIMS FOR THIS 4224 02:14:37,600 --> 02:14:38,160 PROJECT. 4225 02:14:38,160 --> 02:14:39,440 THE FIRST WAS TO ASSESS RECEIPT 4226 02:14:39,440 --> 02:14:41,160 OF ANY CANCER TREATMENT AMONG 4227 02:14:41,160 --> 02:14:44,480 PEOPLE WITH HIV COMPARED TO 4228 02:14:44,480 --> 02:14:45,440 THOSE WITHOUT, THEN WE REPEATED 4229 02:14:45,440 --> 02:14:47,120 THE SAME ANALYSIS FOR LOCAL 4230 02:14:47,120 --> 02:14:51,080 STAGE CANCERS TO ASSESS THE 4231 02:14:51,080 --> 02:14:52,840 RELATIONSHIP BETWEEN HIV STATUS 4232 02:14:52,840 --> 02:14:53,480 AND RECEIPT OF STANDARD 4233 02:14:53,480 --> 02:14:54,760 TREATMENT MODALITIES. 4234 02:14:54,760 --> 02:15:00,240 AND THE NEXT THEME, WE EXAMINED 4235 02:15:00,240 --> 02:15:01,480 PREDICTORS OF TREATMENT AMONG 4236 02:15:01,480 --> 02:15:02,320 PEOPLE WITH HIV. 4237 02:15:02,320 --> 02:15:04,640 AND TO ANSWER THESE AIMS, WE 4238 02:15:04,640 --> 02:15:06,320 UTILIZED THE HIV/AIDS CANCER 4239 02:15:06,320 --> 02:15:08,720 MATCH STUDY, WHICH INVOLVES A 4240 02:15:08,720 --> 02:15:11,360 LINKAGE OF 13 CANCER REGISTRIES 4241 02:15:11,360 --> 02:15:13,200 WITH HIV SURVEILLANCE DATA. 4242 02:15:13,200 --> 02:15:23,640 THE LINKAGE INVOLVES SO 4243 02:16:31,120 --> 02:16:33,600 HERE'S JUST AN OVERVIEW OF OUR 4244 02:16:33,600 --> 02:16:35,040 STUDY OF POPULATION. 4245 02:16:35,040 --> 02:16:37,320 THERE ARE APPROXIMATELY 16,700 4246 02:16:37,320 --> 02:16:40,280 PEOPLE WITH HIV AND A LITTLE 4247 02:16:40,280 --> 02:16:41,040 OVER 3 MILLION PEOPLE WITH 4248 02:16:41,040 --> 02:16:42,280 CANCER THAT WERE INCLUDED IN 4249 02:16:42,280 --> 02:16:43,920 THIS PARTICULAR STUDY. 4250 02:16:43,920 --> 02:16:45,760 THE MOST COMMON CANCERS IN 4251 02:16:45,760 --> 02:16:48,720 PEOPLE WITH HIV WERE LUNG, 4252 02:16:48,720 --> 02:16:50,160 DIFFUSE LARGE B CELL LYMPHOMA, 4253 02:16:50,160 --> 02:16:54,240 AND PROSTATE CANCER. 4254 02:16:54,240 --> 02:16:55,640 IN PEOPLE WITHOUT HIV, IT 4255 02:16:55,640 --> 02:16:56,440 DIFFERED SLIGHTLY. 4256 02:16:56,440 --> 02:16:57,640 IT HAPPENED TO BE BREAST, 4257 02:16:57,640 --> 02:17:01,480 PROSTATE AND LUNG CANCER. 4258 02:17:01,480 --> 02:17:03,840 SIMILAR TO THE HIV EPIDEMIC, 4259 02:17:03,840 --> 02:17:04,440 APPROXIMATELY THREE FOURTHS OF 4260 02:17:04,440 --> 02:17:06,120 PEOPLE WITH HIV WERE MALE WHILE 4261 02:17:06,120 --> 02:17:08,240 THE REMAINING QUARTER WERE 4262 02:17:08,240 --> 02:17:08,640 FEMALE. 4263 02:17:08,640 --> 02:17:10,040 THE AGE AT CANCER DIAGNOSIS 4264 02:17:10,040 --> 02:17:11,520 TENDED TO BE YOUNGER IN PEOPLE 4265 02:17:11,520 --> 02:17:13,160 WITH HIV, WITH ALMOST TWO THIRDS 4266 02:17:13,160 --> 02:17:15,880 OF DIAGNOSES OCCURRING IN THOSE 4267 02:17:15,880 --> 02:17:17,920 AGED 45 TO 65. 4268 02:17:17,920 --> 02:17:19,720 AND WHEN WE LOOK AT THE RACIAL 4269 02:17:19,720 --> 02:17:22,080 ETHNIC BREAKDOWN, IT'S SIMILARLY 4270 02:17:22,080 --> 02:17:23,400 ALSO NEAR THAT OF THE HIV 4271 02:17:23,400 --> 02:17:31,200 EPIDEMIC IN THE U.S. 4272 02:17:31,200 --> 02:17:33,000 SO WHEN WE LOOKED AT WHAT CANCER 4273 02:17:33,000 --> 02:17:34,160 SITES WERE LESS LIKELY TO 4274 02:17:34,160 --> 02:17:36,000 RECEIVE TREATMENT, YOU CAN SEE 4275 02:17:36,000 --> 02:17:40,200 ALL SITES HAD AN INCREASED ODDS 4276 02:17:40,200 --> 02:17:50,400 OF NO JOB TO 4277 02:29:01,600 --> 02:29:02,960 TREAT THE HIV, IT'S REALLY ONLY 4278 02:29:02,960 --> 02:29:06,200 TO WORRY ABOUT THE CANCER OR 4279 02:29:06,200 --> 02:29:06,560 VICE VERSA. 4280 02:29:06,560 --> 02:29:12,200 SO I THINK A LOT OF THE TIMES, 4281 02:29:12,200 --> 02:29:15,040 PATIENTS EITHER AREN'T -- WELL, 4282 02:29:15,040 --> 02:29:16,240 ACTUALLY I GUESS I CAN ONLY 4283 02:29:16,240 --> 02:29:19,120 SPECULATE, BUT MY FEELING FROM 4284 02:29:19,120 --> 02:29:20,120 BEING WITH IMMERSED IN THE HIV 4285 02:29:20,120 --> 02:29:21,440 CARE AND TREATMENT WORLD FOR 4286 02:29:21,440 --> 02:29:24,640 MANY YEARS BEFORE COMING TO NCI 4287 02:29:24,640 --> 02:29:28,280 IS THAT FOLKS ARE EITHER 4288 02:29:28,280 --> 02:29:29,480 UNDERTREATING PEOPLE WITH HIV OR 4289 02:29:29,480 --> 02:29:33,880 THEY'RE USING THE HIV AS AN 4290 02:29:33,880 --> 02:29:35,640 EXCUSE OR POTENTIAL CAUTION TO 4291 02:29:35,640 --> 02:29:37,640 NOT TREAT CANCER AS AGGRESSIVELY 4292 02:29:37,640 --> 02:29:39,960 AS THEY WOULD IN THOSE WITHOUT 4293 02:29:39,960 --> 02:29:41,560 HIV, AND SO I FEEL LIKE THAT'S 4294 02:29:41,560 --> 02:29:43,520 WHY IT IS SO IMPORTANT TO HAVE 4295 02:29:43,520 --> 02:29:47,200 ACTUAL GUIDANCE WITH THE NCC AND 4296 02:29:47,200 --> 02:29:47,880 CANCER GUIDELINES. 4297 02:29:47,880 --> 02:29:51,280 THEY ONLY WERE RELEASED IN LATE 4298 02:29:51,280 --> 02:29:52,160 2018/2019, SO THERE'S STILL SO 4299 02:29:52,160 --> 02:29:53,720 MUCH WORK TO BE DONE TO SEE, YOU 4300 02:29:53,720 --> 02:29:56,840 KNOW, FOR THOSE CLINICIANS, 4301 02:29:56,840 --> 02:30:05,400 ESPECIALLY WI WITHIN HIGH HIV 4302 02:30:05,400 --> 02:30:06,120 PREVALENCE, GIVEN INDIVIDUALS 4303 02:30:06,120 --> 02:30:07,440 KNOW WHO TO GO TO IF THEY HAVE 4304 02:30:07,440 --> 02:30:08,440 TREATMENT CONCERNS ABOUT 4305 02:30:08,440 --> 02:30:09,360 TOXICITY, YOU KNOW, ONE OF THE 4306 02:30:09,360 --> 02:30:10,520 OTHER THINGS I SHOULD SAY UP 4307 02:30:10,520 --> 02:30:12,640 FRONT TOO, WE DON'T HAVE ANY 4308 02:30:12,640 --> 02:30:14,600 INFORMATION ON THE ADDITIONAL 4309 02:30:14,600 --> 02:30:15,680 COMORBIDITIES THAT MIGHT BE IN 4310 02:30:15,680 --> 02:30:18,240 THIS POPULATION, SO WE DON'T 4311 02:30:18,240 --> 02:30:19,920 KNOW IF MAYBE TREATMENT IS 4312 02:30:19,920 --> 02:30:22,760 WITHHELD BECAUSE OF ADDITIONAL 4313 02:30:22,760 --> 02:30:23,600 COMORBIDITIES, BUT I STILL 4314 02:30:23,600 --> 02:30:26,040 THINK, YOU KNOW, FUTURE WORK IS 4315 02:30:26,040 --> 02:30:30,240 ALSO WARRANTED TO SEE HOW DO WE 4316 02:30:30,240 --> 02:30:31,000 ACHIEVE EQUITY WITHIN THIS 4317 02:30:31,000 --> 02:30:35,560 POPULATION. 4318 02:30:35,560 --> 02:30:36,200 >>THANK YOU. 4319 02:30:36,200 --> 02:30:37,520 YES, PLEASE AT THE BACK, GO 4320 02:30:37,520 --> 02:30:37,720 AHEAD. 4321 02:30:37,720 --> 02:30:38,400 >>THANK YOU. 4322 02:30:38,400 --> 02:30:39,960 CAN YOU HEAR ME? 4323 02:30:39,960 --> 02:30:43,360 >>YES, I CAN. 4324 02:30:43,360 --> 02:30:46,960 >>MY NAME IS JENNIFER 4325 02:30:46,960 --> 02:30:48,040 LANGELEER, I WORK AT THE 4326 02:30:48,040 --> 02:30:49,160 NATIONAL RURAL ONCOLOGY 4327 02:30:49,160 --> 02:30:51,240 COLLABORATIVE, SO WE'RE A PILOT 4328 02:30:51,240 --> 02:30:53,640 STUDY PROGRAM WORKING ON BRAIN 4329 02:30:53,640 --> 02:30:55,600 CANCER TO RURAL HOSPITALS AND 4330 02:30:55,600 --> 02:30:56,560 RURAL COMMUNITIES. 4331 02:30:56,560 --> 02:30:57,440 JUST A COMMENT THAT ACTUALLY AS 4332 02:30:57,440 --> 02:30:59,960 I STOOD UP HERE, YOU MENTIONED 4333 02:30:59,960 --> 02:31:01,720 IT, IS ON THE GROUND, WE'RE 4334 02:31:01,720 --> 02:31:02,960 REALLY SEEING QUITE A BIT OF 4335 02:31:02,960 --> 02:31:04,360 STIGMA, JUST EVEN JUST AROUND 4336 02:31:04,360 --> 02:31:06,880 CANCER AND PEOPLE COMING TO GET 4337 02:31:06,880 --> 02:31:09,520 TREATMENT. 4338 02:31:09,520 --> 02:31:12,080 BUT ALSO NOW WITH HIGH LEVELS OF 4339 02:31:12,080 --> 02:31:14,080 HIV IN THE SOUTH, THAT DOUBLE 4340 02:31:14,080 --> 02:31:16,280 WHAMMY STIGMA OF HIV AND CANCER 4341 02:31:16,280 --> 02:31:17,800 IN RURAL AND JUST KIND OF WANTED 4342 02:31:17,800 --> 02:31:19,200 TO COMMENT TO SEE IF THERE WAS 4343 02:31:19,200 --> 02:31:21,280 ANYTHING YOU HAD LOOKED AT IN 4344 02:31:21,280 --> 02:31:23,240 REGARDS TO RURALITY. 4345 02:31:23,240 --> 02:31:25,800 >>NO, UNFORTUNATELY I HAVE NOT 4346 02:31:25,800 --> 02:31:27,680 LOOKED AT RURALITY IN RELATION 4347 02:31:27,680 --> 02:31:30,480 TO THESE OUTCOMES. 4348 02:31:30,480 --> 02:31:31,560 UNFORTUNATELY SOME OF THE STATES 4349 02:31:31,560 --> 02:31:32,760 THAT WE COULD REALLY -- YOU 4350 02:31:32,760 --> 02:31:33,960 KNOW, THAT UNFORTUNATELY ARE 4351 02:31:33,960 --> 02:31:36,200 BEARING THE BRUNT OF HIV WITHIN 4352 02:31:36,200 --> 02:31:39,160 THE SOUTH, MISSISSIPPI, ALABAMA, 4353 02:31:39,160 --> 02:31:41,120 WE DO HAVE LGBTQIA, THEY ARE 4354 02:31:41,120 --> 02:31:43,040 ACTUALLY NOT INCLUDED IN OUR HIV 4355 02:31:43,040 --> 02:31:47,840 CANCER MATCH STUDY, SO I THINK 4356 02:31:47,840 --> 02:31:49,800 WE STILL DEFINITELY HAVE WORK TO 4357 02:31:49,800 --> 02:31:53,040 DO, BUT I ALSO THINK THAT IT'S 4358 02:31:53,040 --> 02:31:54,720 BY STATE, BY REGION, BY COUNTY, 4359 02:31:54,720 --> 02:31:57,760 IT CAN BE SO INCREDIBLY GRANULAR 4360 02:31:57,760 --> 02:31:59,120 THAT THE THINGS THAT ARE 4361 02:31:59,120 --> 02:32:00,400 RELEVANT AND IMPORTANT IN THE 4362 02:32:00,400 --> 02:32:03,040 CONTEXT IN THAT GIVEN LOCALE 4363 02:32:03,040 --> 02:32:03,920 MIGHT BE SO DIFFERENT. 4364 02:32:03,920 --> 02:32:05,400 THE NICE THING ABOUT THIS IS 4365 02:32:05,400 --> 02:32:06,240 WE'RE JUST TALKING ABOUT 4366 02:32:06,240 --> 02:32:07,600 TREATMENT DISPARITIES OVERALL 4367 02:32:07,600 --> 02:32:09,560 AND THE HOPE IS THEN TO DO A 4368 02:32:09,560 --> 02:32:10,880 DEEPER DIVE TO UNDERSTAND WHAT 4369 02:32:10,880 --> 02:32:14,080 MIGHT BE THE FACILITATORS OR THE 4370 02:32:14,080 --> 02:32:15,480 MECHANISMS WITHIN THESE 4371 02:32:15,480 --> 02:32:16,480 SPECIFICALLY LOCALES, EVEN IF 4372 02:32:16,480 --> 02:32:18,600 YOU LOOK AT POLICY, YOU KNOW, 4373 02:32:18,600 --> 02:32:20,280 ONE OF THE VARIABLES THAT WE 4374 02:32:20,280 --> 02:32:21,800 DON'T HAVE IN THIS INFORMATION 4375 02:32:21,800 --> 02:32:22,800 IS INSURANCE COVERAGE. 4376 02:32:22,800 --> 02:32:25,760 WHAT IS O DOES OUR POPULATION LK 4377 02:32:25,760 --> 02:32:27,360 LIKE, WHO IS PAYING FOR CANCER 4378 02:32:27,360 --> 02:32:28,800 TREATMENT? 4379 02:32:28,800 --> 02:32:31,600 IS IT RYAN WHITE, IS IT 4380 02:32:31,600 --> 02:32:34,280 MEDICAID, ARE THEY RECEIVING 4381 02:32:34,280 --> 02:32:35,360 CHARITY CARE, THEY'RE NOT ABLE 4382 02:32:35,360 --> 02:32:40,240 TO ENS A THAT ANSWER THAT WITHA 4383 02:32:40,240 --> 02:32:42,160 BUT IT WARRANTS FURTHER 4384 02:32:42,160 --> 02:32:42,800 EXPLORATION AND IT'S REALLY 4385 02:32:42,800 --> 02:32:43,880 IMPORTANT TO ACHIEVE EQUITY FOR 4386 02:32:43,880 --> 02:32:45,960 A POPULATION AT INCREASED VUL 4387 02:32:45,960 --> 02:32:49,440 NERVULNERABILITY AND STIGMA. 4388 02:32:49,440 --> 02:32:50,200 >>THANK YOU. 4389 02:32:50,200 --> 02:32:52,040 >>WELL, PLEASE GIVE ANOTHER 4390 02:32:52,040 --> 02:32:53,040 HAND FOR DR. MCGEE-AVILA. 4391 02:32:53,040 --> 02:32:59,400 [APPLAUSE] 4392 02:32:59,400 --> 02:33:00,400 GIVE US A MOMENT TO TRANSITION 4393 02:33:00,400 --> 02:33:01,600 TO OUR NEXT SPEAKER, WHICH IS 4394 02:33:01,600 --> 02:33:11,680 ME. 4395 02:33:23,680 --> 02:33:24,400 ALL RIGHT. 4396 02:33:24,400 --> 02:33:29,120 CAN EVERYONE HEAR ME ALL RIGHT? 4397 02:33:29,120 --> 02:33:30,880 OKAY. 4398 02:33:30,880 --> 02:33:33,160 SO I'M GOING TO BE CLOSING OUT 4399 02:33:33,160 --> 02:33:35,120 TODAY'S SESSION, AND I'M REALLY 4400 02:33:35,120 --> 02:33:37,080 HONORED TO FOLLOW TWO AMAZING 4401 02:33:37,080 --> 02:33:40,160 SPEAKERS BEFORE ME AND SHARE A 4402 02:33:40,160 --> 02:33:43,400 LITTLE BIT ABOUT A REE RECENT 4403 02:33:43,400 --> 02:33:45,560 PROJECT I'VE BEEN WORKING ON IN 4404 02:33:45,560 --> 02:33:48,400 THE LABORATORY OF HUMAN 4405 02:33:48,400 --> 02:33:49,760 CARCINOGENESIS IN CCR. 4406 02:33:49,760 --> 02:33:51,160 AS YOU'VE PROBABLY NOTICED MANY 4407 02:33:51,160 --> 02:33:52,720 OF THE TALKS SO FAR ARE CHASING 4408 02:33:52,720 --> 02:33:53,520 REALLY IMPORTANT QUESTIONS IN 4409 02:33:53,520 --> 02:33:54,960 THE DISPARITIES FIELD AT THE 4410 02:33:54,960 --> 02:33:55,920 POPULATION LEVEL. 4411 02:33:55,920 --> 02:33:57,360 SO IT MIGHT BE A LITTLE JARRING 4412 02:33:57,360 --> 02:33:59,240 GOING FROM SUCH A MACROSCOPIC 4413 02:33:59,240 --> 02:34:00,840 SCALE TO SUCH A MICRO SCROPG ONE 4414 02:34:00,840 --> 02:34:02,480 WITH THE WORK THAT I'LL PRESENT 4415 02:34:02,480 --> 02:34:03,120 TODAY. 4416 02:34:03,120 --> 02:34:06,440 BUT MY HOPE IS TO MAKE THIS TALK 4417 02:34:06,440 --> 02:34:10,160 AS ACCESSIBLE AND NOT BORING AS 4418 02:34:10,160 --> 02:34:11,240 POSSIBLE, AND HOPEFULLY CONVINCE 4419 02:34:11,240 --> 02:34:13,440 YOU THAT WE CAN REALLY LEVERAGE 4420 02:34:13,440 --> 02:34:15,680 CELL LINES TO ANSWER INTERESTING 4421 02:34:15,680 --> 02:34:17,440 QUESTIONS REGARDING GENETIC 4422 02:34:17,440 --> 02:34:18,960 ANCESTRY IN BREAST CANCER IN 4423 02:34:18,960 --> 02:34:22,320 WOMEN OF AFRICAN DESCE DESCENTST 4424 02:34:22,320 --> 02:34:23,040 ALSO TO PROVIDE SOME GUIDANCE 4425 02:34:23,040 --> 02:34:24,040 FOR THOSE WORKING WITH THESE 4426 02:34:24,040 --> 02:34:25,040 CELL LINES EVERY DAY AT THE 4427 02:34:25,040 --> 02:34:28,000 BENCH. 4428 02:34:28,000 --> 02:34:29,560 SO WE'VE HEARD A LOT SO FAR AND 4429 02:34:29,560 --> 02:34:32,120 WE ALSO KNOW FROM A WEALTH OF 4430 02:34:32,120 --> 02:34:37,360 LITERATURE THAT WOMEN OF AFRICAN 4431 02:34:37,360 --> 02:34:39,560 DESCENT HAVE A DISPROPORTIONATE 4432 02:34:39,560 --> 02:34:42,880 RISK OF DYING FROM A FORM OF 4433 02:34:42,880 --> 02:34:45,000 GRES TRIPLE NEGATIVE BREAST 4434 02:34:45,000 --> 02:34:45,960 CANCER ACROSS ALL POPULATION 4435 02:34:45,960 --> 02:34:46,200 GROUPS. 4436 02:34:46,200 --> 02:34:48,960 IN THE UNITED STATES, TRIPLE 4437 02:34:48,960 --> 02:34:50,840 NEGATIVE BREAST CANCER ACCOUNTS 4438 02:34:50,840 --> 02:34:52,040 FOR APPROXIMATELY 12% OF BREAST 4439 02:34:52,040 --> 02:34:52,800 CANCERS ON AVERAGE. 4440 02:34:52,800 --> 02:34:54,360 WHEN BROKEN DOWN BY RACE, WE SEE 4441 02:34:54,360 --> 02:34:55,760 THAT BLACK WOMEN ARE TWICE AS 4442 02:34:55,760 --> 02:34:57,040 LIKELY TO DEVELOP THIS 4443 02:34:57,040 --> 02:34:58,240 AGGRESSIVE DISEASE. 4444 02:34:58,240 --> 02:35:00,080 SO DESPITE HAVING A GENERALLY 4445 02:35:00,080 --> 02:35:01,160 LOWER INCIDENCE RATE, BLACK 4446 02:35:01,160 --> 02:35:03,080 WOMEN IN THE UNITED STATES ARE 4447 02:35:03,080 --> 02:35:04,720 40% MORE LIKELY TO DIE FROM 4448 02:35:04,720 --> 02:35:06,520 THEIR BREAST CANCER COMPARED TO 4449 02:35:06,520 --> 02:35:07,200 WHITE WOMEN. 4450 02:35:07,200 --> 02:35:09,600 AND THIS DISPARITY IN SURVIVAL 4451 02:35:09,600 --> 02:35:11,720 IS, AS WE'VE HEARD ALREADY IN 4452 02:35:11,720 --> 02:35:13,720 THIS SYMPOSIUM, EXTREMELY 4453 02:35:13,720 --> 02:35:15,560 COMPLEX AND A MULTIFACTORIAL 4454 02:35:15,560 --> 02:35:16,760 PROBLEM ATTRIBUTABLE TO BOTH 4455 02:35:16,760 --> 02:35:18,200 SOCIAL DETERMINANTS AND ALSO 4456 02:35:18,200 --> 02:35:19,080 BIOLOGICAL DETERMINANTS OF 4457 02:35:19,080 --> 02:35:21,080 HEALTH AND LIKELY A VERY DYNAMIC 4458 02:35:21,080 --> 02:35:23,040 INTERACTION BETWEEN THE TWO. 4459 02:35:23,040 --> 02:35:25,080 SO IT'S BELIEVED THAT GENETIC 4460 02:35:25,080 --> 02:35:26,520 FACTORS DO CONTRIBUTE IN PART TO 4461 02:35:26,520 --> 02:35:28,560 THE INCREASED RISK OF 4462 02:35:28,560 --> 02:35:30,160 BIOLOGICALLY AGGRESSIVE TUMOR 4463 02:35:30,160 --> 02:35:30,720 SUBTYPES. 4464 02:35:30,720 --> 02:35:32,360 AND SOME STUDIES HAVE INDICATED 4465 02:35:32,360 --> 02:35:34,080 THAT THE EXTENT OF AFRICAN 4466 02:35:34,080 --> 02:35:36,000 ANCESTRY ITSELF CORRELATES WITH 4467 02:35:36,000 --> 02:35:37,080 THE LIKELIHOOD OF BEING 4468 02:35:37,080 --> 02:35:38,520 DIAGNOSED WITH MORE AGGRESSIVE 4469 02:35:38,520 --> 02:35:39,520 BREAST CANCER SUBTYPES THAN 4470 02:35:39,520 --> 02:35:41,920 WOMEN FROM OTHER POPULATION 4471 02:35:41,920 --> 02:35:42,960 GROUPS. 4472 02:35:42,960 --> 02:35:44,960 SO RESEARCHERS HAVE FOUND THAT 4473 02:35:44,960 --> 02:35:46,960 TNBC IS MORE PREVALENT IN 4474 02:35:46,960 --> 02:35:48,040 AFRICAN AMERICAN WOMEN WHO CAN 4475 02:35:48,040 --> 02:35:50,280 TRACE THEIR ANCESTRY TO WESTERN 4476 02:35:50,280 --> 02:35:51,040 SUB-SAHARAN AFRICA. 4477 02:35:51,040 --> 02:35:53,120 AND INDEED IN SUB-SAHARAN 4478 02:35:53,120 --> 02:35:54,480 AFRICA, BREAST CANCER IS ALSO A 4479 02:35:54,480 --> 02:35:57,440 LEADING CAUSE OF DEATH. 4480 02:35:57,440 --> 02:35:58,760 OF CANCER DEATH AMONG AFRICAN 4481 02:35:58,760 --> 02:35:59,000 WOMEN. 4482 02:35:59,000 --> 02:36:01,000 AND MANY STUDYS HAVE FOUND THAT 4483 02:36:01,000 --> 02:36:02,640 TRIPLE NEGATIVE BREAST CANCER IS 4484 02:36:02,640 --> 02:36:04,200 MORE PREVALENT IN WESTERN 4485 02:36:04,200 --> 02:36:13,640 NATIONS LIKE GHANA -- WELL, 4486 02:36:13,640 --> 02:36:16,080 YOU'RE WELCOME FOR USING WEBEX. 4487 02:36:16,080 --> 02:36:16,640 [LAUGHTER] 4488 02:36:16,640 --> 02:36:19,320 SO YES, SO THERE'S CERTAINLY A 4489 02:36:19,320 --> 02:36:21,160 LOT THAT WE STILL DON'T KNOW 4490 02:36:21,160 --> 02:36:22,360 REGARDING THE EXTENT THIS BREAST 4491 02:36:22,360 --> 02:36:27,040 CANCER IN AFRICA IS -- BREAST 4492 02:36:27,040 --> 02:36:29,480 CANCER IN AFRICAN AMERICAN WOMEN 4493 02:36:29,480 --> 02:36:30,960 AND GENETIC ANCESTRY IN 4494 02:36:30,960 --> 02:36:32,040 PARTICULAR TO DISEASE 4495 02:36:32,040 --> 02:36:32,640 AGGRESSIVENESS. 4496 02:36:32,640 --> 02:36:34,440 SO THIS IS A VERY COMPLEX ISSUE 4497 02:36:34,440 --> 02:36:36,000 IN RESEARCH THAT'S FURTHER 4498 02:36:36,000 --> 02:36:36,880 COMPLICATED BY THE FACT THAT 4499 02:36:36,880 --> 02:36:39,280 MANY STUDIES IN THE U.S. USE 4500 02:36:39,280 --> 02:36:40,680 SELF-REPORTED RACE AS A PROXY 4501 02:36:40,680 --> 02:36:42,440 FOR ANCESTRY, AND WE GOT A GREAT 4502 02:36:42,440 --> 02:36:45,480 PRIMER ON THAT FROM LORD, AND 4503 02:36:45,480 --> 02:36:48,800 ALSO RECENT STUDIES BY MELISSA 4504 02:36:48,800 --> 02:36:50,240 DAVIS' GROUP INCLUDING WORK LED 4505 02:36:50,240 --> 02:36:52,560 BY DR. RACHEL MARTINI WHO'S IN 4506 02:36:52,560 --> 02:36:54,000 THE FRONT ROW AND GAVE A 4507 02:36:54,000 --> 02:36:54,920 FANTASTIC TALK YESTERDAY THAT I 4508 02:36:54,920 --> 02:36:57,960 HOPE EVERYONE HAD A CHANCE TO 4509 02:36:57,960 --> 02:36:59,880 HEAR, HAVE BEGAN TO REALLY KIND 4510 02:36:59,880 --> 02:37:01,320 OF DISENTANGLE SELF-REPORTED 4511 02:37:01,320 --> 02:37:02,080 RACE FROM ANCESTRY. 4512 02:37:02,080 --> 02:37:03,720 IN THIS STUDY, FINDING THAT 4513 02:37:03,720 --> 02:37:05,200 ALMOST 50% OF GENE EXPRESSION 4514 02:37:05,200 --> 02:37:06,400 ASSOCIATED WITH ANCESTRY WAS 4515 02:37:06,400 --> 02:37:07,480 DISTINCT FROM THAT ASSOCIATED 4516 02:37:07,480 --> 02:37:10,560 WITH SELF-REPORTED RACE. 4517 02:37:10,560 --> 02:37:13,480 IN TRIPLE NEGATIVE BREAST 4518 02:37:13,480 --> 02:37:15,880 CANCERS FROM ADDMIXED AFRICAN 4519 02:37:15,880 --> 02:37:16,240 AMERICAN WOMEN. 4520 02:37:16,240 --> 02:37:17,680 SO WE WERE REALLY INTERESTED IN 4521 02:37:17,680 --> 02:37:18,920 THIS AND DECIDED TO TAKE THE 4522 02:37:18,920 --> 02:37:21,120 ABSOLUTE MOST REDUCTIONIST 4523 02:37:21,120 --> 02:37:22,640 APPROACH POSSIBLE TO LOOK AT HOW 4524 02:37:22,640 --> 02:37:27,200 GENETIC ANCESTRY INFLUENCED THE 4525 02:37:27,200 --> 02:37:29,720 PROPERTIES IN A DISH DERIVED 4526 02:37:29,720 --> 02:37:30,680 FROM EITHER AFRICAN AMERICAN 4527 02:37:30,680 --> 02:37:32,080 WOMEN OR EUROPEAN-AMERICAN 4528 02:37:32,080 --> 02:37:34,000 WOMEN. 4529 02:37:34,000 --> 02:37:36,200 SO WE'RE USING THESE HUMAN 4530 02:37:36,200 --> 02:37:37,200 TRIPLE NEGATIVE BREAST CANCER 4531 02:37:37,200 --> 02:37:39,600 CELL LINES THAT ARE ACTUALLY 4532 02:37:39,600 --> 02:37:40,840 INCREDIBLY COMMON IN BIOMEDICAL 4533 02:37:40,840 --> 02:37:41,440 RESEARCH. 4534 02:37:41,440 --> 02:37:42,160 FOR THOSE THAT AREN'T FAMILIAR 4535 02:37:42,160 --> 02:37:43,240 WITH THE TERM CELL LINES, SO 4536 02:37:43,240 --> 02:37:44,600 THESE ARE CELLS THAT WERE 4537 02:37:44,600 --> 02:37:46,960 ORIGINALLY ISOLATED FROM A 4538 02:37:46,960 --> 02:37:48,680 PATIENT TUMOR AND CAN BE 4539 02:37:48,680 --> 02:37:49,600 CULTURED ALMOST INDEFINITELY IN 4540 02:37:49,600 --> 02:37:49,920 THE LAB. 4541 02:37:49,920 --> 02:37:52,400 AND UNDER THE PROPER GROWTH 4542 02:37:52,400 --> 02:37:55,400 CONDITIONS, THEY CAN RETAIN MANY 4543 02:37:55,400 --> 02:38:05,760 OF THE SAME GENETIC 4544 02:41:10,720 --> 02:41:12,600 WHERE THERE WAS AN EXTREME 4545 02:41:12,600 --> 02:41:13,200 MISCLASSIFICATION ERROR IN A 4546 02:41:13,200 --> 02:41:13,800 CELL LINE. 4547 02:41:13,800 --> 02:41:15,120 THIS CAN NEGATIVELY IMPACT THE 4548 02:41:15,120 --> 02:41:16,160 FIELD IN MANY WAYS. 4549 02:41:16,160 --> 02:41:17,560 SO I THINK THAT VIGILANCE IS 4550 02:41:17,560 --> 02:41:18,360 IMPORTANT HERE WHEN YOU'RE 4551 02:41:18,360 --> 02:41:21,640 WORKING WITH THESE IN THE LAB. 4552 02:41:21,640 --> 02:41:23,040 NOW THAT I'VE DELIVERED MY 4553 02:41:23,040 --> 02:41:25,160 FRIENDLY PSA, WE DECIDED TO TAKE 4554 02:41:25,160 --> 02:41:26,400 AN EPIGENETIC APPROACH BECAUSE 4555 02:41:26,400 --> 02:41:28,000 THE EPIGENETICS OF RACIAL AND 4556 02:41:28,000 --> 02:41:29,320 POPULATION DIVERSITY IN THE 4557 02:41:29,320 --> 02:41:30,480 CONTEXT OF TRIPLE NEGATIVE 4558 02:41:30,480 --> 02:41:32,760 BREAST CANCER IS GENERALLY AN 4559 02:41:32,760 --> 02:41:33,360 UNDERINVESTIGATED AREA. 4560 02:41:33,360 --> 02:41:36,240 SO WE PERFORMED SOMETHING CALLED 4561 02:41:36,240 --> 02:41:37,640 ATAC SEQUENCING TO PROFILE 4562 02:41:37,640 --> 02:41:39,200 BASICALLY HOW OPEN OR CLOSED THE 4563 02:41:39,200 --> 02:41:40,920 DNA IS IN THESE CELLS. 4564 02:41:40,920 --> 02:41:42,640 AND THIS CAN GIVE US A TON OF 4565 02:41:42,640 --> 02:41:44,400 INFORMATION NOT ONLY ABOUT GENE 4566 02:41:44,400 --> 02:41:46,040 EXPRESSION BUT ALSO ABOUT 4567 02:41:46,040 --> 02:41:47,640 TRANSCRIPTION FACTOR ACTIVITY 4568 02:41:47,640 --> 02:41:51,680 AND GENE REGULATORY NETWORKS. 4569 02:41:51,680 --> 02:41:53,520 WE HAD TWO MAIN GOALS IN THIS 4570 02:41:53,520 --> 02:41:54,520 STUDY, SO FIRST TO UNDERSTAND IF 4571 02:41:54,520 --> 02:41:55,880 THERE ARE DIFFERENCES IN 4572 02:41:55,880 --> 02:41:58,320 CHROMATIN ACCESSIBILITY BETWEEN 4573 02:41:58,320 --> 02:42:02,760 EA D DERIVED AND AA DERIVED CELL 4574 02:42:02,760 --> 02:42:04,400 LINES AND ALSO HOW DO THOSE 4575 02:42:04,400 --> 02:42:05,240 DIFFERENCES IMPACT THE BIOLOGY 4576 02:42:05,240 --> 02:42:07,040 OF THESE CANCER CELLS IN 4577 02:42:07,040 --> 02:42:08,480 MEANINGFUL WAYS. 4578 02:42:08,480 --> 02:42:10,680 SO WE WONDERED WHETHER CHROMATIN 4579 02:42:10,680 --> 02:42:12,480 PROFILES EVEN SEPARATED BY 4580 02:42:12,480 --> 02:42:13,280 GENETIC ANCESTRY, AND IT TURNS 4581 02:42:13,280 --> 02:42:14,600 OUT THAT THEY DO, WHICH YOU CAN 4582 02:42:14,600 --> 02:42:17,000 SEE HERE ON THIS PCA. 4583 02:42:17,000 --> 02:42:19,040 AND WHEN WE LOOKED AT 4584 02:42:19,040 --> 02:42:20,120 DIFFERENTIALLY OPEN OR 4585 02:42:20,120 --> 02:42:24,120 ACCESSIBLE REGIONS AT KIND OF A 4586 02:42:24,120 --> 02:42:25,640 ZOOMED OUT BIRD'S-EYE VIEW 4587 02:42:25,640 --> 02:42:28,960 ACROSS CHROME ZONES, WE SAW 4588 02:42:28,960 --> 02:42:30,040 AFRICAN AMERICAN CELLS SHOWED A 4589 02:42:30,040 --> 02:42:31,560 DISTINCT CHROMATIN PATTERN OF 4590 02:42:31,560 --> 02:42:32,400 ACCESSIBILITY SO THIS KIND OF 4591 02:42:32,400 --> 02:42:33,480 GAVE US AN INDICATION THAT THERE 4592 02:42:33,480 --> 02:42:36,080 MAY INDEED BE SOME GENOME-WIDE 4593 02:42:36,080 --> 02:42:37,800 DIFFERENCES IN CHROMATIN BY 4594 02:42:37,800 --> 02:42:39,120 GENETIC ANCESTRY. 4595 02:42:39,120 --> 02:42:41,440 SO NEXT WE WONDERED, DOES 4596 02:42:41,440 --> 02:42:42,960 TRANSCRIPTION FACTOR BINDING AND 4597 02:42:42,960 --> 02:42:44,880 ACTIVITY DIFFER BY GENETIC 4598 02:42:44,880 --> 02:42:46,080 ANCESTRY IN TRIPLE NEGATIVE 4599 02:42:46,080 --> 02:42:47,320 BREAST CANCER? 4600 02:42:47,320 --> 02:42:49,280 BUT FIRST WHY DO WE CARE ABOUT 4601 02:42:49,280 --> 02:42:51,320 TRANSCRIPTION FACTORS? 4602 02:42:51,320 --> 02:42:52,320 SO TRANSCRIPTION FACTORS ARE A 4603 02:42:52,320 --> 02:42:54,640 CLASS OF PROTEIN THAT IS 4604 02:42:54,640 --> 02:42:55,880 ABSOLUTELY ESSENTIAL FOR 4605 02:42:55,880 --> 02:42:57,200 REGULATING GENE EXPRESSION. 4606 02:42:57,200 --> 02:42:59,240 AND THEY DO SO BY BINDING DNA AT 4607 02:42:59,240 --> 02:43:03,240 SPECIFIC PLACES CALLED MOTIFS. 4608 02:43:03,240 --> 02:43:05,800 AND THIS CAN ALTER THE CHROMATIN 4609 02:43:05,800 --> 02:43:06,120 ENVIRONMENT. 4610 02:43:06,120 --> 02:43:07,560 AND IMPORTANTLY, WHEN THINGS GO 4611 02:43:07,560 --> 02:43:09,360 WRONG, WHICH THEY OFTEN DO IN 4612 02:43:09,360 --> 02:43:10,880 CANCER, USUALLY THROUGH 4613 02:43:10,880 --> 02:43:13,360 MUTATIONS OR DYSREGULATION OF 4614 02:43:13,360 --> 02:43:14,440 SOME KIND, TRANSCRIPTION FACTORS 4615 02:43:14,440 --> 02:43:15,960 CAN ACTUALLY END UP MAKING 4616 02:43:15,960 --> 02:43:17,400 CANCER A LOT WORSE. 4617 02:43:17,400 --> 02:43:19,080 SO PERHAPS UNSURPRISINGLY THEY 4618 02:43:19,080 --> 02:43:20,640 PLAY A CRITICAL ROLE IN BOTH 4619 02:43:20,640 --> 02:43:22,720 CANCER INITIATION AND ALSO 4620 02:43:22,720 --> 02:43:23,960 PROGRESSION SO THERE'S ACTUALLY 4621 02:43:23,960 --> 02:43:25,240 A LOT OF RESEARCH THAT'S 4622 02:43:25,240 --> 02:43:26,920 DEDICATED TO HOW TO POTENTIALLY 4623 02:43:26,920 --> 02:43:29,280 TARGET THESE THINGS 4624 02:43:29,280 --> 02:43:30,920 THERAPEUTICALLY. 4625 02:43:30,920 --> 02:43:32,040 SO TO ANSWER OUR QUESTION WE 4626 02:43:32,040 --> 02:43:33,400 FIRST IDENTIFIED CHROMATIN 4627 02:43:33,400 --> 02:43:34,360 REGIONS THAT WERE DIFFERENTIALLY 4628 02:43:34,360 --> 02:43:36,200 OPEN OR ACCESSIBLE BY ANCESTRY. 4629 02:43:36,200 --> 02:43:37,760 AND THEN WE LOOKED WITHIN EACH 4630 02:43:37,760 --> 02:43:45,000 OF THOSE REGIONS OF THESE MOTIFS 4631 02:43:45,000 --> 02:43:46,360 AND PLOTTED HERE IS A HEAT MAP 4632 02:43:46,360 --> 02:43:49,120 SHOWING THE TOP 50 MOST VARIABLE 4633 02:43:49,120 --> 02:43:50,120 TRANSCRIPTION FACTORS BY 4634 02:43:50,120 --> 02:43:50,560 ANCESTRY. 4635 02:43:50,560 --> 02:43:52,440 AND I'M NOT GOING TO BORE YOU BY 4636 02:43:52,440 --> 02:43:54,360 GETTING TOO INTO THE WEEDS HERE, 4637 02:43:54,360 --> 02:43:56,440 BUT I'LL SUMMARIZE IT BY SAYING 4638 02:43:56,440 --> 02:43:57,880 THAT TRIPLE NEGATIVE BREAST 4639 02:43:57,880 --> 02:43:59,160 CANCER CELLS FROM AFRICAN 4640 02:43:59,160 --> 02:44:01,320 AMERICAN WOMEN, WE SAW AN 4641 02:44:01,320 --> 02:44:02,400 OVERABUNDANCE IN CERTAIN 4642 02:44:02,400 --> 02:44:04,160 TRANSCRIPTION FACTORS -- 4643 02:44:04,160 --> 02:44:06,160 FAMILIES AND SUBFAMILIES, MANY 4644 02:44:06,160 --> 02:44:07,840 OF WHICH HAPPEN TO HAVE SUPER 4645 02:44:07,840 --> 02:44:10,480 WEIRD NAMES LIKE THERE'S GRAINY 4646 02:44:10,480 --> 02:44:21,040 HEAD AND FORK HEAD BOX, WHICH IS 4647 02:50:07,120 --> 02:50:07,800 CANCER CELL LINES ARE USED 4648 02:50:07,800 --> 02:50:09,960 ROUTINELY IN BIOMEDICAL AND 4649 02:50:09,960 --> 02:50:10,520 PRE-CLINICAL STUDIES AND FOR 4650 02:50:10,520 --> 02:50:12,280 BETTER OR FOR WORSE, THESE ARE 4651 02:50:12,280 --> 02:50:13,240 THE DISCOVERY TOOLS IN CANCER 4652 02:50:13,240 --> 02:50:14,240 RESEARCH. 4653 02:50:14,240 --> 02:50:16,840 SO THIS MEANS THAT ISSUES AND A 4654 02:50:16,840 --> 02:50:19,600 LACK OF RIGOR AT THIS MOST BASIC 4655 02:50:19,600 --> 02:50:21,080 LEVEL CAN ACTUALLY HAVE PRETTY 4656 02:50:21,080 --> 02:50:23,120 PROFOUND RIPPLE EFFECTS LATER ON 4657 02:50:23,120 --> 02:50:25,280 IN THE BIOMEDICAL RESEARCH AND 4658 02:50:25,280 --> 02:50:28,640 DRUG DEVELOPMENT PIPELINE. 4659 02:50:28,640 --> 02:50:30,960 MUCH LIKE GENETIC STUDIES AND 4660 02:50:30,960 --> 02:50:32,200 CLINICAL TRIALS AT THE 4661 02:50:32,200 --> 02:50:36,480 MACROSCOPIC LEVEL, WE SEE TH THE 4662 02:50:36,480 --> 02:50:37,760 SAME ISSUE CONTINUE AT THE 4663 02:50:37,760 --> 02:50:39,400 MICROSCOPIC LEVEL, WHERE THERE 4664 02:50:39,400 --> 02:50:49,680 REMAINS A REALLY 4665 02:52:23,320 --> 02:52:23,720 YOUR ATTENTION. 4666 02:52:23,720 --> 02:52:30,320 [APPLAUSE] 4667 02:52:30,320 --> 02:52:32,600 AND PERHAPS, STEFAN, YOU CAN 4668 02:52:32,600 --> 02:52:33,600 MODERATE ANY SLIDO QUESTIONS 4669 02:52:33,600 --> 02:52:35,400 THAT COME IN. 4670 02:52:35,400 --> 02:52:38,040 >>THANKS FOR A GREAT TALK. 4671 02:52:38,040 --> 02:52:40,040 I WAS REALLY INTERESTED IN YOUR 4672 02:52:40,040 --> 02:52:43,560 FINDING ABOUT THE P53 IN THAT 4673 02:52:43,560 --> 02:52:47,440 CONNECTIVITY NETWORK, AND I JUST 4674 02:52:47,440 --> 02:52:48,400 WONDERED, THINKING ABOUT THE 4675 02:52:48,400 --> 02:52:50,360 DRIVER MUTATIONS, WE KNOW THAT 4676 02:52:50,360 --> 02:52:52,000 P53 MUTATIONS ARE MORE COMMON IN 4677 02:52:52,000 --> 02:52:55,080 BLACK WOMEN, AND IS IT A FACTOR 4678 02:52:55,080 --> 02:52:55,920 THAT'S CONTROLLED FOR IN THESE 4679 02:52:55,920 --> 02:52:57,800 KINDS OF ANALYSES WHAT THE 4680 02:52:57,800 --> 02:52:59,640 DRIVER MUTATIONS ARE IN EACH OF 4681 02:52:59,640 --> 02:53:01,600 THESE DIFFERENT TRIPLE NEGATIVE 4682 02:53:01,600 --> 02:53:03,800 CELL LINES OR IS THERE MUCH 4683 02:53:03,800 --> 02:53:05,200 DIVERSITY WITH RESPECT TO THOSE 4684 02:53:05,200 --> 02:53:06,600 MUTATIONS IN THESE LINES? 4685 02:53:06,600 --> 02:53:08,040 >>THAT'S A GREAT QUESTION. 4686 02:53:08,040 --> 02:53:09,600 THANK YOU SO MUCH. 4687 02:53:09,600 --> 02:53:12,080 YES, SO ACTUALLY EACH OF THESE 4688 02:53:12,080 --> 02:53:13,440 LINES -- WHAT YOU SAID IS 4689 02:53:13,440 --> 02:53:14,520 COMPLETELY TRUE, BUT IT JUST SO 4690 02:53:14,520 --> 02:53:15,360 HAPPENED THAT EACH OF THESE 4691 02:53:15,360 --> 02:53:19,200 LINES DO HAVE P53 MUTATIONS, 4692 02:53:19,200 --> 02:53:20,000 WHICH IS INTERESTING. 4693 02:53:20,000 --> 02:53:21,600 I DON'T KNOW THE EXACT NATURE OF 4694 02:53:21,600 --> 02:53:23,280 THOSE MUTATIONS. 4695 02:53:23,280 --> 02:53:24,760 I KNOW WHAT I'VE BEEN ABLE TO 4696 02:53:24,760 --> 02:53:27,160 PULL FROM ATCC, WI BUT I THINK T 4697 02:53:27,160 --> 02:53:28,280 THAT'S KIND OF INTERESTING IN 4698 02:53:28,280 --> 02:53:29,760 AND OF ITSELF THAT, WHILE ALL 4699 02:53:29,760 --> 02:53:31,520 THE LINES HAVE P53 MUTATIONS, 4700 02:53:31,520 --> 02:53:33,480 WHICH IS SO COMMON IN TRIPLE 4701 02:53:33,480 --> 02:53:35,000 NEGATIVE BREAST CANCER CELLS, WE 4702 02:53:35,000 --> 02:53:37,760 SAW THAT SIGNAL POP OUT 4703 02:53:37,760 --> 02:53:39,400 SPECIFICALLY ASSOCIATED WITH 4704 02:53:39,400 --> 02:53:40,560 AFRICAN ANCESTRY. 4705 02:53:40,560 --> 02:53:41,200 SO DEFINITELY SOMETHING THAT I 4706 02:53:41,200 --> 02:53:41,800 THINK SHOULD BE EXPLORED 4707 02:53:41,800 --> 02:53:42,440 FURTHER. 4708 02:53:42,440 --> 02:53:45,080 >>THANK YOU. 4709 02:53:45,080 --> 02:53:48,480 >>FANTASTIC TALK. 4710 02:53:48,480 --> 02:53:51,480 SO MAYBE I MIGHT HAVE MISSED IT, 4711 02:53:51,480 --> 02:53:55,880 BUT IN YOUR PCA ANALYSIS, THEY 4712 02:53:55,880 --> 02:53:57,600 NICELY SEPARATE BASED ON THE 4713 02:53:57,600 --> 02:53:59,440 ANCESTRY, AND I WONDER IF 4714 02:53:59,440 --> 02:54:02,960 THERE'S OTHER -- IF YOU SEE ANY 4715 02:54:02,960 --> 02:54:05,880 SKEW IN OTHER POTENTIALLY 4716 02:54:05,880 --> 02:54:09,080 CONFOUNDING FACTORS LIKE -- 4717 02:54:09,080 --> 02:54:11,360 CULTURE -- [INAUDIBLE] CELL 4718 02:54:11,360 --> 02:54:15,960 LINES WERE ESTABLISHED, THAT'S 4719 02:54:15,960 --> 02:54:17,120 MY FIRST QUESTION. 4720 02:54:17,120 --> 02:54:19,000 THEN SECONDLY I WAS STRUCK BY 4721 02:54:19,000 --> 02:54:24,120 YOUR FINDINGS IN -- [INAUDIBLE] 4722 02:54:24,120 --> 02:54:29,680 SO I WONDER IF THE METHYLATION 4723 02:54:29,680 --> 02:54:30,280 PATTERN [INAUDIBLE] 4724 02:54:30,280 --> 02:54:30,720 >>THANK YOU SO MUCH. 4725 02:54:30,720 --> 02:54:32,200 THOSE ARE BOTH GREAT QUESTIONS. 4726 02:54:32,200 --> 02:54:33,440 SO TO ANSWER YOUR QUESTION 4727 02:54:33,440 --> 02:54:35,800 FIRST, I THINK IT'S A REALLY 4728 02:54:35,800 --> 02:54:36,560 IMPORTANT ONE. 4729 02:54:36,560 --> 02:54:38,520 SO THESE EXPERIMENTS WERE DONE, 4730 02:54:38,520 --> 02:54:40,400 ALL THE LINES WERE GROWING IN 4731 02:54:40,400 --> 02:54:43,320 TANDEM, BUT HAVE NOT 4732 02:54:43,320 --> 02:54:43,960 INVESTIGATED SPECIFICALLY 4733 02:54:43,960 --> 02:54:45,520 LOOKING AT SOME OF THOSE 4734 02:54:45,520 --> 02:54:47,520 FACTORS, BUT IT IS IMPORTANT TO 4735 02:54:47,520 --> 02:54:49,200 REMEMBER THAT THINGS DO CHANGE 4736 02:54:49,200 --> 02:54:52,480 AS CELL LINES CONTINUE, AND MORE 4737 02:54:52,480 --> 02:54:55,080 PASSAGES ARE INCURRED. 4738 02:54:55,080 --> 02:54:57,040 GENERALLY WE TRY TO DO OUR DUE 4739 02:54:57,040 --> 02:54:59,000 DILIGENCE AND KEEP THINGS IN 4740 02:54:59,000 --> 02:55:00,000 LOGARITHMIC PHASE OF GROWTH AND 4741 02:55:00,000 --> 02:55:01,520 MAKE SURE THEY DON'T GET PAST A 4742 02:55:01,520 --> 02:55:03,240 CERTAIN POINT WITH PASSAGE 4743 02:55:03,240 --> 02:55:03,880 NUMBER, BUT DEFINITELY SOMETHING 4744 02:55:03,880 --> 02:55:06,440 THAT NEEDS TO BE CONTROLLED FOR. 4745 02:55:06,440 --> 02:55:07,720 AND RELATIVE TO YOUR SECOND 4746 02:55:07,720 --> 02:55:11,400 QUESTION, CAN YOU REPEAT THE 4747 02:55:11,400 --> 02:55:12,000 TARGETS THAT YOU MENTIONED? 4748 02:55:12,000 --> 02:55:14,160 I DIDN'T CATCH THEM. 4749 02:55:14,160 --> 02:55:15,240 >>[INAUDIBLE] 4750 02:55:15,240 --> 02:55:16,320 >>SO IT'S REALLY INTERESTING. 4751 02:55:16,320 --> 02:55:17,520 SO RIGHT NOW WE'RE ACTUALLY KIND 4752 02:55:17,520 --> 02:55:19,560 OF WORKING ON CHASING SOME OF 4753 02:55:19,560 --> 02:55:20,080 THOSE LEADS. 4754 02:55:20,080 --> 02:55:23,600 I DO THINK, LIKE, BECAUSE OF -- 4755 02:55:23,600 --> 02:55:25,000 THAT METHYLATION WOULD BE A VERY 4756 02:55:25,000 --> 02:55:26,640 LOGICAL NEXT STEP IN THIS STUDY, 4757 02:55:26,640 --> 02:55:27,960 BUT NOT SOMETHING THAT WE'VE 4758 02:55:27,960 --> 02:55:29,880 INVESTIGATED SPECIFICALLY. 4759 02:55:29,880 --> 02:55:33,160 THANK YOU. 4760 02:55:33,160 --> 02:55:33,920 GLG HI. 4761 02:55:33,920 --> 02:55:35,040 REALLY ENGAGING TALK. 4762 02:55:35,040 --> 02:55:36,560 SO MY QUESTION IS RELATED TO 4763 02:55:36,560 --> 02:55:40,160 DRIVER MUTATIONS AND IN YOUR 4764 02:55:40,160 --> 02:55:42,120 CELL LINE MODEL, ARE YOU ABLE TO 4765 02:55:42,120 --> 02:55:45,080 MEASURE THINGS LIKE TUMOR 4766 02:55:45,080 --> 02:55:46,080 MUTATION BURDEN? 4767 02:55:46,080 --> 02:55:47,200 BECAUSE THAT COULD POTENTIALLY 4768 02:55:47,200 --> 02:55:49,080 BE VERY HELPFUL IF YOU'RE REALLY 4769 02:55:49,080 --> 02:55:50,600 TRYING TO DRAW PARALLELS BETWEEN 4770 02:55:50,600 --> 02:55:53,040 WHAT CAN BE DONE CLINICALLY AND 4771 02:55:53,040 --> 02:55:54,760 WHAT YOU'RE TRYING TO DO IN A 4772 02:55:54,760 --> 02:55:55,600 DISH. 4773 02:55:55,600 --> 02:55:56,280 >>THAT'S ANOTHER GREAT 4774 02:55:56,280 --> 02:55:57,320 QUESTION. 4775 02:55:57,320 --> 02:55:59,320 SO WE HAVE KIND OF A GENERAL 4776 02:55:59,320 --> 02:56:01,040 UNDERSTANDING OF SOME OF THE 4777 02:56:01,040 --> 02:56:03,040 MAIN, YOU KNOW, SOURCES OF 4778 02:56:03,040 --> 02:56:03,840 MUTATIONS, KIND OF THE BIG ONES 4779 02:56:03,840 --> 02:56:05,960 THAT WE WERE ABLE TO PULL FROM 4780 02:56:05,960 --> 02:56:07,800 ATCC, BUT THAT SAID, I THINK 4781 02:56:07,800 --> 02:56:10,040 THOSE DATA DEFINITELY EXIST, YOU 4782 02:56:10,040 --> 02:56:11,680 KNOW, IN REPOSITORIES AND IT'S 4783 02:56:11,680 --> 02:56:14,640 SOMETHING THAT WE COULD LOOK AT 4784 02:56:14,640 --> 02:56:16,720 MORE SPECIFICALLY, WE JUST 4785 02:56:16,720 --> 02:56:18,280 HAVEN'T YET, BUT THAT'S A GREAT 4786 02:56:18,280 --> 02:56:18,520 QUESTION. 4787 02:56:18,520 --> 02:56:24,800 THANK YOU. 4788 02:56:24,800 --> 02:56:25,640 >>HI. 4789 02:56:25,640 --> 02:56:26,120 GREAT TALK. 4790 02:56:26,120 --> 02:56:30,120 I JUST HAD TWO GENERIC QUESTI 4791 02:56:30,120 --> 02:56:30,400 QUESTIONS. 4792 02:56:30,400 --> 02:56:32,600 I THINK I MAY HAVE MISSED IT IN 4793 02:56:32,600 --> 02:56:33,640 YOUR PATHWAY ENRICHMENT 4794 02:56:33,640 --> 02:56:34,840 ANALYSIS, BUT IN YOUR FINDINGS 4795 02:56:34,840 --> 02:56:37,080 AS FAR AS THE GENES, DID YOU SEE 4796 02:56:37,080 --> 02:56:39,000 ANY GENES ASSOCIATED WITH 4797 02:56:39,000 --> 02:56:43,360 RESISTANCE AS FAR AS AFRICAN 4798 02:56:43,360 --> 02:56:44,680 ANCESTRY COMPARED TO THE 4799 02:56:44,680 --> 02:56:45,840 EUROPEAN ANCESTRY? 4800 02:56:45,840 --> 02:56:47,880 >>WITH THERAPEUTIC RESISTANCE? 4801 02:56:47,880 --> 02:56:48,120 YES. Y 4802 02:56:48,120 --> 02:56:50,920 >Y>>YES, WE DID. 4803 02:56:50,920 --> 02:56:52,320 THERE WERE A FEW THAT JUMPED OUT 4804 02:56:52,320 --> 02:56:53,560 THAT WERE ASSOCIATED WITH 4805 02:56:53,560 --> 02:56:54,240 THERAPEUTIC RESISTANCE. 4806 02:56:54,240 --> 02:56:56,280 I CAN'T FOR THE LIFE OF ME OF 4807 02:56:56,280 --> 02:56:58,160 COURSE RECALL THEM AT THE 4808 02:56:58,160 --> 02:56:59,680 MOMENT, BUT I THINK THAT 4809 02:56:59,680 --> 02:57:00,360 GENERALLY IT WAS SOMETHING THAT 4810 02:57:00,360 --> 02:57:02,200 WE SAW. 4811 02:57:02,200 --> 02:57:04,080 I THINK THE HYPOXIA SIGNATURE IS 4812 02:57:04,080 --> 02:57:06,440 ALSO A LITTLE BIT OF INTEREST IN 4813 02:57:06,440 --> 02:57:07,000 TERMS OF THAT. 4814 02:57:07,000 --> 02:57:09,560 SO WE FOUND A FEW KIND OF LINES 4815 02:57:09,560 --> 02:57:12,800 OF EVIDENCE THAT WOULD SUPPORT 4816 02:57:12,800 --> 02:57:14,440 THAT WHAT WE ARE FINDING IS 4817 02:57:14,440 --> 02:57:15,840 ASSOCIATED, MAYBE, WITH 4818 02:57:15,840 --> 02:57:17,240 THERAPEUTIC RESISTANCE. 4819 02:57:17,240 --> 02:57:18,360 AND I THINK PROBABLY AN 4820 02:57:18,360 --> 02:57:19,320 INTERESTING NEXT STEP WOULD BE 4821 02:57:19,320 --> 02:57:22,520 TO FOLLOW UP ON THAT WITH SOME 4822 02:57:22,520 --> 02:57:25,120 EXPERIMENTAL WORK TO TRY 4823 02:57:25,120 --> 02:57:26,040 DIFFERENT COMMON THERAPIES OUT 4824 02:57:26,040 --> 02:57:27,960 IN THESE LINES AND SEE WHAT 4825 02:57:27,960 --> 02:57:29,520 THEIR RESPONSE IS. 4826 02:57:29,520 --> 02:57:31,160 AND ALSO THERE'S SOME 4827 02:57:31,160 --> 02:57:32,880 REPOSITORIES THAT HAVE SOME OF 4828 02:57:32,880 --> 02:57:34,400 THAT INFORMATION ALREADY IN 4829 02:57:34,400 --> 02:57:37,760 TERMS OF TESTING DIFFERENT 4830 02:57:37,760 --> 02:57:40,840 COMMON DRUGS AND CELL LINES SO 4831 02:57:40,840 --> 02:57:42,400 WE'RE GOING TO LEAN INTO THAT AS 4832 02:57:42,400 --> 02:57:43,280 WELL BUT THAT'S A GREAT QUESTION 4833 02:57:43,280 --> 02:57:45,360 AND I GOOD, I THINK, NEXT STEP 4834 02:57:45,360 --> 02:57:46,000 FOR THIS WORK. 4835 02:57:46,000 --> 02:57:47,760 >>COOL. 4836 02:57:47,760 --> 02:57:48,960 ALSO IN THE LAB, DID YOU 4837 02:57:48,960 --> 02:57:50,080 ACTUALLY SEE WITH THESE SPECIFIC 4838 02:57:50,080 --> 02:57:52,080 CELL LINES WITH AFRICAN ANCESTRY 4839 02:57:52,080 --> 02:57:53,400 THAT THEY PROLIFERATED MORE 4840 02:57:53,400 --> 02:57:54,320 RAPIDLY THAN THE OTHER CELL 4841 02:57:54,320 --> 02:57:54,520 LINES? 4842 02:57:54,520 --> 02:57:56,920 >>SUCH A GOOD QUESTION. 4843 02:57:56,920 --> 02:57:58,960 THAT'S ACTUALLY SOMETHING THAT 4844 02:57:58,960 --> 02:58:00,320 I'VE NOT DIRECTLY TESTED 4845 02:58:00,320 --> 02:58:01,440 ALTHOUGH IT WOULD BE SOMETHING 4846 02:58:01,440 --> 02:58:02,960 VERY EASY TO AND PROBABLY 4847 02:58:02,960 --> 02:58:03,720 SHOULD, AND I THINK PROBABLY 4848 02:58:03,720 --> 02:58:06,240 WHEN WE SUBMIT THIS WORK, A 4849 02:58:06,240 --> 02:58:07,360 REVIEWER WILL PROBABLY 4850 02:58:07,360 --> 02:58:08,280 DEFINITELY ASK FOR THIS 4851 02:58:08,280 --> 02:58:10,120 EXPERIMENT. 4852 02:58:10,120 --> 02:58:11,200 SO DOING EDU, SOMETHING LIKE 4853 02:58:11,200 --> 02:58:13,840 THAT WOULD BE GREAT TO ANSWER 4854 02:58:13,840 --> 02:58:16,440 BECAUSE WE SAW THESE KIND OF 4855 02:58:16,440 --> 02:58:17,880 SIGNALS THAT JUMPED OUT THAT ARE 4856 02:58:17,880 --> 02:58:19,760 ASSOCIATED WITH PROLIFERATION, 4857 02:58:19,760 --> 02:58:21,480 BUT DIRECTLY TESTING IT IS 4858 02:58:21,480 --> 02:58:23,160 DEFINITELY THE NEXT STEP TO 4859 02:58:23,160 --> 02:58:24,240 FOLLOW UP EXPERIMENTALLY. 4860 02:58:24,240 --> 02:58:25,000 THANK YOU. 4861 02:58:25,000 --> 02:58:26,120 GREAT QUESTIONS. 4862 02:58:26,120 --> 02:58:26,920 >>THANK YOU. 4863 02:58:26,920 --> 02:58:28,680 THANK YOU FOR A GREAT 4864 02:58:28,680 --> 02:58:29,320 PRESENTATION. 4865 02:58:29,320 --> 02:58:30,600 I THINK YOU ALREADY ADDRESSED 4866 02:58:30,600 --> 02:58:32,520 THIS WITH THE FIRST ANSWER THAT 4867 02:58:32,520 --> 02:58:34,200 YOU JUST GAVE NOW BUT I WAS 4868 02:58:34,200 --> 02:58:36,040 ASKING ABOUT THE AFRICAN 4869 02:58:36,040 --> 02:58:38,960 ANCESTRY LINES AND THEN THE -- 4870 02:58:38,960 --> 02:58:42,240 AND IF YOU EXPLORE TARGETING -- 4871 02:58:42,240 --> 02:58:43,520 RESPONSE IN THE AA LINE AS 4872 02:58:43,520 --> 02:58:45,800 OPPOSED TO THE EA LINES IN TERMS 4873 02:58:45,800 --> 02:58:48,720 OF UTILIZING -- DUE TO THE 4874 02:58:48,720 --> 02:58:49,320 HYPOXIA ENVIRONMENT YOU JUST 4875 02:58:49,320 --> 02:58:49,600 DESCRIBED. 4876 02:58:49,600 --> 02:58:51,240 >>I THINK THAT THIS AUDIENCE IS 4877 02:58:51,240 --> 02:58:53,080 TOTALLY ON IT, AND I SHOULD BE 4878 02:58:53,080 --> 02:58:54,360 TAKING NOTES FOR NEXT 4879 02:58:54,360 --> 02:58:56,840 EXPERIMENTAL STEPS HERE. 4880 02:58:56,840 --> 02:58:58,280 YOU KNOW, THERE IS A LOT OF WORK 4881 02:58:58,280 --> 02:59:00,240 IN THE FIELD RIGHT NOW 4882 02:59:00,240 --> 02:59:02,720 ESPECIALLY AFTER JOHN KARPTON'S 4883 02:59:02,720 --> 02:59:03,920 RECENT PUBLICATION LOOKING AT 4884 02:59:03,920 --> 02:59:05,040 HYPOXIA AND DID SEE THOSE 4885 02:59:05,040 --> 02:59:06,160 DIFFERENCES BY RACE, SO I THINK 4886 02:59:06,160 --> 02:59:08,200 A LOT OF PEOPLE ARE KIND OF 4887 02:59:08,200 --> 02:59:10,520 CHASING THIS THOUGHT THAT 4888 02:59:10,520 --> 02:59:12,720 HYPOXIA MAY BE MORE COMMONLY 4889 02:59:12,720 --> 02:59:14,880 SEEN IN TMBC IN AFRICAN AMERICAN 4890 02:59:14,880 --> 02:59:15,400 WOMEN. 4891 02:59:15,400 --> 02:59:16,800 IT'S NOT SOMETHING THAT WE'VE 4892 02:59:16,800 --> 02:59:19,320 PARTICULARLY TESTED YET, BUT 4893 02:59:19,320 --> 02:59:21,840 CERTAINLY SOMETHING THAT CAN BE 4894 02:59:21,840 --> 02:59:22,920 DONE, ESPECIALLY GIVEN ALL OF 4895 02:59:22,920 --> 02:59:26,640 THE EVIDENCE POINTING TO THAT WE 4896 02:59:26,640 --> 02:59:27,880 SEE THE SAME KIND OF THING IN 4897 02:59:27,880 --> 02:59:29,680 OUR CELL LINES AS WE DO IN 4898 02:59:29,680 --> 02:59:30,320 PATIENT TUMORS. 4899 02:59:30,320 --> 02:59:37,080 SO I THINK GREAT NEXT STEP. 4900 02:59:37,080 --> 02:59:38,120 >>I CAN MAYBE SAY SOMETHING 4901 02:59:38,120 --> 02:59:38,600 BRIEFLY. 4902 02:59:38,600 --> 02:59:39,760 SO WHEN WE STARTED THE 4903 02:59:39,760 --> 02:59:40,480 EXPERIMENT, ALL THOSE QUESTIONS 4904 02:59:40,480 --> 02:59:41,560 CAME UP THAT THESE CELL LINES 4905 02:59:41,560 --> 02:59:43,400 ARE SO HETEROGENEOUS AND IT 4906 02:59:43,400 --> 02:59:44,800 LOOKED LIKE YOU CANNOT FIND 4907 02:59:44,800 --> 02:59:45,320 SOMETHING. 4908 02:59:45,320 --> 02:59:46,480 WHAT WE DID, WE FOUND REALLY 4909 02:59:46,480 --> 02:59:47,880 SOMETHING VERY SIGNIFICANT 4910 02:59:47,880 --> 03:00:24,200 ASSOCIATED WITH ANCESTRY 4911 03:00:24,200 --> 03:00:24,520 >>ALL RIGHT. 4912 03:00:24,520 --> 03:00:26,160 SO LET'S GET STARTED WITH THE 4913 03:00:26,160 --> 03:00:27,360 AFTERNOON PROGRAM. 4914 03:00:27,360 --> 03:00:29,040 BRIEFLY, I WOULD LIKE TO THANK 4915 03:00:29,040 --> 03:00:31,440 ALL OF THE POSTER PRESENTERS FOR 4916 03:00:31,440 --> 03:00:33,200 THEIR POSTERS. 4917 03:00:33,200 --> 03:00:35,000 EXCELLENT POSTERS. 4918 03:00:35,000 --> 03:00:35,840 ALSO WOULD LIKE TO THANK 4919 03:00:35,840 --> 03:00:38,440 EVERYBODY WHO CAME TO THE 4920 03:00:38,440 --> 03:00:38,760 POSTERS,. 4921 03:00:38,760 --> 03:00:39,520 IT'S VERY, VERY IMPORTANT THAT 4922 03:00:39,520 --> 03:00:41,400 THEY GET THE RECOGNITION. 4923 03:00:41,400 --> 03:00:42,720 SECONDLY, WE WOULD LIKE TO GET 4924 03:00:42,720 --> 03:00:44,360 FEEDBACK FROM YOU. 4925 03:00:44,360 --> 03:00:46,240 I'M SAYING IT NOW. 4926 03:00:46,240 --> 03:00:48,520 SO PLEASE MAYBE THROUGH SLIDO, 4927 03:00:48,520 --> 03:00:52,040 YOU CAN PROVIDE FEEDBACK ON THE 4928 03:00:52,040 --> 03:00:52,480 CONFERENCE. 4929 03:00:52,480 --> 03:00:53,920 MAY ACTUALLY MAKE SOME 4930 03:00:53,920 --> 03:00:55,520 SUGGESTIONS FOR THE NEXT 4931 03:00:55,520 --> 03:00:56,760 CONFERENCE, WHAT WE SHOULD 4932 03:00:56,760 --> 03:00:59,120 INCLUDE, WHAT WE HAVE NOT 4933 03:00:59,120 --> 03:01:00,920 INCLUDED. 4934 03:01:00,920 --> 03:01:04,360 AND I WANTED TO SAY SOMETHING, 4935 03:01:04,360 --> 03:01:06,040 IF YOU'VE SEEN WE HAVE QUITE 4936 03:01:06,040 --> 03:01:08,880 SOME FELLOWS BEING CHAIRS OF 4937 03:01:08,880 --> 03:01:11,720 SESSIONS AND I CAN TELL YOU FROM 4938 03:01:11,720 --> 03:01:13,280 OUR EXPERIENCE, IT'S GREAT, 4939 03:01:13,280 --> 03:01:15,000 THOSE FELLOWS ARE JUST 4940 03:01:15,000 --> 03:01:17,800 FANTASTIC, AND APPLAUSE TO THE 4941 03:01:17,800 --> 03:01:18,720 FELLOWS, PLEASE, AND -- OKAY. 4942 03:01:18,720 --> 03:01:22,120 [APPLAUSE] 4943 03:01:22,120 --> 03:01:26,080 AND I WANT TO HAND OVER TO 4944 03:01:26,080 --> 03:01:28,720 CONSTANZA THE CHAIR FOR THE NEXT 4945 03:01:28,720 --> 03:01:31,000 SESSION. 4946 03:01:31,000 --> 03:01:33,600 >>THANK YOU, DR. AMBS. 4947 03:01:33,600 --> 03:01:36,080 GOOD AFTER NOORNTION EVERYONE. 4948 03:01:36,080 --> 03:01:37,560 I'M CONSTANZA CAMARGO, I'M AN 4949 03:01:37,560 --> 03:01:39,120 INVESTIGATOR IN THE DIVISION OF 4950 03:01:39,120 --> 03:01:40,640 CANCER EPIDEMIOLOGY AND GENETICS 4951 03:01:40,640 --> 03:01:42,560 AT THE NATIO NATIONAL CANCER 4952 03:01:42,560 --> 03:01:42,800 INSTITUTE. 4953 03:01:42,800 --> 03:01:44,360 OUR MISSION IS PART OF THE 4954 03:01:44,360 --> 03:01:45,120 INTRAMURAL PROGRAM OF NCI. 4955 03:01:45,120 --> 03:01:50,080 I WANT TO ECHO DR. AMBS' WORDS 4956 03:01:50,080 --> 03:01:51,160 ABOUT THE POSTER SESSION. 4957 03:01:51,160 --> 03:01:56,880 WE HAVE A GREAT SESSION AND WE 4958 03:01:56,880 --> 03:01:57,840 THANK MORE THAN 50 PRESENTERS 4959 03:01:57,840 --> 03:01:59,600 THAT WE HAD, VERY EXCITED TO 4960 03:01:59,600 --> 03:02:00,720 RECEIVE SO MANY APPLICATION. 4961 03:02:00,720 --> 03:02:03,320 WE ARE GOING TO TURN TO SESSION 4962 03:02:03,320 --> 03:02:04,640 NUMBER 13, AND IN THIS SESSION, 4963 03:02:04,640 --> 03:02:06,520 WE ARE GOING TO ADDRESS CANCER 4964 03:02:06,520 --> 03:02:09,040 DISPARITY RESEARCH IN THE 4965 03:02:09,040 --> 03:02:10,640 DIVISION OF CANCER EPIDEMIOLOGY 4966 03:02:10,640 --> 03:02:11,720 AND GENETICS. 4967 03:02:11,720 --> 03:02:14,640 WE HAVE THREE PRESENTERS. 4968 03:02:14,640 --> 03:02:15,680 WE ARE GOING TO HAVE 4969 03:02:15,680 --> 03:02:17,840 PRESENTATIONS OF 20 MINUTES 4970 03:02:17,840 --> 03:02:18,960 FOLLOWED BY FIVE MINUTES FOR 4971 03:02:18,960 --> 03:02:21,040 QUESTIONS. 4972 03:02:21,040 --> 03:02:22,640 THE FIRST PRESENTER, IT IS MY 4973 03:02:22,640 --> 03:02:25,640 PLEASURE TO INTRODUCE DR. BARRY 4974 03:02:25,640 --> 03:02:26,680 GRAUBARD. 4975 03:02:26,680 --> 03:02:28,680 HE IS SENIOR INVESTIGATOR. 4976 03:02:28,680 --> 03:02:30,800 HE'S A BIOSTATISTICIAN, HE'S A 4977 03:02:30,800 --> 03:02:32,320 MEMBER OF THE BIOSTATISTICS 4978 03:02:32,320 --> 03:02:33,720 BRANCH IN OUR DIVISION, AND HE'S 4979 03:02:33,720 --> 03:02:37,920 GOING TO TALK ABOUT THE 4980 03:02:37,920 --> 03:02:39,560 PORTFOLIO OF DCEG FOR HEALTH 4981 03:02:39,560 --> 03:02:40,600 DISPARITIES AND SOME FUTURE 4982 03:02:40,600 --> 03:02:42,560 PLANS. 4983 03:02:42,560 --> 03:02:43,040 WELCOME, DR. GRAUBARD. 4984 03:02:43,040 --> 03:02:46,640 [APPLAUSE] 4985 03:02:46,640 --> 03:02:51,200 >>THANK YOU VERY MUCH, KA 4986 03:02:51,200 --> 03:02:55,480 STANZA. 4987 03:02:55,480 --> 03:02:55,760 CONSTANZA. 4988 03:02:55,760 --> 03:02:57,680 I'M NOT GOING TO SAY MUCH ABOUT 4989 03:02:57,680 --> 03:03:01,360 THE PORTFOLIO BECAUSE I DON'T 4990 03:03:01,360 --> 03:03:02,000 HAVE MUCH INFORMATION AT THIS 4991 03:03:02,000 --> 03:03:04,280 TIME, BUT I'LL TALK ABOUT SOME 4992 03:03:04,280 --> 03:03:05,840 RESEARCH, BECAUSE I'M A 4993 03:03:05,840 --> 03:03:06,720 BIOSTATISTICIAN, I'M GOING TO 4994 03:03:06,720 --> 03:03:08,360 TALK ABOUT SOME STATISTICAL 4995 03:03:08,360 --> 03:03:09,520 RESEARCH THAT WE'RE INVOLVED 4996 03:03:09,520 --> 03:03:11,840 WITH, AND ALSO SPEND A FAIR 4997 03:03:11,840 --> 03:03:13,440 AMOUNT OF TIME ON A PARTICULAR 4998 03:03:13,440 --> 03:03:16,880 THING DEALING WITH FUTURE PLANS. 4999 03:03:16,880 --> 03:03:17,960 OKAY. 5000 03:03:17,960 --> 03:03:20,040 SO AS I SAID, THIS IS THE 5001 03:03:20,040 --> 03:03:22,240 OUTLINE OF MY TALK, AND I JUST 5002 03:03:22,240 --> 03:03:24,760 BASICALLY WENT OVER THAT. 5003 03:03:24,760 --> 03:03:26,920 FIRST WILL BE A LITTLE BIT ABOUT 5004 03:03:26,920 --> 03:03:30,520 THE RESEARCH, AND SOME OF THE 5005 03:03:30,520 --> 03:03:33,280 RECOMMENDATIONS OF A HEALTH 5006 03:03:33,280 --> 03:03:35,000 DISPARITIES ADVISORY GROUP FOR 5007 03:03:35,000 --> 03:03:37,040 OUR DIVISION, THE DIVISION OF 5008 03:03:37,040 --> 03:03:38,080 CANCER EPIDEMIOLOGY AND 5009 03:03:38,080 --> 03:03:41,320 GENETICS. 5010 03:03:41,320 --> 03:03:47,120 AND THEN I'LL TALK ABOUT SOME 5011 03:03:47,120 --> 03:03:49,800 ONGOING STATISTICAL METHODOLOGY, 5012 03:03:49,800 --> 03:03:56,240 AND ALSO THIS DATA. 5013 03:03:56,240 --> 03:04:01,760 SO AT THE END OF NOVEMBER, OUR 5014 03:04:01,760 --> 03:04:04,880 DIVISION CONVENED AN ADVISORY 5015 03:04:04,880 --> 03:04:07,520 GROUP TO HELP ADVISE THE 5016 03:04:07,520 --> 03:04:09,880 DIVISION LEADERSHIP ON HOW TO -- 5017 03:04:09,880 --> 03:04:12,320 ON FOCUSING OUR PROGRAM MORE 5018 03:04:12,320 --> 03:04:14,240 TOWARDS CANCER HEALTH 5019 03:04:14,240 --> 03:04:14,880 DISPARITIES WITHIN OUR 5020 03:04:14,880 --> 03:04:18,320 PORTFOLIO. 5021 03:04:18,320 --> 03:04:19,760 AND THE PANEL CONSISTED OF 5022 03:04:19,760 --> 03:04:21,400 EXTRAMURAL RESEARCHERS FROM 5023 03:04:21,400 --> 03:04:23,080 UNIVERSITIES AND OTHER PLACES, 5024 03:04:23,080 --> 03:04:26,440 AND THEN THROUGHOUT THE NIH, AND 5025 03:04:26,440 --> 03:04:30,760 ALSO WITHIN OUR DIVISION. 5026 03:04:30,760 --> 03:04:33,120 SO IN PREPARATION FOR THIS 5027 03:04:33,120 --> 03:04:34,880 ADVISORY GROUP, THERE WAS A 5028 03:04:34,880 --> 03:04:37,280 LITTLE SURVEY THAT WAS DONE, AND 5029 03:04:37,280 --> 03:04:38,520 I'LL SAY JUST A FEW WORDS ABOUT 5030 03:04:38,520 --> 03:04:41,080 THAT. 5031 03:04:41,080 --> 03:04:42,520 SO THE SUMMARY FROM THE SURVEY 5032 03:04:42,520 --> 03:04:44,400 ABOUT THE ONGOING RESEARCH IN 5033 03:04:44,400 --> 03:04:45,800 OUR DIVISION, AND BY THE WAY, 5034 03:04:45,800 --> 03:04:47,320 YOU'VE HEARD A LOT OF SPEAKERS 5035 03:04:47,320 --> 03:04:51,280 HERE FROM OUR DIVISION, I THINK 5036 03:04:51,280 --> 03:04:54,240 MAINLY POSTDOCS AND RESEARCH 5037 03:04:54,240 --> 03:04:56,000 FELLOWS WHO FRANKLY I JUST WANT 5038 03:04:56,000 --> 03:04:57,440 TO SAY, THEY'RE THE REAL ENGINE 5039 03:04:57,440 --> 03:04:58,960 FOR OUR DIVISION IN TERMS OF 5040 03:04:58,960 --> 03:05:00,960 COMING UP WITH EXCELLENT 5041 03:05:00,960 --> 03:05:04,440 RESEARCH STUDIES AND SO FORTH. 5042 03:05:04,440 --> 03:05:06,800 BUT THIS ACTUAL SURVEY WAS 5043 03:05:06,800 --> 03:05:11,360 REALLY DONE TO THE PIs, 5044 03:05:11,360 --> 03:05:13,000 QUERYING THEM ABOUT ONGOING 5045 03:05:13,000 --> 03:05:13,360 PROJECTS. 5046 03:05:13,360 --> 03:05:16,680 THIS STATEMENT HERE BASICALLY 5047 03:05:16,680 --> 03:05:20,040 SAYS THAT LARGELY A LOT OF THE 5048 03:05:20,040 --> 03:05:21,240 STUDIES THAT HAVE BEEN DONE IN 5049 03:05:21,240 --> 03:05:24,200 HEALTH DISPARITIES IN OUR 5050 03:05:24,200 --> 03:05:25,360 DIVISION, THEY'RE KIND OF 5051 03:05:25,360 --> 03:05:31,160 ONE-OFF THINGS RELYING ON 5052 03:05:31,160 --> 03:05:33,360 PUBLICLY AVAILABLE RESOURCES 5053 03:05:33,360 --> 03:05:42,360 WHISTWHICH SELDOM CONTAIN 5054 03:05:42,360 --> 03:05:43,120 SINGLE-SOURCE HIGH QUALITY DATA 5055 03:05:43,120 --> 03:05:45,240 ON DEMOGRAPHIC FACTORS, RISK 5056 03:05:45,240 --> 03:05:48,440 BEHAVIORS, INDIVIDUAL-LEVEL AND 5057 03:05:48,440 --> 03:05:49,800 NEIGHBORHOOD-LEVEL 5058 03:05:49,800 --> 03:05:50,840 SOCIOCONTEXTUAL FACTORS, WITH 5059 03:05:50,840 --> 03:05:52,320 ACCESS TO HEALTHCARE AND HEALTH 5060 03:05:52,320 --> 03:05:53,640 SEEKING BEHAVIORS, SO FORTH, HOW 5061 03:05:53,640 --> 03:05:55,880 MUCH CAN THEY CONTRIBUTE TO THE 5062 03:05:55,880 --> 03:05:58,520 DIFFERENCES WE'RE SEEING IN 5063 03:05:58,520 --> 03:06:00,480 CANCER INCIDENCE OUTCOMES AND 5064 03:06:00,480 --> 03:06:01,800 STAGING AND QUALITY OF 5065 03:06:01,800 --> 03:06:02,360 HEALTHCARE. 5066 03:06:02,360 --> 03:06:06,000 SO YOU KNOW, SO AS THE DATA -- 5067 03:06:06,000 --> 03:06:08,160 THE DATA WE HAVE IS JUST NOT 5068 03:06:08,160 --> 03:06:09,800 RICH ENOUGH IN THE ABOVE 5069 03:06:09,800 --> 03:06:10,800 VARIABLES, AND I'LL SAY A LITTLE 5070 03:06:10,800 --> 03:06:13,360 BIT MORE WHEN I TALK ABOUT THIS 5071 03:06:13,360 --> 03:06:14,240 NEW RESOURCE THAT WE'RE TRYING 5072 03:06:14,240 --> 03:06:18,760 TO GET TOGETHER, AND THAT WILL 5073 03:06:18,760 --> 03:06:20,280 HAVE THE VARIABLES WE NEED TO 5074 03:06:20,280 --> 03:06:22,560 TRY TO EXPLAIN SOME OF THE 5075 03:06:22,560 --> 03:06:23,120 DISPARITIES WE'RE ACTUALLY 5076 03:06:23,120 --> 03:06:23,800 SEEING. 5077 03:06:23,800 --> 03:06:24,880 SO TWO AREAS THAT WERE 5078 03:06:24,880 --> 03:06:32,200 IDENTIFIED BY THIS ADVISORY 5079 03:06:32,200 --> 03:06:35,160 GROUP, ONE IS THE NEED FOR DOING 5080 03:06:35,160 --> 03:06:38,760 MORE EPIDEMIOLOGY AND 5081 03:06:38,760 --> 03:06:41,800 BIOSTATISTICAL METHODOLOGICAL 5082 03:06:41,800 --> 03:06:52,080 RESEARCH INTO -- 5083 03:06:58,080 --> 03:07:08,320 [PLEASE STAND BY] 5084 03:07:11,360 --> 03:07:12,480 >>IT'S JUST RESTARTING. 5085 03:07:12,480 --> 03:07:22,920 IT WILL BE UP IN A SECOND. 5086 03:07:24,240 --> 03:07:25,840 >>MAYBE I SHOULD TALK FROM 5087 03:07:25,840 --> 03:07:27,280 MEMORY HERE AND NOT FROM THE 5088 03:07:27,280 --> 03:07:30,880 SLIDES. 5089 03:07:30,880 --> 03:07:36,120 SO -- NO, MAYBE I SHOULD WAIT. 5090 03:07:36,120 --> 03:07:38,640 MAYBE I'LL SCREW IT UP. 5091 03:07:38,640 --> 03:07:40,040 [LAUGHTER] 5092 03:07:40,040 --> 03:07:50,480 >>I HAVE MY SLIDES HERE. 5093 03:07:51,400 --> 03:07:56,480 SO THERE ARE TWO ASPECTS. 5094 03:07:56,480 --> 03:07:59,160 WTHE ADVISORY GROUP AND ALSO THE 5095 03:07:59,160 --> 03:08:00,520 PEOPLE IN OUR DIVISION FELT THAT 5096 03:08:00,520 --> 03:08:03,440 WE NEED MORE METHODOLOGY TO 5097 03:08:03,440 --> 03:08:05,360 INCLUDE THESE FACTORS THAT I 5098 03:08:05,360 --> 03:08:09,200 JUST LISTED EARLIER TO TRY TO 5099 03:08:09,200 --> 03:08:10,840 EXPLAIN HEALTH DISPARITIES. 5100 03:08:10,840 --> 03:08:13,200 THE OTHER WAS A NEED FOR 5101 03:08:13,200 --> 03:08:16,160 METHODOLOGICAL WORK TO COMBINE 5102 03:08:16,160 --> 03:08:17,840 MULTIPLE REPRESENTATIVE SAMPLES 5103 03:08:17,840 --> 03:08:22,440 AND OFTEN THESE SAMPLES INVOLVE 5104 03:08:22,440 --> 03:08:25,200 COMPLEX SURVEY SAMPLES, AND I'LL 5105 03:08:25,200 --> 03:08:27,360 SAY MORE ABOUT THAT AT THE END, 5106 03:08:27,360 --> 03:08:29,800 BUT THESE SURVEYS AND THE 5107 03:08:29,800 --> 03:08:32,720 SAMPLES THAT THEY'RE ASKING US 5108 03:08:32,720 --> 03:08:34,640 TO MAKE BETTER USE OF WOULD 5109 03:08:34,640 --> 03:08:40,720 REPRESENT THE U.S. POPULATION 5110 03:08:40,720 --> 03:08:42,760 OVERALL IN A REPRESENTATIVE 5111 03:08:42,760 --> 03:08:44,120 FASHION, OKAY? 5112 03:08:44,120 --> 03:08:46,160 THE OTHER AREA AS I SAID WITH 5113 03:08:46,160 --> 03:08:48,360 DEVELOPMENT OF NEW DATA 5114 03:08:48,360 --> 03:08:49,560 RESOURCES, AND THE 5115 03:08:49,560 --> 03:08:51,680 RECOMMENDATION WAS THAT WE 5116 03:08:51,680 --> 03:08:53,840 HARNESS EXPERTISE AND EXPERIENCE 5117 03:08:53,840 --> 03:08:55,840 IN WORKING WITH REGISTERED 5118 03:08:55,840 --> 03:08:57,560 LINKED DATA TO CREATE NOVEL 5119 03:08:57,560 --> 03:09:01,040 RESOURCES OF RESEARCH, AND SO 5120 03:09:01,040 --> 03:09:02,000 THIS -- HERE WE ARE. 5121 03:09:02,000 --> 03:09:06,240 SO THE SECOND BULLET WAS AN 5122 03:09:06,240 --> 03:09:09,480 ATTEMPT TO -- WE'VE BEEN 5123 03:09:09,480 --> 03:09:12,120 INTERESTED IN USING TWO OF THE 5124 03:09:12,120 --> 03:09:13,680 MAJOR NATIONAL HEALTH SURVEYS, 5125 03:09:13,680 --> 03:09:15,440 THE NATIONAL HEALTH INTERVIEW 5126 03:09:15,440 --> 03:09:18,400 SURVEY, AND THE NHANES, THE 5127 03:09:18,400 --> 03:09:21,400 NATIONAL HEALTH AND NUTRITION 5128 03:09:21,400 --> 03:09:23,600 EXAMINATION SURVEY. 5129 03:09:23,600 --> 03:09:25,800 AND THEIR RICH DATA TO LOOK AT 5130 03:09:25,800 --> 03:09:26,880 SOCIAL DETERMINANTS OF HEALTH 5131 03:09:26,880 --> 03:09:29,560 AND ALSO MULTILEVEL FACTORS. 5132 03:09:29,560 --> 03:09:30,800 BACK TO MY SLIDES HERE. 5133 03:09:30,800 --> 03:09:34,120 SO I WAS GOING TO SAY A FEW 5134 03:09:34,120 --> 03:09:35,440 WORDS ABOUT TWO THINGS THAT WE 5135 03:09:35,440 --> 03:09:39,960 WERE WORKING ON TO TRY TO 5136 03:09:39,960 --> 03:09:40,920 PARTITION OBSERVED DISPARITIES 5137 03:09:40,920 --> 03:09:45,800 THAT WE SEE IN THE DATA. 5138 03:09:45,800 --> 03:09:49,240 SO YOU HAVE TWO GROUPS AND ONE 5139 03:09:49,240 --> 03:09:51,880 IS AN DISADVANTAGED GROUP, 5140 03:09:51,880 --> 03:09:54,600 THAT'S GROUP 1, AND GROUP 2 IS 5141 03:09:54,600 --> 03:09:59,400 THE ADVANTAGED GROUP. 5142 03:09:59,400 --> 03:10:01,160 YOU HAVE SOME QUANTITATIVE 5143 03:10:01,160 --> 03:10:03,400 VARIABLE, NOT BINARY. 5144 03:10:03,400 --> 03:10:05,360 SO I'M GOING TO BE USING BMI AS 5145 03:10:05,360 --> 03:10:08,200 AN EXAMPLE. 5146 03:10:08,200 --> 03:10:13,000 AND THAT DIFFERS BETWEEN THE TWO 5147 03:10:13,000 --> 03:10:13,560 GROUPS. 5148 03:10:13,560 --> 03:10:14,440 NORMALLY YOU WOULDN'T BOTHER 5149 03:10:14,440 --> 03:10:15,640 WITH THIS UNLESS YOU SAY OH, I 5150 03:10:15,640 --> 03:10:16,720 SEE AN OBSERVED DIFFERENCE 5151 03:10:16,720 --> 03:10:18,320 BETWEEN THE ADVANTAGED GROUP AND 5152 03:10:18,320 --> 03:10:22,760 THE DISADVANTAGED GROUP. 5153 03:10:22,760 --> 03:10:24,920 AND THEN WE NEED TO RELY ON SOME 5154 03:10:24,920 --> 03:10:27,200 SORT OF DATA, COVARIATES, WHERE 5155 03:10:27,200 --> 03:10:28,800 WE CAN TRY TO EXPLAIN WHAT THAT 5156 03:10:28,800 --> 03:10:30,480 DIFFERENCE MIGHT BE, AND SEE HOW 5157 03:10:30,480 --> 03:10:33,440 MUCH WE CAN EXPLAIN OF THE 5158 03:10:33,440 --> 03:10:34,760 OBSERVED DIFFERENCE IN THE MEANS 5159 03:10:34,760 --> 03:10:36,280 AND THEN HOW MUCH CAN WE NOT 5160 03:10:36,280 --> 03:10:38,000 EXPLAIN. 5161 03:10:38,000 --> 03:10:40,600 SO THAT'S WHAT THIS SECOND -- 5162 03:10:40,600 --> 03:10:42,520 THIS LAST BULLET HERE IS. 5163 03:10:42,520 --> 03:10:44,240 AND SO THIS USES A METHOD THAT'S 5164 03:10:44,240 --> 03:10:48,880 SOMETIMES CALLED PETERS BELSON 5165 03:10:48,880 --> 03:10:50,280 REGRESSION METHOD BUT IT'S VERY 5166 03:10:50,280 --> 03:10:53,920 SIMILAR TO WHEN ECONOMISTS 5167 03:10:53,920 --> 03:10:56,400 SOMETIMES USE WAHAKA LONG TERM 5168 03:10:56,400 --> 03:10:59,600 METHOD. 5169 03:10:59,600 --> 03:11:02,000 SO THE IDEA IS THE FIT 5170 03:11:02,000 --> 03:11:03,800 REGRESSION TO THE ADVANTAGED 5171 03:11:03,800 --> 03:11:04,280 GROUP. 5172 03:11:04,280 --> 03:11:06,720 SO THAT MEANS THAT WE HAVE THE 5173 03:11:06,720 --> 03:11:11,200 OUTCOME, AND WE HAVE THE Xs 5174 03:11:11,200 --> 03:11:13,000 FOR THE GROUP 2 AND WE FIT THAT 5175 03:11:13,000 --> 03:11:14,920 REGRESSION ONLY TO THAT GROUP. 5176 03:11:14,920 --> 03:11:19,840 AND THEN WE OBTAIN THE PREDICTED 5177 03:11:19,840 --> 03:11:22,160 Ys OR THE OUTCOME FOR EACH 5178 03:11:22,160 --> 03:11:23,160 DISADVANTAGED INDIVIDUAL AT 5179 03:11:23,160 --> 03:11:26,440 THEIR PARTICULAR Xs, USING THE 5180 03:11:26,440 --> 03:11:28,720 ESTIMATED COEFFICIENTS FROM THE 5181 03:11:28,720 --> 03:11:31,120 ADVANTAGED GROUP UP HERE. 5182 03:11:31,120 --> 03:11:34,400 THEN YOU CAN SHOW VERY EASILY 5183 03:11:34,400 --> 03:11:36,280 JUST -- IT'S JUST SIMPLE, THAT 5184 03:11:36,280 --> 03:11:41,760 YOU CAN THEN PARTITION THE HE 5185 03:11:41,760 --> 03:11:43,160 OBSERVED DISPARITY INTO TWO 5186 03:11:43,160 --> 03:11:44,000 PARTS. 5187 03:11:44,000 --> 03:11:47,440 THE PART THAT'S EXPLAINED BY THE 5188 03:11:47,440 --> 03:11:49,960 Xs THAT YOU HAVE AVAILABLE TO 5189 03:11:49,960 --> 03:11:53,240 YOU, AND THEN THE PART THAT YOU 5190 03:11:53,240 --> 03:11:59,280 CAN'T EXPLAIN. 5191 03:11:59,280 --> 03:12:00,800 THIS IS JUST AN EXAMPLE. 5192 03:12:00,800 --> 03:12:05,200 THIS IS LOOKING AT BMI BY RACE 5193 03:12:05,200 --> 03:12:08,000 IN THE NHANES, AND YOU HAVE TWO 5194 03:12:08,000 --> 03:12:11,320 RACES, WHITE AND BLACK, AND THIS 5195 03:12:11,320 --> 03:12:13,800 IS AMONG WOMEN. 5196 03:12:13,800 --> 03:12:15,680 SO THE WHITE WOMEN ON AVERAGE, 5197 03:12:15,680 --> 03:12:19,400 THEIR MEAN BMI IS SMALLER THAN 5198 03:12:19,400 --> 03:12:22,360 THE BLACKS. 5199 03:12:22,360 --> 03:12:24,880 AND THEN YOU CAN PREDICT USING 5200 03:12:24,880 --> 03:12:27,600 THIS KIND OF COUNTERFACTUAL 5201 03:12:27,600 --> 03:12:29,800 CALCULATION THAT I JUST 5202 03:12:29,800 --> 03:12:34,120 MENTIONED THAT IF THE BLACKS HAD 5203 03:12:34,120 --> 03:12:38,040 BEEN WHITE, THEN THEIR MEAN BMI 5204 03:12:38,040 --> 03:12:40,440 WOULD HAVE BEEN 28.4 USING THAT 5205 03:12:40,440 --> 03:12:41,560 REGRESSION I JUST DESCRIBED. 5206 03:12:41,560 --> 03:12:44,320 HOWEVER THAT, IT TURNS OUT, THIS 5207 03:12:44,320 --> 03:12:48,200 OBSERVED DIFFERENCE OF THOSE 5208 03:12:48,200 --> 03:12:54,160 COVARIATES ONLY EXPLAIN 18%, 5209 03:12:54,160 --> 03:12:56,440 ABOUT, OF DISPARITY, AND 82% IS 5210 03:12:56,440 --> 03:12:56,880 UNEXPLAINED. 5211 03:12:56,880 --> 03:12:58,440 AND THESE WERE THE COVARIATES 5212 03:12:58,440 --> 03:13:01,320 THAT I USED DOWN HERE AT THE 5213 03:13:01,320 --> 03:13:03,680 BOTTOM. 5214 03:13:03,680 --> 03:13:14,120 SO THAT'S HOW THAT WORKS. 5215 03:13:29,680 --> 03:13:32,440 SO WHAT WE'VE DONE IS, WE'VE 5216 03:13:32,440 --> 03:13:33,920 SAID, WELL, YOU KNOW, THIS IS 5217 03:13:33,920 --> 03:13:35,560 VERY GOOD FOR LOOKING AT LIKE A 5218 03:13:35,560 --> 03:13:36,920 MEAN DISPARITY BETWEEN TWO 5219 03:13:36,920 --> 03:13:38,280 GROUPS WHEN YOU TALK ABOUT A 5220 03:13:38,280 --> 03:13:40,680 CONTINUOUS VARIABLE. 5221 03:13:40,680 --> 03:13:42,720 BUT MAYBE THE DISPARITY VARIES 5222 03:13:42,720 --> 03:13:44,920 ACROSS THE PERCENTILES. 5223 03:13:44,920 --> 03:13:46,800 PEOPLE THAT HAVE LOW BMI 5224 03:13:46,800 --> 03:13:47,960 COMPARED TO THE PEOPLE THAT HAVE 5225 03:13:47,960 --> 03:13:48,680 HIGHER BMI. 5226 03:13:48,680 --> 03:13:52,160 MAYBE THE TYPE OF DISPARITY THAT 5227 03:13:52,160 --> 03:13:53,240 EXISTS IS GOING TO CHANGE, IT'S 5228 03:13:53,240 --> 03:13:56,640 GOING TO GET BIGGER OR SMALLER, 5229 03:13:56,640 --> 03:13:59,480 AND THE EFFECT OF THE COVARIATES 5230 03:13:59,480 --> 03:14:01,080 ALSO DIFFER SO THE AMOUNT YOU 5231 03:14:01,080 --> 03:14:01,880 EXPLAIN MAY DEPEND ON WHERE YOU 5232 03:14:01,880 --> 03:14:03,600 ARE IN TERMS OF THE PERCENTILES. 5233 03:14:03,600 --> 03:14:05,440 I USE THE WORD QUANTILE ALSO IN 5234 03:14:05,440 --> 03:14:10,000 PLACE OF PERCENTILES HERE. 5235 03:14:10,000 --> 03:14:14,360 AND SO IT MAY ACCOUNT FOR 5236 03:14:14,360 --> 03:14:16,800 DIFFERENTIALLY -- MAY ACCOUNT 5237 03:14:16,800 --> 03:14:20,440 DIFFERENTIALLY ACROSS -- FOR THE 5238 03:14:20,440 --> 03:14:21,280 DISPARITIES ACROSS THE 5239 03:14:21,280 --> 03:14:21,840 PERCENTILES. 5240 03:14:21,840 --> 03:14:24,080 SO THIS LEADS TO SOMETHING 5241 03:14:24,080 --> 03:14:25,200 CALLED QUANTILE REGRESSION 5242 03:14:25,200 --> 03:14:26,800 RATHER THAN JUST LINEAR 5243 03:14:26,800 --> 03:14:27,840 REGRESSION WHICHS WAY DOING 5244 03:14:27,840 --> 03:14:28,400 BEFORE. 5245 03:14:28,400 --> 03:14:32,560 THIS WORK WAS DONE BY GRACE HONG 5246 03:14:32,560 --> 03:14:33,760 AND OTHERS THAT WE WORKED WITH. 5247 03:14:33,760 --> 03:14:38,040 SO THIS IS JUST SHOWING THE 5248 03:14:38,040 --> 03:14:40,240 RESULTS OF THAT. 5249 03:14:40,240 --> 03:14:42,320 THIS FIRST GRAPH HERE IS THE -- 5250 03:14:42,320 --> 03:14:47,000 IS BASICALLY THE OBSERVED BMIs 5251 03:14:47,000 --> 03:14:49,000 AT EACH QUANTILE IN THE 5252 03:14:49,000 --> 03:14:49,880 POPULATION. 5253 03:14:49,880 --> 03:14:55,360 AND YOU CAN SEE FOR THE ASIANS, 5254 03:14:55,360 --> 03:14:56,880 IT'S SUPPOSED TO BE ORANGE, IT 5255 03:14:56,880 --> 03:14:58,600 LOOKS KIND OF YELLOW, THAT'S THE 5256 03:14:58,600 --> 03:15:05,240 BOTTOM ONE, AND THE PINK ONE, 5257 03:15:05,240 --> 03:15:10,800 WHICH IS IN HERE, IT'S KIND OF 5258 03:15:10,800 --> 03:15:13,160 BIG -- IT'S BELOW THE RED ONE, 5259 03:15:13,160 --> 03:15:14,720 THAT'S THE NON-HISPANIC WHITES, 5260 03:15:14,720 --> 03:15:16,840 AND THEN THE RED IS THE 5261 03:15:16,840 --> 03:15:20,440 HISPANICS AND THE BLACK IS 5262 03:15:20,440 --> 03:15:23,080 BLACKS, AND YOU CAN SEE THAT THE 5263 03:15:23,080 --> 03:15:24,680 DIFFERENCE, OF COURSE, DIFFERS, 5264 03:15:24,680 --> 03:15:24,880 OKAY? 5265 03:15:24,880 --> 03:15:26,400 AND YOU WOULD EXPECT THAT 5266 03:15:26,400 --> 03:15:29,160 BECAUSE AS YOU GET INTO HIGHER 5267 03:15:29,160 --> 03:15:32,080 BMI, THERE'S MORE VARIABILITY 5268 03:15:32,080 --> 03:15:33,480 OFTEN IN THOSE VALUES. 5269 03:15:33,480 --> 03:15:37,320 NOW, YOU CAN USE THIS QUANTILE 5270 03:15:37,320 --> 03:15:39,400 REGRESSION SIMILARLY TO THE 5271 03:15:39,400 --> 03:15:41,360 PETERS BELSON WITH RESPECT TO 5272 03:15:41,360 --> 03:15:44,400 LINEAR REGRESSION, AND YOU CAN 5273 03:15:44,400 --> 03:15:47,480 SEE THAT THE DISPARITY, YOU'LL 5274 03:15:47,480 --> 03:15:48,880 SEE NEGATIVE BMIs HERE BECAUSE 5275 03:15:48,880 --> 03:15:52,640 WE'RE LOOKING AT THE WHITES 5276 03:15:52,640 --> 03:15:54,280 MINUS THE BLACKS AS WE GO ALONG 5277 03:15:54,280 --> 03:15:56,920 ACROSS THE PERCENTILES, AND OF 5278 03:15:56,920 --> 03:15:58,640 COURSE THE BLACKS HAVE HIGHER 5279 03:15:58,640 --> 03:16:01,200 BMI, SO THE BMI IS ACTUALLY -- 5280 03:16:01,200 --> 03:16:02,560 SO THE DIFFERENCE BECOMES 5281 03:16:02,560 --> 03:16:02,840 NEGATIVE. 5282 03:16:02,840 --> 03:16:05,120 BUT YOU CAN SEE AS YOU INCREASE 5283 03:16:05,120 --> 03:16:08,720 THE QUANTILES OR PERCENTILES, 5284 03:16:08,720 --> 03:16:10,920 THAT THE DIFFERENCE GETS BIGGER 5285 03:16:10,920 --> 03:16:13,840 AND KIND OF LEVELS OFF HERE 5286 03:16:13,840 --> 03:16:15,280 ABOUT THE 25TH PERCENTILE, IT 5287 03:16:15,280 --> 03:16:16,520 BOUNCES AROUND A LITTLE AND GOES 5288 03:16:16,520 --> 03:16:16,960 DOWN. 5289 03:16:16,960 --> 03:16:19,240 THE SHADED AREA IS THE 5290 03:16:19,240 --> 03:16:19,760 CONFIDENCE INTERVAL. 5291 03:16:19,760 --> 03:16:21,280 YOU CAN SEE THAT THE PATTERNS 5292 03:16:21,280 --> 03:16:24,600 ARE DIFFERENT FOR TH THE HISPAN, 5293 03:16:24,600 --> 03:16:26,880 WHERE ACTUALLY AT THE 75TH 5294 03:16:26,880 --> 03:16:28,240 PERCENTILE, THERE IS NO 5295 03:16:28,240 --> 03:16:28,640 DISPARITY. 5296 03:16:28,640 --> 03:16:29,760 IT'S AT ZERO. 5297 03:16:29,760 --> 03:16:31,360 AND THEN IT GOES -- THEN IT 5298 03:16:31,360 --> 03:16:32,920 FLIPS IN THE OTHER DIRECTION, 5299 03:16:32,920 --> 03:16:38,200 WHERE NOW THE HISPANICS ARE 5300 03:16:38,200 --> 03:16:41,240 ACTUALLY -- HAVE SMALLER BMI. 5301 03:16:41,240 --> 03:16:42,920 AND THEN THE ASIANS HAVE ALSO 5302 03:16:42,920 --> 03:16:49,240 VERY INTERESTING PATTERNS HERE. 5303 03:16:49,240 --> 03:16:50,680 THE OTHER APPROACH WE USE IS 5304 03:16:50,680 --> 03:16:53,720 SOMETHING CALLED THE -- CURVES. 5305 03:16:53,720 --> 03:16:54,920 NOW I'M NOT GOING TO SAY TOO 5306 03:16:54,920 --> 03:16:58,240 MUCH ABOUT THIS, BUT LORENZ 5307 03:16:58,240 --> 03:17:01,800 CURVE IS VERY POPULAR IN 5308 03:17:01,800 --> 03:17:03,600 ECONOMICS TO LOOK AT THE 5309 03:17:03,600 --> 03:17:06,840 INEQUALITY OF INCOME OR OTHER 5310 03:17:06,840 --> 03:17:11,440 FINANCIAL OR MONETARY VALUES. 5311 03:17:11,440 --> 03:17:14,280 SO IT LOOKS AT THE 5312 03:17:14,280 --> 03:17:16,960 NON-UNIFORMITY OR THE INEQUALITY 5313 03:17:16,960 --> 03:17:19,960 IN THESE INDIVIDUAL LEVEL 5314 03:17:19,960 --> 03:17:23,400 VARIABLES, AND THE EXTENT OF THE 5315 03:17:23,400 --> 03:17:24,480 NON-UNIFORMITY IS CHARACTERIZED 5316 03:17:24,480 --> 03:17:26,040 BY THE MAGNITUDE OF THE 5317 03:17:26,040 --> 03:17:27,200 DISPARITY. 5318 03:17:27,200 --> 03:17:29,800 SO THE LORENZ CURVE IS THE PLOT 5319 03:17:29,800 --> 03:17:31,040 OF THE PORTION OF THE SHARE OF 5320 03:17:31,040 --> 03:17:32,320 THE TOTAL POPULATION OF THE SUM 5321 03:17:32,320 --> 03:17:33,000 OF THE Ys. 5322 03:17:33,000 --> 03:17:34,760 SO IF I'M GOING TO APPLY THIS TO 5323 03:17:34,760 --> 03:17:35,960 BMI, IT'S GOING TO BE THE SUM OF 5324 03:17:35,960 --> 03:17:38,120 THE POPULATION WISE NORMALIZED 5325 03:17:38,120 --> 03:17:40,680 FOR THE POPULATION SIZE HERE, I 5326 03:17:40,680 --> 03:17:42,400 HAVE TO NORMALIZE FOR POPULATION 5327 03:17:42,400 --> 03:17:43,960 SIZE, SO EACH RACIAL GROUP HAS 5328 03:17:43,960 --> 03:17:45,800 THE SAME POPULATION SIZE. 5329 03:17:45,800 --> 03:17:48,800 WE MAKE THAT ADJUSTMENT. 5330 03:17:48,800 --> 03:17:50,720 AND WHAT WE'VE DONE IS WE'VE 5331 03:17:50,720 --> 03:17:52,600 EXTENDED THIS LORENZ CURVE IDEA, 5332 03:17:52,600 --> 03:17:54,120 AS I SAID, TO HEALTH 5333 03:17:54,120 --> 03:17:56,320 DISPARITIES, AND WE'VE ALSO 5334 03:17:56,320 --> 03:17:57,000 CREATED SOMETHING A LITTLE 5335 03:17:57,000 --> 03:17:58,600 DIFFERENT THAN THE STANDARD 5336 03:17:58,600 --> 03:17:59,920 LORENZ CURVE AND I JUST WANTED 5337 03:17:59,920 --> 03:18:01,360 TO POINT OUT WHAT THAT IS. 5338 03:18:01,360 --> 03:18:03,880 WE CALL IT A RELATIVELY LORENZ 5339 03:18:03,880 --> 03:18:04,600 CURVE. 5340 03:18:04,600 --> 03:18:08,120 AND THAT'S BECAUSE ON THE X AXIS 5341 03:18:08,120 --> 03:18:12,600 HERE IS THE PERCENTILE OF BMI IN 5342 03:18:12,600 --> 03:18:15,160 A -- IN WHAT WE CALL AN IDEAL 5343 03:18:15,160 --> 03:18:16,240 GROUP, WE CALL IT THE HEALTHY 5344 03:18:16,240 --> 03:18:16,560 GROUP. 5345 03:18:16,560 --> 03:18:18,120 THESE ARE PEOPLE THAT DON'T HAVE 5346 03:18:18,120 --> 03:18:20,160 ANY CHRONIC CONDITIONS 5347 03:18:20,160 --> 03:18:21,400 BASICALLY, HEART, DIABETES, 5348 03:18:21,400 --> 03:18:23,800 THINGS LIKE THAT. 5349 03:18:23,800 --> 03:18:30,560 AND THEN WE PLOT THE CUMULATIVE 5350 03:18:30,560 --> 03:18:35,880 DISTRIBUTION AS THEY FALL IN THE 5351 03:18:35,880 --> 03:18:37,640 PERCENTILES OF THE BMI, AND SO 5352 03:18:37,640 --> 03:18:41,080 LET ME JUST MOVE ON TO THE 5353 03:18:41,080 --> 03:18:46,320 NEXT -- SO FOR PEOPLE -- THE 5354 03:18:46,320 --> 03:18:48,080 BLUE CURVE IS THE NON-HISPANIC 5355 03:18:48,080 --> 03:18:49,800 WHITES AND THE BLACK CURVE ARE 5356 03:18:49,800 --> 03:18:51,360 THE BLACKS -- I'M SORRY -- IS 5357 03:18:51,360 --> 03:18:53,320 THE HEALTHY GROUP HERE. 5358 03:18:53,320 --> 03:18:57,480 ACTUALLY THE RED CURVE IS 5359 03:18:57,480 --> 03:18:59,920 NON-HISPANIC BLACKS HERE. 5360 03:18:59,920 --> 03:19:04,920 AND YOU CAN SEE THAT THE FURTHER 5361 03:19:04,920 --> 03:19:08,760 THE CURB DIPS DOWN BELOW THE 5362 03:19:08,760 --> 03:19:09,880 DIAGONAL, THAT MEANS THERE'S 5363 03:19:09,880 --> 03:19:11,080 MORE INEQUALITY, THERE'S MORE 5364 03:19:11,080 --> 03:19:14,040 DISPARITY THERE, AND FOR THE 5365 03:19:14,040 --> 03:19:16,640 HEALTHY GROUP, IT'S CLOSE TO THE 5366 03:19:16,640 --> 03:19:17,800 DIAGONAL, IT'S THE CLOSEST ONE 5367 03:19:17,800 --> 03:19:19,840 AS YOU WOULD EXPECT. 5368 03:19:19,840 --> 03:19:22,640 THERE'S GOING TO BE LESS 5369 03:19:22,640 --> 03:19:26,240 INEQUALITY THERE, BUT THE BLUE 5370 03:19:26,240 --> 03:19:27,800 CURVE FOR THE NON-HISPANIC 5371 03:19:27,800 --> 03:19:30,280 WHITES IS THE SECOND CLOSEST 5372 03:19:30,280 --> 03:19:31,520 ONE, AND THE BLACKS ARE DOWN 5373 03:19:31,520 --> 03:19:35,880 FURTHER AND SO AT THE 50TH 5374 03:19:35,880 --> 03:19:38,760 PERCENTILE FOR BLACKS THAT ARE 5375 03:19:38,760 --> 03:19:41,320 AT THE -- THE NON-HISPANIC 5376 03:19:41,320 --> 03:19:43,440 BLACKS THAT ARE AT THE 50TH 5377 03:19:43,440 --> 03:19:44,880 PERCENTILE IN THE HEALTHY GROUP, 5378 03:19:44,880 --> 03:19:46,680 THAT ACCOUNTS FOR ONLY 15% OF 5379 03:19:46,680 --> 03:19:50,760 THEIR TOTAL CUMULATIVE BMI IN 5380 03:19:50,760 --> 03:19:55,880 THEIR POPULATION WHEREAS FOR THE 5381 03:19:55,880 --> 03:19:58,320 WHITES, IT'S 35%. 5382 03:19:58,320 --> 03:20:01,200 SO THAT KIND OF QUANTIFIES 5383 03:20:01,200 --> 03:20:02,200 WHAT'S GOING ON THERE. 5384 03:20:02,200 --> 03:20:03,600 ANOTHER WAY TO QUANTIFY IT IS TO 5385 03:20:03,600 --> 03:20:04,680 DO SOMETHING THAT YOU MIGHT HAVE 5386 03:20:04,680 --> 03:20:07,280 HEARD OF CALLED THE GENIE INDEX. 5387 03:20:07,280 --> 03:20:08,840 THE GENIE INDEX IS TWICE THE 5388 03:20:08,840 --> 03:20:10,360 AREA BETWEEN THE DIAGONAL AND 5389 03:20:10,360 --> 03:20:12,680 THE CURVE, AND THAT GIVES YOU 5390 03:20:12,680 --> 03:20:14,080 ANOTHER CHARACTERIZATION OF THE 5391 03:20:14,080 --> 03:20:18,320 EXTENT OF THE DISPARITY. 5392 03:20:18,320 --> 03:20:21,520 OKAY. 5393 03:20:21,520 --> 03:20:27,160 SO OKAY. 5394 03:20:27,160 --> 03:20:28,440 SO WHERE I'D LIKE TO SPEND THE 5395 03:20:28,440 --> 03:20:30,960 REST OF THE TIME IS ABOUT 5396 03:20:30,960 --> 03:20:34,800 DEVELOPING A NEW DATA RESOURCE. 5397 03:20:34,800 --> 03:20:36,680 SO IN OUR DIVISION, AND I THINK 5398 03:20:36,680 --> 03:20:40,560 IN A LOT OF PARTS OF 5399 03:20:40,560 --> 03:20:41,800 EPIDEMIOLOGY, COHORTS HAVE BEEN 5400 03:20:41,800 --> 03:20:43,680 CENTRAL TO CANCER EPIDEMIOLOGY 5401 03:20:43,680 --> 03:20:46,600 RESEARCH. 5402 03:20:46,600 --> 03:20:48,280 MANY -- THERE ARE FREQUENT 5403 03:20:48,280 --> 03:20:50,000 LIMITATIONS OF EXISTING COHORTS, 5404 03:20:50,000 --> 03:20:54,120 I MEAN, THEY OFTEN HAVE LIMITED 5405 03:20:54,120 --> 03:20:55,240 RACE/ETHNIC MINORITIES, THEY'RE 5406 03:20:55,240 --> 03:20:57,520 NOT DIVERSE IN SES, THEY CAN BE 5407 03:20:57,520 --> 03:20:59,600 BETTER EDUCATED, HIGHER INCOME, 5408 03:20:59,600 --> 03:21:00,960 THEY LACK POPULATION 5409 03:21:00,960 --> 03:21:01,720 REPRESENTATIVENESS BECAUSE 5410 03:21:01,720 --> 03:21:03,920 THEY'RE OFTEN SPECIALIZED GROUPS 5411 03:21:03,920 --> 03:21:06,600 OR THEY'RE JUST VOLUNTEERS. 5412 03:21:06,600 --> 03:21:09,160 THESE COHORTS ARE STAGNANT 5413 03:21:09,160 --> 03:21:09,560 OFTEN. 5414 03:21:09,560 --> 03:21:11,240 ONCE THEY COLLECT THEM, THEY'RE 5415 03:21:11,240 --> 03:21:11,600 CLOSED. 5416 03:21:11,600 --> 03:21:13,040 THAT'S NOT TRUE FOR ALL COHORTS, 5417 03:21:13,040 --> 03:21:15,520 BUT THEY TEND TO BE THAT WAY. 5418 03:21:15,520 --> 03:21:16,840 SO THE POPULATION OF THE UNITED 5419 03:21:16,840 --> 03:21:18,360 STATES IS NOT STAGNANT, IT 5420 03:21:18,360 --> 03:21:20,560 CHANGING ALL THE TIME. 5421 03:21:20,560 --> 03:21:21,760 AND THEY'RE LIMITED WITH RESPECT 5422 03:21:21,760 --> 03:21:23,480 TO VARIOUS TYPES OF IMPORTANT 5423 03:21:23,480 --> 03:21:26,040 VARIABLES THAT MAKE IT EASY FOR 5424 03:21:26,040 --> 03:21:28,200 US TO TRY -- OR MAKE IT BETTER 5425 03:21:28,200 --> 03:21:30,280 FOR US TO TRY TO ADDRESS HEALTH 5426 03:21:30,280 --> 03:21:31,520 DISPARITIES. 5427 03:21:31,520 --> 03:21:34,960 SO WE NEED A BETTER RESOURCE, 5428 03:21:34,960 --> 03:21:36,760 AND I'M GOING TO TALK ABOUT WHAT 5429 03:21:36,760 --> 03:21:39,160 I JUST MENTIONED, A LINKAGE 5430 03:21:39,160 --> 03:21:41,640 BETWEEN THE NATIONAL HEALTH 5431 03:21:41,640 --> 03:21:44,480 INTERVIEW SURVEY, IT'S A 5432 03:21:44,480 --> 03:21:45,720 HOUSEHOLD SURVEY DONE EVERY YEAR 5433 03:21:45,720 --> 03:21:47,200 BY THE NATIONAL CENTER FOR 5434 03:21:47,200 --> 03:21:50,720 HEALTH STATISTICS, AND THE 5435 03:21:50,720 --> 03:21:52,240 NHANES, THE NATIONAL HEALTH 5436 03:21:52,240 --> 03:21:55,920 NUTRITION EXAMINATION SURVEY. 5437 03:21:55,920 --> 03:22:00,480 TAKING THEIR DATA FROM -- NHIS 5438 03:22:00,480 --> 03:22:03,200 FROM 1997 ON AND THE NHANES FROM 5439 03:22:03,200 --> 03:22:04,200 1999 ON. 5440 03:22:04,200 --> 03:22:05,520 NHANES IS PUBLISHED EVERY TWO 5441 03:22:05,520 --> 03:22:08,120 YEARS, THEY COME OUT WITH NEW 5442 03:22:08,120 --> 03:22:10,640 DATA. 5443 03:22:10,640 --> 03:22:13,280 THE DATASETS DIFFER IN VARIOUS 5444 03:22:13,280 --> 03:22:14,240 AMOUNTS. 5445 03:22:14,240 --> 03:22:16,840 BASICALLY THE NHIS IS INTERVIEW 5446 03:22:16,840 --> 03:22:22,120 DATA SURVEY, AND THE NHANES IS 5447 03:22:22,120 --> 03:22:23,240 BOTH INTERVIEW AND EXAMINATION. 5448 03:22:23,240 --> 03:22:24,240 SO THEY COLLECT BLOOD. 5449 03:22:24,240 --> 03:22:25,800 I THINK EVERYBODY HERE PROBABLY 5450 03:22:25,800 --> 03:22:27,280 KNOWS ABOUT WHAT THEY HAVE, BUT 5451 03:22:27,280 --> 03:22:28,920 IT'S A VERY RICH DATASET. 5452 03:22:28,920 --> 03:22:33,000 HOUR, IT'S SMALLER, ONLY ABOUT 5453 03:22:33,000 --> 03:22:36,920 5,000 ADULTS ARE INTERVIEWED AND 5454 03:22:36,920 --> 03:22:37,920 COLLECTED DATA FROM EVERY TWO 5455 03:22:37,920 --> 03:22:39,920 YEARS, WHEREAS THE NHIS VARIES 5456 03:22:39,920 --> 03:22:42,320 FROM 30 TO 80,000 ADULTS FOR 5457 03:22:42,320 --> 03:22:44,480 EVERY YEAR. 5458 03:22:44,480 --> 03:22:45,960 AND I'M NOT GOING TO GO THROUGH 5459 03:22:45,960 --> 03:22:53,640 ALL THESE ISSUES HERE, BUT THE 5460 03:22:53,640 --> 03:22:54,560 NATIONAL CENTER FOR HEALTH 5461 03:22:54,560 --> 03:22:55,880 STATISTICS HAS ALREADY LINKED 5462 03:22:55,880 --> 03:23:00,440 THIS DATA TO THE NATIONAL TETHEH 5463 03:23:00,440 --> 03:23:01,000 INDEX. 5464 03:23:01,000 --> 03:23:02,880 PEOPLE USE THIS TO LOOK AT 5465 03:23:02,880 --> 03:23:03,880 MORTALITY USING THE BASELINE 5466 03:23:03,880 --> 03:23:06,280 DATA FROM THE SURVEYS AS TO 5467 03:23:06,280 --> 03:23:11,080 COLLECT THE RISK FACTORS. 5468 03:23:11,080 --> 03:23:13,760 IF YOU LOOP ALL THE NHISs, YOU 5469 03:23:13,760 --> 03:23:16,120 HAVE ABOUT 1.5 MILLION PEOPLE, 5470 03:23:16,120 --> 03:23:18,080 AND THEY'RE U.S. REPRESENTATIVE 5471 03:23:18,080 --> 03:23:18,560 SAMPLE. 5472 03:23:18,560 --> 03:23:24,640 AND OF THAT, 1.5 MILLION, IT'S 5473 03:23:24,640 --> 03:23:26,120 320,000 RACE/ETHNIC MINORITIES 5474 03:23:26,120 --> 03:23:26,760 THERE. 5475 03:23:26,760 --> 03:23:27,840 NHANES, AGAIN MUCH SMALLER BUT 5476 03:23:27,840 --> 03:23:30,360 THEY HAD THIS EXAMINATION 5477 03:23:30,360 --> 03:23:31,240 INFORMATION THAT'S VERY 5478 03:23:31,240 --> 03:23:34,160 EXPENSIVE AND VERY UNIQUE, AND 5479 03:23:34,160 --> 03:23:35,600 IT'S U.S. REPRESENTATIVE AGAIN, 5480 03:23:35,600 --> 03:23:38,120 AND IT GIVES YOU OVER THOSE 5481 03:23:38,120 --> 03:23:40,960 YEARS 1999 ON ABOUT 60,000 5482 03:23:40,960 --> 03:23:43,200 PEOPLE WITH ABOUT 35,000 BECAUSE 5483 03:23:43,200 --> 03:23:46,280 OF THE OVERSAMPLING OF THE 5484 03:23:46,280 --> 03:23:49,840 RACE/ETHNIC MINORITIES. 5485 03:23:49,840 --> 03:23:55,600 SO AS I INDICATE THERE, NHIS HAS 5486 03:23:55,600 --> 03:23:57,080 ALREADY LINKED THIS DATA TO 5487 03:23:57,080 --> 03:23:58,160 VARIOUS DATA SOURCES. 5488 03:23:58,160 --> 03:24:00,880 THIS IS THE NHIS YEARS AND THIS 5489 03:24:00,880 --> 03:24:03,600 TELLS YOU FOR THE NATIONAL DEATH 5490 03:24:03,600 --> 03:24:05,320 INDEX HOW FAR THE LINKAGE IS 5491 03:24:05,320 --> 03:24:07,200 GONE OUT TO MEDICARE DATA AND 5492 03:24:07,200 --> 03:24:08,360 MEDICAID AND OTHER DATA 5493 03:24:08,360 --> 03:24:13,200 INCLUDING HUD DATA. 5494 03:24:13,200 --> 03:24:17,120 SO HOW MANY CANCERS WOULD YOU 5495 03:24:17,120 --> 03:24:20,840 EXPECT, AND SO THIS IS FROM THE 5496 03:24:20,840 --> 03:24:25,000 NHIS UP TO, I THINK 1988 HERE, I 5497 03:24:25,000 --> 03:24:27,000 CAN'T REMEMBER EXACTLY WHERE WE 5498 03:24:27,000 --> 03:24:32,040 DID THIS NOW, BUT IT WAS -- WE 5499 03:24:32,040 --> 03:24:39,640 WOULD GET ABOUT 106, 107,000 5500 03:24:39,640 --> 03:24:42,520 CASES FOR ALL SITES, 89,000 5501 03:24:42,520 --> 03:24:44,520 BEING WHITES AND ALMOST 18,000 5502 03:24:44,520 --> 03:24:48,280 AMONG NON-WHITE, AND THESE WOULD 5503 03:24:48,280 --> 03:24:52,440 BE THE DIFFERENT NUMBERS 5504 03:24:52,440 --> 03:24:54,160 ANTICIPATED THAT IF WE DID THE 5505 03:24:54,160 --> 03:24:55,320 LINKAGE BASICALLY TODAY, WE 5506 03:24:55,320 --> 03:24:56,080 WOULD HAVE ABOUT THIS OR A 5507 03:24:56,080 --> 03:25:00,160 LITTLE BIT MORE BY NOW, OKAY? 5508 03:25:00,160 --> 03:25:03,000 SO THE LINKAGE METHODOLOGY, 5509 03:25:03,000 --> 03:25:05,400 THERE'S ALL THESE ALGORITHMS FOR 5510 03:25:05,400 --> 03:25:07,000 HASHING AND TOKENIZATION USING 5511 03:25:07,000 --> 03:25:08,240 VARIOUS FREE AND COMMERCIAL 5512 03:25:08,240 --> 03:25:10,440 SOFTWARE TO PRESERVE 5513 03:25:10,440 --> 03:25:11,120 CONFIDENTIALITY. 5514 03:25:11,120 --> 03:25:13,920 THAT'S BEEN THE HANGUP. 5515 03:25:13,920 --> 03:25:14,880 THE NATIONAL CENTER FOR HEALTH 5516 03:25:14,880 --> 03:25:18,520 STATISTICS IS NOT GOING TO 5517 03:25:18,520 --> 03:25:21,280 DIVULGE OR PROVIDE DATA ANYWAY 5518 03:25:21,280 --> 03:25:23,600 THAT PEOPLE CAN MISUSE IT AND 5519 03:25:23,600 --> 03:25:24,880 IDENTIFY PEOPLE. 5520 03:25:24,880 --> 03:25:26,080 THAT'S PART OF THE HANGUP. 5521 03:25:26,080 --> 03:25:28,720 THE OTHER PART IS WHERE THE DATA 5522 03:25:28,720 --> 03:25:33,760 WOULD ACTUALLY BE USED, AND YOU 5523 03:25:33,760 --> 03:25:35,840 KNOW, WERE SOMEBODY SITTING AT A 5524 03:25:35,840 --> 03:25:36,800 UNIVERSITY, WHERE CAN THEY 5525 03:25:36,800 --> 03:25:38,200 ANALYZE THIS DATA? 5526 03:25:38,200 --> 03:25:40,040 DO THEY HAVE TO -- THEY HAVE TO 5527 03:25:40,040 --> 03:25:42,640 GO TO A RESEARCH DATA CENTER, 5528 03:25:42,640 --> 03:25:45,320 WHICH THERE ARE ABOUT 35, 37 5529 03:25:45,320 --> 03:25:47,520 CENTERS AROUND THE COUNTRY WHERE 5530 03:25:47,520 --> 03:25:49,520 NCHS HAS AN AGREEMENT WITH THE 5531 03:25:49,520 --> 03:25:51,120 CENSUS BUREAU TO ACTUALLY 5532 03:25:51,120 --> 03:25:51,800 ANALYZE THE DATA. 5533 03:25:51,800 --> 03:25:52,880 BUT THAT'S INCONVENIENT, SO 5534 03:25:52,880 --> 03:25:54,880 RIGHT NOW THERE'S WORK UNDERWAY 5535 03:25:54,880 --> 03:25:58,040 TO DEVELOP A VIRTUAL DATA 5536 03:25:58,040 --> 03:25:59,160 REPOSITORY, AND THAT MEANS THAT 5537 03:25:59,160 --> 03:26:01,240 SOMEONE CAN SIT AT THE DESK 5538 03:26:01,240 --> 03:26:04,640 THAT,SEND THEIR PROGRAMS IN ANDE 5539 03:26:04,640 --> 03:26:08,720 WILL BE SOME SORT OF FIREWALL 5540 03:26:08,720 --> 03:26:12,200 THAT THEY CAN'T DOWNLOAD UNTIL 5541 03:26:12,200 --> 03:26:13,920 NCHS HAS INSPECTED, SO THIS WILL 5542 03:26:13,920 --> 03:26:15,880 MAKE IT A LOT MORE EASY. 5543 03:26:15,880 --> 03:26:18,400 WE WANTED TO IMPLEMENT THIS 5544 03:26:18,400 --> 03:26:20,280 THING, WE WANTED TO START OFF 5545 03:26:20,280 --> 03:26:21,480 WITH TWO CANCER REGISTRIES OR 5546 03:26:21,480 --> 03:26:24,560 MORE, JUST TO DO A PILOT WHO ARE 5547 03:26:24,560 --> 03:26:26,160 WILLING TO SHARE THEIR PII AND 5548 03:26:26,160 --> 03:26:27,280 SO FORTH. 5549 03:26:27,280 --> 03:26:29,040 THAT WAY WE CAN ACTUALLY 5550 03:26:29,040 --> 03:26:31,720 DETERMINE ACCURACY OF THE 5551 03:26:31,720 --> 03:26:33,400 LINKAGE AND WE HAD SOME 5552 03:26:33,400 --> 03:26:37,000 DISCUSSIONS WITH TEXAS AN AND 5553 03:26:37,000 --> 03:26:44,880 LOUANDLOUISIANA AND WE WANTED TK 5554 03:26:44,880 --> 03:26:46,400 AT -- SEE THE ACCURACY OF THIS 5555 03:26:46,400 --> 03:26:47,520 EFFORT AND ALSO THE WILLINGNESS 5556 03:26:47,520 --> 03:26:51,280 OF THE REGISTRIES ACROSS THE 5557 03:26:51,280 --> 03:26:53,400 BOARD TO SEE IF WE COULD GET 5558 03:26:53,400 --> 03:26:55,520 ABOUT -- AT LEAST 75% COVERAGE 5559 03:26:55,520 --> 03:26:57,840 OF THE U.S. POPULATION. 5560 03:26:57,840 --> 03:27:00,080 THAT'S WHAT WE WERE PLANNING TO 5561 03:27:00,080 --> 03:27:01,160 DO IN PHASE ONE. 5562 03:27:01,160 --> 03:27:02,440 IN PHASE TWO, WE WANTED TO 5563 03:27:02,440 --> 03:27:05,360 EXPAND THIS ACROSS ALL THE 5564 03:27:05,360 --> 03:27:07,360 REGISTRIES AND IN PHASE THREE 5565 03:27:07,360 --> 03:27:09,200 HOPEFULLY GET EVERYBODY IN AT 5566 03:27:09,200 --> 03:27:10,040 SOME POINT. 5567 03:27:10,040 --> 03:27:12,600 SO THERE ARE A LOT OF POTENTIAL 5568 03:27:12,600 --> 03:27:15,080 RESEARCH QUESTIONS THAT CAN BE 5569 03:27:15,080 --> 03:27:17,760 ADDRESSED WITH THIS DATA IF IT 5570 03:27:17,760 --> 03:27:18,200 COMES ABOUT. 5571 03:27:18,200 --> 03:27:21,800 I'D HAVE TO SAY, I'VE BEEN -- 5572 03:27:21,800 --> 03:27:23,840 WE'VE BEEN TALKING ABOUT THIS 5573 03:27:23,840 --> 03:27:26,840 SINCE 2015, AND WE'RE IN 2023 5574 03:27:26,840 --> 03:27:28,880 NOW AND NOTHING'S HAPPENED, BUT 5575 03:27:28,880 --> 03:27:32,000 WE HAD SOME GOOD CONVERSATIONS 5576 03:27:32,000 --> 03:27:34,200 THIS PAST WEEK, AND I THINK 5577 03:27:34,200 --> 03:27:36,040 THERE'S A REAL POSSIBILITY. 5578 03:27:36,040 --> 03:27:37,920 AND THIS DATA WILL BE MADE 5579 03:27:37,920 --> 03:27:38,920 PUBLICLY AVAILABLE, LIKE IT'S 5580 03:27:38,920 --> 03:27:40,000 NOT JUST FOR NCI. 5581 03:27:40,000 --> 03:27:44,680 THIS IS FOR ANYBODY, ANY 5582 03:27:44,680 --> 03:27:45,880 RESEARCHER AS FAR AS I CAN 5583 03:27:45,880 --> 03:27:47,560 DETERMINE IN THE UNITED STATES 5584 03:27:47,560 --> 03:27:49,240 AT LEAST AND MAYBE BEYOND THAT, 5585 03:27:49,240 --> 03:27:51,840 I DIDN DON'T KNOW HOW THAT WOULD 5586 03:27:51,840 --> 03:27:52,200 WORK. 5587 03:27:52,200 --> 03:27:53,280 BUT THESE ARE TYPES OF QUESTIONS 5588 03:27:53,280 --> 03:27:56,840 THAT YOU COULD TRY TO ADDRESS 5589 03:27:56,840 --> 03:27:57,920 BECAUSE QUESTIONS ABOUT HOW 5590 03:27:57,920 --> 03:28:01,800 THINGS ARE CHANGING OVER TIME, 5591 03:28:01,800 --> 03:28:05,360 THESE SURVEYS REPRESENT 5592 03:28:05,360 --> 03:28:06,800 POPULATIONS OVER TIME BECAUSE 5593 03:28:06,800 --> 03:28:09,320 THEY'RE DONE EVERY YEAR LIKE 5594 03:28:09,320 --> 03:28:12,240 NHIS, NHANES EVERY OTHER YEAR -- 5595 03:28:12,240 --> 03:28:16,280 EVERY TWO YEARS. 5596 03:28:16,280 --> 03:28:17,280 SO THIS IS A RARITY. 5597 03:28:17,280 --> 03:28:19,480 I MEAN, TALKING ABOUT A COHORT, 5598 03:28:19,480 --> 03:28:22,200 LIKE I SAY, IT'S STAGNANT, YOU 5599 03:28:22,200 --> 03:28:23,000 CAN'T -- THEY DON'T REPRESENT 5600 03:28:23,000 --> 03:28:24,200 ANYTHING TO START WITH USUALLY, 5601 03:28:24,200 --> 03:28:28,520 AND THEN WHATEVER THEY 5602 03:28:28,520 --> 03:28:30,720 REPRESENT, THEY'VE ONLY BEEN 5603 03:28:30,720 --> 03:28:32,480 TAKING THAT AT ONE POINT IN TIME 5604 03:28:32,480 --> 03:28:33,040 AND THEN THAT'S IT. 5605 03:28:33,040 --> 03:28:34,880 I MEAN, YOU KNOW, WHATEVER THEY 5606 03:28:34,880 --> 03:28:39,320 ARE LATER IN TIME. 5607 03:28:39,320 --> 03:28:42,240 SO THIS CAN BE VERY USEFUL FOR 5608 03:28:42,240 --> 03:28:43,880 BOTH DISPARITY RESEARCH AND JUST 5609 03:28:43,880 --> 03:28:50,120 GENERAL CANCER RESEARCH. 5610 03:28:50,120 --> 03:28:50,560 ACROSS ALL GROUPS. 5611 03:28:50,560 --> 03:28:54,080 SO I THINK I'LL PRETTY MUCH STOP 5612 03:28:54,080 --> 03:28:55,080 THERE, JUST WANT TO SAY SOME OF 5613 03:28:55,080 --> 03:29:00,760 THE PEOPLE THAT I WORK WITH, 5614 03:29:00,760 --> 03:29:01,920 ANIL CHATURVEDI WAS SUPPOSED TO 5615 03:29:01,920 --> 03:29:03,360 GIVE THIS TALK, NOT ME, ANYWAY, 5616 03:29:03,360 --> 03:29:08,520 SO I GOT STUCK WITH IT, BUT ALSO 5617 03:29:08,520 --> 03:29:11,760 CONSTANZA HAS BEEN INVOLVED WITH 5618 03:29:11,760 --> 03:29:14,520 THIS, AND FROM THE METHODS SIDE, 5619 03:29:14,520 --> 03:29:16,120 THESE ARE THE STATISTICIANS ON 5620 03:29:16,120 --> 03:29:20,120 THE PAPERS I TALKED ABOUT, AND 5621 03:29:20,120 --> 03:29:21,440 THE OTHERS ARE SENIOR PEOPLE. 5622 03:29:21,440 --> 03:29:22,760 SO I'LL LEAVE IT AT THAT. 5623 03:29:22,760 --> 03:29:32,960 [APPLAUSE] 5624 03:29:48,560 --> 03:29:50,120 >>GOOD AFTERNOON, THANK YOU SO 5625 03:29:50,120 --> 03:29:50,360 MUCH. 5626 03:29:50,360 --> 03:29:52,480 I WAS JUST CURIOUS, YOU WERE 5627 03:29:52,480 --> 03:29:54,040 TALKING ABOUT THE COUNTERFACTUAL 5628 03:29:54,040 --> 03:29:55,760 MODEL AND THE THING THAT KEPT 5629 03:29:55,760 --> 03:29:57,160 COMING UP FOR ME AROUND 5630 03:29:57,160 --> 03:29:58,400 MEASURING DISPARITIES IS THAT 5631 03:29:58,400 --> 03:30:01,360 WHEN WE THINK ABOUT DISPARITIES, 5632 03:30:01,360 --> 03:30:02,560 THE TWO SORT OF MAIN ASSUMPTIONS 5633 03:30:02,560 --> 03:30:04,760 FOR THE COUNTERFACTUAL WHICH ARE 5634 03:30:04,760 --> 03:30:05,880 LININGLIKE THE TIME VARYING 5635 03:30:05,880 --> 03:30:07,440 EFFECT AND THEN THE 5636 03:30:07,440 --> 03:30:09,440 HETEROGENEOUS EFFECT OF THE 5637 03:30:09,440 --> 03:30:11,760 EXPOSURE ON SORT OF THE -- I 5638 03:30:11,760 --> 03:30:14,840 GUESS THE OUTCOME VARIES, RIGHT? 5639 03:30:14,840 --> 03:30:15,520 SO -- 5640 03:30:15,520 --> 03:30:16,640 >>YOU MEAN BETWEEN THE GROUPS? 5641 03:30:16,640 --> 03:30:17,880 >>BETWEEN THE GROUPS, YEAH, SO 5642 03:30:17,880 --> 03:30:18,960 HOW DO WE ACCOUNT FOR THAT? 5643 03:30:18,960 --> 03:30:21,040 THOSE ARE THE TWO SORT OF -- 5644 03:30:21,040 --> 03:30:26,520 >>SO YOU NOTICE THE PETERS 5645 03:30:26,520 --> 03:30:28,400 BELLSON IDEA, YOU FIT THE MODEL 5646 03:30:28,400 --> 03:30:30,680 TO JUST -- TO THE ADVANTAGE 5647 03:30:30,680 --> 03:30:32,000 GROUP, OKAY? 5648 03:30:32,000 --> 03:30:36,760 SO IT ACTUALLY -- YOU CAN SHOW 5649 03:30:36,760 --> 03:30:39,360 MATHEMATICALLY THAT IT'S GIVING 5650 03:30:39,360 --> 03:30:41,000 YOU -- IT'S LIKE YOU'RE MATCHING 5651 03:30:41,000 --> 03:30:44,840 TO THE -- BETWEEN THE MINORITY 5652 03:30:44,840 --> 03:30:47,000 OR DISADVANTAGED GROUP TO THE 5653 03:30:47,000 --> 03:30:49,640 ADVANTAGE GROUP, THERE'S NO 5654 03:30:49,640 --> 03:30:51,600 ASSUMPTION THAT THE RELATIONSHIP 5655 03:30:51,600 --> 03:30:55,200 HOLDS EXACTLY THE SAME. 5656 03:30:55,200 --> 03:30:58,280 IT MAY SEEM LIKE THAT, BUT I'M 5657 03:30:58,280 --> 03:30:59,560 ONLY FITTING A MODEL TO ONE 5658 03:30:59,560 --> 03:31:01,040 GROUP AND THAT'S WHY I'M GETTING 5659 03:31:01,040 --> 03:31:02,280 AROUND THAT. 5660 03:31:02,280 --> 03:31:06,600 IF THERE IS SOME INTERACTION, 5661 03:31:06,600 --> 03:31:09,160 AND IT'S NOT PROPERLY REFLECTED 5662 03:31:09,160 --> 03:31:11,720 IN THE WAY I JUST DESCRIBED, 5663 03:31:11,720 --> 03:31:13,800 THEN IT WILL BE -- IT WILL GET 5664 03:31:13,800 --> 03:31:16,000 PUSHED INTO THE UNEXPLAINED 5665 03:31:16,000 --> 03:31:17,120 COMPONENT, OKAY? 5666 03:31:17,120 --> 03:31:18,720 AND THEN YOU CAN EXPLORE THAT A 5667 03:31:18,720 --> 03:31:20,680 LITTLE BIT FURTHER. 5668 03:31:20,680 --> 03:31:23,240 THE WAHAKA BLINDER METHOD, AT 5669 03:31:23,240 --> 03:31:25,280 LEAST FOR LINEAR REGRESSION, 5670 03:31:25,280 --> 03:31:27,280 TRIES TO TAKE THAT INTO ACCOUNT 5671 03:31:27,280 --> 03:31:29,680 BY A THIRD ASPECT OF THEIR 5672 03:31:29,680 --> 03:31:30,640 PARTITIONING, AND THAT CAN BE 5673 03:31:30,640 --> 03:31:32,840 DONE HERE TOO, OKAY, SO IF YOU 5674 03:31:32,840 --> 03:31:34,800 WANT TO EXPLICITLY LOOK AT THAT, 5675 03:31:34,800 --> 03:31:39,200 YOU CAN DO SOMETHING LIKE THE 5676 03:31:39,200 --> 03:31:42,200 WAHAKA BLINDER. 5677 03:31:42,200 --> 03:31:43,240 >>THANK YOU SO MUCH FOR THE 5678 03:31:43,240 --> 03:31:43,600 TALK. 5679 03:31:43,600 --> 03:31:44,840 I HAD A QUESTION THAT IS SIMILAR 5680 03:31:44,840 --> 03:31:48,000 AND I WANTED TO LIFT SOMETHING 5681 03:31:48,000 --> 03:31:49,640 UP THAT WAS ASKED THIS MORNING 5682 03:31:49,640 --> 03:31:50,560 ABOUT INTERSECTIONALITY BECAUSE 5683 03:31:50,560 --> 03:31:54,320 IT DOESN'T SEEM LIKE THE PETERS 5684 03:31:54,320 --> 03:31:55,880 BELSON METHOD TAKES PEOPLE INTO 5685 03:31:55,880 --> 03:31:57,480 ACCOUNT WHO BELONG TO MORE THAN 5686 03:31:57,480 --> 03:31:58,920 ONE MARGINALIZED GROUP AND I'M 5687 03:31:58,920 --> 03:32:01,680 WONDER IF THE BIOSTATISTICS 5688 03:32:01,680 --> 03:32:03,800 BRANCH AND DCEG IS GOING TO TRY 5689 03:32:03,800 --> 03:32:05,960 TO TACKLE ANY OF THE ISSUES THAT 5690 03:32:05,960 --> 03:32:07,520 COME WITH STUDYING 5691 03:32:07,520 --> 03:32:07,920 INTERSECTIONALITY. 5692 03:32:07,920 --> 03:32:09,760 >>OKAY. 5693 03:32:09,760 --> 03:32:12,240 SO INTERSECTIONALITY IS A 5694 03:32:12,240 --> 03:32:12,960 TOUGH -- IS A VERY DIFFICULT 5695 03:32:12,960 --> 03:32:14,680 THING FOR STATISTICIANS TO DEAL 5696 03:32:14,680 --> 03:32:19,520 WITH, BECAUSE WHEN YOU START 5697 03:32:19,520 --> 03:32:20,800 TAKING THAT INTO ACCOUNT, THEN 5698 03:32:20,800 --> 03:32:22,560 THE NUMBERS GET -- IF YOU HAD TO 5699 03:32:22,560 --> 03:32:24,840 HAVE THE INFORMATION TO MAKE THE 5700 03:32:24,840 --> 03:32:26,280 IDENTIFICATION, NUMBERS GET 5701 03:32:26,280 --> 03:32:28,480 REALLY SMALL. 5702 03:32:28,480 --> 03:32:29,600 NOW, ONE OF THE ADVANTAGES OF 5703 03:32:29,600 --> 03:32:31,920 THE PETERS BELSON APPROACH IS 5704 03:32:31,920 --> 03:32:32,960 THAT SINCE YOU'RE FITTING THE 5705 03:32:32,960 --> 03:32:34,480 MODEL TO THE ADVANTAGED GROUP, 5706 03:32:34,480 --> 03:32:36,120 WHICH TENDS TO BE THE MAJORITY 5707 03:32:36,120 --> 03:32:38,800 GROUP BUT NOT ALWAYS, THEN YOU 5708 03:32:38,800 --> 03:32:41,720 DON'T NEED TO -- THE SMALL 5709 03:32:41,720 --> 03:32:42,720 NUMBERS IN THE GROUPS THAT 5710 03:32:42,720 --> 03:32:46,360 YOU'RE COMPARING, YOU'RE NOT 5711 03:32:46,360 --> 03:32:48,400 ESTIMATING PARAMETERS WITH THEM. 5712 03:32:48,400 --> 03:32:50,520 SO IT ACTUALLY -- IT'S HELPFUL 5713 03:32:50,520 --> 03:32:52,200 FOR THAT, BUT STILL, IF THE 5714 03:32:52,200 --> 03:32:55,040 NUMBERS GET SMALL, IT A 5715 03:32:55,040 --> 03:32:58,240 DIFFICULT THING. 5716 03:32:58,240 --> 03:33:00,440 SO WE HAVE TO -- STATISTICIANS 5717 03:33:00,440 --> 03:33:01,760 HAVE TO THINK OF OTHER THINGS TO 5718 03:33:01,760 --> 03:33:03,800 DO HERE. 5719 03:33:03,800 --> 03:33:07,240 SOME MAY BE IMPOSSIBLE, BUT 5720 03:33:07,240 --> 03:33:09,840 THERE MAY BE WAYS TO USE -- I 5721 03:33:09,840 --> 03:33:12,200 HAVEN'T THOUGHT ABOUT IT 5722 03:33:12,200 --> 03:33:13,560 EXTENSIVELY, BUT SOME SORT OF 5723 03:33:13,560 --> 03:33:16,800 LATE GROUPINGS THAT COULD BORROW 5724 03:33:16,800 --> 03:33:19,880 STRENGTH OR ACROSS GROUPS IN 5725 03:33:19,880 --> 03:33:22,200 SOME WAY SO THAT YOU CAN GET 5726 03:33:22,200 --> 03:33:23,800 SOME SORT OF ESTIMATE IF YOU 5727 03:33:23,800 --> 03:33:25,040 HAVE VARIABLES THAT CAN IDENTIFY 5728 03:33:25,040 --> 03:33:26,600 WHAT THOSE LATENT GROUPS ARE. 5729 03:33:26,600 --> 03:33:28,480 YOU KNOW, AND THAT HAS TO BE 5730 03:33:28,480 --> 03:33:29,520 LOOKED AT. 5731 03:33:29,520 --> 03:33:31,040 THAT'S WORK THAT WE'RE ALREADY 5732 03:33:31,040 --> 03:33:32,400 THINKING ABOUT, THAT'S RIGHT. 5733 03:33:32,400 --> 03:33:35,720 THAT'S IMPORTANT. 5734 03:33:35,720 --> 03:33:36,120 OKAY. 5735 03:33:36,120 --> 03:33:46,320 [APPLAUSE] 5736 03:33:53,000 --> 03:33:54,600 >> -- MORTALITY AMONG BLACK 5737 03:33:54,600 --> 03:33:58,760 INDIVIDUALS IN THE U.S. 5738 03:33:58,760 --> 03:34:01,520 WELCOME, DR. LAWRENCE. 5739 03:34:01,520 --> 03:34:02,560 [APPLAUSE] 5740 03:34:02,560 --> 03:34:03,440 >>HELLO. 5741 03:34:03,440 --> 03:34:05,080 THANK YOU FOR THE INTRODUCTION. 5742 03:34:05,080 --> 03:34:07,160 ONCE AGAIN MY NAME IS WAYNE 5743 03:34:07,160 --> 03:34:08,880 LAWRENCE, RESEARCH FELLOW AT THE 5744 03:34:08,880 --> 03:34:10,040 NATIONAL CANCER INSTITUTE. 5745 03:34:10,040 --> 03:34:12,680 I'M EXCITED TO SHARE A STUDY WE 5746 03:34:12,680 --> 03:34:15,920 COMPLETED THAT SOUGHT TO 5747 03:34:15,920 --> 03:34:18,080 DESCRIBE TRANS -- MORTALITY OVER 5748 03:34:18,080 --> 03:34:18,560 A TWO DECADE PERIOD. 5749 03:34:18,560 --> 03:34:21,120 BEFORE I BEGIN, PLEASE NOTE THE 5750 03:34:21,120 --> 03:34:24,920 OPINIONS ARE MY OWN AND MAY NOT 5751 03:34:24,920 --> 03:34:26,960 REPRESENT THE ENTITY OR NIH AS A 5752 03:34:26,960 --> 03:34:27,600 WHOLE. 5753 03:34:27,600 --> 03:34:28,960 CANCER IS THE SECOND LEEING 5754 03:34:28,960 --> 03:34:31,040 CAUSE OF MORTALITY IN THE UNITED 5755 03:34:31,040 --> 03:34:32,200 STATES, IT IS ESTIMATED IN 2020 5756 03:34:32,200 --> 03:34:37,400 THERE WERE OVER SIX HUP THOUSANS 5757 03:34:37,400 --> 03:34:38,040 DUE TO CANCER. 5758 03:34:38,040 --> 03:34:38,880 BLACK INDIVIDUALS CONTINUE TO 5759 03:34:38,880 --> 03:34:40,360 BEAR A HIGHER CANCER BURDEN 5760 03:34:40,360 --> 03:34:41,800 COMPARED WITH MOST OTHER RACIAL 5761 03:34:41,800 --> 03:34:43,680 AND ETHNIC GROUPS. 5762 03:34:43,680 --> 03:34:45,400 STUDIES THAT HAVE SHOWN THAT -- 5763 03:34:45,400 --> 03:34:50,760 STUDIES HAVE SHOWN VARIOUS 5764 03:34:50,760 --> 03:34:55,760 ADVANCEMENT -- CANCER MORTALITY 5765 03:34:55,760 --> 03:34:57,240 WITHIN THE UNITED STATES. 5766 03:34:57,240 --> 03:34:59,120 HOWEVER, WITH THE INCREASED 5767 03:34:59,120 --> 03:35:00,280 ATTENTION TO -- WITH INCREASED 5768 03:35:00,280 --> 03:35:03,040 ATTENTION TO HEALTH EQUITY AS 5769 03:35:03,040 --> 03:35:05,560 WELL AS THE ADVANCES MADE IN 5770 03:35:05,560 --> 03:35:06,800 CANCER PREVENTION, DETECTION AND 5771 03:35:06,800 --> 03:35:08,160 TREATMENT AS WELL AS EXPANSION 5772 03:35:08,160 --> 03:35:09,040 OF HEALTHCARE UNDER THE PATIENT 5773 03:35:09,040 --> 03:35:10,640 PROTECTION AND AFFORDABLE CARE 5774 03:35:10,640 --> 03:35:11,400 ACT HAS CONTRIBUTED NATIONALLY 5775 03:35:11,400 --> 03:35:12,800 TO REDUCTION IN CANCER MORTALITY 5776 03:35:12,800 --> 03:35:13,520 AS A WHOLE. 5777 03:35:13,520 --> 03:35:14,960 HOWEVER, THE SPECIFIC IMPACTS OF 5778 03:35:14,960 --> 03:35:17,480 THESE FACTORS ON CANCER DEATH 5779 03:35:17,480 --> 03:35:20,040 RATES AMONG BLACK PLEN AND WOMEN 5780 03:35:20,040 --> 03:35:21,920 ESPECIALLY OVER TIME REMAINED 5781 03:35:21,920 --> 03:35:23,280 NOT WELL UNDERSTOOD AT THE TIME 5782 03:35:23,280 --> 03:35:23,840 OF THE STUDY. 5783 03:35:23,840 --> 03:35:25,560 SO A DETAILED UNDERSTANDING OF 5784 03:35:25,560 --> 03:35:27,640 CANCER MORTALITY RATES AMONG 5785 03:35:27,640 --> 03:35:29,520 BLACK MEN AND WOMEN IS ESSENTIAL 5786 03:35:29,520 --> 03:35:30,560 TO ASSESS RECENT PROGRESS WE 5787 03:35:30,560 --> 03:35:33,560 HAVE MADE AS WELL AS TO INFORM 5788 03:35:33,560 --> 03:35:35,240 INTERVENTIONS AT CANCER 5789 03:35:35,240 --> 03:35:36,320 DISPARITIES IN THE UNITED 5790 03:35:36,320 --> 03:35:37,320 STATES, PARTICULARLIAGE BLACK 5791 03:35:37,320 --> 03:35:37,720 INDIVIDUALS. 5792 03:35:37,720 --> 03:35:40,000 SO THEREFORE WE SOUGHT TO 5793 03:35:40,000 --> 03:35:41,360 DESCRIBE THE CURRENT TRENDS IN 5794 03:35:41,360 --> 03:35:42,840 CANCER MORTALITY AMONG BLACK MEN 5795 03:35:42,840 --> 03:35:44,040 AND WOMEN AGES 20 YEARS AND 5796 03:35:44,040 --> 03:35:45,360 OLDER IN THE UNITED STATES BY 5797 03:35:45,360 --> 03:35:49,200 AGE, BY SEX, BY LEADING CANCER 5798 03:35:49,200 --> 03:35:50,720 SITES AND AS WELL AS BY STATES. 5799 03:35:50,720 --> 03:35:53,800 AND THEN IN 2019, WE SOUGHT TO 5800 03:35:53,800 --> 03:35:56,560 COMPARE BLACK INDIVIDUALS TO ALL 5801 03:35:56,560 --> 03:36:00,160 OTHER RACIAL ETHNICALLY DEFINED 5802 03:36:00,160 --> 03:36:02,000 BROAD GROUPS, HOW DO WE LOOK AS 5803 03:36:02,000 --> 03:36:03,680 A NATION AT THAT ONE STANDPOINT, 5804 03:36:03,680 --> 03:36:04,840 TIME POINT. 5805 03:36:04,840 --> 03:36:07,720 SO BRIEFLY IN METHODS, THE 5806 03:36:07,720 --> 03:36:09,400 PRESENT STUDY FOCUSED ON OVERALL 5807 03:36:09,400 --> 03:36:11,200 CANCER MORTALITY AND LEADING 5808 03:36:11,200 --> 03:36:15,600 CAUSES OF CANCER DEATHS, 5809 03:36:15,600 --> 03:36:19,760 DEMOGRAPHIC CHARACTERISTICS, 5810 03:36:19,760 --> 03:36:26,120 REGRESSJOINPOINT REGRESSION PROS 5811 03:36:26,120 --> 03:36:30,360 USED, STANDARDIZED TO THE 2000 5812 03:36:30,360 --> 03:36:31,440 POPULATION PER 100,000 5813 03:36:31,440 --> 03:36:32,040 INDIVIDUALS. 5814 03:36:32,040 --> 03:36:35,280 SO OVER THE STUDY PERIOD FROM 5815 03:36:35,280 --> 03:36:38,840 1999 TO 2019 THERE WERE 5816 03:36:38,840 --> 03:36:39,760 1 MILLION CANCERS DEATHS WITHIN 5817 03:36:39,760 --> 03:36:40,880 THE UNITED STATES. 5818 03:36:40,880 --> 03:36:42,280 OVERALL, THERE WAS A 2% 5819 03:36:42,280 --> 03:36:44,200 REDUCTION OVER THIS TIME PERIOD 5820 03:36:44,200 --> 03:36:46,680 FROM 1999 TO 2019, WHERE CANCER 5821 03:36:46,680 --> 03:36:48,920 MORTALITY RATES DECLINE FASTER 5822 03:36:48,920 --> 03:36:50,440 AMONG BLACK MEN COMPARED WITH 5823 03:36:50,440 --> 03:36:51,200 BLACK WOMEN. 5824 03:36:51,200 --> 03:36:53,040 CANCER MORTALITY RATES ON BLACK 5825 03:36:53,040 --> 03:36:55,080 MEN ARE SHOWN IN THE RED LINE, 5826 03:36:55,080 --> 03:36:56,480 BLACK WOMEN SHOWN IN BLUE LINE. 5827 03:36:56,480 --> 03:36:58,280 AMONG THE YOUNGER AGE GROUPS, 5828 03:36:58,280 --> 03:37:05,320 CANCER MORTALITY RATES WERE 5829 03:37:05,320 --> 03:37:06,600 HIGHER -- SO WITH THE 5830 03:37:06,600 --> 03:37:08,480 CONTRIBUTIONS OF ADVANCEMENTS IN 5831 03:37:08,480 --> 03:37:09,680 CANCER CARE THROUGHOUT THE 5832 03:37:09,680 --> 03:37:11,200 CANCER CONTROL CONTINUUM, THAT 5833 03:37:11,200 --> 03:37:12,160 WAS ONE ASPECT THAT HELPED TO 5834 03:37:12,160 --> 03:37:13,600 REDUCE THE CANCER MORTALITY 5835 03:37:13,600 --> 03:37:16,800 RATES, HOWEVER, THERE WERE SHARP 5836 03:37:16,800 --> 03:37:19,080 DECLINE IN CIGARETTE SMOKING 5837 03:37:19,080 --> 03:37:22,160 FROM 24.3% ESTIMATED IN 1999 TO 5838 03:37:22,160 --> 03:37:23,600 APPROXIMATELY 14% IN 2019. 5839 03:37:23,600 --> 03:37:25,160 SO THEREFORE, IT CONTRIBUTED TO 5840 03:37:25,160 --> 03:37:28,520 A LOT OF THE CIGARETTE SMOKE 5841 03:37:28,520 --> 03:37:29,680 RELATED CANCER MORTALITIES. 5842 03:37:29,680 --> 03:37:31,880 BUT NOW WHEN FOCUSING 5843 03:37:31,880 --> 03:37:33,760 SPECIFICALLY ON BLACK MEN IN THE 5844 03:37:33,760 --> 03:37:35,400 UNITED STATES, FOR MOST OF THE 5845 03:37:35,400 --> 03:37:36,320 LEADING CANCER DEATHS, THERE WAS 5846 03:37:36,320 --> 03:37:38,560 A DECLINE OVERALL. 5847 03:37:38,560 --> 03:37:40,120 HOWEVER, INTERESTINGLY FOR LIVER 5848 03:37:40,120 --> 03:37:41,320 CANCER SHOWN BY THE GREEN LINE 5849 03:37:41,320 --> 03:37:46,880 IN BOX A, IT INCREASED FROM 1999 5850 03:37:46,880 --> 03:37:49,080 TO AROUND 2013 AND LATER 5851 03:37:49,080 --> 03:37:51,280 DECLINED FROM 2013 TO 2019. 5852 03:37:51,280 --> 03:37:52,520 HOWEVER, OVER THIS STUDY PERIOD, 5853 03:37:52,520 --> 03:37:54,520 THE LARGEST AND THE SHARPEST 5854 03:37:54,520 --> 03:37:55,760 DECLINE THAT WE OBSERVE IS FOR 5855 03:37:55,760 --> 03:37:57,520 LUNG CANCER, WHERE MORTALITY 5856 03:37:57,520 --> 03:38:00,480 RAILTS DECLINED ON AVERAGE ABOUT 5857 03:38:00,480 --> 03:38:02,520 3.8% FROM 1999 TO 2019. 5858 03:38:02,520 --> 03:38:04,480 SO OVERALL WE DID SEE A LARGE 5859 03:38:04,480 --> 03:38:06,040 DECLINE IN ADULT BLACK 5860 03:38:06,040 --> 03:38:07,120 POPULATION AS A WHOLE WHERE THE 5861 03:38:07,120 --> 03:38:08,360 GREATEST DECLINE WAS OBSERVED 5862 03:38:08,360 --> 03:38:11,080 FOR LUNG CANCER MORTALITY. 5863 03:38:11,080 --> 03:38:13,040 NOW IN FOCUSING SPECIFICALLY NOW 5864 03:38:13,040 --> 03:38:15,000 ON BLACK WOMEN, WE SEE A SIMILAR 5865 03:38:15,000 --> 03:38:16,560 TREND WHERE OVER TIME, THERE WAS 5866 03:38:16,560 --> 03:38:19,600 LARGELY A DECREASE FOR LEADING 5867 03:38:19,600 --> 03:38:20,680 CANCER MORTALITY SITES. 5868 03:38:20,680 --> 03:38:22,240 HOWEVER, FOR LIVER CANCER NOW, 5869 03:38:22,240 --> 03:38:24,000 LOOKING AT THE GREEN LINE IN BOX 5870 03:38:24,000 --> 03:38:25,760 B, AND UTERINE CANCER, THE GREEN 5871 03:38:25,760 --> 03:38:27,920 LINE SHOWN IN BOX C, WE SEE THAT 5872 03:38:27,920 --> 03:38:30,560 FOR THESE TWO CANCERS, THERE WAS 5873 03:38:30,560 --> 03:38:32,520 AN INCREASE OF ABOUT 1% AVERAGE 5874 03:38:32,520 --> 03:38:37,680 PER YEAR ANNUALLY FROM 1999 T 5875 03:38:37,680 --> 03:38:39,840 TO -- SO ULTIMATELY WE SEE A 5876 03:38:39,840 --> 03:38:44,680 DECLINE FOR MOST CANCER SITES -- 5877 03:38:44,680 --> 03:38:46,960 ABOUT 1% ON AVERAGE PER YEAR. 5878 03:38:46,960 --> 03:38:48,320 NOW LET'S TURN AGAIN BACK TO 5879 03:38:48,320 --> 03:38:49,720 BLACK MEN. 5880 03:38:49,720 --> 03:38:51,160 WHEN STRATIFIED BY AGE GROUP, WE 5881 03:38:51,160 --> 03:38:53,440 SEE THAT FOR BLACK MEN CANCER 5882 03:38:53,440 --> 03:38:55,280 DEATHS DECLINED ACROSS ALL AGE 5883 03:38:55,280 --> 03:38:56,720 GROUPS AS A WHOLE FOR MOST 5884 03:38:56,720 --> 03:38:58,480 CANCER SITES WITH THE GREATEST 5885 03:38:58,480 --> 03:39:00,080 DECLINE FOR LUNG CANCER AMONG 5886 03:39:00,080 --> 03:39:02,640 THOSE 35 TO 49, 50 TO 64 AND 5887 03:39:02,640 --> 03:39:06,440 65 TO 79 YEARS OF AGE. 5888 03:39:06,440 --> 03:39:08,000 HOWEVER, IT'S HARD TO SEE HERE 5889 03:39:08,000 --> 03:39:12,080 BUT FOR PROSTATE CANCER, -- AM 5890 03:39:12,080 --> 03:39:14,240 THOSE AGES 65 TO 79 YEARS OF AGE 5891 03:39:14,240 --> 03:39:17,320 AND WE HAVE PROVE SIGHED THAT IN 5892 03:39:17,320 --> 03:39:19,640 2013, THIS MAY BE DUE TO THE 5893 03:39:19,640 --> 03:39:22,440 2012 U.S. PREVENTIVE TASK FORCE 5894 03:39:22,440 --> 03:39:23,160 RECOMMENDATION AGAINST SCREENING 5895 03:39:23,160 --> 03:39:26,160 AT THAT TIME, THOUGH IN 2018 THE 5896 03:39:26,160 --> 03:39:28,320 TASK FORCE RECOMMENDED FOR MEN 5897 03:39:28,320 --> 03:39:29,360 TO DISCUSS THIS WITH THEIR 5898 03:39:29,360 --> 03:39:31,960 PHYSICIAN AMONG THOSE AGES 50 TO 5899 03:39:31,960 --> 03:39:35,520 69 YEARS OF AGE -- BENEFITS AND 5900 03:39:35,520 --> 03:39:36,400 HARMS OF THE SCREENING. 5901 03:39:36,400 --> 03:39:38,000 WHEN WE LOOK AT BLACK MEN AGAIN, 5902 03:39:38,000 --> 03:39:39,680 AS SHOWN BY THE GREEN LINE, FOR 5903 03:39:39,680 --> 03:39:41,800 BLACK MEN AGES 50 TO 64, THEY 5904 03:39:41,800 --> 03:39:44,400 HAD A SHARP INCREASE IN LIVER 5905 03:39:44,400 --> 03:39:45,480 CANCER MORTALITY SHOWN BY THE 5906 03:39:45,480 --> 03:39:47,600 GREEN LINE FROM 1999 PLATEAUING 5907 03:39:47,600 --> 03:39:50,760 FROM 2009 TO 2014, AND A SHARP 5908 03:39:50,760 --> 03:39:52,960 DECLINE FROM 2014 TO 2019. 5909 03:39:52,960 --> 03:39:54,920 HOWEVER, WE SEE THAT FOR MEN 5910 03:39:54,920 --> 03:39:57,240 AGES 65 TO 79, THE BOTTOM LEFT 5911 03:39:57,240 --> 03:39:58,360 CORNER, THERE WAS A SHARP 5912 03:39:58,360 --> 03:39:59,800 INCREASE IN LIVER CANCER 5913 03:39:59,800 --> 03:40:00,880 MORTALITY AMONG THIS AGE GROUP 5914 03:40:00,880 --> 03:40:01,800 THAT THEY CONTINUE TO EXPERIENCE 5915 03:40:01,800 --> 03:40:08,640 TO THIS DAY TSH TO T -- TO THIS. 5916 03:40:08,640 --> 03:40:09,960 FOR BLACK WOMEN SPECIFICALLY 5917 03:40:09,960 --> 03:40:11,160 CANCER DEATH DECLINED ACROSS 5918 03:40:11,160 --> 03:40:14,760 MOST OF THE AGE GROUPS FOR 5919 03:40:14,760 --> 03:40:16,200 CANCER GROUPS, WITH LUNG CANCER 5920 03:40:16,200 --> 03:40:17,840 WITH THE SHARPEST DECLINE FROM 5921 03:40:17,840 --> 03:40:20,480 35 TO 79 YEARS OF AGE. 5922 03:40:20,480 --> 03:40:22,000 HOWEVER, WE OBSERVED A STEADY 5923 03:40:22,000 --> 03:40:23,440 INCREASE IN UTERINE CANCER 5924 03:40:23,440 --> 03:40:27,520 MORTALITY AMONG THOSE 35 TO 49, 5925 03:40:27,520 --> 03:40:32,760 50 TO 64 AND 65 TO 79, WHERE THE 5926 03:40:32,760 --> 03:40:33,600 GREATEST ANNUAL INCREASE 5927 03:40:33,600 --> 03:40:35,680 OBSERVED IN THE 50 TO 64 YEAR 5928 03:40:35,680 --> 03:40:38,080 AGE GROUP WHERE IT INCREASED AT 5929 03:40:38,080 --> 03:40:42,440 ABOUT 2% ON AVERAGE PER YEAR FOR 5930 03:40:42,440 --> 03:40:44,440 RELATED CANCER MORTALITY. 5931 03:40:44,440 --> 03:40:45,200 POTENTIAL EXPLANATION BASED ON 5932 03:40:45,200 --> 03:40:47,160 PRIOR STUDIES SUGGEST AFTER 5933 03:40:47,160 --> 03:40:49,800 ACCOUNTING FOR HYSTERECTOMY WHEN 5934 03:40:49,800 --> 03:40:52,080 TALKING ABOUT -- AMONG BLACK 5935 03:40:52,080 --> 03:40:56,240 WOMEN THIS WAS SUGGESTED TO BE 5936 03:40:56,240 --> 03:40:57,920 ATTRIBUTED -- LARGELY GRIFFIN BY 5937 03:40:57,920 --> 03:41:01,840 EXPOSURES TO CHRONIC STRESSORS, 5938 03:41:01,840 --> 03:41:02,960 FURTHER RESEARCH IN THIS AREA. 5939 03:41:02,960 --> 03:41:04,360 NOW THE SIMILAR FINDINGS THAT WE 5940 03:41:04,360 --> 03:41:06,280 OBSERVED FOR LIVER CANCER WHICH 5941 03:41:06,280 --> 03:41:09,960 SHOWN BY THE PURPLE LINE WERE AT 5942 03:41:09,960 --> 03:41:12,960 INCREASED AMONG BLACK WOMEN 5943 03:41:12,960 --> 03:41:14,360 AMONG THOSE 65 TO 79 YEARS OF 5944 03:41:14,360 --> 03:41:15,240 AGE. 5945 03:41:15,240 --> 03:41:16,800 THE INCREASING NUMBER OF CANCER 5946 03:41:16,800 --> 03:41:18,080 MORTALITY NOW AMONG BLACK MEN 5947 03:41:18,080 --> 03:41:20,400 AND WOMEN IN THE OLDER AGE GROUP 5948 03:41:20,400 --> 03:41:22,080 PARTICULARLY MAY BE ATTRIBUTED 5949 03:41:22,080 --> 03:41:25,200 TO HAVING THE LARGEST PREVALENCE 5950 03:41:25,200 --> 03:41:26,680 OF HEPATITIS C INFECTION WITH 5951 03:41:26,680 --> 03:41:28,280 GREATER LIVER CANCER RISK. 5952 03:41:28,280 --> 03:41:29,840 ADDITIONALLY, THE ELEVATED 5953 03:41:29,840 --> 03:41:31,080 MORTALITY AMONG THIS AGE GROUP 5954 03:41:31,080 --> 03:41:33,040 MAY ALSO BE ATTRIBUTED TO HAVING 5955 03:41:33,040 --> 03:41:34,680 THE HIGHER PREVALENCE OF LIVER 5956 03:41:34,680 --> 03:41:38,160 CANCER RIS BE FACTORS, INCLUDING 5957 03:41:38,160 --> 03:41:42,360 OBESITY, METABOLIC DISORDERS, 5958 03:41:42,360 --> 03:41:45,720 MORE SPECIFICALLY DIABETES. 5959 03:41:45,720 --> 03:41:48,160 THE YOUNGER AGE GROUP FOR BLACK 5960 03:41:48,160 --> 03:41:50,560 MEN AND WOMEN COULD BE DUE TO 5961 03:41:50,560 --> 03:41:51,760 IMPROVED SCREENING FOR HEPATITIS 5962 03:41:51,760 --> 03:41:57,720 C VIRUS, HEPATITIS B VIRUS THAT 5963 03:41:57,720 --> 03:41:58,480 REDUCE HEPACELLULAR CARCINOMA, 5964 03:41:58,480 --> 03:42:01,760 AS WELL AS THEIR IMPROVEMENT IN 5965 03:42:01,760 --> 03:42:02,280 LIVER DYSFUNCTION. 5966 03:42:02,280 --> 03:42:04,280 SO OUR NEXT APPROACH WAS TO SEE 5967 03:42:04,280 --> 03:42:05,920 WHICH STATE IN THE UNITED STATES 5968 03:42:05,920 --> 03:42:07,680 OVERALL HAD THE FASTEST OR 5969 03:42:07,680 --> 03:42:08,960 SLOWEST DECLINE IN OVERALL 5970 03:42:08,960 --> 03:42:09,800 CANCER MORTALITY RATE 5971 03:42:09,800 --> 03:42:10,320 NATIONALLY. 5972 03:42:10,320 --> 03:42:12,040 ONE THING -- SO LOOK AT THE LEFT 5973 03:42:12,040 --> 03:42:14,040 SIDE IS BLACK MEN, RIGHT SIDE 5974 03:42:14,040 --> 03:42:14,920 BLACK WOMEN. 5975 03:42:14,920 --> 03:42:16,440 SO STATES WITH THE HIGHEST 5976 03:42:16,440 --> 03:42:20,200 PREVALENCE OF TOBACCO USE HAD 5977 03:42:20,200 --> 03:42:22,440 THE SLOWEST OVERALL DECLINE IN 5978 03:42:22,440 --> 03:42:22,840 CANCER MORTALITY. 5979 03:42:22,840 --> 03:42:26,280 SO AS AN EXAMPLE, IN 2015, 5980 03:42:26,280 --> 03:42:28,080 NEARLY 25% OF WEST VIRGINIA 5981 03:42:28,080 --> 03:42:29,280 POPULATION WERE CURRENT 5982 03:42:29,280 --> 03:42:30,640 CIGARETTE SMOKERS WHERE WE 5983 03:42:30,640 --> 03:42:32,000 OBSERVED THIS STATE HAD THE 5984 03:42:32,000 --> 03:42:33,400 SLOWEST ANNUAL DECLINE IN 5985 03:42:33,400 --> 03:42:35,080 OVERALL CANCER MORTALITY AMONG 5986 03:42:35,080 --> 03:42:36,120 BLACK MEN SHOWN TO THE LEFT AT 5987 03:42:36,120 --> 03:42:37,520 THE TOP. 5988 03:42:37,520 --> 03:42:38,680 SIMILARLY, THE MIDWEST HAS ONE 5989 03:42:38,680 --> 03:42:41,120 OF THE HIGHEST SMOKING 5990 03:42:41,120 --> 03:42:41,560 PREVALENCE AMONG BLACK 5991 03:42:41,560 --> 03:42:43,200 INDIVIDUALS IN THE UNITED 5992 03:42:43,200 --> 03:42:45,080 STATES, WHERE THE PREVALENCE IS 5993 03:42:45,080 --> 03:42:46,680 HIGHEST FOR BLACK WOMEN COMPARED 5994 03:42:46,680 --> 03:42:48,120 WITH MOST OTHER U.S. REGIONS. 5995 03:42:48,120 --> 03:42:50,760 HERE WE SEE A SLOW DECLINE WAS 5996 03:42:50,760 --> 03:42:52,400 OBSERVED AMONG BLACK WOMEN THAT 5997 03:42:52,400 --> 03:42:55,240 RESIDED IN WISCONSIN. 5998 03:42:55,240 --> 03:42:56,760 SO OVERALL WE SEE THERE WAS AN 5999 03:42:56,760 --> 03:42:58,200 OVERALL DECLINE IN CANCER 6000 03:42:58,200 --> 03:42:59,440 MORTALITY OVERALL AND FOR MOST 6001 03:42:59,440 --> 03:42:59,920 CANCER SITES. 6002 03:42:59,920 --> 03:43:05,280 BUT NOW EVERYONE IS SEEN IN 6003 03:43:05,280 --> 03:43:11,040 2019W DOE2019 -- I HAVE BLACK MD 6004 03:43:11,040 --> 03:43:12,800 WOMEN HAD A HIGHER CANCER 6005 03:43:12,800 --> 03:43:13,760 MORTALITY RATE OVERALL COMPARED 6006 03:43:13,760 --> 03:43:17,760 WITH MOST OTHER BROADLY TE DEFID 6007 03:43:17,760 --> 03:43:20,360 RACIAL AND ETHNIC GROUPS. 6008 03:43:20,360 --> 03:43:22,920 PANCREATIC CANCER, COLORECTAL 6009 03:43:22,920 --> 03:43:24,280 CANCER, MYELOMA, COMPARED WITH 6010 03:43:24,280 --> 03:43:25,600 OTHER RACIAL AND ETHNIC GROUPS 6011 03:43:25,600 --> 03:43:27,920 SHOWN ON THIS CHART, BUT MOST 6012 03:43:27,920 --> 03:43:29,520 SHOCKINGLY, WHEN LOOKING AT 6013 03:43:29,520 --> 03:43:30,400 PROSTATE CANCER MORE 6014 03:43:30,400 --> 03:43:31,920 SPECIFICALLY, WE SEE THAT BLACK 6015 03:43:31,920 --> 03:43:37,920 MEN HI A RATE FIVE TIMES HIGHER 6016 03:43:37,920 --> 03:43:39,760 THAN THEIR COUNTERPART IN THE 6017 03:43:39,760 --> 03:43:40,640 UNITED STATES. 6018 03:43:40,640 --> 03:43:42,280 WHEN LOOKING AT BLACK WOMEN, 6019 03:43:42,280 --> 03:43:44,200 THEY HAD A HIGHER BREAST CANCER 6020 03:43:44,200 --> 03:43:45,960 MORTALITY RATE, HIGHER UTERINE 6021 03:43:45,960 --> 03:43:49,360 CANCER, HIGHER CERVICAL CANCER, 6022 03:43:49,360 --> 03:43:51,040 COMPARED WITH ALL OTHER RACIAL 6023 03:43:51,040 --> 03:43:53,760 AND ETHNIC GROUPS IN THE UNITED 6024 03:43:53,760 --> 03:43:55,160 STATES, COMPARED TO ALL OTHER 6025 03:43:55,160 --> 03:43:57,960 RACIAL AND ETHNIC -- FOR THESE 6026 03:43:57,960 --> 03:43:58,880 LEADING CANCERS. 6027 03:43:58,880 --> 03:44:00,600 MOST SHOCKINGLY WE SEE THAT 6028 03:44:00,600 --> 03:44:02,480 BLACK WOMEN HAD A BREAST CANCER 6029 03:44:02,480 --> 03:44:04,920 MORTALITY RATE THAT WAS NEARLY 6030 03:44:04,920 --> 03:44:06,520 TWO TIMES HIGHER THAN THEIR 6031 03:44:06,520 --> 03:44:08,160 ASIAN AND PACIFIC ISLANDER 6032 03:44:08,160 --> 03:44:08,640 COUNTERPARTS. 6033 03:44:08,640 --> 03:44:10,040 SO DESPITE THE NATIONAL PROGRESS 6034 03:44:10,040 --> 03:44:11,440 THAT I'VE SHOWED HERE IN 6035 03:44:11,440 --> 03:44:12,800 REDUCING CANCER MORTALITY, BLACK 6036 03:44:12,800 --> 03:44:14,200 INDIVIDUALS HAD A CONSIDERABLY 6037 03:44:14,200 --> 03:44:18,480 HIGHER CANCER MORTALITY RATES 6038 03:44:18,480 --> 03:44:20,920 COMPARED WITH -- MOST TROUBLING, 6039 03:44:20,920 --> 03:44:22,480 WELL ESTABLISHED MEANS EARLY 6040 03:44:22,480 --> 03:44:24,720 DETECTION AND IMPROVED LONG TERM 6041 03:44:24,720 --> 03:44:27,560 SUR VAIFL STILL REMAIN MARKEDLY 6042 03:44:27,560 --> 03:44:29,120 HIGHER IN BLACK INDIVIDUALS IN 6043 03:44:29,120 --> 03:44:29,320 2019. 6044 03:44:29,320 --> 03:44:32,400 SO HIGHER BREAST CANCER, HIGHER 6045 03:44:32,400 --> 03:44:35,200 PROSTATE, COLORECTAL, AMONG 6046 03:44:35,200 --> 03:44:36,080 BLACK INDIVIDUALS WERE SUGGESTED 6047 03:44:36,080 --> 03:44:38,240 TO BE A RESULT OF HIGH 6048 03:44:38,240 --> 03:44:39,760 INCIDENCE, MORE AGGRESSIVE 6049 03:44:39,760 --> 03:44:41,760 CANCER CHARACTERISTICS, BUT ALSO 6050 03:44:41,760 --> 03:44:48,720 LOWER RECEIPT OF -- BLACK 6051 03:44:48,720 --> 03:44:50,600 PATIENTS ARE MORE LIKELY TO 6052 03:44:50,600 --> 03:44:51,920 EXPERIENCE POOR 6053 03:44:51,920 --> 03:44:53,120 PATIENT-PHYSICIAN INTERACTION, 6054 03:44:53,120 --> 03:44:54,720 MORE LIKELY TO EXPERIENCE LONGER 6055 03:44:54,720 --> 03:44:56,440 REFERRAL TIMES MORE LIKELY TO 6056 03:44:56,440 --> 03:44:59,280 EXPERIENCE DELAYS IN TREATMENT, 6057 03:44:59,280 --> 03:45:01,800 MORE LIKELY TO REPORT MEDICAL 6058 03:45:01,800 --> 03:45:04,440 MISTRUST, UNDERUSE OF TREATMENT 6059 03:45:04,440 --> 03:45:07,280 BR NOW SPECIFICALLY OF THE 6060 03:45:07,280 --> 03:45:07,840 HEALTHCARE SYSTEM. 6061 03:45:07,840 --> 03:45:09,600 THESE ARE ALL FACTORS THAT HAVE 6062 03:45:09,600 --> 03:45:10,840 CONTRIBUTED TO A 6063 03:45:10,840 --> 03:45:11,440 DISPROPORTIONATE BURDEN OF 6064 03:45:11,440 --> 03:45:12,880 CANCER MORTALITY AMONG BLACK 6065 03:45:12,880 --> 03:45:14,320 INDIVIDUALS AND THIS HAS BEEN 6066 03:45:14,320 --> 03:45:16,280 WELL DOCUMENTED FOR DECADES NOW. 6067 03:45:16,280 --> 03:45:17,560 I MUST ALSO NOTE THAT BLACK 6068 03:45:17,560 --> 03:45:18,840 INDIVIDUALS ARE MORE LIKELY TO 6069 03:45:18,840 --> 03:45:19,880 RESIDE IN NEIGHBORHOODS WITH 6070 03:45:19,880 --> 03:45:21,560 POOR ACCESSIBILITY TO SEE A 6071 03:45:21,560 --> 03:45:22,760 PHYSICIAN, PARTICULARLY A CANCER 6072 03:45:22,760 --> 03:45:24,920 SPECIALIST, TO SEE A PHYSICIAN 6073 03:45:24,920 --> 03:45:27,040 THAT REPORTS LOWER ACCESS TO 6074 03:45:27,040 --> 03:45:28,160 CLINICAL RESOURCES. 6075 03:45:28,160 --> 03:45:32,400 AND -- ASSOCIATED WITH ELEVATED 6076 03:45:32,400 --> 03:45:33,720 CANCER RISKS. 6077 03:45:33,720 --> 03:45:36,680 THEREFORE, CONTINUING TO SOLELY 6078 03:45:36,680 --> 03:45:38,880 FOCUS ON THINGS SUCH AS 6079 03:45:38,880 --> 03:45:41,480 BEHAVIORAL AND BIOLOGICAL IS 6080 03:45:41,480 --> 03:45:43,400 INSUFFICIENT BUT UNDERSTANDING 6081 03:45:43,400 --> 03:45:46,320 THE CONTRIBUTIONS OF SOCIAL 6082 03:45:46,320 --> 03:45:47,280 INEQUITIES AMONG BLACK 6083 03:45:47,280 --> 03:45:48,880 INDIVIDUALS WITHIN UNITED 6084 03:45:48,880 --> 03:45:49,480 STATES. 6085 03:45:49,480 --> 03:45:50,640 ADDRESSING INEQUALITIES THAT 6086 03:45:50,640 --> 03:45:51,800 CONTRIBUTE TO RACIAL DISPARITIES 6087 03:45:51,800 --> 03:45:53,040 IN CANCER MORTALITY REQUIRES 6088 03:45:53,040 --> 03:45:54,840 POLICIES THAT SEEK TO RESOLVE 6089 03:45:54,840 --> 03:45:56,280 THE ADVERSE SOCIOENVIRONMENTAL 6090 03:45:56,280 --> 03:45:58,080 CONDITIONS THAT CONTRIBUTE TO 6091 03:45:58,080 --> 03:46:01,240 RACIAL INEQUITYING AND CANCER 6092 03:46:01,240 --> 03:46:03,360 MORTALITY THROUGHOUT THE ENTIRE 6093 03:46:03,360 --> 03:46:03,880 CANCER CARE CONTINUUM. 6094 03:46:03,880 --> 03:46:05,480 SO IN SUMMARY, WE OBSERVED THERE 6095 03:46:05,480 --> 03:46:07,160 WAS A STEADY DECLINE IN OVERALL 6096 03:46:07,160 --> 03:46:08,600 CANCER MORTALITY RATES AMONG 6097 03:46:08,600 --> 03:46:10,440 BLACK INDIVIDUALS WHICH DOES 6098 03:46:10,440 --> 03:46:11,960 LIKELY REFLECT ADVANCES IN 6099 03:46:11,960 --> 03:46:13,200 CANCER TREATMENT AND EARLY 6100 03:46:13,200 --> 03:46:14,200 DETECTION AS WELL AS POPULATION 6101 03:46:14,200 --> 03:46:17,600 CHANGES AND EXPOSURES TO CERTAIN 6102 03:46:17,600 --> 03:46:18,080 CANCER CARCINOGENS. 6103 03:46:18,080 --> 03:46:20,040 HOWEVER, DESPITE THE DECREASE WE 6104 03:46:20,040 --> 03:46:21,440 SEE AMONG BLACK INDIVIDUALS, 6105 03:46:21,440 --> 03:46:23,240 BLACK MEN AND WOMEN CONTINUE TO 6106 03:46:23,240 --> 03:46:28,480 HAVE THE HIGHEST MORTALITY 6107 03:46:28,480 --> 03:46:30,200 RATES, HIGHLIGHTING THE NEED TO 6108 03:46:30,200 --> 03:46:33,520 TEST THE PERVASIVENESS THAT 6109 03:46:33,520 --> 03:46:34,840 PERSISTS TO THIS DAY. 6110 03:46:34,840 --> 03:46:35,920 ELIMINATING RACIAL AND ETHNIC 6111 03:46:35,920 --> 03:46:37,560 DISPARITIES IN CANCER MORTALITY 6112 03:46:37,560 --> 03:46:39,120 WILL REQUIRE EQUITABLE ACCESS TO 6113 03:46:39,120 --> 03:46:41,200 CANCER PREVENTION, EARLY 6114 03:46:41,200 --> 03:46:42,520 DIAGNOSIS AND TIMELINE AND HIGH 6115 03:46:42,520 --> 03:46:43,960 QUALITY TREATMENT THROUGHOUT THE 6116 03:46:43,960 --> 03:46:45,600 ENTIRE CANCER CARE CONTROL 6117 03:46:45,600 --> 03:46:46,920 CONTINUUM. 6118 03:46:46,920 --> 03:46:49,320 SO TO SEE MORE ON THESE 6119 03:46:49,320 --> 03:46:51,520 FINDINGS, WE PUBLISHED THEM 6120 03:46:51,520 --> 03:46:53,480 ALMOST A YEAR AGO FROM JAMA 6121 03:46:53,480 --> 03:46:54,560 ONCOLOGY THAT GOES INTO FURTHER 6122 03:46:54,560 --> 03:46:54,800 DETAILS. 6123 03:46:54,800 --> 03:46:55,800 THANK YOU FOR YOUR TIME AND I 6124 03:46:55,800 --> 03:46:56,600 CAN ANSWER ANY QUESTIONS THAT 6125 03:46:56,600 --> 03:46:56,880 YOU HAVE. 6126 03:46:56,880 --> 03:47:04,680 [APPLAUSE] 6127 03:47:04,680 --> 03:47:07,320 >>THANK YOU, DR. LAWRENCE. 6128 03:47:07,320 --> 03:47:08,320 WE WELCOME QUESTIONS FROM THE 6129 03:47:08,320 --> 03:47:08,600 AUDIENCE. 6130 03:47:08,600 --> 03:47:09,960 >>HI, DR. LAWRENCE. 6131 03:47:09,960 --> 03:47:10,360 GREAT PRESENTATION. 6132 03:47:10,360 --> 03:47:12,000 I KNOW THE CANCER PLAN CAME OUT 6133 03:47:12,000 --> 03:47:12,920 EARLIER THIS WEEK THAT SAID THEY 6134 03:47:12,920 --> 03:47:14,760 WANT TO REDUCE CANCER MORTALITY 6135 03:47:14,760 --> 03:47:16,640 BY 50% IN THE NEXT 25 YEARS. 6136 03:47:16,640 --> 03:47:18,600 WHERE DO YOU SEE WE CAN HAVE THE 6137 03:47:18,600 --> 03:47:20,800 MOST IMPACT FOR OUR BLACK 6138 03:47:20,800 --> 03:47:24,360 COMMUNITIES AND INDIVIDUALS TH 6139 03:47:24,360 --> 03:47:25,440 THAT -- TARGETED INTERVENTION OR 6140 03:47:25,440 --> 03:47:26,960 WHAT SHOULD WE BE DOING? 6141 03:47:26,960 --> 03:47:27,760 LOVE TO HEAR YOUR THOUGHTS. 6142 03:47:27,760 --> 03:47:29,280 >>ONE THING IS ACCESS TO CARE. 6143 03:47:29,280 --> 03:47:31,480 ACCESS TO CARE IS ONE AREA WHEN 6144 03:47:31,480 --> 03:47:34,080 IT COME TO ACCESS TO CANCER 6145 03:47:34,080 --> 03:47:36,280 SCREENING OR HAVING INSURANCE TO 6146 03:47:36,280 --> 03:47:36,920 COVER CANCER COVERAGE. 6147 03:47:36,920 --> 03:47:38,720 AT THE END OF THE DAY, EVERY 6148 03:47:38,720 --> 03:47:41,320 RACIAL DISPARITY WE SEE IT IS 6149 03:47:41,320 --> 03:47:43,000 ALL I ASSUME PREVENTABLE DEATHS 6150 03:47:43,000 --> 03:47:45,120 THAT COULD HAVE BEEN STOPPED SO 6151 03:47:45,120 --> 03:47:46,480 THAT CARRIES ONE ASPECT OF IT. 6152 03:47:46,480 --> 03:47:48,680 AS WELL AS MORE LIKELY TO HAVE 6153 03:47:48,680 --> 03:47:49,800 QUALITY MEDICAL CARE TOO. 6154 03:47:49,800 --> 03:47:52,000 SO FROM PREVENTION TO TIMELY 6155 03:47:52,000 --> 03:47:53,720 TREATMENT OR DIAGNOSIS, ALL THE 6156 03:47:53,720 --> 03:47:55,680 WAY TO SURVIVORSHIP, THESE ARE 6157 03:47:55,680 --> 03:47:56,120 ALL FACTORS. 6158 03:47:56,120 --> 03:47:57,760 I CAN'T JUST NAME ONE, BUT IT 6159 03:47:57,760 --> 03:47:59,560 THROUGHOUT THE ENTIRE CONTINUUM, 6160 03:47:59,560 --> 03:48:00,760 IT ALL NEEDS TO BE ADDRESSED, 6161 03:48:00,760 --> 03:48:02,480 BUT THE FIRST INSTANCE IS GIVING 6162 03:48:02,480 --> 03:48:08,320 PEOPLE ACCESS TO MEDICAL CARE. 6163 03:48:08,320 --> 03:48:10,440 >>BUILDING ON THAT CONCEPT OF 6164 03:48:10,440 --> 03:48:12,160 ACCESS TO CARE, GREAT DATA, AND 6165 03:48:12,160 --> 03:48:13,520 I LOVE THE FACT THAT YOU ENDED 6166 03:48:13,520 --> 03:48:20,000 WITH A POLICY RECOMMENDATION AND 6167 03:48:20,000 --> 03:48:21,440 PRIORITIZING -- 6168 03:48:21,440 --> 03:48:23,080 >>POLICY -- AND THE MULTILEVEL 6169 03:48:23,080 --> 03:48:24,400 INTERVENTION PIECE. 6170 03:48:24,400 --> 03:48:25,440 >>BUT ONE PIECE IN ACCESS TO 6171 03:48:25,440 --> 03:48:26,880 CARE, I'M CURIOUS TO KNOW, WHAT 6172 03:48:26,880 --> 03:48:28,800 DO YOU THINK THE ROLE OF 6173 03:48:28,800 --> 03:48:30,040 COMMUNITY CLINICS CAN PLAY IN 6174 03:48:30,040 --> 03:48:30,440 THIS? 6175 03:48:30,440 --> 03:48:31,600 I LOVE THE FACT THAT YOU 6176 03:48:31,600 --> 03:48:33,560 MENTIONED EARLY DETECTION, BUT 6177 03:48:33,560 --> 03:48:34,320 I'M HOPING WE CAN THINK ABOUT 6178 03:48:34,320 --> 03:48:35,560 HOW YOUR PAPER AND OTHER 6179 03:48:35,560 --> 03:48:37,080 FINDINGS LIKE THAT CAN INFORM 6180 03:48:37,080 --> 03:48:40,480 WHERE WE GO FOR INFORMING 6181 03:48:40,480 --> 03:48:42,600 CLINICAL TRIALS, COMMUNITY 6182 03:48:42,600 --> 03:48:43,760 CLINICS, FEDERALLY QUALIFIED 6183 03:48:43,760 --> 03:48:46,040 HEALTH CENTERS, NON-ACADEMIC 6184 03:48:46,040 --> 03:48:46,920 MEDICAL CENTERS BECAUSE THIS 6185 03:48:46,920 --> 03:48:48,160 ACCESS TO CARE IS ONE THING, BUT 6186 03:48:48,160 --> 03:48:49,560 ALSO WHERE WE CONDUCT THE 6187 03:48:49,560 --> 03:48:51,120 RESEARCH AND WHERE WE ENSURE 6188 03:48:51,120 --> 03:48:52,760 THAT PEOPLE GET EARLY DETECTION 6189 03:48:52,760 --> 03:48:53,760 WITH INNOVATIVE TREATMENT IS 6190 03:48:53,760 --> 03:48:54,600 ALSO ANOTHER THING. 6191 03:48:54,600 --> 03:48:56,200 SO I'D LOVE TO HEAR HOW YOU 6192 03:48:56,200 --> 03:48:58,000 THINK YOUR PAPER -- 6193 03:48:58,000 --> 03:49:02,200 >>SO THIS IS AN AREA I'M -- ONE 6194 03:49:02,200 --> 03:49:03,640 ASPECT I DO LIKE IS THE MOBILE 6195 03:49:03,640 --> 03:49:04,120 CLINIC. 6196 03:49:04,120 --> 03:49:05,640 SO THE MOBILE CLINIC THAT ALLOWS 6197 03:49:05,640 --> 03:49:07,040 FOR DETECTION SUCH AS 6198 03:49:07,040 --> 03:49:07,920 MILLIMETERGRAPHY, SO YOU BRING 6199 03:49:07,920 --> 03:49:08,640 IN THE RESOURCES TO THE 6200 03:49:08,640 --> 03:49:10,560 COMMUNITY, TO THE POPULATION 6201 03:49:10,560 --> 03:49:14,400 THAT'S UNDERSERVED, STRUCTURALLY 6202 03:49:14,400 --> 03:49:15,240 MARGINALIZED, SO I THINK THAT'S 6203 03:49:15,240 --> 03:49:16,280 ONE AREA THAT IS IMPORTANT, 6204 03:49:16,280 --> 03:49:19,440 BRINGING THE CARE TO THOSE THAT 6205 03:49:19,440 --> 03:49:22,040 HAVE DR -- REDUCING BARRIERS TO 6206 03:49:22,040 --> 03:49:23,360 CARE SO THAT'S ONE ASPECT OF IT. 6207 03:49:23,360 --> 03:49:24,440 WHEN IT COMES TO RESEARCH. 6208 03:49:24,440 --> 03:49:26,080 WE NEED RESEARCH THAT DOES NOT 6209 03:49:26,080 --> 03:49:27,120 JUST HIGHLIGHT THE FINDINGS THAT 6210 03:49:27,120 --> 03:49:29,200 I DID TODAY BUT ALSO HOW CAN WE 6211 03:49:29,200 --> 03:49:30,840 TRANSLATE THIS TO COMMUNITY 6212 03:49:30,840 --> 03:49:31,440 INTERVENTIONS TOO. 6213 03:49:31,440 --> 03:49:32,640 SO FOR INSTANCE WE SAW THAT 6214 03:49:32,640 --> 03:49:36,440 CERTAIN AREAS SUCH AS WEST 6215 03:49:36,440 --> 03:49:38,120 VIRGINIA HAS A 6216 03:49:38,120 --> 03:49:39,120 DISPROPORTIONATELY HIGH LEVEL OF 6217 03:49:39,120 --> 03:49:39,680 CANCER BURDEN. 6218 03:49:39,680 --> 03:49:41,200 HOW DO WE TRANSLATE THAT TO 6219 03:49:41,200 --> 03:49:42,040 INTERVENTIONS THAT WILL HELP 6220 03:49:42,040 --> 03:49:42,960 PROVIDE THESE COMMUNITIES WITH 6221 03:49:42,960 --> 03:49:45,360 THESE RESOURCES. 6222 03:49:45,360 --> 03:49:46,800 SO YES, BRING THE CARE TO THE 6223 03:49:46,800 --> 03:49:48,200 INDIVIDUALS, BUT ALSO -- YOU 6224 03:49:48,200 --> 03:49:49,920 MUST ALSO TAKE ON OUR RESEARCH 6225 03:49:49,920 --> 03:49:51,320 FROM WHAT WE FOUND IN THE 6226 03:49:51,320 --> 03:49:52,640 COMPUTER AND PUBLISHING JOURNAL 6227 03:49:52,640 --> 03:49:53,880 TO ACTUALLY IMPACT INDIVIDUALS 6228 03:49:53,880 --> 03:49:54,800 AS WELL TOO. 6229 03:49:54,800 --> 03:49:58,280 >>THANK YOU. 6230 03:49:58,280 --> 03:50:03,600 >>GREAT QUESTION. 6231 03:50:03,600 --> 03:50:05,440 >>TH THANK YOU. 6232 03:50:05,440 --> 03:50:06,600 THAT WAS REALLY AMAZING OR 6233 03:50:06,600 --> 03:50:07,000 GREAT. 6234 03:50:07,000 --> 03:50:08,480 I HAD JUST A QUESTION OR A NOWT. 6235 03:50:08,480 --> 03:50:10,360 THOUGHT. 6236 03:50:10,360 --> 03:50:11,880 I KNOW YOU HAD MENTIONED SOME 6237 03:50:11,880 --> 03:50:12,520 SPECIFIC POLICIES. 6238 03:50:12,520 --> 03:50:13,640 I WAS WONDERING IF YOU HAD 6239 03:50:13,640 --> 03:50:15,280 THOUGHT ABOUT DOING KIND OF AN 6240 03:50:15,280 --> 03:50:16,880 INTERRUPTED TIME SERIES MODEL, 6241 03:50:16,880 --> 03:50:18,960 REALLY INCORPORATING THE 6242 03:50:18,960 --> 03:50:22,440 INVESTMENT THAT HRSA HAS DONE, 6243 03:50:22,440 --> 03:50:23,560 REFERENCED IN EARLIER 6244 03:50:23,560 --> 03:50:24,920 CONVERSATIONS AROUND COMMUNITY 6245 03:50:24,920 --> 03:50:26,200 CLINIC, POLICY LEVEL AND 6246 03:50:26,200 --> 03:50:27,480 SYSTEMIC LEVEL INTERVENTIONS, A 6247 03:50:27,480 --> 03:50:29,560 LOT OF WHAT HRSA DOES AND 6248 03:50:29,560 --> 03:50:30,520 SUPPORTS AND FACILITATES COULD 6249 03:50:30,520 --> 03:50:33,080 BE CONSIDERED PARTICULARLY 6250 03:50:33,080 --> 03:50:34,240 BENEFICIAL TO BLACK PEOPLE IN 6251 03:50:34,240 --> 03:50:35,560 THE UNITED STATES, AS WELL AS 6252 03:50:35,560 --> 03:50:37,400 OTHER MARGINALIZED GROUPS, SO I 6253 03:50:37,400 --> 03:50:39,720 WAS JUST CURIOUS ABOUT ANY WORK 6254 03:50:39,720 --> 03:50:41,040 YOU'VE THOUGHT ABOUT IN TERMS OF 6255 03:50:41,040 --> 03:50:42,840 COMMUNITY LEVEL OR SYSTEM LEVEL 6256 03:50:42,840 --> 03:50:44,480 INVESTMENTS THAT HAVE -- THAT 6257 03:50:44,480 --> 03:50:45,880 COULD BE INCORPORATED INTO 6258 03:50:45,880 --> 03:50:47,600 MODELS RELATIVELY EASILY. 6259 03:50:47,600 --> 03:50:49,120 >>SO IF I UNDERSTAND YOUR 6260 03:50:49,120 --> 03:50:51,080 QUESTION, SO TAKEN INTO ACCOUNT 6261 03:50:51,080 --> 03:50:52,480 AT DIFFERENT TIME POINTS, 6262 03:50:52,480 --> 03:50:55,360 VARIOUS INTERVENTIONS THAT WERE 6263 03:50:55,360 --> 03:50:57,040 FUNDED OR IMPLEMENTED AND HOW 6264 03:50:57,040 --> 03:50:58,880 THAT MAY HAVE ON CANCER 6265 03:50:58,880 --> 03:50:59,200 OUTCOMES. 6266 03:50:59,200 --> 03:50:59,440 >>YEAH. 6267 03:50:59,440 --> 03:51:03,640 >>I THINK THAT'S A GREAT IDEA. 6268 03:51:03,640 --> 03:51:08,440 I'LL DEFINITELY HAPPY TO DISCUSS 6269 03:51:08,440 --> 03:51:08,640 MORE. 6270 03:51:08,640 --> 03:51:09,880 >>I WOULD BE HAPPY TO TALK 6271 03:51:09,880 --> 03:51:10,120 OFFLINE. 6272 03:51:10,120 --> 03:51:10,440 >>THANK YOU. 6273 03:51:10,440 --> 03:51:12,400 >>THANK YOU, DR. LAWRENCE. 6274 03:51:12,400 --> 03:51:19,640 [APPLAUSE] 6275 03:51:19,640 --> 03:51:25,560 OUR THIRD PRESENTER IS DR 6276 03:51:25,560 --> 03:51:29,200 DR. JACQUELINE VO, THE TITLE OF 6277 03:51:29,200 --> 03:51:30,600 HER PRESENTATION IS BREAST 6278 03:51:30,600 --> 03:51:34,760 CANCER SURVIVORSHIP, INEQUITIES 6279 03:51:34,760 --> 03:51:36,640 AMONG ASIAN AMERICANS, NATIVE 6280 03:51:36,640 --> 03:51:37,760 HAWAIIANS AND OTHER PACIFIC 6281 03:51:37,760 --> 03:51:39,280 ISLANDER WOMEN. 6282 03:51:39,280 --> 03:51:41,760 WELCOME, DR. VO. 6283 03:51:41,760 --> 03:51:45,200 >>THANK YOU. 6284 03:51:45,200 --> 03:51:46,960 GOOD AFTERNOON AND THANK YOU FOR 6285 03:51:46,960 --> 03:51:47,840 THE OPPORTUNITY TO BE HERE AND 6286 03:51:47,840 --> 03:51:48,880 PRESENT MY RESEARCH AS PART OF 6287 03:51:48,880 --> 03:51:50,200 THE NCI INTRAMURAL RESEARCH 6288 03:51:50,200 --> 03:51:51,920 PROGRAM. 6289 03:51:51,920 --> 03:51:54,000 FOR BACKGROUND I AM A NURSE 6290 03:51:54,000 --> 03:51:56,640 SCIENTIST AND CLINICAL 6291 03:51:56,640 --> 03:51:57,200 EPIDEMIOLOGIST, ASSISTANT 6292 03:51:57,200 --> 03:51:58,720 CLINICAL INVESTIGATOR IN THE 6293 03:51:58,720 --> 03:51:59,880 RADIATION EPIDEMIOLOGY BRANCH 6294 03:51:59,880 --> 03:52:02,200 HERE IN THE CANCER OF 6295 03:52:02,200 --> 03:52:04,200 EPIDEMIOLOGY AND GENETICS AT 6296 03:52:04,200 --> 03:52:04,840 NCI. 6297 03:52:04,840 --> 03:52:06,080 DELIGHTED TO SHARE ONE OF MY 6298 03:52:06,080 --> 03:52:09,760 AREAS SIEF ENS I'M DEEPLY 6299 03:52:09,760 --> 03:52:12,480 PASSIONATE ABOUT, BREAST CANCER 6300 03:52:12,480 --> 03:52:14,240 SURVIVORSHIP INEQUITIES AMONG 6301 03:52:14,240 --> 03:52:16,200 ASIAN AMERICAN, NATIVE HAWAIIAN 6302 03:52:16,200 --> 03:52:17,000 AND OTHER PACIFIC ISLANDER 6303 03:52:17,000 --> 03:52:17,720 WOMEN. 6304 03:52:17,720 --> 03:52:20,040 IN 1997, ABOUT 26 YEARS AGO, THE 6305 03:52:20,040 --> 03:52:22,240 OFFICE OF MANAGEMENT AND BUDGET 6306 03:52:22,240 --> 03:52:23,160 DEVELOPED REVISIONS TO THE 6307 03:52:23,160 --> 03:52:25,800 STANDARDS FOR THE CLASSIFICATION 6308 03:52:25,800 --> 03:52:27,440 OF FEDERAL DATA ON RACE AND 6309 03:52:27,440 --> 03:52:28,200 ETHNICITY. 6310 03:52:28,200 --> 03:52:31,120 SO ESSENTIALLY THIS WAS USED FOR 6311 03:52:31,120 --> 03:52:32,480 CENSUS STANDARDS AND THE NEW 6312 03:52:32,480 --> 03:52:33,760 CATEGORIES SEPARATE ASIAN AND 6313 03:52:33,760 --> 03:52:35,200 NATIVE HAWAIIAN AND OTHER 6314 03:52:35,200 --> 03:52:36,920 PACIFIC ISLANDER INTO TWO 6315 03:52:36,920 --> 03:52:38,320 DISTINCT RACIAL CATEGORIES. 6316 03:52:38,320 --> 03:52:39,120 UNFORTUNATELY DATA COLLECTION 6317 03:52:39,120 --> 03:52:42,520 HAS NOT CONSISTENTLY SEPARATED 6318 03:52:42,520 --> 03:52:43,960 ASIANS FROM NATIVE HAWAIIAN AND 6319 03:52:43,960 --> 03:52:44,440 OTHER PACIFIC ISLANDER 6320 03:52:44,440 --> 03:52:45,760 INDIVIDUALS FOR EACH STATE, AND 6321 03:52:45,760 --> 03:52:47,160 FOR EXAMPLE, ON DEATH 6322 03:52:47,160 --> 03:52:47,920 CERTIFICATE DATA. 6323 03:52:47,920 --> 03:52:49,240 AND IMPORTANTLY, MANY PEOPLE DO 6324 03:52:49,240 --> 03:52:52,800 NOT KNOW THAT ACTUALLY PACIFIC 6325 03:52:52,800 --> 03:52:54,040 ISLANDER INDIVIDUALS DO NOT COME 6326 03:52:54,040 --> 03:52:56,240 FROM ASIAN COUNTRIES, THEY 6327 03:52:56,240 --> 03:52:57,040 ACTUALLY REPRESENT DIFFERENT 6328 03:52:57,040 --> 03:52:58,040 ISLANDS IN OCEANA. 6329 03:52:58,040 --> 03:52:59,360 SO HERE ARE TWO MAPS. 6330 03:52:59,360 --> 03:53:00,920 ON THE LEFT WE HAVE THE MAP OF 6331 03:53:00,920 --> 03:53:02,680 ASIA USING THE UNITED NATION 6332 03:53:02,680 --> 03:53:05,760 SUBDIVISIONS WHICH GROUP ASIAN 6333 03:53:05,760 --> 03:53:06,920 COUNTRIES BY GEOGRAPHIC REGION 6334 03:53:06,920 --> 03:53:08,200 SO NOTABLY ASIAN AMERICANS 6335 03:53:08,200 --> 03:53:11,280 SPECIFICALLY THAT HAVE EMBRAIT 6336 03:53:11,280 --> 03:53:15,120 GRATED FROM THE U.S. COME -- ON 6337 03:53:15,120 --> 03:53:16,400 RIGHT WE HAVE THE MAP OF THE 6338 03:53:16,400 --> 03:53:17,960 PACIFIC ISLANDERS PART OF OCEANA 6339 03:53:17,960 --> 03:53:19,600 AND NOT ASIA WHICH ARE GROUPED 6340 03:53:19,600 --> 03:53:22,000 INTO REGIONS KNOWN AS 6341 03:53:22,000 --> 03:53:24,120 MICRONESIA, MELANESIA AND 6342 03:53:24,120 --> 03:53:25,200 POLYNESIA. 6343 03:53:25,200 --> 03:53:27,760 HAWAII IS CONSIDERED AS PART OF 6344 03:53:27,760 --> 03:53:28,160 POLYNESIA. 6345 03:53:28,160 --> 03:53:30,600 IN THE U.S., ASIAN AMERICANS ARE 6346 03:53:30,600 --> 03:53:31,680 VERY HETEROGENEOUS GROUP 6347 03:53:31,680 --> 03:53:33,600 REPRESENTING OVER 30 COUNTRIES 6348 03:53:33,600 --> 03:53:36,440 IN OVER 100 DIFFERENT LANGUAGES. 6349 03:53:36,440 --> 03:53:38,720 85% OF ASIAN AMERICANS ARE FROM 6350 03:53:38,720 --> 03:53:40,480 OR HAVE ORIGINS FROM SIX 6351 03:53:40,480 --> 03:53:42,280 COUNTRIES IN PARTICULAR, JAPAN, 6352 03:53:42,280 --> 03:53:44,040 KOREA, VIETNAM, THE PHILIPPINES, 6353 03:53:44,040 --> 03:53:45,040 CHINA AND INDIA. 6354 03:53:45,040 --> 03:53:45,880 ASIAN AMERICANS HAVE THE 6355 03:53:45,880 --> 03:53:47,320 GREATEST INCOME INEQUALITY HERE 6356 03:53:47,320 --> 03:53:49,760 IN THE U.S., WHICH IS 6357 03:53:49,760 --> 03:53:51,600 DRASTICALLY INCREASED SINCE 6358 03:53:51,600 --> 03:53:51,800 1970. 6359 03:53:51,800 --> 03:53:53,880 SPECIFICALLY, THE TOP 10% OF 6360 03:53:53,880 --> 03:53:55,840 WEALTHIEST ASIAN AMERICANS EARN 6361 03:53:55,840 --> 03:53:58,560 OVER 10 TIMES THE INCOME OF THE 6362 03:53:58,560 --> 03:53:59,880 ASIAN AMERICANS IN THE BOTTOM 6363 03:53:59,880 --> 03:54:00,400 10%. 6364 03:54:00,400 --> 03:54:02,840 THIS IS GREATER THAN ALL OTHER 6365 03:54:02,840 --> 03:54:05,200 RACIAL ETHNIC GROUPS IN THE U.S. 6366 03:54:05,200 --> 03:54:06,600 THERE IS ALSO VARIATION IN 6367 03:54:06,600 --> 03:54:07,840 EDUCATION LEVEL AS WELL, SO AS 6368 03:54:07,840 --> 03:54:09,840 YOU CAN SEE WITH USING THE 6369 03:54:09,840 --> 03:54:11,800 AGGREGATE GROUP, 54% OF ASIAN 6370 03:54:11,800 --> 03:54:12,840 AMERICANS HAVE A 6371 03:54:12,840 --> 03:54:13,280 BACHELOR'S DEGREE. 6372 03:54:13,280 --> 03:54:16,000 BUT IF YOU DISAGGREGATE USING 6373 03:54:16,000 --> 03:54:17,680 THE THIRD FIGURE, THIS RANGES 6374 03:54:17,680 --> 03:54:20,640 FROM 75% OF INDIANS WHO HAVE A 6375 03:54:20,640 --> 03:54:25,360 BACHELOR'S DEGREE TO 15% OF -- 6376 03:54:25,360 --> 03:54:27,080 32% OF VIETNAMESE INDIVIDUALS IN 6377 03:54:27,080 --> 03:54:29,400 THE U.S. 6378 03:54:29,400 --> 03:54:30,680 THESE WITHIN GROUP DIFFERENCES 6379 03:54:30,680 --> 03:54:32,000 ARE ALSO PRESENT WITHIN NATIVE 6380 03:54:32,000 --> 03:54:33,320 HAWAIIAN AND OTHER PACIFIC 6381 03:54:33,320 --> 03:54:34,000 ISLANDER INDIVIDUALS HERE IN THE 6382 03:54:34,000 --> 03:54:35,400 U.S. AS WELL. 6383 03:54:35,400 --> 03:54:37,760 WHO REPRESENT OVER 100 NATIONS 6384 03:54:37,760 --> 03:54:38,440 ACROSS 20,000 ISLANDS. 6385 03:54:38,440 --> 03:54:40,640 THERE ARE VARYING LEVELS OF 6386 03:54:40,640 --> 03:54:42,080 ENGLISH PROFICIENCY AMONG NATIVE 6387 03:54:42,080 --> 03:54:43,480 HAWAIIAN AND OTHER PACIFIC 6388 03:54:43,480 --> 03:54:44,800 ISLANDERs, AND FIGURES TWO AND 6389 03:54:44,800 --> 03:54:46,480 THREE SHOW AN IMPORTANT 6390 03:54:46,480 --> 03:54:48,080 DISTINCTION BETWEEN NATIVE 6391 03:54:48,080 --> 03:54:49,040 HAWAIIAN AND OTHER PACIFIC 6392 03:54:49,040 --> 03:54:49,880 ISLANDERs FROM ASIAN 6393 03:54:49,880 --> 03:54:51,280 INDIVIDUALS. 6394 03:54:51,280 --> 03:54:52,920 SO FIGURE 2 SHOWS LOWER 6395 03:54:52,920 --> 03:54:54,160 EDUCATIONAL ATTAINMENT FOR 6396 03:54:54,160 --> 03:54:55,120 NATIVE HAWAIIAN AND OTHER 6397 03:54:55,120 --> 03:54:56,840 PACIFIC ISLANDERS COMPARED TO 6398 03:54:56,840 --> 03:54:58,720 ASIANS, AND FIGURE 3 SHOWS A 6399 03:54:58,720 --> 03:55:01,120 GREATER POVERTY LEVEL FOR NATIVE 6400 03:55:01,120 --> 03:55:04,240 HAWAIIAN AND OTHER PACIFIC 6401 03:55:04,240 --> 03:55:05,200 ISLANDER INDIVIDUALS COMPARED TO 6402 03:55:05,200 --> 03:55:07,280 ASIANS HERE IN THE U.S. 6403 03:55:07,280 --> 03:55:08,360 SO I'VE CHARACTERIZED 6404 03:55:08,360 --> 03:55:10,880 DIFFERENCES IN ASIAN AMERICANS 6405 03:55:10,880 --> 03:55:14,440 FROM NATIVE HAWAIIAN AND THESE 6406 03:55:14,440 --> 03:55:15,360 AGGREGATE MEASURES WHEN YOU 6407 03:55:15,360 --> 03:55:17,280 GROUP THEM TOGETHER CAN BE 6408 03:55:17,280 --> 03:55:19,280 MISLEADING, AFFECT POLICIES, 6409 03:55:19,280 --> 03:55:21,160 UNCONSCIOUS BIASES AND PUBLIC 6410 03:55:21,160 --> 03:55:21,600 HEALTH IMPLICATIONS. 6411 03:55:21,600 --> 03:55:22,720 SO I'M REALLY EXCITED TO SHARE 6412 03:55:22,720 --> 03:55:24,040 SOME OF THIS WORK. 6413 03:55:24,040 --> 03:55:25,560 I'M REALLY GRATEFUL ACTUALLY TO 6414 03:55:25,560 --> 03:55:30,720 SHARE THIS SPACE TO CHARACTERIZE 6415 03:55:30,720 --> 03:55:33,560 THE DIFFERENCE IN CANCER 6416 03:55:33,560 --> 03:55:36,080 INCIDENCE BY DISAGGREGATED 6417 03:55:36,080 --> 03:55:36,560 INDIVIDUALS. 6418 03:55:36,560 --> 03:55:37,760 SO I'M GOING TO BRIEFLY SHOW 6419 03:55:37,760 --> 03:55:41,320 THREE STUDIES CONDUCTED HERE AT 6420 03:55:41,320 --> 03:55:42,640 DCEG, NCI. 6421 03:55:42,640 --> 03:55:44,440 THIS SHOWS A CURRENTLY STUDY 6422 03:55:44,440 --> 03:55:48,080 RECENTLY UNDER REVIEW, THAT 6423 03:55:48,080 --> 03:55:49,280 OVERALL NATIVE HAWAIIAN AND 6424 03:55:49,280 --> 03:55:50,440 PACIFIC ISLANDER WOMEN HAVE A 6425 03:55:50,440 --> 03:55:52,080 GREATER CANCER MORTALITY 6426 03:55:52,080 --> 03:55:53,520 COMPARED TO ASIAN INDIVIDUALS, 6427 03:55:53,520 --> 03:55:54,960 WHICH WAS CONSISTENT FOR SEVERAL 6428 03:55:54,960 --> 03:56:00,040 CANCER SITES. 6429 03:56:00,040 --> 03:56:00,800 BREAST CANCER, PARTICULAR 6430 03:56:00,800 --> 03:56:02,960 INTEREST OF MIND, BUT YOU CAN 6431 03:56:02,960 --> 03:56:06,360 ALSO SEE NATIVE HAWAIIAN AND 6432 03:56:06,360 --> 03:56:08,480 PACIFIC ISLANDERs HAVE A 6433 03:56:08,480 --> 03:56:09,920 TWOFOLD RISK COMPARED TO 6434 03:56:09,920 --> 03:56:10,880 NON-ASIAN WOMEN. 6435 03:56:10,880 --> 03:56:14,400 THIS STUDY USES NATIONWIDE DEATH 6436 03:56:14,400 --> 03:56:15,960 CERTIFICATE MEASURE FROM 2018 TO 6437 03:56:15,960 --> 03:56:16,160 2020. 6438 03:56:16,160 --> 03:56:18,720 YOU MAY BE WONDERING WHY 2018 6439 03:56:18,720 --> 03:56:21,040 WHEN OMB SET STANDARDS BACK IN 6440 03:56:21,040 --> 03:56:21,440 1997. 6441 03:56:21,440 --> 03:56:24,200 SO LIKE ME I QUESTIONED THIS AND 6442 03:56:24,200 --> 03:56:26,120 LEARNED IT WAS NOT UNTIL 2018 6443 03:56:26,120 --> 03:56:34,200 WHEN EVERY STATE IN THE SU NATIN 6444 03:56:34,200 --> 03:56:35,040 SEPARATED DATA ON DEATH 6445 03:56:35,040 --> 03:56:35,840 CERTIFICATES. 6446 03:56:35,840 --> 03:56:36,880 IT'S VERY CLEAR WE HAVE A LONG 6447 03:56:36,880 --> 03:56:38,480 WAY TO GO. 6448 03:56:38,480 --> 03:56:39,960 THIS IS ANOTHER STUDY THAT WAS 6449 03:56:39,960 --> 03:56:42,040 RECENTLY PUBLISHED LED BY MY 6450 03:56:42,040 --> 03:56:44,440 DEAR COLLEAGUE JAMIE SHIELS ALSO 6451 03:56:44,440 --> 03:56:47,000 IN D.C. WHICH SHOWS DATA 6452 03:56:47,000 --> 03:56:48,400 AGGRAVATION MASKS CANCER 6453 03:56:48,400 --> 03:56:49,000 INCIDENCE. 6454 03:56:49,000 --> 03:56:53,040 ON THE LEFT, THE RATE WAS 6455 03:56:53,040 --> 03:56:54,240 7.6 PER HUNDRED THOUSAND 6456 03:56:54,240 --> 03:56:55,240 INDIVIDUALS WHEN YOU GROUP THEM 6457 03:56:55,240 --> 03:56:57,480 TOGETHER BUT THE DISAGGREGATED 6458 03:56:57,480 --> 03:57:00,960 DATA SHOWS AN INCIDENT RATE 6459 03:57:00,960 --> 03:57:02,880 OF -- AND 10.1 FOR SOUTHEAST 6460 03:57:02,880 --> 03:57:03,800 ASIAN WOMEN. 6461 03:57:03,800 --> 03:57:05,160 ON THE RIGHT THIS IS REALLY 6462 03:57:05,160 --> 03:57:08,520 SIMILAR FOR MEN WITH 6463 03:57:08,520 --> 03:57:11,360 OROPHARYNGEAL SQUAMOUS CELL 6464 03:57:11,360 --> 03:57:13,720 CARCINOMA WITH 1.8 WHEREAS 6465 03:57:13,720 --> 03:57:16,920 DISAGGREGATED DATA SHOWS A RATE 6466 03:57:16,920 --> 03:57:19,400 FOR 4.2 PER 100,000 INDIVIDUALS 6467 03:57:19,400 --> 03:57:20,640 FOR NATIVE HAWAIIAN OR PACIFIC 6468 03:57:20,640 --> 03:57:21,560 ISLANDER MEN. 6469 03:57:21,560 --> 03:57:22,840 SO SPECIFICALLY FOR BREAST 6470 03:57:22,840 --> 03:57:24,680 CANCER INCIDENCE WHICH IS A 6471 03:57:24,680 --> 03:57:25,640 PARTICULAR INTEREST OF MINE THE 6472 03:57:25,640 --> 03:57:26,920 GREY LINE HERE SHOWS ASIAN 6473 03:57:26,920 --> 03:57:29,040 INDIVIDUALS, WHEN EXAMINED AS AN 6474 03:57:29,040 --> 03:57:31,640 AGGREGATE, HAD NO CHANGE IN 6475 03:57:31,640 --> 03:57:32,320 CANCER INCIDENCE OVER TIME BUT 6476 03:57:32,320 --> 03:57:34,280 WHEN YOU LOOK AT THE 6477 03:57:34,280 --> 03:57:35,440 DISAGGREGATED DATA IT SHOWS 6478 03:57:35,440 --> 03:57:36,960 BREAST CANCER INCIDENCE ARE 6479 03:57:36,960 --> 03:57:40,840 INCREASING AMONG FILIPINO, 6480 03:57:40,840 --> 03:57:41,440 CHINESE, JAPANESE AND KOREAN 6481 03:57:41,440 --> 03:57:42,440 WOMEN AS HIGHLIGHTED BY THE 6482 03:57:42,440 --> 03:57:42,720 STARS. 6483 03:57:42,720 --> 03:57:44,360 SO I'M GOING TO SWITCH GEARS 6484 03:57:44,360 --> 03:57:45,920 BRIEFLY OVER TO BREAST CANCER 6485 03:57:45,920 --> 03:57:48,640 SURVIVORSHIP AND TIE ALL OF THIS 6486 03:57:48,640 --> 03:57:49,360 TOGETHER. 6487 03:57:49,360 --> 03:57:51,880 SO CURRENTLY THERE ARE OVER 6488 03:57:51,880 --> 03:57:52,400 3.8 MILLION BREAST CANCER 6489 03:57:52,400 --> 03:57:53,320 SURVIVORS LIVING HERE IN THE 6490 03:57:53,320 --> 03:57:54,520 U.S., WHICH HAS A FIVE-YEAR 6491 03:57:54,520 --> 03:57:57,040 SURVIVAL RATE OF 91%. 6492 03:57:57,040 --> 03:57:58,120 ADVANCES IN TREATMENT AND 6493 03:57:58,120 --> 03:57:59,680 SCREENING HAVE CONTRIBUTED TO 6494 03:57:59,680 --> 03:58:00,800 LONGER SURVIVAL, BUT MANY BREAST 6495 03:58:00,800 --> 03:58:02,880 CANCER SURVIVORS ARE AT 6496 03:58:02,880 --> 03:58:03,720 INCREASED RISK FOR DEVELOPING 6497 03:58:03,720 --> 03:58:05,360 AND DYING OF CARDIOVASCULAR 6498 03:58:05,360 --> 03:58:06,720 DISEASE DUE TO SHARED RISK 6499 03:58:06,720 --> 03:58:08,360 FACTORS IN CARDIOTOXIC CANCER 6500 03:58:08,360 --> 03:58:08,760 TREATMENT. 6501 03:58:08,760 --> 03:58:11,280 BY WAY OF BACKGROUND, I WAS A 6502 03:58:11,280 --> 03:58:13,120 CARDIAC ICU NURSE AND I'M VERY 6503 03:58:13,120 --> 03:58:14,160 PASSIONATE ABOUT REDUCING THE 6504 03:58:14,160 --> 03:58:16,360 IMPACT OF LONG TERM 6505 03:58:16,360 --> 03:58:16,920 CARDIOVASCULAR DISEASE AMONG 6506 03:58:16,920 --> 03:58:18,800 CANCER SURVIVORS. 6507 03:58:18,800 --> 03:58:20,560 SO THE FIGURE ON THE LEFT SHOWS 6508 03:58:20,560 --> 03:58:21,600 SEVERAL TREATMENTS THAT ARE 6509 03:58:21,600 --> 03:58:22,960 ASSOCIATED WITH INCREASED RISK 6510 03:58:22,960 --> 03:58:24,600 OF CARDIOVASCULAR DISEASE 6511 03:58:24,600 --> 03:58:28,720 INCLUDING CHEMOTHERAPY SUCH AS 6512 03:58:28,720 --> 03:58:29,600 ANTHROCYCLINES, CHEST 6513 03:58:29,600 --> 03:58:31,120 RADIOTHERAPY AND HORMONE 6514 03:58:31,120 --> 03:58:31,360 THERAPY. 6515 03:58:31,360 --> 03:58:32,440 AS A RESULT OF INCREASING 6516 03:58:32,440 --> 03:58:36,880 KNOWLEDGE AND AWARENESS OF 6517 03:58:36,880 --> 03:58:39,160 CARDIOTOXICOLOGY, SCREENING FOR 6518 03:58:39,160 --> 03:58:40,280 CARDIAC DYSFUNCTION FOR SPECIFIC 6519 03:58:40,280 --> 03:58:40,800 CANCER TREATMENTS. 6520 03:58:40,800 --> 03:58:42,720 BUT WITH LIMITED RESOURCES AND 6521 03:58:42,720 --> 03:58:45,040 ACCESS TO GUIDELINE CONCORDANT 6522 03:58:45,040 --> 03:58:46,440 HEALTHCARE, THIS MAY RESULT IN 6523 03:58:46,440 --> 03:58:47,720 DISPARITIES IN CARDIOVASCULAR 6524 03:58:47,720 --> 03:58:49,040 DISEASE MORTALITY GIVEN THE 6525 03:58:49,040 --> 03:58:50,320 HIGHLY SPECIALIZED 6526 03:58:50,320 --> 03:58:53,040 CARDIOONCOLOGY FIELD. 6527 03:58:53,040 --> 03:58:55,280 AND WHEN I REFERRED TO HIGHLY 6528 03:58:55,280 --> 03:58:56,200 SPECIALIZED, MANY OF YOU COME 6529 03:58:56,200 --> 03:58:57,600 FROM DIFFERENT AREAS ACROSS THE 6530 03:58:57,600 --> 03:58:59,160 U.S. AND NOT EVERY SINGLE 6531 03:58:59,160 --> 03:59:00,640 INSTITUTION HAS A CARDIOONCOLOGY 6532 03:59:00,640 --> 03:59:03,320 CLINIC WHICH IS CARDIOLOGISTS 6533 03:59:03,320 --> 03:59:04,040 WHO ACTUALLY HAVE EXPERIENCE AND 6534 03:59:04,040 --> 03:59:06,040 KNOWLEDGE IN CANCER TREATMENTS. 6535 03:59:06,040 --> 03:59:12,880 SO I RECENTLY PUBLISHED TWO -- 6536 03:59:12,880 --> 03:59:15,080 BY SOCIOECONOMIC STATUS AND BY 6537 03:59:15,080 --> 03:59:16,560 RACIAL AND ETHNIC DISPARITIES. 6538 03:59:16,560 --> 03:59:18,880 I'M GOING TO HIGHLIGHT A FEW 6539 03:59:18,880 --> 03:59:21,920 FINDINGS FROM THE LATTER STUDY. 6540 03:59:21,920 --> 03:59:24,200 SO THIS IS QUITE LITERALLY HOT 6541 03:59:24,200 --> 03:59:24,800 OFF THE PRESS. 6542 03:59:24,800 --> 03:59:26,840 THIS ARTICLE WAS PUBLISHED TWO 6543 03:59:26,840 --> 03:59:27,240 WEEKS AGO. 6544 03:59:27,240 --> 03:59:29,040 MY TEAM AND I USE STANDARDIZED 6545 03:59:29,040 --> 03:59:30,400 MORTALITY RATIOS WHICH ARE 6546 03:59:30,400 --> 03:59:32,640 CALCULATED AS THE OBSERVED HEART 6547 03:59:32,640 --> 03:59:34,360 DISEASE DEATHS AMONG BREAST 6548 03:59:34,360 --> 03:59:38,960 CANCER SURVIVORS BY THE GENERAL 6549 03:59:38,960 --> 03:59:39,760 POPULATION. 6550 03:59:39,760 --> 03:59:40,840 SO FINDING DEMONSTRATED THAT WE 6551 03:59:40,840 --> 03:59:42,880 OBSERVED ELEVATED HEART DISEASE 6552 03:59:42,880 --> 03:59:44,720 MORTALITY AMONG BLACK AND LATINA 6553 03:59:44,720 --> 03:59:46,920 BREAST CANCER SURVIVORS OVERALL 6554 03:59:46,920 --> 03:59:48,960 AND BY INITIAL TREATMENT 6555 03:59:48,960 --> 03:59:50,560 RECEIPT, AS WELL AS ASIAN 6556 03:59:50,560 --> 03:59:52,120 AMERICAN, NATIVE HAWAIIAN AND 6557 03:59:52,120 --> 03:59:53,040 PACIFIC ISLANDER WOMEN TREATED 6558 03:59:53,040 --> 03:59:54,280 WITH CHEMOTHERAPY OR 6559 03:59:54,280 --> 03:59:55,720 RADIOTHERAPY. 6560 03:59:55,720 --> 03:59:57,520 AN IMPORTANT CAVEAT HERE, SO THE 6561 03:59:57,520 --> 04:00:00,960 DATA USED WERE FROM 2000 TO 2018 6562 04:00:00,960 --> 04:00:02,600 FROM SEER AND, THEREFORE, WE 6563 04:00:02,600 --> 04:00:05,760 REPORTED THE AGGREGATED ASIAN 6564 04:00:05,760 --> 04:00:06,360 AMERICAN, NATIVE HAWAIIAN AND 6565 04:00:06,360 --> 04:00:08,200 PACIFIC ISLANDER DATA SINCE WE 6566 04:00:08,200 --> 04:00:09,600 COULD NOT DISAGGREGATE THE 6567 04:00:09,600 --> 04:00:11,040 EXPECTED RATES IN THE 6568 04:00:11,040 --> 04:00:16,280 CERTIFICATE DATA PRIOR TO 2018. 6569 04:00:16,280 --> 04:00:18,880 SO THIS FIGURE HERE SHOWS THE 6570 04:00:18,880 --> 04:00:21,640 HEART DISEASE SMRs BY RAIS AND 6571 04:00:21,640 --> 04:00:24,120 ETHNICITY OVERALL AND STRIKE STD 6572 04:00:24,120 --> 04:00:28,560 BY TREATMENT IN CANCER STAGE. 6573 04:00:28,560 --> 04:00:30,120 TREATMENT AND STAGE. 6574 04:00:30,120 --> 04:00:31,240 AND I'M GOING TO HIGHLIGHT ONLY 6575 04:00:31,240 --> 04:00:33,360 JUST THE FINDINGS FOR THE ASIAN 6576 04:00:33,360 --> 04:00:34,400 AMERICAN AND NATIVE HAWAIIAN AND 6577 04:00:34,400 --> 04:00:36,160 PACIFIC ISLANDER WOMEN AND I'LL 6578 04:00:36,160 --> 04:00:37,560 EXPLAIN WHY. 6579 04:00:37,560 --> 04:00:38,840 SPECIFICALLY WE OBSERVED 6580 04:00:38,840 --> 04:00:39,840 SIGNIFICANTLY HIGHER HEART 6581 04:00:39,840 --> 04:00:42,400 DISEASE MORTALITY FOR ASIAN 6582 04:00:42,400 --> 04:00:44,040 AMERICAN, NATIVE HAWAIIAN AND 6583 04:00:44,040 --> 04:00:45,800 PACIFIC ISLANDER BREAST CANCER 6584 04:00:45,800 --> 04:00:46,960 SURVIVORS WHEN TREATED WITH 6585 04:00:46,960 --> 04:00:49,120 CHEMOTHERAPY AND RADIOTHERAPY, 6586 04:00:49,120 --> 04:00:50,680 BUT WE COMPARED THEM TO THE 6587 04:00:50,680 --> 04:00:52,720 ASIAN AMERICAN AND NATIVE 6588 04:00:52,720 --> 04:00:53,400 HAWAIIAN, PACIFIC ISLANDER WOMEN 6589 04:00:53,400 --> 04:00:54,640 IN THE GENERAL POPULATION 6590 04:00:54,640 --> 04:00:56,280 MATCHED ON AGE AND CALENDAR 6591 04:00:56,280 --> 04:00:57,840 YEAR. 6592 04:00:57,840 --> 04:00:59,000 SO A FEW THINGS TO NOTE ABOUT 6593 04:00:59,000 --> 04:00:59,760 THIS STUDY. 6594 04:00:59,760 --> 04:01:01,920 WE REVEALED SOME DISPARITIES IN 6595 04:01:01,920 --> 04:01:04,160 HEART DISEASE MORTALITY AMONG 6596 04:01:04,160 --> 04:01:07,000 ASIAN AMERICAN, NATIVE HAWAIIAN 6597 04:01:07,000 --> 04:01:07,760 AND PACIFIC ISLANDER BREAST 6598 04:01:07,760 --> 04:01:08,760 CANCER SURVIVORS WHEN COMPARED 6599 04:01:08,760 --> 04:01:10,640 TO THEIR RACIAL AND ETHNIC MATCH 6600 04:01:10,640 --> 04:01:11,960 GENERAL POPULATION AS THE 6601 04:01:11,960 --> 04:01:14,320 REFERENCE GROUP USING THE SMR 6602 04:01:14,320 --> 04:01:15,000 APPROACH. 6603 04:01:15,000 --> 04:01:16,440 THIS LIKELY WOULD HAVE BEEN 6604 04:01:16,440 --> 04:01:17,640 MASKED IF WE COMPARED THEM TO 6605 04:01:17,640 --> 04:01:20,520 THE TRADITIONAL METHOD OF USING 6606 04:01:20,520 --> 04:01:21,840 NON-HISPANIC WHITE AS THE 6607 04:01:21,840 --> 04:01:24,560 INDIVIDUAL REFERENCE GROUP. 6608 04:01:24,560 --> 04:01:27,400 ONE OF THE DISTINCT -- IN THE 6609 04:01:27,400 --> 04:01:29,480 GENERAL POPULATION, SO IT'S 6610 04:01:29,480 --> 04:01:30,600 UNKNOWN IF OBSERVED ELEVATED 6611 04:01:30,600 --> 04:01:33,120 RISK WERE ATTRIBUTED TO ASIANS 6612 04:01:33,120 --> 04:01:33,960 OR NATIVE HAWAIIAN AND PACIFIC 6613 04:01:33,960 --> 04:01:36,920 ISLANDER WOMEN, OR WHICH 6614 04:01:36,920 --> 04:01:38,960 ETHNOGEOGRAPHIC REGION. 6615 04:01:38,960 --> 04:01:40,520 SO ETHNOGEOGRAPHY IS DEFINED BY 6616 04:01:40,520 --> 04:01:43,080 THE DICTIONARY AS THE GEOGRAPHIC 6617 04:01:43,080 --> 04:01:44,240 DISTRIBUTION OF RACES OR PEOPLE 6618 04:01:44,240 --> 04:01:45,480 IN THEIR RELATION TO THE 6619 04:01:45,480 --> 04:01:46,640 ENVIRONMENTS OF WHICH THEY LIVE. 6620 04:01:46,640 --> 04:01:49,760 SO THIS CAN REFER TO ASIANS, 6621 04:01:49,760 --> 04:01:51,040 PACIFIC ISLANDERs, ALSO MORE 6622 04:01:51,040 --> 04:01:53,920 GRANULAR IN TERMS OF SOUTHEAST 6623 04:01:53,920 --> 04:01:56,000 ASIAN, EAST ASIAN AND SOUTH 6624 04:01:56,000 --> 04:01:57,880 ASIAN DESCENT. 6625 04:01:57,880 --> 04:01:59,160 SO I WANTED TO FOLLOW UP ON 6626 04:01:59,160 --> 04:02:00,080 THESE FINDINGS TO UNDERSTAND 6627 04:02:00,080 --> 04:02:03,160 WHAT ARE DRIVING THESE ELEVATED 6628 04:02:03,160 --> 04:02:04,280 RISK AMONG BREAST CANCER 6629 04:02:04,280 --> 04:02:04,920 SURVIVORS. 6630 04:02:04,920 --> 04:02:07,800 I'M VERY GRATEFUL TO MY CURRENT 6631 04:02:07,800 --> 04:02:09,120 MENTEE, RAISE YOUR HAND, 6632 04:02:09,120 --> 04:02:14,120 CAROLINE, WHO WA IS A CURRENT 6633 04:02:14,120 --> 04:02:16,600 STUDENT AT GEORGE WASHINGTON WHO 6634 04:02:16,600 --> 04:02:17,200 FACILITATED THIS ANALYSIS OVER 6635 04:02:17,200 --> 04:02:18,440 THE LAST YEAR. 6636 04:02:18,440 --> 04:02:21,800 SO AGAIN USING SEER 17 REGISTRY 6637 04:02:21,800 --> 04:02:23,680 DATA, WE INCLUDED OVER 56,000 6638 04:02:23,680 --> 04:02:26,240 WOMEN WHO IDENTIFIED AS ASIAN 6639 04:02:26,240 --> 04:02:27,800 AMERICAN, NATIVE HAWAIIAN OR 6640 04:02:27,800 --> 04:02:28,440 OTHER PACIFIC ISLANDER WOMEN 6641 04:02:28,440 --> 04:02:29,720 DIAGNOSED WITH BREAST CANCER 6642 04:02:29,720 --> 04:02:32,520 BETWEEN THE AGES OF 18 TO 84, 6643 04:02:32,520 --> 04:02:34,280 BETWEEN 2000 AND 2018 AND 6644 04:02:34,280 --> 04:02:36,240 SURVIVED AT LEAST ONE YEAR AFTER 6645 04:02:36,240 --> 04:02:40,080 THEIR INITIAL CANCER DIAGNOSIS. 6646 04:02:40,080 --> 04:02:42,920 FOR OUR EXPOSURE, WE GROUPED THE 6647 04:02:42,920 --> 04:02:43,560 WOMEN BY ETHNOGEOGRAPHIC REGION 6648 04:02:43,560 --> 04:02:45,640 SO EAST ASIAN, WHICH INCLUDED 6649 04:02:45,640 --> 04:02:46,960 CHINESE, JAPANESE AND KOREAN 6650 04:02:46,960 --> 04:02:48,840 WOMEN, SOUTH ASIAN INCLUDING 6651 04:02:48,840 --> 04:02:50,840 ASIAN, INDIAN, PAKISTANI, 6652 04:02:50,840 --> 04:02:53,920 SOUTHEAST ASIAN INCLUDING 6653 04:02:53,920 --> 04:02:59,600 FILIPINO, VE VIETNAMESE, LAOTIA, 6654 04:02:59,600 --> 04:03:02,240 HMONG, THAI, NATIVE HAWAIIAN AND 6655 04:03:02,240 --> 04:03:04,480 OTHER PACIFIC ISLANDER INCLUDING 6656 04:03:04,480 --> 04:03:05,920 POLYNESIAN, MICRO KNEE SHAN, 6657 04:03:05,920 --> 04:03:06,760 MELANIE SHAN AND OTHER 6658 04:03:06,760 --> 04:03:07,080 INDIVIDUALS. 6659 04:03:07,080 --> 04:03:07,960 WE ALSO WANTED TO LOOK 6660 04:03:07,960 --> 04:03:10,680 SPECIFICALLY AT HEART DISEASE 6661 04:03:10,680 --> 04:03:11,600 AND CEREBROVASCULAR DISEASE 6662 04:03:11,600 --> 04:03:12,920 MORTALITY, TYPES OF 6663 04:03:12,920 --> 04:03:16,760 CARDIOVASCULAR DISEASE. 6664 04:03:16,760 --> 04:03:18,400 FOR THE ANALYSIS FOLLOW-UP TIME 6665 04:03:18,400 --> 04:03:19,840 STARTED ONE YEAR AFTER BREAST 6666 04:03:19,840 --> 04:03:20,960 CANCER DIAGNOSIS AND CONTINUED 6667 04:03:20,960 --> 04:03:22,320 INTO THE FIRST OF FOLLOWING 6668 04:03:22,320 --> 04:03:23,400 EVENTS. 6669 04:03:23,400 --> 04:03:24,160 CARDIOVASCULAR DISEASE DEATH, 6670 04:03:24,160 --> 04:03:26,080 OTHER CAUSE OF DEATH, LOSS TO 6671 04:03:26,080 --> 04:03:27,800 FOLLOW-UP OR END OF STUDY WHICH 6672 04:03:27,800 --> 04:03:29,840 WAS DECEMBER 31ST, 2019. 6673 04:03:29,840 --> 04:03:30,840 FOR ANALYSIS WE USED THREE 6674 04:03:30,840 --> 04:03:31,560 DIFFERENT APPROACHES. 6675 04:03:31,560 --> 04:03:33,560 FIRST WE REPORTED CUMULATIVE 6676 04:03:33,560 --> 04:03:34,200 MORTALITY ESTIMATES ACCOUNTING 6677 04:03:34,200 --> 04:03:36,640 FOR COMPETING EVENTS. 6678 04:03:36,640 --> 04:03:38,520 NEXT WE USED ADJUSTED HAZARD 6679 04:03:38,520 --> 04:03:40,280 RATIOS USING COX PROPORTIONAL 6680 04:03:40,280 --> 04:03:43,680 HAZARD MODELS TO ESTIMATE THE 6681 04:03:43,680 --> 04:03:46,720 RISK OF SOUTH ASIAN, SOUTHEAST 6682 04:03:46,720 --> 04:03:48,160 ASIAN, COMPARED TO EAST ASIAN 6683 04:03:48,160 --> 04:03:48,400 WOMEN. 6684 04:03:48,400 --> 04:03:50,120 WE USED THIS EAST ASIAN AS THE 6685 04:03:50,120 --> 04:03:51,160 REFERENCE GROUP AS IT WAS THE 6686 04:03:51,160 --> 04:03:54,480 LARGEST SAMPLE. 6687 04:03:54,480 --> 04:03:55,640 ALSO I WANTED TO FOLLOW UP ON 6688 04:03:55,640 --> 04:03:57,040 THOSE FINDINGS I PRESENTED 6689 04:03:57,040 --> 04:03:59,080 EARLIER ON THE PRIOR PUBLISHED 6690 04:03:59,080 --> 04:04:00,440 ARTICLE WHERE WE LOOKED AT 6691 04:04:00,440 --> 04:04:02,160 STANDARDIZED MORTALITY RATIOS, 6692 04:04:02,160 --> 04:04:04,000 WITH THE CAVEAT THAT WE COMPARED 6693 04:04:04,000 --> 04:04:05,840 EAST ASIAN, SOUTH ASIAN, 6694 04:04:05,840 --> 04:04:07,440 SOUTHEAST ASIAN AND NHPI WOMEN 6695 04:04:07,440 --> 04:04:08,960 TO THE AGGREGATE OF ASIAN 6696 04:04:08,960 --> 04:04:10,640 AMERICAN AND NHPI WOMEN IN THE 6697 04:04:10,640 --> 04:04:11,280 GENERAL POPULATION. 6698 04:04:11,280 --> 04:04:14,960 SO SPECIFIC ANALYSIS RELATED TO 6699 04:04:14,960 --> 04:04:16,920 FOLLOW-UP THAT WE OBSERVED. 6700 04:04:16,920 --> 04:04:18,400 THIS TABLE SHOWS THE DESCRIPTIVE 6701 04:04:18,400 --> 04:04:20,120 CHARACTERISTICS OF THE STUDY 6702 04:04:20,120 --> 04:04:21,480 POPULATION STRATIFIED BY 6703 04:04:21,480 --> 04:04:22,360 ETHNOGEOGRAPHIC REGION. 6704 04:04:22,360 --> 04:04:25,040 SO OF NOTE, SOUTHEAST ASIAN 6705 04:04:25,040 --> 04:04:27,440 WOMEN WERE THE YOUNGEST AT 6706 04:04:27,440 --> 04:04:28,880 BREAST CANCER DIAGNOSIS AND FOR 6707 04:04:28,880 --> 04:04:34,400 STAGE, SOUTH ASIAN AND NHPI -- 6708 04:04:34,400 --> 04:04:35,400 AGGRESSIVE STAGE BREAST CANCER 6709 04:04:35,400 --> 04:04:36,920 AND IT WAS REALLY INTERESTING 6710 04:04:36,920 --> 04:04:37,640 THAT NATIVE HAWAIIAN AND PACIFIC 6711 04:04:37,640 --> 04:04:38,840 ISLANDER WOMEN HAD THE GREATEST 6712 04:04:38,840 --> 04:04:40,920 PROPORTION OF ER POSITIVE BREAST 6713 04:04:40,920 --> 04:04:42,440 CANCER, WHICH IS THE LESS 6714 04:04:42,440 --> 04:04:43,760 AGGRESSIVE OF THE TWO COMPARED 6715 04:04:43,760 --> 04:04:46,480 TO ER NEGATIVE. 6716 04:04:46,480 --> 04:04:47,880 IN TERMS OF CANCER TREATMENT, 6717 04:04:47,880 --> 04:04:50,520 SOUTH ASIAN, SOUTHEAST ASIAN AND 6718 04:04:50,520 --> 04:04:51,920 NHPI WOMEN HAD GREATER 6719 04:04:51,920 --> 04:04:54,080 PROPORTIONS OF RECEIVING 6720 04:04:54,080 --> 04:04:54,560 CHEMOTHERAPY, THESE TWO 6721 04:04:54,560 --> 04:04:55,520 TREATMENT CATEGORIES HIGHLIGHTED 6722 04:04:55,520 --> 04:04:57,000 HERE IN THE RED BOX, COMPARED TO 6723 04:04:57,000 --> 04:05:00,160 EAST ASIAN WOMEN JUST 6724 04:05:00,160 --> 04:05:00,920 DESCRIPTIVELY. 6725 04:05:00,920 --> 04:05:02,080 SO FOR RESULTS I'M GOING TO 6726 04:05:02,080 --> 04:05:03,360 FIRST SHOW YOU THE CUMULATIVE 6727 04:05:03,360 --> 04:05:05,080 MORTALITY ESTIMATES, STRATIFIED 6728 04:05:05,080 --> 04:05:06,760 BY AGE AND ETHNOGEOGRAPHIC 6729 04:05:06,760 --> 04:05:07,080 REGION. 6730 04:05:07,080 --> 04:05:08,880 WE CHOS 70 YEARS AS THE CUTOFF 6731 04:05:08,880 --> 04:05:09,640 BASED ON THE DISTRIBUTION OF 6732 04:05:09,640 --> 04:05:11,160 EVENTS WITHIN THE STUDY 6733 04:05:11,160 --> 04:05:12,040 POPULATION AND OUR ESTIMATES 6734 04:05:12,040 --> 04:05:13,640 ACCOUNTED FOR COMPETING RISK SO 6735 04:05:13,640 --> 04:05:15,280 ANY OTHER NON-CARDIOVASCULAR 6736 04:05:15,280 --> 04:05:17,600 DISEASE DEATHS. 6737 04:05:17,600 --> 04:05:19,560 SO ON THE LEFT WERE WOMEN 6738 04:05:19,560 --> 04:05:21,600 DIAGNOSED PRIOR TO AGE 70. 6739 04:05:21,600 --> 04:05:23,280 NHPI WOMEN HAD THE GREATEST 6740 04:05:23,280 --> 04:05:24,960 10-YEAR CUMULATIVE MORTALITY, 6741 04:05:24,960 --> 04:05:26,600 APPROXIMATELY 1 IN 40 WOMEN 6742 04:05:26,600 --> 04:05:29,880 DYING OF CARDIOVASCULAR DISEASE, 6743 04:05:29,880 --> 04:05:33,920 FOLLO.ON THE RIGHT FOR WOMEN DID 6744 04:05:33,920 --> 04:05:35,400 AFTER AGE 70, WE FOUND REALLY 6745 04:05:35,400 --> 04:05:38,760 SIMILAR PATTERNS WITH THE GRE 6746 04:05:38,760 --> 04:05:40,080 GREATEST CUMULATIVE MORTALITY 6747 04:05:40,080 --> 04:05:42,840 FOR NHPI WOMEN, APPROXIMATELY 6748 04:05:42,840 --> 04:05:45,600 1 IN 7 DYING OF CARDIOVASCULAR 6749 04:05:45,600 --> 04:05:48,360 DISEASE. 6750 04:05:48,360 --> 04:05:49,640 SO THIS FIGURE SHOWS THE 6751 04:05:49,640 --> 04:05:51,760 ADJUSTED HAZARD RATIOS OF 6752 04:05:51,760 --> 04:05:53,560 CARDIOVASCULAR DISEASE MORTALITY 6753 04:05:53,560 --> 04:05:54,320 BY ETHNOGEOGRAPHIC WOMEN WITH 6754 04:05:54,320 --> 04:05:55,240 EAST ASIAN AS THE REFERENCE 6755 04:05:55,240 --> 04:05:57,720 GROUP. 6756 04:05:57,720 --> 04:06:00,920 OVERALL WE OBSERVED SIGNIFICANT 6757 04:06:00,920 --> 04:06:02,640 HETEROGENEITY IN ETHNOGEOGRAPHIC 6758 04:06:02,640 --> 04:06:04,600 REGION WHICH PERSISTED BY AGE, 6759 04:06:04,600 --> 04:06:06,160 TREATMENT -- AND ERC STATUS. 6760 04:06:06,160 --> 04:06:11,880 SO COMPARED TO EAST ASIAN, SOUTH 6761 04:06:11,880 --> 04:06:13,400 ASIAN, SOUTHEAST ASIAN, NHPI 6762 04:06:13,400 --> 04:06:15,680 WOMEN HAD A SIGNIFICANTLY HIGHER 6763 04:06:15,680 --> 04:06:16,240 CARDIOVASCULAR DISEASE 6764 04:06:16,240 --> 04:06:18,200 MORTALITY. 6765 04:06:18,200 --> 04:06:19,920 THESE PATTERNS WERE MOSTLY 6766 04:06:19,920 --> 04:06:22,040 SIMILAR BY AGE AT BREAST CANCER 6767 04:06:22,040 --> 04:06:23,280 DIAGNOSIS AS WELL WITH ELEVATED 6768 04:06:23,280 --> 04:06:26,600 RISK FOR SOUTHEAST ASIAN, NHPI 6769 04:06:26,600 --> 04:06:27,840 WOMEN DIAGNOSED BEFORE AGE 70, 6770 04:06:27,840 --> 04:06:29,280 AND THEN AFTER AGE 70, WE 6771 04:06:29,280 --> 04:06:31,440 OBSERVED ELEVATED RISK FOR SOUTH 6772 04:06:31,440 --> 04:06:33,160 ASIAN, SOUTHEAST ASIAN, NHPI 6773 04:06:33,160 --> 04:06:36,960 WOMEN COMPARED TO EAST ASIAN 6774 04:06:36,960 --> 04:06:37,200 WOMEN. 6775 04:06:37,200 --> 04:06:39,200 BY INITIAL TREATMENT RECEIPT, 6776 04:06:39,200 --> 04:06:40,960 NHPI WOMEN HAD ELEVATED 6777 04:06:40,960 --> 04:06:42,080 CARDIOVASCULAR DISEASE MORTALITY 6778 04:06:42,080 --> 04:06:44,440 ACROSS ALL TYPES, SO SURGERY, 6779 04:06:44,440 --> 04:06:45,320 CHEMOTHERAPY, KEEM THEIR WITH 6780 04:06:45,320 --> 04:06:47,000 RADIOTHERAPY AND RADIOTHERAPY, 6781 04:06:47,000 --> 04:06:48,520 COMPARED TO EAST ASIAN WOMEN. 6782 04:06:48,520 --> 04:06:49,800 AND THEN SPECIFICALLY FOR WOMEN 6783 04:06:49,800 --> 04:06:51,760 TREATED WITH RADIOTHERAPY ONLY, 6784 04:06:51,760 --> 04:06:53,760 WE OBSERVED ELEVATED RISK FOR 6785 04:06:53,760 --> 04:06:55,440 SOUTH ASIAN, SOUTHEAST ASIAN, 6786 04:06:55,440 --> 04:06:58,280 NHPI WOMEN. 6787 04:06:58,280 --> 04:07:00,120 AND BY ER STATUS COMPARED TO 6788 04:07:00,120 --> 04:07:03,280 EAST ASIAN WOMEN, SOUTH ASIAN, 6789 04:07:03,280 --> 04:07:05,000 SOUTHEAST ASIAN AND NHPI WOMEN 6790 04:07:05,000 --> 04:07:06,880 DIAGNOSED WITH ER POSITIVE 6791 04:07:06,880 --> 04:07:08,720 BREAST CANCER HAD A 6792 04:07:08,720 --> 04:07:09,560 SIGNIFICANTLY HIGHER 6793 04:07:09,560 --> 04:07:11,200 CARDIOVASCULAR DISEASE 6794 04:07:11,200 --> 04:07:20,120 MORTALITY. 6795 04:07:20,120 --> 04:07:21,760 I DID WANT TO HIGHLIGHT THAT WE 6796 04:07:21,760 --> 04:07:23,080 OBSERVED REALLY SIMILAR PATTERNS 6797 04:07:23,080 --> 04:07:24,520 BUT ATTENUATED RESULTS FOR HEART 6798 04:07:24,520 --> 04:07:26,240 DISEASE MORTALITY, WHICH WERE 6799 04:07:26,240 --> 04:07:28,440 FURTHER ATTENUATED FOR 6800 04:07:28,440 --> 04:07:29,080 CEREBROVASCULAR DISEASE 6801 04:07:29,080 --> 04:07:31,040 MORTALITY. 6802 04:07:31,040 --> 04:07:32,680 SO THIS SLIDE HERE IS ME TRYING 6803 04:07:32,680 --> 04:07:34,160 TO UNDERSTAND THE RESULTS OF THE 6804 04:07:34,160 --> 04:07:34,600 PRIOR STUDY. 6805 04:07:34,600 --> 04:07:39,160 SO ON THE TOP IS A SNIPPET OF 6806 04:07:39,160 --> 04:07:40,400 THE FIGURE WHERE WE FOUND 6807 04:07:40,400 --> 04:07:43,480 ELEVATED HEART DISEASE SMRs 6808 04:07:43,480 --> 04:07:44,480 FOR THE WOMEN TOGETHER. 6809 04:07:44,480 --> 04:07:46,120 ON THE BOTTOM IS THE PRESENT 6810 04:07:46,120 --> 04:07:48,480 STUDY, WHERE WE DISAGGREGATED BY 6811 04:07:48,480 --> 04:07:49,680 ETHNOGEOGRAPHIC REGION BUT WE 6812 04:07:49,680 --> 04:07:50,640 STILL HAD TO USE THE SAME 6813 04:07:50,640 --> 04:07:53,400 REFERENCE GROUP. 6814 04:07:53,400 --> 04:07:55,560 SO OVERALL, SOUTH ASIAN NHPI 6815 04:07:55,560 --> 04:07:57,080 WOMEN HAD ELEVATED HEART DISEASE 6816 04:07:57,080 --> 04:07:58,240 MORTALITY COMPARED TO THE 6817 04:07:58,240 --> 04:07:59,800 AGGREGATE ASIAN AMERICAN NATIVE 6818 04:07:59,800 --> 04:08:01,280 HAWAIIAN AND PACIFIC ISLANDER 6819 04:08:01,280 --> 04:08:03,040 GENERAL POPULATION AND THE 6820 04:08:03,040 --> 04:08:03,640 NATIVE HAWAIIAN AND PACIFIC 6821 04:08:03,640 --> 04:08:05,120 ISLANDER WOMEN ALSO HAD ELEVATED 6822 04:08:05,120 --> 04:08:06,880 RISK ACROSS ALL TREATMENT GROUPS 6823 04:08:06,880 --> 04:08:07,840 BUT SPECIFICALLY WHEN WE 6824 04:08:07,840 --> 04:08:09,760 COMPARED THE FINDINGS THAT WE 6825 04:08:09,760 --> 04:08:11,320 FOUND EARLIER, WHERE ASIAN 6826 04:08:11,320 --> 04:08:12,120 AMERICAN, NATIVE HAWAIIAN AND 6827 04:08:12,120 --> 04:08:13,320 PACIFIC ISLANDER AS AN AGGREGATE 6828 04:08:13,320 --> 04:08:14,840 WERE TREATED WITH CHEMOTHERAPY 6829 04:08:14,840 --> 04:08:17,560 PLUS RADIOTHERAPY, HAD ELEVATED 6830 04:08:17,560 --> 04:08:19,080 RISK, WE FOUND IT WAS LIKELY 6831 04:08:19,080 --> 04:08:21,240 ATTRIBUTED TO SOUTHEAST ASIAN 6832 04:08:21,240 --> 04:08:23,640 AND NHPI WOMEN TO THAT ELEVATED 6833 04:08:23,640 --> 04:08:25,720 HEART DISEASE MORTALITY. 6834 04:08:25,720 --> 04:08:27,480 IMPORTANTLY, BECAUSE WE COULD 6835 04:08:27,480 --> 04:08:28,640 NOT DISAGGREGATE THE 6836 04:08:28,640 --> 04:08:29,560 DENOMINATOR, WE ALSO COULDN'T 6837 04:08:29,560 --> 04:08:31,720 ACCOUNT FOR THE DIFFERENCES BY 6838 04:08:31,720 --> 04:08:32,360 ETHNOGEOGRAPHIC REGION IN THE 6839 04:08:32,360 --> 04:08:36,000 GENERAL POPULATION. 6840 04:08:36,000 --> 04:08:39,120 SO IN TERMS OF THE MAIN 6841 04:08:39,120 --> 04:08:40,320 TAKEAWAYS, WE FOUND SIGNIFICANT 6842 04:08:40,320 --> 04:08:41,840 DIFFERENCES IN CARDIOVASCULAR 6843 04:08:41,840 --> 04:08:45,320 DISEASE MORTALITY AMONG ASIAN 6844 04:08:45,320 --> 04:08:46,960 AMERICAN, NATIVE HAWAIIAN AND 6845 04:08:46,960 --> 04:08:49,720 PACIFIC ISLANDER WREAS CANCER 6846 04:08:49,720 --> 04:08:52,360 SURVIVORS -- ATTENUATED FOR 6847 04:08:52,360 --> 04:08:53,320 HEART DISEASE AND 6848 04:08:53,320 --> 04:08:53,960 CEREBROVASCULAR DISEASE 6849 04:08:53,960 --> 04:08:55,040 MORTALITY. 6850 04:08:55,040 --> 04:08:56,680 IMPORTANTLY, WE REALLY RECOGNIZE 6851 04:08:56,680 --> 04:08:58,400 THAT ASIAN AMERICANS ARE NOT THE 6852 04:08:58,400 --> 04:08:59,480 SAME AS NATIVE HAWAIIAN AND 6853 04:08:59,480 --> 04:09:00,000 OTHER PACIFIC ISLANDER 6854 04:09:00,000 --> 04:09:01,240 INDIVIDUALS. 6855 04:09:01,240 --> 04:09:02,920 WHEN YOU AGGREGATE THE TWO 6856 04:09:02,920 --> 04:09:04,680 GROUPS, THEY MASK DISPARITIES. 6857 04:09:04,680 --> 04:09:06,440 AND THE GREATEST CARDIOVASCULAR 6858 04:09:06,440 --> 04:09:09,480 DISEASE BURDEN WERE OBSERVED 6859 04:09:09,480 --> 04:09:11,080 AMONG NATIVE HAWAIIAN AND 6860 04:09:11,080 --> 04:09:13,800 PACIFIC ISLANDER WOMEN WITH 2 TO 6861 04:09:13,800 --> 04:09:15,320 6% GREATER MORTALITY COMPARED TO 6862 04:09:15,320 --> 04:09:17,720 EAST ASIAN WOMEN AMONG NATIVE 6863 04:09:17,720 --> 04:09:18,360 HAWAIIAN AND PACIFIC ISLANDER 6864 04:09:18,360 --> 04:09:19,720 INDIVIDUALS. 6865 04:09:19,720 --> 04:09:21,120 SOUTH ASIAN AND SOUTHEAST ASIAN 6866 04:09:21,120 --> 04:09:23,760 ALSO HAD ELEVATED CARDIOVASCULAR 6867 04:09:23,760 --> 04:09:25,000 DISEASE MORTALITY COMPARED TO 6868 04:09:25,000 --> 04:09:26,880 EAST ASIAN WOMEN AS WELL, AND 6869 04:09:26,880 --> 04:09:28,600 THESE DESCRIPTIVE STUDIES USING 6870 04:09:28,600 --> 04:09:29,520 LARGE NATIONAL STUDIES ARE 6871 04:09:29,520 --> 04:09:31,120 USEFUL TO UNDERSTAND THESE 6872 04:09:31,120 --> 04:09:32,760 PATTERNS BUT WE REALLY NEED 6873 04:09:32,760 --> 04:09:34,400 ADDITIONAL STUDIES WITH THE 6874 04:09:34,400 --> 04:09:35,840 DISAGO DATED DATA AVAILABLE SO 6875 04:09:35,840 --> 04:09:37,760 WE CAN UNDERSTAND WHAT'S DRIVING 6876 04:09:37,760 --> 04:09:41,040 THESE RISK FACTORS. 6877 04:09:41,040 --> 04:09:43,280 SO I WANTED TO BRIEFLY SHOW THE 6878 04:09:43,280 --> 04:09:44,520 FRAMEWORK, IT'S BEEN REALLY 6879 04:09:44,520 --> 04:09:45,800 GREAT TO LEARN TODAY AND 6880 04:09:45,800 --> 04:09:47,120 YESTERDAY ABOUT THE DIFFERENT 6881 04:09:47,120 --> 04:09:48,400 UPSTREAM AND DOWNSTREAM FRAME 6882 04:09:48,400 --> 04:09:49,680 WORKS THAT DRIVE OTHER STUDIES 6883 04:09:49,680 --> 04:09:51,120 DURING THIS CONFERENCE. 6884 04:09:51,120 --> 04:09:52,920 THIS FRAMEWORK DESCRIBES HOW 6885 04:09:52,920 --> 04:09:56,480 HEALTH INEQUITIES -- FROM SOCIAL 6886 04:09:56,480 --> 04:09:57,760 AND STRUCTURAL DETERMINANTS OF 6887 04:09:57,760 --> 04:10:00,960 HEALTH, SYSTEMIC INEQUITIES, AND 6888 04:10:00,960 --> 04:10:01,520 CLINICAL INEQUITIES. 6889 04:10:01,520 --> 04:10:02,960 BUT AS I MENTIONED WE REALLY 6890 04:10:02,960 --> 04:10:04,200 NEED MORE DATA THAT PULLS THESE 6891 04:10:04,200 --> 04:10:05,280 PIECES TOGETHER SO WE CAN 6892 04:10:05,280 --> 04:10:06,040 ATTEMPT TO UNDERSTAND WHAT 6893 04:10:06,040 --> 04:10:09,200 DRIVES THESE HEALTH DISPARITIES. 6894 04:10:09,200 --> 04:10:10,600 SO LASTLY I JUST REALLY WANTED 6895 04:10:10,600 --> 04:10:12,840 TO HIGHLIGHT HOW I'M TRYING TO 6896 04:10:12,840 --> 04:10:14,760 DO MY DUE DILIGENCE IN 6897 04:10:14,760 --> 04:10:16,040 INCREASING THE RACIAL DIVERSITY 6898 04:10:16,040 --> 04:10:18,320 IN CANCER COHORTS, BUT 6899 04:10:18,320 --> 04:10:21,320 SPECIFICALLY DIVERSITY -- 6900 04:10:21,320 --> 04:10:23,280 DIVERSIFYING BREAST CANCER 6901 04:10:23,280 --> 04:10:29,720 SURVIVOR COHORTS AMONG ASIAN 6902 04:10:29,720 --> 04:10:30,840 AMERICAN AND NATIVE HAWAIIAN AND 6903 04:10:30,840 --> 04:10:32,000 PACIFIC ISLANDER INDIVIDUALS. 6904 04:10:32,000 --> 04:10:35,040 I'M THE COPI OF THE KAISER 6905 04:10:35,040 --> 04:10:36,000 PERMANENTE BREAST CANCER 6906 04:10:36,000 --> 04:10:37,080 SURVIVORS COHORT. 6907 04:10:37,080 --> 04:10:40,600 THIS IS A LONG TERM EFFORT FROM 6908 04:10:40,600 --> 04:10:42,720 DR. GIERACH AND DR. GONZALEZ WHO 6909 04:10:42,720 --> 04:10:44,080 RECENTLY LEFT THE NCI AND 6910 04:10:44,080 --> 04:10:45,840 RETURNED TO THE UK AND WE 6911 04:10:45,840 --> 04:10:48,040 RECENTLY RETRIEVED DATA FROM 6912 04:10:48,040 --> 04:10:49,880 FOUR KAISER PERMANENTE SITES FOR 6913 04:10:49,880 --> 04:10:51,640 OVERARCHING STUDY AIM. 6914 04:10:51,640 --> 04:10:53,840 WITH THE RISK OF SECOND CANCERS, 6915 04:10:53,840 --> 04:10:55,320 CARDIOVASCULAR DISEASE RISK AND 6916 04:10:55,320 --> 04:10:56,200 MORTALITY AMONG BREAST CANCER 6917 04:10:56,200 --> 04:10:57,680 SURVIVORS. 6918 04:10:57,680 --> 04:11:02,200 WITH MY COLLEAGUE DR. CO DI 6919 04:11:02,200 --> 04:11:02,840 RAYMOND -- OVER THIS LAST YEAR 6920 04:11:02,840 --> 04:11:04,640 WHICH INCLUDES A PATIENT 6921 04:11:04,640 --> 04:11:06,760 POPULATION OF OVER 50% 6922 04:11:06,760 --> 04:11:07,360 NON-HISPANIC BLACK WOMEN WHICH 6923 04:11:07,360 --> 04:11:10,720 IS FUNDED BY THE DCEG FELLOWS 6924 04:11:10,720 --> 04:11:11,920 HEALTH DISPARITIES BOARD. 6925 04:11:11,920 --> 04:11:13,480 BUT THIS IS THE MAP I ENVISION 6926 04:11:13,480 --> 04:11:16,160 FOR THE NEAR FUTURE, WHICH ADDS 6927 04:11:16,160 --> 04:11:18,440 KAISER PERMANENTE HAWAII. 6928 04:11:18,440 --> 04:11:20,280 HAWAII IS HOME TO ONE OF THE 6929 04:11:20,280 --> 04:11:22,360 LARGEST U.S. POPULATIONS OF 6930 04:11:22,360 --> 04:11:23,880 ASIAN AMERICANS, NATIVE 6931 04:11:23,880 --> 04:11:25,080 HAWAIIANS AND OTHER PACIFIC 6932 04:11:25,080 --> 04:11:25,600 ISLANDERS. 6933 04:11:25,600 --> 04:11:26,600 SPECIFICALLY IT INCLUDES 6934 04:11:26,600 --> 04:11:27,400 APPROXIMATELY 40% ASIAN 6935 04:11:27,400 --> 04:11:29,240 AMERICANS AND APPROXIMATELY 20% 6936 04:11:29,240 --> 04:11:30,720 NATIVE HAWAIIAN AND OTHER 6937 04:11:30,720 --> 04:11:31,720 PACIFIC ISLANDER BREAST CANCER 6938 04:11:31,720 --> 04:11:32,560 SURVIVORS. 6939 04:11:32,560 --> 04:11:34,800 KAISER HAWAII IS A DCEG CONNECT 6940 04:11:34,800 --> 04:11:36,360 FOR CANCER PREVENTION STUDY SITE 6941 04:11:36,360 --> 04:11:39,320 AND HAS ESTABLISHED PARTNERSHIPS 6942 04:11:39,320 --> 04:11:41,040 WITH DR. STACY HONDA AND HER KP 6943 04:11:41,040 --> 04:11:42,240 HAWAII TEAM SO REALLY LOOKING 6944 04:11:42,240 --> 04:11:44,560 FORWARD TO JOINING EFFORTS WITH 6945 04:11:44,560 --> 04:11:45,960 KAISER HAWAII IN THE NEAR 6946 04:11:45,960 --> 04:11:46,200 FUTURE. 6947 04:11:46,200 --> 04:11:48,680 SO I JUST WANTED TO BRIEFLY END 6948 04:11:48,680 --> 04:11:50,200 WITH THE ADDITION OF KAISER 6949 04:11:50,200 --> 04:11:51,720 HAWAII, WE'LL BE INCREASING OUR 6950 04:11:51,720 --> 04:11:53,240 ASIAN PROPORTION OF OUR COHORT 6951 04:11:53,240 --> 04:11:57,280 FROM 4% TO 11.5%, AND FOR THE 6952 04:11:57,280 --> 04:11:57,960 PACIFIC ISLANDER PROPORTION FROM 6953 04:11:57,960 --> 04:12:00,200 LESS THAN 1% TO 6%. 6954 04:12:00,200 --> 04:12:02,080 AND WE'RE HOPING TO ABSTRACT 6955 04:12:02,080 --> 04:12:03,720 DATA FROM THESE MEDICAL RECORDS 6956 04:12:03,720 --> 04:12:04,800 AND CANCER REGISTRY TO SET THE 6957 04:12:04,800 --> 04:12:06,960 STAGE TO STUDY RACIAL INEQUITIES 6958 04:12:06,960 --> 04:12:08,840 AMONG BREAST CANCER SURVIVORS 6959 04:12:08,840 --> 04:12:11,160 WITHIN DCEG. 6960 04:12:11,160 --> 04:12:12,680 AND SO I'M GOING TO END ON THESE 6961 04:12:12,680 --> 04:12:15,720 LAST RESEARCH SUGGESTIONS. 6962 04:12:15,720 --> 04:12:17,800 FIRST IS TO COLLECT DATA ON 6963 04:12:17,800 --> 04:12:18,400 DETAILED RACE. 6964 04:12:18,400 --> 04:12:20,400 SO THAT'S ASIAN AND PACIFIC 6965 04:12:20,400 --> 04:12:21,600 ISLANDERS, AND AS WELL AS 6966 04:12:21,600 --> 04:12:23,000 ETHNICITY. 6967 04:12:23,000 --> 04:12:24,640 SO VIETNAMESE, CHINESE, 6968 04:12:24,640 --> 04:12:25,760 HAWAIIAN, SAMOAN, TO REALLY 6969 04:12:25,760 --> 04:12:27,240 ALLOW US TO HAVE MEANINGFUL 6970 04:12:27,240 --> 04:12:27,680 GROUPINGS. 6971 04:12:27,680 --> 04:12:33,560 AS I MENTIONED EARLIER -- IT 6972 04:12:33,560 --> 04:12:35,040 TAKES A REALLY, REALLY LONG TIME 6973 04:12:35,040 --> 04:12:38,000 TO BE ABLE TO HAVE DATA CATCH UP 6974 04:12:38,000 --> 04:12:39,280 TO RESEARCH. 6975 04:12:39,280 --> 04:12:41,120 SO I REALLY ENCOURAGE IF YOU ARE 6976 04:12:41,120 --> 04:12:42,120 COLLECTING DATA, TO PLEASE ALLOW 6977 04:12:42,120 --> 04:12:44,680 FOR THE COLLECTION OF DETAILED 6978 04:12:44,680 --> 04:12:44,880 RACE. 6979 04:12:44,880 --> 04:12:46,480 WHEN POSSIBLE, DO NOT ANALYZE 6980 04:12:46,480 --> 04:12:48,040 ASIAN AMERICAN AND NATIVE 6981 04:12:48,040 --> 04:12:49,040 HAWAIIAN AND PACIFIC ISLANDER 6982 04:12:49,040 --> 04:12:50,400 INDIVIDUALS TOGETHER. 6983 04:12:50,400 --> 04:12:51,600 ESPECIALLY WHEN THE 6984 04:12:51,600 --> 04:12:53,600 DISAGGREGATED DATA ARE 6985 04:12:53,600 --> 04:12:54,200 AVAILABLE. 6986 04:12:54,200 --> 04:12:55,080 NATIVE HAWAIIANS ARE A MUCH 6987 04:12:55,080 --> 04:12:56,200 SPALLER GROUP, THEY WERE THE 6988 04:12:56,200 --> 04:12:57,200 SMALLEST GROUP IN OUR SAMPLE 6989 04:12:57,200 --> 04:12:59,040 HERE, SO WHEN YOU'RE ANALYZING 6990 04:12:59,040 --> 04:13:00,560 THESE ASIAN AND PACIFIC ISLANDER 6991 04:13:00,560 --> 04:13:01,680 INDIVIDUALS TOGETHER, YOU'RE 6992 04:13:01,680 --> 04:13:02,760 REALLY JUST REPORTING THE RISK 6993 04:13:02,760 --> 04:13:05,120 OF ASIANS AND MASKING THE BURDEN 6994 04:13:05,120 --> 04:13:05,960 AMONG NATIVE HAWAIIAN AND 6995 04:13:05,960 --> 04:13:07,120 PACIFIC ISLANDER INDIVIDUALS. 6996 04:13:07,120 --> 04:13:08,280 CONSIDER USING REFERENCE GROUPS 6997 04:13:08,280 --> 04:13:10,480 OTHER THAN NON-HISPANIC WHITE AS 6998 04:13:10,480 --> 04:13:11,240 APPROPRIATE. 6999 04:13:11,240 --> 04:13:12,360 AND THEN ACTIVELY ENGAGE 7000 04:13:12,360 --> 04:13:13,160 COMMUNITY PARTNERS TO BETTER 7001 04:13:13,160 --> 04:13:14,640 UNDERSTAND THE REAL LIFE 7002 04:13:14,640 --> 04:13:16,320 EXPERIENCES AND CULTURAL AND 7003 04:13:16,320 --> 04:13:18,080 HISTORICAL CONTEXT, SPECIFICALLY 7004 04:13:18,080 --> 04:13:20,240 THE RECENT RISE OF ANTI-ASIAN 7005 04:13:20,240 --> 04:13:22,560 HIT CRIMES SINCE THE COVID-19 7006 04:13:22,560 --> 04:13:25,480 PANDEMIC AS WELL AS SE XENOPHOB. 7007 04:13:25,480 --> 04:13:27,120 I WANTED TO GIVE A BRIEF EXAMPLE 7008 04:13:27,120 --> 04:13:29,960 OF HOW I'VE DONE THIS IN TERMS 7009 04:13:29,960 --> 04:13:31,720 EVER ENGAGING COMMUNITY PARTNERS 7010 04:13:31,720 --> 04:13:33,480 I WAS REALLY INTERESTED IN 7011 04:13:33,480 --> 04:13:34,040 UNDERSTANDING ABOUT NATIVE 7012 04:13:34,040 --> 04:13:34,640 HAWAIIAN AND OTHER PACIFIC 7013 04:13:34,640 --> 04:13:36,280 ISLANDER INDIVIDUALS SO I 7014 04:13:36,280 --> 04:13:37,680 DIDN'T -- I DON'T WORK WITH 7015 04:13:37,680 --> 04:13:39,240 ANYONE WHO'S NATIVE HAWAIIAN OR 7016 04:13:39,240 --> 04:13:41,000 OTHER PACIFIC ISLANDER, AND SO I 7017 04:13:41,000 --> 04:13:42,880 SENT A TWITTER DM TO A COLLEAGUE 7018 04:13:42,880 --> 04:13:49,080 OF MINE WHOSE NAME IS COCOA, THE 7019 04:13:49,080 --> 04:13:49,720 REST IS HISTORY. 7020 04:13:49,720 --> 04:13:51,240 SO I REALLY ENCOURAGE YOU REACH 7021 04:13:51,240 --> 04:13:54,960 OUT TO PEOPLE, THEY'RE OFTEN 7022 04:13:54,960 --> 04:13:56,280 REALLY WILLING TO TEACH, EDUCATE 7023 04:13:56,280 --> 04:13:57,600 AND HELP MAKE CHANGE IN THE 7024 04:13:57,600 --> 04:14:00,000 RESEARCH COMMUNITY. 7025 04:14:00,000 --> 04:14:01,760 AND SO WITH THAT, I JUST WANT TO 7026 04:14:01,760 --> 04:14:03,280 ACKNOWLEDGE MY MENTORS, MY 7027 04:14:03,280 --> 04:14:05,680 COLLEAGUES, THE DCEG FELLOWS 7028 04:14:05,680 --> 04:14:07,320 CANCER HEALTH DISPARITIES 7029 04:14:07,320 --> 04:14:09,080 INTEREST GROUP AS WELL AS MY 7030 04:14:09,080 --> 04:14:10,840 KAESER PERMANENTE COLLABORATORS 7031 04:14:10,840 --> 04:14:11,480 AND MY MENTEES. 7032 04:14:11,480 --> 04:14:16,880 [APPLAUSE] 7033 04:14:16,880 --> 04:14:19,520 >>THANK YOU SO MUCH, DR. VO. 7034 04:14:19,520 --> 04:14:20,440 VERY INFORMATIVE PRESENTATION. 7035 04:14:20,440 --> 04:14:21,520 DO WE HAVE ANY QUESTIONS FROM 7036 04:14:21,520 --> 04:14:27,840 THE AUDIENCE HERE? 7037 04:14:27,840 --> 04:14:28,560 >>HI. 7038 04:14:28,560 --> 04:14:31,920 VERY NICE PRESENTATION. 7039 04:14:31,920 --> 04:14:33,000 SO MAYBE YOU TOUCHED UPON THIS 7040 04:14:33,000 --> 04:14:35,800 BEFORE AND MAYBE OTHER SPEAKERS 7041 04:14:35,800 --> 04:14:38,160 HAVE ALSO TALKED ABOUT THIS, BUT 7042 04:14:38,160 --> 04:14:39,680 WHEN YOU TALK ABOUT AGGRAVATE 7043 04:14:39,680 --> 04:14:41,200 GATING, WHAT HAPPENS TO THE 7044 04:14:41,200 --> 04:14:42,080 POWER FOR THE DIFFERENT GROUPS? 7045 04:14:42,080 --> 04:14:43,240 SO IF UR OOO TALKING ABOUT 7046 04:14:43,240 --> 04:14:44,440 RECRUITING PEOPLE FOR NEW 7047 04:14:44,440 --> 04:14:46,560 STUDIES, DO YOU HAVE TO TRY TO 7048 04:14:46,560 --> 04:14:48,080 RECRUIT MORE INDIVIDUALS FROM 7049 04:14:48,080 --> 04:14:49,600 THE SEPARATE AGGREGATED GROUPS, 7050 04:14:49,600 --> 04:14:51,640 HOW DO YOU GO ABOUT DEALING WITH 7051 04:14:51,640 --> 04:14:53,000 THAT? 7052 04:14:53,000 --> 04:14:54,320 >>THAT'S A REALLY GREAT 7053 04:14:54,320 --> 04:14:55,280 QUESTION AND SOMETHING THAT 7054 04:14:55,280 --> 04:14:56,200 WE'RE CONSTANTLY DEALING WITH 7055 04:14:56,200 --> 04:14:57,760 AND I THINK THAT'S WHY IT'S VERY 7056 04:14:57,760 --> 04:14:59,480 EASY FOR INDIVIDUALS OR 7057 04:14:59,480 --> 04:15:00,480 RESEARCHERS TO GROUP ASIANS AND 7058 04:15:00,480 --> 04:15:02,360 PACIFIC ISLANDERS TOGETHER 7059 04:15:02,360 --> 04:15:04,040 BECAUSE OF STATISTICAL POWER. 7060 04:15:04,040 --> 04:15:06,120 BUT I THINK ONE OF THE 7061 04:15:06,120 --> 04:15:07,400 COMMENTS -- ONE OF THE POINTS MY 7062 04:15:07,400 --> 04:15:09,200 TAKE-HOME MESSAGES WAS WHEN THE 7063 04:15:09,200 --> 04:15:10,840 DATA IS NOT AVAILABLE -- OR WHEN 7064 04:15:10,840 --> 04:15:12,720 IT'S POSSIBLE TO SEPARATE THE 7065 04:15:12,720 --> 04:15:15,120 TWO GROUPS, SO FOR EXAMPLE, IF 7066 04:15:15,120 --> 04:15:16,560 YOUR POPULATION IS LARGELY ASIAN 7067 04:15:16,560 --> 04:15:19,160 AND YOU HAVE, SAY, TWO OR THREE 7068 04:15:19,160 --> 04:15:20,560 CASES WHO ARE REPRESENTING 7069 04:15:20,560 --> 04:15:21,680 NATIVE HAWAIIAN OR PACIFIC 7070 04:15:21,680 --> 04:15:22,600 ISLANDERS, CONSIDER DROPPING 7071 04:15:22,600 --> 04:15:25,320 THOSE CASES -- SO WE'RE NOT 7072 04:15:25,320 --> 04:15:27,040 CHANGING THE MESSAGE IN THE 7073 04:15:27,040 --> 04:15:28,280 STORY LINES OF NATIVE HAWAIIAN 7074 04:15:28,280 --> 04:15:29,640 AND PACIFIC ISLANDERS JUST BY 7075 04:15:29,640 --> 04:15:30,920 LUMPING THEM TOGETHER WITH 7076 04:15:30,920 --> 04:15:31,920 ASIANS, IF THAT MAKES SENSE. 7077 04:15:31,920 --> 04:15:32,680 BUT IT'S DEFINITELY SOMETHING TO 7078 04:15:32,680 --> 04:15:33,680 CONSIDER AND WE'RE DEFINITELY 7079 04:15:33,680 --> 04:15:37,360 TRYING TO DO OUR BEST TO 7080 04:15:37,360 --> 04:15:38,240 OVERSAMPLE MORE OF 7081 04:15:38,240 --> 04:15:40,200 UNDERREPRESENTED POPULATIONS, 7082 04:15:40,200 --> 04:15:40,960 BUT YEAH, IT'S DEFINITELY GOING 7083 04:15:40,960 --> 04:15:42,000 TO BE SOMETHING TO CONSIDER, BUT 7084 04:15:42,000 --> 04:15:44,040 WE'RE REALLY LUCKY TO WORK WITH 7085 04:15:44,040 --> 04:15:45,480 KAISER HAWAII, WHICH HAS A LARGE 7086 04:15:45,480 --> 04:15:46,960 PROPORTION OF ASIAN, PACIFIC 7087 04:15:46,960 --> 04:15:50,600 ISLANDER INDIVIDUALS. 7088 04:15:50,600 --> 04:15:52,560 >>HI. 7089 04:15:52,560 --> 04:15:53,800 CAROLINE THOMPSON, UNC. 7090 04:15:53,800 --> 04:15:54,400 GREAT TALK. 7091 04:15:54,400 --> 04:15:55,880 I LOVE YOUR ENTHUSIASM AND 7092 04:15:55,880 --> 04:16:00,120 YOU'RE DOING AMAZING WORK. 7093 04:16:00,120 --> 04:16:02,440 SO THIS DISAGGREGATION THING IS 7094 04:16:02,440 --> 04:16:04,400 BEING PERPETUATED OR THE LACK OF 7095 04:16:04,400 --> 04:16:06,000 DISAGGREGATION IS BEING 7096 04:16:06,000 --> 04:16:07,160 PERPETUATED IN THE MEDICAL 7097 04:16:07,160 --> 04:16:08,160 JOURNALS. 7098 04:16:08,160 --> 04:16:09,760 I SPENT A DECENT AMOUNT OF TIME 7099 04:16:09,760 --> 04:16:11,400 WHEN I REVIEW PAPERS THAT HAVING 7100 04:16:11,400 --> 04:16:14,120 A GATED ASIAN TRYING TO PUSH 7101 04:16:14,120 --> 04:16:15,440 BACK AND PUSH BACK, ESPECIALLY 7102 04:16:15,440 --> 04:16:16,840 WHEN THE SAMPLE SIZES ARE THERE. 7103 04:16:16,840 --> 04:16:18,240 AND SO YOU KNOW, I THINK ONE 7104 04:16:18,240 --> 04:16:21,120 THING IS THAT IF YOU ARE 7105 04:16:21,120 --> 04:16:24,440 REVIEWING PAPERS, THE SAMPLE 7106 04:16:24,440 --> 04:16:25,760 SIZES ARE THERE, PUSH BACK. 7107 04:16:25,760 --> 04:16:26,080 >>YES. 7108 04:16:26,080 --> 04:16:26,480 THANK YOU. 7109 04:16:26,480 --> 04:16:28,960 >>THERE IS A PROBLEM OUT THERE 7110 04:16:28,960 --> 04:16:30,280 STILL, AND IT'S EITHER -- I 7111 04:16:30,280 --> 04:16:31,400 DON'T KNOW -- YOU KNOW, 7112 04:16:31,400 --> 04:16:33,240 SOMETIMES I SUSPECT IT'S A 7113 04:16:33,240 --> 04:16:34,680 POWER, LIKE OH, WELL, YOU KNOW, 7114 04:16:34,680 --> 04:16:36,640 IF WE DISAGGREGATE, THEN OUR 7115 04:16:36,640 --> 04:16:38,080 RESULTS WON'T LOOK AT EXCITING 7116 04:16:38,080 --> 04:16:40,120 AND WE WON'T GET INTO THIS, YOU 7117 04:16:40,120 --> 04:16:41,320 KNOW, HIGH IMPACT MEDICAL 7118 04:16:41,320 --> 04:16:42,840 JOURNAL, BUT IT'S JUST -- IT 7119 04:16:42,840 --> 04:16:44,880 KEEPS GETTING PERPETUATED, SO 7120 04:16:44,880 --> 04:16:46,280 IT'S A COMMENT BUT ALSO A 7121 04:16:46,280 --> 04:16:49,720 QUESTION, LIKE HOW CAN WE MAKE 7122 04:16:49,720 --> 04:16:51,120 THIS HAPPEN FASTER IN THESE 7123 04:16:51,120 --> 04:16:53,240 MEDICAL JOURNALS, PERHAPS THE 7124 04:16:53,240 --> 04:16:55,480 ONES THAT AREN'T NECESSARILY AS 7125 04:16:55,480 --> 04:16:56,600 TUNED IN TO THE RESEARCH THAT 7126 04:16:56,600 --> 04:16:59,000 WE'RE ALL CONDUCTING IN THIS 7127 04:16:59,000 --> 04:16:59,200 ROOM. 7128 04:16:59,200 --> 04:17:01,000 >>I THINK IT'S A REALLY GREAT 7129 04:17:01,000 --> 04:17:01,280 POINT. 7130 04:17:01,280 --> 04:17:03,920 I THINK YOU'VE SET A REALLY 7131 04:17:03,920 --> 04:17:04,800 ALMOST SIMPLE EXAMPLE THAT 7132 04:17:04,800 --> 04:17:05,240 EVERYONE CAN DO. 7133 04:17:05,240 --> 04:17:06,720 WE'RE ALL REVIEWING ARTICLES AND 7134 04:17:06,720 --> 04:17:08,320 IF YOU ARE SEEING A POPULATION 7135 04:17:08,320 --> 04:17:09,320 OF ASIAN AND PACIFIC ISLANDERS 7136 04:17:09,320 --> 04:17:10,800 THAT ARE GROUPED TOGETHER, PUSH 7137 04:17:10,800 --> 04:17:11,560 BACK. 7138 04:17:11,560 --> 04:17:12,760 ASK WHY NOT. 7139 04:17:12,760 --> 04:17:13,680 IT'S POSSIBLE. 7140 04:17:13,680 --> 04:17:15,760 >>AND CAN I ASK A FOLLOW-UP? 7141 04:17:15,760 --> 04:17:16,200 >>YEAH, ABSOLUTELY. 7142 04:17:16,200 --> 04:17:18,120 >>SO JUST CURIOUS, LIKE IT 7143 04:17:18,120 --> 04:17:19,560 FEELS LIKE THERE'S -- SO WE GO 7144 04:17:19,560 --> 04:17:21,960 FROM LIKE AGGREGATED -- ALL THE 7145 04:17:21,960 --> 04:17:25,320 WAY DOWN TO LIKE SIX OR MORE 7146 04:17:25,320 --> 04:17:26,840 GROUPS, SEVEN, PLUS NHPI. 7147 04:17:26,840 --> 04:17:27,840 DO YOU THINK THAT THIS -- I 7148 04:17:27,840 --> 04:17:30,880 HADN'T REALLY SEEN MUCH OF THIS 7149 04:17:30,880 --> 04:17:32,280 ETHNOGEOGRAPHIC, IS THIS A GOOD 7150 04:17:32,280 --> 04:17:32,960 MIDDLE GROUND? 7151 04:17:32,960 --> 04:17:34,160 AS A REVIEWER, COULD I SAY 7152 04:17:34,160 --> 04:17:36,040 CONSIDER DOING THIS? 7153 04:17:36,040 --> 04:17:37,360 >>IT'S SOMETHING THAT I'M 7154 04:17:37,360 --> 04:17:39,320 DEFINITELY STRUGGLING WITH, 7155 04:17:39,320 --> 04:17:40,160 BECAUSE FIRST AND FOREMOST, 7156 04:17:40,160 --> 04:17:40,880 ASIANS AND PACIFIC ISLANDERS 7157 04:17:40,880 --> 04:17:42,040 NEED TO BE SEPARATED. 7158 04:17:42,040 --> 04:17:43,960 THAT'S LIKE BATTLE NUMBER ONE, 7159 04:17:43,960 --> 04:17:45,200 MAJOR ISSUE THAT'S STILL 7160 04:17:45,200 --> 04:17:46,600 ONGOING, LIKE YOU SAID, IN 7161 04:17:46,600 --> 04:17:48,160 CLINICAL JOURNALS. 7162 04:17:48,160 --> 04:17:52,280 BUT YES, I DO THINK -- 7163 04:17:52,280 --> 04:17:54,400 PERSONALLY, I'M VIETNAMESE 7164 04:17:54,400 --> 04:17:54,800 AMERICAN. 7165 04:17:54,800 --> 04:17:55,960 NEITHER OF MY PARENTS WENT TO 7166 04:17:55,960 --> 04:17:57,720 HIGH SCHOOL SO I'M A FIRST 7167 04:17:57,720 --> 04:17:58,640 GENERATION HIGH SCHOOL, COLLEGE 7168 04:17:58,640 --> 04:18:00,840 AND DOCTORAL DEGREE STUDENT, AND 7169 04:18:00,840 --> 04:18:02,680 THAT'S SOMETHING THAT'S ALWAYS 7170 04:18:02,680 --> 04:18:03,880 PUSHED BACK ON ME. 7171 04:18:03,880 --> 04:18:04,760 THE THINGS I'VE EXPERIENCED 7172 04:18:04,760 --> 04:18:06,160 GROWING UP IN TERMS OF HEARING 7173 04:18:06,160 --> 04:18:07,480 WELL, YOU'RE ASIAN, YOU MUST BE 7174 04:18:07,480 --> 04:18:08,800 SMART, LIKE, THAT'S JUST -- YOU 7175 04:18:08,800 --> 04:18:10,280 KNOW, BECAUSE ALL ASIANS ARE 7176 04:18:10,280 --> 04:18:10,720 SMART. 7177 04:18:10,720 --> 04:18:12,360 I WAS LIKE, WHO AROUND ME IS 7178 04:18:12,360 --> 04:18:12,800 SMART? 7179 04:18:12,800 --> 04:18:14,360 WHERE IS THIS COMING FROM? 7180 04:18:14,360 --> 04:18:16,520 SO I ALWAYS WANT -- LIKE THAT IS 7181 04:18:16,520 --> 04:18:19,600 THE GOAL, RIGHT, IS TO BE ABLE 7182 04:18:19,600 --> 04:18:21,360 TO SEPARATE, BUT IN A VERY 7183 04:18:21,360 --> 04:18:21,920 MEANINGFUL WAY. 7184 04:18:21,920 --> 04:18:24,320 SO I THINK AS I REALLY LIKE THE 7185 04:18:24,320 --> 04:18:26,240 IDEA OF THE ETHNOGEOGRAPHIC 7186 04:18:26,240 --> 04:18:27,040 REGIONS, BECAUSE A LOT OF THE 7187 04:18:27,040 --> 04:18:29,080 INDIVIDUALS FROM SOUTHEAST ASIA 7188 04:18:29,080 --> 04:18:30,840 ARE IMMIGRATING TO THE U.S. IN 7189 04:18:30,840 --> 04:18:32,200 REALLY SIMILAR PATTERNS, WHICH 7190 04:18:32,200 --> 04:18:33,400 INFLUENCES WHEN THEY COME. 7191 04:18:33,400 --> 04:18:36,200 LIKE THERE'S A REASON WHY 7192 04:18:36,200 --> 04:18:37,760 INDIAN -- ASIAN INDIANS IN THE 7193 04:18:37,760 --> 04:18:39,640 U.S. HAVE A HIGHER EDUCATIONAL 7194 04:18:39,640 --> 04:18:40,280 ATTAINMENT. 7195 04:18:40,280 --> 04:18:42,760 THEY'RE COMING OVER AS COLLEGE 7196 04:18:42,760 --> 04:18:43,200 STUDENTS. 7197 04:18:43,200 --> 04:18:44,920 IT'S VERY DIFFERENT THAN MY 7198 04:18:44,920 --> 04:18:47,000 PARENTS WHO EMIGRATED FROM WAR 7199 04:18:47,000 --> 04:18:48,480 TORN VIETNAM AS REFUGEES IN THE 7200 04:18:48,480 --> 04:18:49,720 80s. 7201 04:18:49,720 --> 04:18:52,200 SO THOSE THINGS INFLUENCE HOW I 7202 04:18:52,200 --> 04:18:54,800 WAS RAISED, HOW I'M GOING TO, 7203 04:18:54,800 --> 04:18:56,560 YOU KNOW, ATTAIN COLLEGE ONE 7204 04:18:56,560 --> 04:18:57,960 DAY, LIKE ALL OF THAT INFLUENCED 7205 04:18:57,960 --> 04:18:59,840 MY PERSONAL HISTORY AND MY 7206 04:18:59,840 --> 04:19:02,360 FAMILY, AND SO YES, I DO, 7207 04:19:02,360 --> 04:19:03,840 LIKE -- ETHNOGEOGRAPHIC REGIONS 7208 04:19:03,840 --> 04:19:05,200 ARE A REALLY GREAT WAY TO BE 7209 04:19:05,200 --> 04:19:07,040 ABLE, BUT THERE'S STILL NUANCES 7210 04:19:07,040 --> 04:19:07,800 WITHIN EACH REGION AS WELL. 7211 04:19:07,800 --> 04:19:09,080 ONE OF THE PAPERS I MENTIONED 7212 04:19:09,080 --> 04:19:10,680 EARLIER FOR CERVICAL CANCER 7213 04:19:10,680 --> 04:19:11,880 INCIDENCE RATES, THE HIGHEST 7214 04:19:11,880 --> 04:19:13,120 RISK THAT WE OBSERVED FOR 7215 04:19:13,120 --> 04:19:15,560 CERVICAL CANCER WAS AMONG 7216 04:19:15,560 --> 04:19:16,720 VIETNAMESE AND LAOTIAN WOMEN, 7217 04:19:16,720 --> 04:19:18,200 WHICH ARE PART OF SOUTHEAST 7218 04:19:18,200 --> 04:19:20,520 ASIA, BUT WE ACTUALLY OBSERVED 7219 04:19:20,520 --> 04:19:22,320 LOWER RISK FOR FILIPINO 7220 04:19:22,320 --> 04:19:23,280 INDIVIDUALS, ALSO CONSIDERED 7221 04:19:23,280 --> 04:19:24,400 SOUTHEAST ASIA. 7222 04:19:24,400 --> 04:19:26,160 SO THERE'S DEFINITELY CHALLENGES 7223 04:19:26,160 --> 04:19:28,760 BOTH WAYS, BUT YES, I DO 7224 04:19:28,760 --> 04:19:30,080 ENCOURAGE TRYING TO FIGURE IT 7225 04:19:30,080 --> 04:19:32,440 OUT, BUT I'M HOPING TO CONTINUE 7226 04:19:32,440 --> 04:19:34,440 TO GROW THIS AREA IN MY RESEARCH 7227 04:19:34,440 --> 04:19:34,960 CAREER. 7228 04:19:34,960 --> 04:19:38,280 SO THANK YOU SO MUCH. 7229 04:19:38,280 --> 04:19:39,640 >>THANK YOU FOR THE 7230 04:19:39,640 --> 04:19:40,440 PRESENTATION. 7231 04:19:40,440 --> 04:19:43,640 MY NAME IS LORENA FROM 7232 04:19:43,640 --> 04:19:44,680 CEDARS-SINAI CANCER. 7233 04:19:44,680 --> 04:19:45,680 ACTUALLY MY COMMENT IS RELATED 7234 04:19:45,680 --> 04:19:46,800 TO LIVED EXPERIENCE THAT YOU 7235 04:19:46,800 --> 04:19:48,280 JUST SHARED. 7236 04:19:48,280 --> 04:19:50,080 AND I WOULD ACTUALLY ENCOURAGE 7237 04:19:50,080 --> 04:19:52,400 FOR YOU TO ADD THAT TO THE LIST 7238 04:19:52,400 --> 04:19:54,200 OF RESEARCH SUGGESTIONS 7239 04:19:54,200 --> 04:19:56,200 BECAUSE -- SO THANK YOU FOR 7240 04:19:56,200 --> 04:19:57,760 PRESENTING DISAGGREGATED DATA ON 7241 04:19:57,760 --> 04:19:58,440 THE SOCIODEMOGRAPHICS IN THE 7242 04:19:58,440 --> 04:19:59,680 START OF YOUR PRESENTATION, BUT 7243 04:19:59,680 --> 04:20:03,080 I WOULD ALSO CAUTION USING THESE 7244 04:20:03,080 --> 04:20:05,480 GENERIC TRADITIONAL MEASURES OF 7245 04:20:05,480 --> 04:20:07,120 SES AS WE JUST SAID, RIGHT? 7246 04:20:07,120 --> 04:20:08,400 SO FOR EXAMPLE, SOME GROUPS -- 7247 04:20:08,400 --> 04:20:09,760 LIKE YOU'RE SAYING, SOME GROUPS 7248 04:20:09,760 --> 04:20:11,800 MAY HAVE HIGH EDUCATION BUT 7249 04:20:11,800 --> 04:20:13,680 WE'RE NOT CAPTURING OR 7250 04:20:13,680 --> 04:20:15,360 COLLECTING REPORTING DATA THAT 7251 04:20:15,360 --> 04:20:18,200 THEIR DEGREES WERE PROBABLY 7252 04:20:18,200 --> 04:20:21,880 RECEIVED OVERSEAS, AND -- SOME 7253 04:20:21,880 --> 04:20:23,080 MAY HAVE HIGH INCOME. 7254 04:20:23,080 --> 04:20:24,240 IT LOOKS GOOD. 7255 04:20:24,240 --> 04:20:26,040 AND THEY'RE SUPPORTING 7256 04:20:26,040 --> 04:20:28,200 MULTIGENERATIONAL HOUSEHOLDS, 7257 04:20:28,200 --> 04:20:30,720 AND LOTS OF IMMIGRANTS, AND ALSO 7258 04:20:30,720 --> 04:20:32,600 SUPPORTING OTHER FAMILY MEMBERS 7259 04:20:32,600 --> 04:20:32,960 OVERSEAS. 7260 04:20:32,960 --> 04:20:35,920 SO IT'S JUST -- ENCOURAGE TO 7261 04:20:35,920 --> 04:20:40,040 YOU -- LIKE ALSO THE RESEARCH 7262 04:20:40,040 --> 04:20:42,000 SUGGESTIONS, ADD THOSE NUANCES 7263 04:20:42,000 --> 04:20:43,080 THERE, YOU SEEM TO BE VERY AWARE 7264 04:20:43,080 --> 04:20:44,160 OF THEM, BUT ALSO THERE'S 7265 04:20:44,160 --> 04:20:45,640 MOVEMENT WITH THE DATA 7266 04:20:45,640 --> 04:20:48,560 DISAGGREGATION AND PART OF THE 7267 04:20:48,560 --> 04:20:50,640 ASIAN AMERICAN NHPI DATA 7268 04:20:50,640 --> 04:20:51,600 DISAGGREGATION WORK GROUP IN 7269 04:20:51,600 --> 04:20:53,840 L.A. COUNTY, AND WE ARE PART OF 7270 04:20:53,840 --> 04:20:57,280 THE LISTENING SESSIONS, OMB IS 7271 04:20:57,280 --> 04:20:59,520 HOLDING LISTENING SESSIONS 7272 04:20:59,520 --> 04:21:03,520 BECAUSE THERE'S A PUSH TO UPDATE 7273 04:21:03,520 --> 04:21:05,960 THE MINIMUM STANDARDS FOR DATA 7274 04:21:05,960 --> 04:21:07,480 REPORTING ON RACE/ETHNICITY, SO 7275 04:21:07,480 --> 04:21:09,760 THERE'S MOVEMENT GOING ON. 7276 04:21:09,760 --> 04:21:11,560 SO I ENCOURAGE EVERYONE TO 7277 04:21:11,560 --> 04:21:13,280 GOOGLE IT, TO SUPPORT IT, TO 7278 04:21:13,280 --> 04:21:14,200 JOIN THE LISTENING SESSIONS IF 7279 04:21:14,200 --> 04:21:14,760 THEY CAN. 7280 04:21:14,760 --> 04:21:17,240 >>THANK YOU. 7281 04:21:17,240 --> 04:21:18,760 >>THANK YOU, DR. VO. 7282 04:21:18,760 --> 04:21:22,920 [APPLAUSE] 7283 04:21:22,920 --> 04:21:25,880 JUST TO CONCLUDE THIS SESSION, I 7284 04:21:25,880 --> 04:21:32,560 THINK THAT TO YOUR POINT, THE 7285 04:21:32,560 --> 04:21:33,440 STATISTICAL METHODS TO BE USED 7286 04:21:33,440 --> 04:21:34,920 TO STUDY DISPARITIES, THERE ARE 7287 04:21:34,920 --> 04:21:35,760 SOME THAT ARE AVAILABLE, SOME 7288 04:21:35,760 --> 04:21:36,920 THAT NEED TO BE DEVELOPED. 7289 04:21:36,920 --> 04:21:38,360 THE SECOND POINT, HOW TO CREATE 7290 04:21:38,360 --> 04:21:39,800 NEW RESOURCES. 7291 04:21:39,800 --> 04:21:41,560 WE HOPE THAT DCEG IN 7292 04:21:41,560 --> 04:21:42,440 COLLABORATION WITH OTHER 7293 04:21:42,440 --> 04:21:46,240 DIVISIONS AT NCI COULD REALLY 7294 04:21:46,240 --> 04:21:47,680 MATERIALIZE THE CREATION OF 7295 04:21:47,680 --> 04:21:49,960 THESE LARGE COHORT WITH THE 7296 04:21:49,960 --> 04:21:51,720 NATIONAL SURVEYS AND 7297 04:21:51,720 --> 04:21:54,080 DR. LAWRENCE AND DR. VO BROUGHT 7298 04:21:54,080 --> 04:21:57,360 ATTENTION TO DISAGGREGATION OF 7299 04:21:57,360 --> 04:21:57,560 DATA. 7300 04:21:57,560 --> 04:21:59,480 DR. LAWRENCE CLEARLY SHOWED THE 7301 04:21:59,480 --> 04:22:01,760 DISPARITIES ACROSS GEOGRAPHY IN 7302 04:22:01,760 --> 04:22:04,920 THE U.S. AND ABOUT 7303 04:22:04,920 --> 04:22:06,680 RACE/ETHNICITY, ALSO ABOUT -- 7304 04:22:06,680 --> 04:22:07,320 ONE MISSING VARIABLE ALSO WE 7305 04:22:07,320 --> 04:22:07,880 NEED TO CONSIDER. 7306 04:22:07,880 --> 04:22:08,960 THANK YOU SO MUCH FOR YOUR 7307 04:22:08,960 --> 04:22:09,320 PARTICIPATION. 7308 04:22:09,320 --> 04:22:11,160 WE ARE GOING TO TRANSITION TO 7309 04:22:11,160 --> 04:22:13,280 SESSION NUMBER 14, DR. AMBS. 7310 04:22:13,280 --> 04:22:14,440 THANK YOU. 7311 04:22:14,440 --> 04:22:16,560 >>THANK YOU SO MUCH, CONSTANZA. 7312 04:22:16,560 --> 04:22:17,840 THANK YOU SO MUCH TO THE 7313 04:22:17,840 --> 04:22:20,280 SPEAKERS FOR THESE EXCITING 7314 04:22:20,280 --> 04:22:20,600 TALKS. 7315 04:22:20,600 --> 04:22:22,480 WE WILL CONTINUE TO DO SO. 7316 04:22:22,480 --> 04:22:25,040 SO WE WILL NOW START THE NEXT 7317 04:22:25,040 --> 04:22:26,440 SESSION, SESSION 14, WHICH WILL 7318 04:22:26,440 --> 04:22:29,160 HIGHLIGHT THE USE OF 7319 04:22:29,160 --> 04:22:30,880 TELEMEDICINE IN IMPROVING CANCER 7320 04:22:30,880 --> 04:22:32,880 CARE DELIVERY TO AMERICANS WHO 7321 04:22:32,880 --> 04:22:35,040 HAVE LIMITED ACCESS TO CANCER 7322 04:22:35,040 --> 04:22:37,040 CARE DELIVERY. 7323 04:22:37,040 --> 04:22:38,000 BECAUSE THEY LIVE IN RURAL AREAS 7324 04:22:38,000 --> 04:22:40,120 OR IN OTHERWISE UNDERSERVED 7325 04:22:40,120 --> 04:22:41,320 AREAS AFFECTING MINORITY 7326 04:22:41,320 --> 04:22:42,480 POPULATIONS. 7327 04:22:42,480 --> 04:22:44,120 WE HAVE TWO SPEAKERS. 7328 04:22:44,120 --> 04:22:45,280 THE FIRST SPEAKER WILL BE 7329 04:22:45,280 --> 04:22:46,200 DR. DEBRA FRIEDMAN. 7330 04:22:46,200 --> 04:22:50,360 SHE'S THE CHAIR OF PEDIATRIC 7331 04:22:50,360 --> 04:22:52,320 ONCOLOGY, ALSO HEADING THE 7332 04:22:52,320 --> 04:22:53,320 CANCER CONTROL PREVENTION 7333 04:22:53,320 --> 04:22:55,520 CONTROL PROGRAM AND DIRECTS A 7334 04:22:55,520 --> 04:22:58,200 CANCER SURVIVOR PROGRAM, AND SHE 7335 04:22:58,200 --> 04:23:01,760 HAS DEVELOPED AN INTEREST IN 7336 04:23:01,760 --> 04:23:02,680 TELEHEALTH TO REACH RURAL 7337 04:23:02,680 --> 04:23:04,040 COMMUNITIES IN NEED OF 7338 04:23:04,040 --> 04:23:05,800 COMPREHENSIVE CANCER CARE. 7339 04:23:05,800 --> 04:23:06,480 DR. FRIEDMAN, THANK YOU SO MUCH 7340 04:23:06,480 --> 04:23:07,320 FOR BEING HERE TODAY. 7341 04:23:07,320 --> 04:23:12,400 [APPLAUSE] 7342 04:23:12,400 --> 04:23:12,920 >>THANK YOU. 7343 04:23:12,920 --> 04:23:15,960 THANKS. 7344 04:23:15,960 --> 04:23:18,400 I'D LIKE TO THANK THE NCI FOR 7345 04:23:18,400 --> 04:23:19,960 THE OPPORTUNITY TO SPEAK AT THIS 7346 04:23:19,960 --> 04:23:23,640 REALLY WHAT HAS BEEN AN AMAZING 7347 04:23:23,640 --> 04:23:24,600 SYMPOSIUM. 7348 04:23:24,600 --> 04:23:26,920 SO I'M GOING TO TALK A LITTLE 7349 04:23:26,920 --> 04:23:29,440 BIT ABOUT TELEHEALTH IN AREAS OF 7350 04:23:29,440 --> 04:23:31,320 A LITTLE BIT ON CLINICAL 7351 04:23:31,320 --> 04:23:34,040 MEDICINE BUT MOSTLY IN AREAS OF 7352 04:23:34,040 --> 04:23:36,080 CANCER CONTROL AND PREVENTION, 7353 04:23:36,080 --> 04:23:37,760 AND I'M GOING TO FOCUS ON RURAL 7354 04:23:37,760 --> 04:23:42,520 AREAS, RURAL POPULATIONS. 7355 04:23:42,520 --> 04:23:45,720 SEW AS PEOPLE KNOW, 20% OF 7356 04:23:45,720 --> 04:23:47,560 AMERICANS ARE RURAL AREAS, AREAS 7357 04:23:47,560 --> 04:23:49,840 THAT HAVE HIGHER RATES OF CANCER 7358 04:23:49,840 --> 04:23:51,400 RELATED BEHAVIOR SUCH AS 7359 04:23:51,400 --> 04:23:53,480 SMOKING, OBESITY, SEDENTARY 7360 04:23:53,480 --> 04:23:55,440 BEHAVIOR, AND CHRONIC DISEASE. 7361 04:23:55,440 --> 04:23:58,080 THEREFORE CANCER INCIDENCE 7362 04:23:58,080 --> 04:23:59,200 ENDURE MORTALITIES HIGHER IN 7363 04:23:59,200 --> 04:24:00,600 THESE AREAS. 7364 04:24:00,600 --> 04:24:02,320 THESE AREAS ALSO HAVE HIGHER 7365 04:24:02,320 --> 04:24:08,200 RATES OF POVERTY, AND AS YOU CAN 7366 04:24:08,200 --> 04:24:13,960 SEON THE MAP, THE DARK MAROON 7367 04:24:13,960 --> 04:24:16,120 AREAS ARE THE RURAL AREAS AND 7368 04:24:16,120 --> 04:24:20,160 THOSE ARE AREAS, COUNTIES OF 7369 04:24:20,160 --> 04:24:21,320 PERSISTENT PROPERTY THAT WERE 7370 04:24:21,320 --> 04:24:23,920 TALKED ABOUT YESTERDAY IN THE 7371 04:24:23,920 --> 04:24:25,000 PRESENTATION, HOW IMPORTANT IT 7372 04:24:25,000 --> 04:24:25,160 IS. 7373 04:24:25,160 --> 04:24:29,160 SO THERE'S A REAL OVERLAP 7374 04:24:29,160 --> 04:24:31,120 BETWEEN RURALITY AND POVERTY. 7375 04:24:31,120 --> 04:24:33,040 THIS CREATES CHALLENGES FOR 7376 04:24:33,040 --> 04:24:34,080 CANCER TREATMENT, SUPPORTIVE 7377 04:24:34,080 --> 04:24:36,800 CARE AND TRANSPORTATION AND 7378 04:24:36,800 --> 04:24:37,920 FINANCES THAT ARE NEEDED FOR 7379 04:24:37,920 --> 04:24:38,880 BOTH OF THESE. 7380 04:24:38,880 --> 04:24:39,800 AND PROVIDERS IN THESE AREAS 7381 04:24:39,800 --> 04:24:41,080 HAVE LIMITED ACCESS TO 7382 04:24:41,080 --> 04:24:44,480 COMPREHENSIVE CARE. 7383 04:24:44,480 --> 04:24:46,920 SO THE CANCER CENTER SITS RIGHT 7384 04:24:46,920 --> 04:24:49,280 IN THE MIDDLE OF THE STATE OF 7385 04:24:49,280 --> 04:24:49,960 TENNESSEE. 7386 04:24:49,960 --> 04:24:51,920 AS YOU CAN SEE BY THE LIGHTER 7387 04:24:51,920 --> 04:24:55,120 BLUE SHADING ON THE MAP, THE 7388 04:24:55,120 --> 04:24:58,920 COUNTIES SURROUNDING VANDERBILT 7389 04:24:58,920 --> 04:25:00,120 INGRAM ARE URBAN COUNTIES, BUT 7390 04:25:00,120 --> 04:25:01,440 AS YOU CAN SEE BY THE DARKER 7391 04:25:01,440 --> 04:25:05,720 TEAL SHADING, 71 OF OUR TOTAL 7392 04:25:05,720 --> 04:25:07,800 123 COUNTIES IN OUR CATCHMENT 7393 04:25:07,800 --> 04:25:09,760 AREA ARE RURAL COUNTIES. 7394 04:25:09,760 --> 04:25:13,040 THESE COUNTIES ARE DIFFERENT 7395 04:25:13,040 --> 04:25:14,680 DEMOGRAPHICALLY THAN THE URBAN 7396 04:25:14,680 --> 04:25:15,600 COUNTIES, AND ALSO DIFFERENT 7397 04:25:15,600 --> 04:25:19,400 FROM THE UNITED STATES. 7398 04:25:19,400 --> 04:25:20,960 THEY ARE MUCH MORE WHITE, HAVE 7399 04:25:20,960 --> 04:25:23,240 VERY LOW HISPANIC OR LATINO 7400 04:25:23,240 --> 04:25:25,280 POPULATIONS, AND ALSO FAIRLY LOW 7401 04:25:25,280 --> 04:25:29,480 BLACK POPULATIONS. 7402 04:25:29,480 --> 04:25:31,480 SO I'M GOING TO FIRST ADDRESS A 7403 04:25:31,480 --> 04:25:32,920 LITTLE BIT ABOUT WHAT'S BEEN 7404 04:25:32,920 --> 04:25:35,960 GOING ON THERE FOR CLINICAL 7405 04:25:35,960 --> 04:25:37,720 SERVICES. 7406 04:25:37,720 --> 04:25:39,880 SO WHEN PANDEMIC HIT IN MARCH OF 7407 04:25:39,880 --> 04:25:41,280 2020, LIKE CENTERS ALL ACROSS 7408 04:25:41,280 --> 04:25:43,040 THE COUNTRY, TELEHEALTH TOOK 7409 04:25:43,040 --> 04:25:45,120 OFF, AND WE REALLY TRIED TO SEE 7410 04:25:45,120 --> 04:25:50,480 HOW CAN WE PROVIDE CANCER CARE 7411 04:25:50,480 --> 04:25:51,160 VIA TELEHEALTH. 7412 04:25:51,160 --> 04:25:52,880 WE STILL HAVEN'T FIGURED OUT HOW 7413 04:25:52,880 --> 04:25:54,640 TO DELIVER CHEMOTHERAPY OR 7414 04:25:54,640 --> 04:25:55,120 RADIOTHERAPY THROUGH THE 7415 04:25:55,120 --> 04:25:57,280 COMPUTER, BUT IF ANYBODY HAS A 7416 04:25:57,280 --> 04:25:58,480 SOLUTION, LET US KNOW. 7417 04:25:58,480 --> 04:26:01,200 BUT WE REALLY TRY TO FIND WAYS 7418 04:26:01,200 --> 04:26:03,120 TO BRING PATIENTS TO THE CENTER 7419 04:26:03,120 --> 04:26:04,400 VIRTUALLY. 7420 04:26:04,400 --> 04:26:08,440 SO BETWEEN 2020 AND 2023, WE'VE 7421 04:26:08,440 --> 04:26:11,600 HAD ALMOST 37,500 TELEHEALTH 7422 04:26:11,600 --> 04:26:11,920 VISITS. 7423 04:26:11,920 --> 04:26:15,000 AS YOU CAN SEE THE SHADING IN 7424 04:26:15,000 --> 04:26:19,840 THE -- THE LIGHT SHADING, 78% OF 7425 04:26:19,840 --> 04:26:21,760 THOSE VISITS WERE AMONG 7426 04:26:21,760 --> 04:26:22,640 NON-RURAL PATIENTS, SO PATIENTS 7427 04:26:22,640 --> 04:26:25,000 WHO LIVED IN THOSE RING COUNTIES 7428 04:26:25,000 --> 04:26:26,720 RIGHT AROUND OUR CANCER CENTER, 7429 04:26:26,720 --> 04:26:28,880 AS OPPOSED TO ONLY 22% WHO LIVED 7430 04:26:28,880 --> 04:26:31,000 IN RURAL COUNTIES FURTHER AWAY 7431 04:26:31,000 --> 04:26:33,920 FROM THE CANCER CENTER, AND YOU 7432 04:26:33,920 --> 04:26:35,520 MIGHT ARGUE HAD MORE NEED FOR 7433 04:26:35,520 --> 04:26:37,400 TELEHEALTH. 7434 04:26:37,400 --> 04:26:39,400 WITH RESPECT TO RACE AND 7435 04:26:39,400 --> 04:26:43,640 ETHNICITY, AGAIN, YOU KNOW, 74% 7436 04:26:43,640 --> 04:26:48,560 OF THE PATIENTS WRITE WHO 7437 04:26:48,560 --> 04:26:54,600 REWHITE WHORECEIVE TELEHEALTH AO 7438 04:26:54,600 --> 04:26:55,240 17% BLACK. 7439 04:26:55,240 --> 04:26:56,480 THESE HAVE TO BE TAKEN WITH A 7440 04:26:56,480 --> 04:26:58,000 LITTLE BIT OF A GRAIN OF SALT 7441 04:26:58,000 --> 04:26:59,320 BECAUSE OF THE DEMOGRAPHICS OF 7442 04:26:59,320 --> 04:27:00,880 OUR CATCHMENT AREA AND THESE 7443 04:27:00,880 --> 04:27:01,720 SOMEWHAT MATCH THE DEMOGRAPHICS 7444 04:27:01,720 --> 04:27:06,320 OF THE ENTIRE CATCHMENT AREA. 7445 04:27:06,320 --> 04:27:07,680 SO A FEW YEARS AGO WITH A 7446 04:27:07,680 --> 04:27:08,880 SUPPLEMENT TO OUR CANCER CENTER 7447 04:27:08,880 --> 04:27:11,560 GRANT, WE CONDUCTED A TELEHEALTH 7448 04:27:11,560 --> 04:27:12,800 SERVICES INTEREST SURVEY. 7449 04:27:12,800 --> 04:27:16,320 AND WE TOOK THIS OUT VIA OUR 7450 04:27:16,320 --> 04:27:17,680 COMMUNITY OUTREACH AND 7451 04:27:17,680 --> 04:27:19,400 ENGAGEMENT OFFICE TO HEALTH 7452 04:27:19,400 --> 04:27:21,720 COUNCILS ACROSS THE STATE. 7453 04:27:21,720 --> 04:27:25,120 AND WE OVERSAMPLED RURAL 7454 04:27:25,120 --> 04:27:26,440 COMMUNITIES IN ADDITION TO 7455 04:27:26,440 --> 04:27:27,040 SAMPLING URBAN COMMUNITIES, AND 7456 04:27:27,040 --> 04:27:30,120 WE ASKED THEM TO RATE THEIR 7457 04:27:30,120 --> 04:27:33,760 INTEREST IN RECEIVING TELEHEALTH 7458 04:27:33,760 --> 04:27:34,120 SERVICES. 7459 04:27:34,120 --> 04:27:35,400 AS YOU CAN SEE, THE BLUE BARS 7460 04:27:35,400 --> 04:27:37,720 ARE RURAL, THE RED BARS ARE 7461 04:27:37,720 --> 04:27:40,320 URBAN, AND ACROSS THE BOARD, IT 7462 04:27:40,320 --> 04:27:43,520 WAS FAIRLY SIMILAR IN TERMS OF 7463 04:27:43,520 --> 04:27:45,320 INTEREST BY RURAL AND URBAN 7464 04:27:45,320 --> 04:27:47,720 COUNTIES FOR TELEHEALTH, RANGING 7465 04:27:47,720 --> 04:27:48,960 ANYWHERE, YOU KNOW, KIND OF FROM 7466 04:27:48,960 --> 04:27:51,200 A LITTLE BIT MORE THAN 30% TO A 7467 04:27:51,200 --> 04:27:53,480 LITTLE BIT MORE THAN 70%, 7468 04:27:53,480 --> 04:27:54,400 EXPRESSING INTEREST. 7469 04:27:54,400 --> 04:27:57,360 AND IF ANYTHING, THE RURAL 7470 04:27:57,360 --> 04:27:59,320 COMMUNITIES IN MOST AREAS 7471 04:27:59,320 --> 04:28:01,240 EXPRESSED HIGHER INTEREST THAN 7472 04:28:01,240 --> 04:28:02,240 THE URBAN COMMUNITIES IN 7473 04:28:02,240 --> 04:28:02,920 TELEHEALTH. 7474 04:28:02,920 --> 04:28:06,000 BUT REMEMBER WHAT I JUST SHOWED 7475 04:28:06,000 --> 04:28:07,760 YOU, WHEN WE DELIVERED 7476 04:28:07,760 --> 04:28:09,480 TELEHEALTH FOR CLINICAL 7477 04:28:09,480 --> 04:28:11,920 SERVICES, 78% OF THOSE WERE FROM 7478 04:28:11,920 --> 04:28:17,840 URBAN AREAS, NOT RURAL AREAS. 7479 04:28:17,840 --> 04:28:18,960 HOWEVER, WE THOUGHT, OKAY, 7480 04:28:18,960 --> 04:28:20,040 PEOPLE ARE SHOWING INTEREST, 7481 04:28:20,040 --> 04:28:21,240 WHERE CAN WE GO FROM HERE? 7482 04:28:21,240 --> 04:28:23,120 SO THE FIRST THING WE DID WAS WE 7483 04:28:23,120 --> 04:28:24,840 CONDUCTED A VERY SMALL PILOT 7484 04:28:24,840 --> 04:28:26,800 TRYING TO SEE IF WE COULD BRING 7485 04:28:26,800 --> 04:28:29,400 CANCER SURVIVORSHIP SERVICES TO 7486 04:28:29,400 --> 04:28:31,600 RURAL COMMUNITIES. 7487 04:28:31,600 --> 04:28:34,600 SO WE PARTNERED WITH ONE OF OUR 7488 04:28:34,600 --> 04:28:37,320 FACILITIES IN OUR VANDERBILT 7489 04:28:37,320 --> 04:28:38,200 HEALTH AFFILIATED NETWORK. 7490 04:28:38,200 --> 04:28:39,480 SO THIS IS THE NETWORK THAT GOES 7491 04:28:39,480 --> 04:28:40,960 ACROSS OUR ENTIRE STATE INTO 7492 04:28:40,960 --> 04:28:44,040 PORTS OF ALABAMA AND KENTUCKY. 7493 04:28:44,040 --> 04:28:45,920 THETHESE ARE NOT VANDERBILT 7494 04:28:45,920 --> 04:28:46,720 FACILITIES. 7495 04:28:46,720 --> 04:28:47,680 THESE ARE AFFILIATED NETWORKS. 7496 04:28:47,680 --> 04:28:49,040 SO THESE ARE INDEPENDENT 7497 04:28:49,040 --> 04:28:50,320 HOSPITALS THAT JUST HAVE AN 7498 04:28:50,320 --> 04:28:51,640 AFFILIATION WITH VANDERBILT. 7499 04:28:51,640 --> 04:28:55,160 AND WE CHOSE ONE IN WESTERN 7500 04:28:55,160 --> 04:28:58,280 TENNESSEE THAT HAS A HIGH RURAL 7501 04:28:58,280 --> 04:28:59,480 POPULATION, LARGELY FROM AREAS 7502 04:28:59,480 --> 04:29:01,040 OF WESTERN TENNESSEE BUT ALSO 7503 04:29:01,040 --> 04:29:05,200 FROM AREAS OF ARKANSAS AND 7504 04:29:05,200 --> 04:29:07,960 MISSISSIPPI THAT BORDER WESTERN 7505 04:29:07,960 --> 04:29:08,240 TENNESSEE. 7506 04:29:08,240 --> 04:29:09,600 WE PILOT TESTED THE 7507 04:29:09,600 --> 04:29:10,640 IMPLEMENTATION OF BRINGING 7508 04:29:10,640 --> 04:29:11,880 SURVIVORSHIP CARE PLANNING VIA 7509 04:29:11,880 --> 04:29:12,520 TELEHEALTH. 7510 04:29:12,520 --> 04:29:14,400 AND WHAT WE DID WAS WE HAD THEM 7511 04:29:14,400 --> 04:29:16,680 REFER THEIR PATIENTS AT THE END 7512 04:29:16,680 --> 04:29:21,720 OF THERAPY, AND WE PROVIDED A 7513 04:29:21,720 --> 04:29:23,360 SURVIVORSHIP CARE VISIT FROM OUR 7514 04:29:23,360 --> 04:29:24,320 SURVIVORSHIP CLINIC AT 7515 04:29:24,320 --> 04:29:26,000 VANDERBILT INGRAM TO THE PATIENT 7516 04:29:26,000 --> 04:29:27,920 DIRECTLY IN THEIR HOME OR AT 7517 04:29:27,920 --> 04:29:29,560 THEIR CLINIC, WHEREVER THEY 7518 04:29:29,560 --> 04:29:31,080 PREFERRED, VIA TELEHEALTH. 7519 04:29:31,080 --> 04:29:33,480 SO OUR ADVANCED PRACTICE NURSE 7520 04:29:33,480 --> 04:29:35,480 GOT THEIR MEDICAL RECORDS 7521 04:29:35,480 --> 04:29:40,640 BECAUSE WE SHARED A SIMILAR 7522 04:29:40,640 --> 04:29:42,040 MEDICAL RECORD SYSTEM SO WE WERE 7523 04:29:42,040 --> 04:29:43,640 ABLE TO GET THEIR MEDICAL 7524 04:29:43,640 --> 04:29:44,920 RECORDS, THEY WERE ABLE TO 7525 04:29:44,920 --> 04:29:49,560 PREPARE A SURVIVOR SHIP PLANNED 7526 04:29:49,560 --> 04:29:51,600 AND PROVIDE A VISIT WITH THE 7527 04:29:51,600 --> 04:29:54,360 PATIENT, CARRIED OUT BY 7528 04:29:54,360 --> 04:30:00,560 NAVIGATORS IN THEIR OWN CLINIC. 7529 04:30:00,560 --> 04:30:02,000 SO THIS IS WHAT IT LOOKED LIKE. 7530 04:30:02,000 --> 04:30:03,120 VERY INTERESTING BECAUSE I JUST 7531 04:30:03,120 --> 04:30:03,880 TOLD YOU THAT RURAL COMMUNITIES 7532 04:30:03,880 --> 04:30:06,080 IN OUR COUNTRY TEND TO BE LESS 7533 04:30:06,080 --> 04:30:08,080 EDUCATED, HAVE LOWER 7534 04:30:08,080 --> 04:30:09,400 SOCIOECONOMIC STATUS, HAVE LOWER 7535 04:30:09,400 --> 04:30:13,240 RATES OF INSURANCE, AND OUR 7536 04:30:13,240 --> 04:30:14,240 POPULATION WHO ACTUALLY 7537 04:30:14,240 --> 04:30:15,520 PARTICIPATED IN THIS WAS REALLY 7538 04:30:15,520 --> 04:30:18,880 MUCH MORE DIVERSE WITH VARYING 7539 04:30:18,880 --> 04:30:21,000 LEVELS OF EDUCATION, INCLUDING 7540 04:30:21,000 --> 04:30:23,120 3% WITH DOCTORATE DEGREES, TWO 7541 04:30:23,120 --> 04:30:26,800 THIRDS HAD PRIVATE OR EMPLOYEE 7542 04:30:26,800 --> 04:30:29,000 INSURANCE, INCOME, MOST OF THE 7543 04:30:29,000 --> 04:30:31,040 PATIENTS FELL INTO THAT BETWEEN 7544 04:30:31,040 --> 04:30:33,600 20 AND $100,000 A YEAR, TWO 7545 04:30:33,600 --> 04:30:35,080 THIRDS WERE WHITE, AND ONE-THIRD 7546 04:30:35,080 --> 04:30:35,480 WERE BLACK. 7547 04:30:35,480 --> 04:30:38,880 AND AS YOU CAN SEE BY THE PIE 7548 04:30:38,880 --> 04:30:39,960 GRAPH, ALMOST ALL WERE WOMEN. 7549 04:30:39,960 --> 04:30:43,240 NOW THIS WAS A VERY SMALL PILOT 7550 04:30:43,240 --> 04:30:46,320 OF 35 PATIENTS. 7551 04:30:46,320 --> 04:30:47,200 BUT THIS WAS INTERESTING THAT 7552 04:30:47,200 --> 04:30:48,000 THESE WERE THE PEOPLE WHO ENDED 7553 04:30:48,000 --> 04:30:54,800 UP GETTING REFERRED. 7554 04:30:54,800 --> 04:30:57,320 WE USED THE NCCN, THE STRESS 7555 04:30:57,320 --> 04:30:58,040 THERMOMETER AND ASSOCIATED 7556 04:30:58,040 --> 04:30:59,840 SCALES AND WE FOUND 7557 04:30:59,840 --> 04:31:00,920 NON-SIGNIFICANT IMPROVEMENTS IN 7558 04:31:00,920 --> 04:31:02,280 PRACTICAL, FAMILY, EMOTIONAL, 7559 04:31:02,280 --> 04:31:03,880 SPIRITUAL AND PHYSICAL DOMAINS 7560 04:31:03,880 --> 04:31:05,560 BEFORE AND AFTER THE 7561 04:31:05,560 --> 04:31:07,760 INTERVENTION, AND AS YOU CAN 7562 04:31:07,760 --> 04:31:09,400 SEE, PRE AND POST INTERVENTION, 7563 04:31:09,400 --> 04:31:11,360 NOT A LOT OF DIFFERENCE ON THE 7564 04:31:11,360 --> 04:31:11,720 THERMOMETER. 7565 04:31:11,720 --> 04:31:12,720 WE DIDN'T EXPECT IT. 7566 04:31:12,720 --> 04:31:14,160 IT WAS A SMALL PILOT. 7567 04:31:14,160 --> 04:31:15,440 THE REASON IT TURNED OUT TO BE 7568 04:31:15,440 --> 04:31:19,840 SUCH A SMALL PILOT WAS THE 7569 04:31:19,840 --> 04:31:21,360 SATISFACTION WAS VERY HIGH AMONG 7570 04:31:21,360 --> 04:31:26,640 THE PATIENTS WHO PARTICIPATED. 7571 04:31:26,640 --> 04:31:29,360 85% RATED THEIR SURVIVORSHIP 7572 04:31:29,360 --> 04:31:31,680 CARE PLAN AS VERY VALUABLE. 7573 04:31:31,680 --> 04:31:34,320 64% SAID TELEHEALTH HELPED 7574 04:31:34,320 --> 04:31:36,080 IMPROVE THEIR ACCESS TO CARE. 7575 04:31:36,080 --> 04:31:38,560 THOSE WHO USED TELEHEALTH 7576 04:31:38,560 --> 04:31:40,920 GENERALLY RATED IT VERY WELL. 7577 04:31:40,920 --> 04:31:44,320 AND THE MAJORITY SAID THAT THEY 7578 04:31:44,320 --> 04:31:45,840 HAD A GOOD FEELING ABOUT USING 7579 04:31:45,840 --> 04:31:46,400 TELEHEALTH AGAIN. 7580 04:31:46,400 --> 04:31:50,920 SO BASED ON THIS, THE CLINIC 7581 04:31:50,920 --> 04:31:52,440 ACTUALLY EXPANDED THEIR OWN 7582 04:31:52,440 --> 04:31:53,520 SURVIVORSHIP SERVICES AND 7583 04:31:53,520 --> 04:31:55,920 CONTINUED TO PROVIDE 7584 04:31:55,920 --> 04:31:57,040 SURVIVORSHIP CARE AFTER THIS 7585 04:31:57,040 --> 04:31:59,680 PILOT TO THEIR PATIENTS USING 7586 04:31:59,680 --> 04:32:02,280 THEIR OWN STAFF. 7587 04:32:02,280 --> 04:32:05,360 SO WE SAW THAT AS A WHIP. 7588 04:32:05,360 --> 04:32:06,360 AS A WIN. 7589 04:32:06,360 --> 04:32:09,240 SO THE NEXT PIECE OF THIS WAS 7590 04:32:09,240 --> 04:32:10,760 CAN WE BRING SOME SUPPORTIVE 7591 04:32:10,760 --> 04:32:12,960 CARE SERVICES TO PATIENTS 7592 04:32:12,960 --> 04:32:14,720 UNDERGOING CANCER TREATMENT, 7593 04:32:14,720 --> 04:32:16,920 ACTIVE CANCER TREATMENT, AND CAN 7594 04:32:16,920 --> 04:32:19,160 WE PROVIDE SERVICES TO 7595 04:32:19,160 --> 04:32:21,400 PROVIDERS, REMEMBER, BECAUSE 7596 04:32:21,400 --> 04:32:23,520 THEY ARE FAR AWAY FROM OUR 7597 04:32:23,520 --> 04:32:24,720 CANCER CENTER IN THESE RURAL 7598 04:32:24,720 --> 04:32:25,840 COMMUNITY, AND THEY DON'T HAVE 7599 04:32:25,840 --> 04:32:27,240 ACCESS TO SUBSPECIALISTS. 7600 04:32:27,240 --> 04:32:29,600 AND THIS IS BEING SUPPORTED BY 7601 04:32:29,600 --> 04:32:35,040 AN ONGOING R01 FROM THE NCI. 7602 04:32:35,040 --> 04:32:37,160 THE IDEA WAS TO TEST A 7603 04:32:37,160 --> 04:32:40,120 MULTILEVEL TELEHEALTH-BASED IFNT 7604 04:32:40,120 --> 04:32:40,760 INTERVENTION. 7605 04:32:40,760 --> 04:32:41,880 ON THE PROVIDER SIDE, WE OFFERED 7606 04:32:41,880 --> 04:32:43,200 THE OPPORTUNITY FOR THEM TO 7607 04:32:43,200 --> 04:32:44,200 PRESENT ANY PATIENT THEY WANTED 7608 04:32:44,200 --> 04:32:47,080 IN THE STUDY TO A MOLECULAR 7609 04:32:47,080 --> 04:32:47,560 TUMOR BOARD. 7610 04:32:47,560 --> 04:32:49,120 THESE COULD BE PATIENTS FOR WHOM 7611 04:32:49,120 --> 04:32:50,680 THEY WANT TO KNOW SHOULD THEY 7612 04:32:50,680 --> 04:32:51,960 GET GENOMIC TESTING ON THE TUMOR 7613 04:32:51,960 --> 04:32:53,800 OR IF THEY GOT GENOMIC TESTING, 7614 04:32:53,800 --> 04:32:57,920 WHAT DOES IT MEAN? 7615 04:32:57,920 --> 04:33:00,000 AT THE PATIENT LEVEL, WE HAD TWO 7616 04:33:00,000 --> 04:33:01,360 SUPPORTIVE CARE INTERVENTIONS. 7617 04:33:01,360 --> 04:33:02,360 I'LL TELL YOU A LITTLE BIT MORE 7618 04:33:02,360 --> 04:33:07,800 ABOUT THEM IN TH IN A MINUTE, CR 7619 04:33:07,800 --> 04:33:09,800 SURVIVORRING AND THRIVING ON AN 7620 04:33:09,800 --> 04:33:11,440 EDUCATIONAL WEBSITE. 7621 04:33:11,440 --> 04:33:12,640 IMPLEMENTATION SCIENCING TO SAY 7622 04:33:12,640 --> 04:33:14,360 WHAT ARE THE FACILITATORS AND 7623 04:33:14,360 --> 04:33:16,480 BARRIERS TO LARGE SCALE 7624 04:33:16,480 --> 04:33:17,480 DISSEMINATION, IMPLEMENTATION? 7625 04:33:17,480 --> 04:33:20,320 IS THIS A MODEL THAT CAN WORK 7626 04:33:20,320 --> 04:33:21,160 THROUGHOUT OUR CATCHMENT AREA 7627 04:33:21,160 --> 04:33:23,800 WHERE WE CAN REALLY BRING 7628 04:33:23,800 --> 04:33:24,920 SUPPORTIVE SERVICES TO THOSE 7629 04:33:24,920 --> 04:33:29,720 LIVING IN RURAL COMMUNITIES? 7630 04:33:29,720 --> 04:33:32,040 SO THIS IS THE STUDY SCHEMA ON 7631 04:33:32,040 --> 04:33:33,480 THE PROVIDER SIDE. 7632 04:33:33,480 --> 04:33:35,920 THEY ENROLLED THE PATIENT, THEY 7633 04:33:35,920 --> 04:33:38,720 ELECTED TO PARTICIPATE IN TUMOR 7634 04:33:38,720 --> 04:33:42,120 BOARD, AND THEN AFTER WHICH WE 7635 04:33:42,120 --> 04:33:43,360 DID SOME SURVEYS OF THE PROVIDER 7636 04:33:43,360 --> 04:33:44,760 AND THE PATIENT TO SEE IF THAT 7637 04:33:44,760 --> 04:33:46,680 TUMOR BOARD WAS HELPFUL, AND ON 7638 04:33:46,680 --> 04:33:48,520 THE PATIENT LEVEL, THE PATIENT 7639 04:33:48,520 --> 04:33:53,200 WAS ENROLLED, IF THE PATIENT WAS 7640 04:33:53,200 --> 04:33:54,000 PROVIDED TUMOR BOARD, THEY 7641 04:33:54,000 --> 04:33:55,840 FILLED OUT A SURVEY, AND THEY 7642 04:33:55,840 --> 04:34:01,000 WERE INITIALLY RANDOMIZED TO THE 7643 04:34:01,000 --> 04:34:02,200 TWO PATIENT CARE INTERVENTIONS, 7644 04:34:02,200 --> 04:34:03,760 AND THEN BEFORE THE 7645 04:34:03,760 --> 04:34:05,040 INTERVENTIONS, THERE WAS A NEEDS 7646 04:34:05,040 --> 04:34:06,320 ASSESSMENT, AND AFTERWARDS, 7647 04:34:06,320 --> 04:34:08,200 THERE WAS NEEDS ASSESSMENT AND 7648 04:34:08,200 --> 04:34:11,040 SOME OTHER MEASURES. 7649 04:34:11,040 --> 04:34:13,520 SO THESE ARE THE TOPICS THAT ARE 7650 04:34:13,520 --> 04:34:16,280 ON OUR EDUCATIONAL WEBSITE. 7651 04:34:16,280 --> 04:34:17,720 SO -- AND WE CHOSE THESE TOPICS 7652 04:34:17,720 --> 04:34:20,680 TO KIND OF MATCH THE TOPICS THAT 7653 04:34:20,680 --> 04:34:22,360 WERE IN THE OTHER ARM OF THE 7654 04:34:22,360 --> 04:34:24,120 PATIENT INTERVENTION STUDY. 7655 04:34:24,120 --> 04:34:27,720 AND PATIENTS COULD CLICK ON 7656 04:34:27,720 --> 04:34:30,280 THESE, AND WE PUT FORTH, YOU 7657 04:34:30,280 --> 04:34:33,600 KNOW, VERY GOOD MATERIAL. 7658 04:34:33,600 --> 04:34:36,240 WE TOOK MATERIAL THAT WAS KIND 7659 04:34:36,240 --> 04:34:37,880 OF EASILY AVAILABLE BUT WE MADE 7660 04:34:37,880 --> 04:34:39,760 SURE THAT THERE WAS LITERACY 7661 04:34:39,760 --> 04:34:41,000 AROUND IT SO PEOPLE COULD 7662 04:34:41,000 --> 04:34:42,400 UNDERSTAND IT AND THEN THERE 7663 04:34:42,400 --> 04:34:45,480 WERE -- AND THEN THERE WERE 7664 04:34:45,480 --> 04:34:46,440 PROMPTS TO REACH US FOR 7665 04:34:46,440 --> 04:34:47,960 ADDITIONAL INFORMATION. 7666 04:34:47,960 --> 04:34:50,200 THE OTHER ARM FOR THE PATIENTS 7667 04:34:50,200 --> 04:34:51,840 WAS CANCER THRIVING AND 7668 04:34:51,840 --> 04:34:52,120 SURVIVING. 7669 04:34:52,120 --> 04:34:54,840 NOW THIS IS GENERALLY AN 7670 04:34:54,840 --> 04:34:56,640 IN-PERSON SELF-MANAGEMENT GROUP. 7671 04:34:56,640 --> 04:34:58,040 IT'S HELD OVER SIX WEEKS, EACH 7672 04:34:58,040 --> 04:35:00,040 SESSION IS ABOUT TWO HOURS A 7673 04:35:00,040 --> 04:35:02,960 WEEK, AND PEOPLE SIT IN A ROOM 7674 04:35:02,960 --> 04:35:05,320 AND REALLY THINK ABOUT ALL THE 7675 04:35:05,320 --> 04:35:06,600 ISSUES THAT ARE FACING PEOPLE 7676 04:35:06,600 --> 04:35:07,400 WITH CANCER. 7677 04:35:07,400 --> 04:35:09,160 IT'S BUILT ON A CHRONIC CARE 7678 04:35:09,160 --> 04:35:11,320 MODEL, AND IN FACT THE PATIENTS 7679 04:35:11,320 --> 04:35:13,080 GET THIS BOOK, LIVING A HEALTHY 7680 04:35:13,080 --> 04:35:14,320 LIFE WITH CHRONIC CONDITIONS. 7681 04:35:14,320 --> 04:35:17,240 AND THEN THERE'S THIS 7682 04:35:17,240 --> 04:35:19,240 SELF-MANAGEMENT TOOLBOX AND WEEK 7683 04:35:19,240 --> 04:35:20,680 BY WEEK, THEY GO THROUGH THIS 7684 04:35:20,680 --> 04:35:23,160 TOOLBOX AND HELP ONE ANOTHER 7685 04:35:23,160 --> 04:35:23,960 NAVIGATE WHAT'S GOING ON WITH 7686 04:35:23,960 --> 04:35:27,520 THEM WITH THEIR CANCER 7687 04:35:27,520 --> 04:35:28,280 DIAGNOSIS, AND TWO MODERATORS 7688 04:35:28,280 --> 04:35:28,720 GUIDE THIS. 7689 04:35:28,720 --> 04:35:30,680 AND WE CONVERTED THIS TO 7690 04:35:30,680 --> 04:35:30,960 TELEHEALTH. 7691 04:35:30,960 --> 04:35:32,440 NOW WE DID THIS ACTUALLY BEFORE 7692 04:35:32,440 --> 04:35:34,160 PANDEMIC AND THEN ONCE PANDEMIC 7693 04:35:34,160 --> 04:35:40,200 HIT, IT WAS VERY HELPFUL. 7694 04:35:40,200 --> 04:35:41,320 SO WHAT HAPPENED? 7695 04:35:41,320 --> 04:35:42,600 ABOUT TWO YEARS INTO THE GRANT, 7696 04:35:42,600 --> 04:35:44,520 WE SAW ACCRUAL WAS TERRIBLE. 7697 04:35:44,520 --> 04:35:46,040 SO INITIALLY WE ATTRIBUTED THIS 7698 04:35:46,040 --> 04:35:50,560 TO THE COVID-19 PANDEMIC. 7699 04:35:50,560 --> 04:35:52,280 BUT THEN EVEN AS THINGS STARTED 7700 04:35:52,280 --> 04:35:54,480 TO OPEN UP IN CLINICS AND MORE 7701 04:35:54,480 --> 04:35:55,880 PATIENTS WERE COMING IN, WE WERE 7702 04:35:55,880 --> 04:35:57,360 STILL NOT GETTING THE ACCRUAL WE 7703 04:35:57,360 --> 04:35:59,560 WANTED, SO WE TOOK A DEEP DIVE 7704 04:35:59,560 --> 04:36:01,280 AND WE ACTUALLY WENT BACK AND 7705 04:36:01,280 --> 04:36:02,920 LOOKED BECAUSE FORTUNATELY WE 7706 04:36:02,920 --> 04:36:05,200 CAPTURED THE REASONS WHY 7707 04:36:05,200 --> 04:36:06,280 PATIENTS AND PROVIDERS DIDN'T 7708 04:36:06,280 --> 04:36:10,440 WANT TO PARTICIPATE. 7709 04:36:10,440 --> 04:36:11,640 PROVIDERS SAID THEY DIDN'T WANT 7710 04:36:11,640 --> 04:36:12,880 TO PARTICIPATE IN THE MOLECULAR 7711 04:36:12,880 --> 04:36:15,200 TUMOR BOARD, THEY THOUGHT IT WAS 7712 04:36:15,200 --> 04:36:17,080 GREAT BUT WERE BUSY. 7713 04:36:17,080 --> 04:36:18,920 WHAT THEY PREFERRED TO DO IS 7714 04:36:18,920 --> 04:36:21,440 SEND ONE OF US A TEXT OR AN 7715 04:36:21,440 --> 04:36:27,800 EMAIL OR GET ON THE PHONE WIT WH 7716 04:36:27,800 --> 04:36:29,240 AN ONCOLOGIST AND SAY HEY I'VE 7717 04:36:29,240 --> 04:36:30,480 GOT THIS PATIENT WITH THIS 7718 04:36:30,480 --> 04:36:32,120 TUMOR, THIS IS WHAT IT SHOWED, 7719 04:36:32,120 --> 04:36:34,000 OR CAN I PHACS TO YOU, CAN YOU 7720 04:36:34,000 --> 04:36:34,720 LOOK AT IT? 7721 04:36:34,720 --> 04:36:36,320 OF COURSE NONE OF US ARE GOING 7722 04:36:36,320 --> 04:36:37,840 TO SAY NO. 7723 04:36:37,840 --> 04:36:39,360 WE SAID ARE YOU GOING TO PRESENT 7724 04:36:39,360 --> 04:36:40,760 THIS TO THE TUMOR BOARD, THAT'S 7725 04:36:40,760 --> 04:36:42,040 GOING TO TAKE TOO MUCH TIME, 7726 04:36:42,040 --> 04:36:43,360 EVEN THOUGH WE QO DO IT 7727 04:36:43,360 --> 04:36:45,080 VIRTUALLY, WE HAD HOURS THAT 7728 04:36:45,080 --> 04:36:45,840 AGREED WITH THEM. 7729 04:36:45,840 --> 04:36:47,000 SO THAT'S WHAT HE WITH LEARNED 7730 04:36:47,000 --> 04:36:47,760 ON THE PROVIDER SIDE. 7731 04:36:47,760 --> 04:36:51,000 ON THE PATIENT SIDE, PATIENTS 7732 04:36:51,000 --> 04:36:52,360 SAID TWO THINGS US TO. 7733 04:36:52,360 --> 04:36:54,440 ONE, WE DON'T WANT TO BE 7734 04:36:54,440 --> 04:36:55,840 RANDOMIZED TO TWO DIFFERENT 7735 04:36:55,840 --> 04:36:56,400 INTERVENTIONS. 7736 04:36:56,400 --> 04:36:59,040 WE WANT TO BE ABLE TO CHOOSE. 7737 04:36:59,040 --> 04:37:02,280 THE SECOND THING THEY SAID WAS, 7738 04:37:02,280 --> 04:37:04,440 WE'RE REALLY NOT INTERESTED IN A 7739 04:37:04,440 --> 04:37:07,960 SIX-WEEK PROGRAM BY TELEHEALTH, 7740 04:37:07,960 --> 04:37:11,280 TALKING TO PEOPLE THROUGH THE 7741 04:37:11,280 --> 04:37:12,720 COMPUTER WHO WE DON'T EVEN KNOW. 7742 04:37:12,720 --> 04:37:13,600 THAT'S WHAT THEY SAID. 7743 04:37:13,600 --> 04:37:15,720 SO WE SAID OKAY. 7744 04:37:15,720 --> 04:37:18,120 AND REMEMBER, OUR SECOND AIM WAS 7745 04:37:18,120 --> 04:37:19,240 AN IMPLEMENTATION SCIENCE AIM, 7746 04:37:19,240 --> 04:37:20,640 SO WE LEARNED VERY QUICKLY WHAT 7747 04:37:20,640 --> 04:37:21,840 THE BARRIERS WERE. 7748 04:37:21,840 --> 04:37:23,200 SO WE ACTUALLY CHANGED IT. 7749 04:37:23,200 --> 04:37:25,760 WE CONTINUED TO OFFER THE 7750 04:37:25,760 --> 04:37:27,520 MOLECULAR TUMOR BOARD TO THE 7751 04:37:27,520 --> 04:37:31,080 PHYSICIANS, AND THAT SLOWLY HAS 7752 04:37:31,080 --> 04:37:32,000 PICKED UP. 7753 04:37:32,000 --> 04:37:33,800 FOR THE PATIENTS, WE GAVE 7754 04:37:33,800 --> 04:37:34,880 EVERYBODY THE EDUCATION ARM 7755 04:37:34,880 --> 04:37:36,480 BECAUSE THAT'S THE ONE THEY 7756 04:37:36,480 --> 04:37:37,880 REALLY WANTED, AND THEN AFTER 7757 04:37:37,880 --> 04:37:40,200 HAVING THE EDUCATION ARM FOR SIX 7758 04:37:40,200 --> 04:37:42,760 WEEKS, WE ASKED THEM IF THEY 7759 04:37:42,760 --> 04:37:43,840 WANTED TO PARTICIPATE IN THE 7760 04:37:43,840 --> 04:37:45,760 CANCER THRIVING AND SURVIVING, 7761 04:37:45,760 --> 04:37:47,040 FIGURING THAT THEY HAD ALREADY 7762 04:37:47,040 --> 04:37:48,560 GOTTEN SOME INFORMATION AND WE 7763 04:37:48,560 --> 04:37:50,160 WOULD SELECT OUT THE PEOPLE WHO 7764 04:37:50,160 --> 04:37:50,960 REALLY THOUGHT IT WOULD BE 7765 04:37:50,960 --> 04:37:53,160 HELPFUL TO THEM. 7766 04:37:53,160 --> 04:37:55,200 SO OF THE 470 CURRENTLY ENROLLED 7767 04:37:55,200 --> 04:37:58,880 IN THE STUDY, 422 HAD EDUCATION 7768 04:37:58,880 --> 04:38:03,600 ONLY OF WHICH 42 WERE INITIALLY 7769 04:38:03,600 --> 04:38:04,680 RANDOMIZED, 42 HAD CANCER 7770 04:38:04,680 --> 04:38:06,680 THRIVING AND SURVIVING ONLY, 7771 04:38:06,680 --> 04:38:08,880 AGAIN BY INITIAL RANDOMIZATION, 7772 04:38:08,880 --> 04:38:11,840 AND ONLY 22 PATIENTS EVEN AFTER 7773 04:38:11,840 --> 04:38:14,360 GETTING THE OPTION OF THE 7774 04:38:14,360 --> 04:38:16,480 EDUCATIONAL WEBSITE, HAVE 7775 04:38:16,480 --> 04:38:18,120 ENROLLED IN THE CANCER THRIVING 7776 04:38:18,120 --> 04:38:19,200 AND SURVIVING. 7777 04:38:19,200 --> 04:38:23,840 AND WE HAVE NOW ONGOING FOCUS 7778 04:38:23,840 --> 04:38:25,040 GROUPS WITH PATIENTS AND 7779 04:38:25,040 --> 04:38:26,680 PROVIDERS TO DIG DEEPER INTO 7780 04:38:26,680 --> 04:38:30,680 THIS DAY DATA TO TRY TO SEE HOE 7781 04:38:30,680 --> 04:38:32,200 CAN WORK THIS OUT AND ADAPT THIS 7782 04:38:32,200 --> 04:38:35,840 TO THE FUTURE TO BE MORE 7783 04:38:35,840 --> 04:38:38,360 SUCCESSFSUCCESS -- TO MORE SUCCY 7784 04:38:38,360 --> 04:38:38,720 USE TELEHEALTH. 7785 04:38:38,720 --> 04:38:42,000 A LITTLE BIT ABOUT WHAT OUR PO 7786 04:38:42,000 --> 04:38:43,480 POPULATION LOOKED LIKE, KIND OF 7787 04:38:43,480 --> 04:38:44,680 AN OLDER POPULATION WITH A 7788 04:38:44,680 --> 04:38:46,200 MEDIAN AGE OF 61, A LITTLE BIT 7789 04:38:46,200 --> 04:38:48,640 MORE FEMALE, BECAUSE OF -- I 7790 04:38:48,640 --> 04:38:50,840 SHOWED YOU OUR CATCHMENT AREA, 7791 04:38:50,840 --> 04:38:53,760 RURAL COUNTIES, 88% WHITE, SO IN 7792 04:38:53,760 --> 04:38:56,760 THIS STUDY, 84% WHITE. 7793 04:38:56,760 --> 04:38:58,320 AND VERY LOW HISPANIC, WHICH IS 7794 04:38:58,320 --> 04:39:01,040 EXACTLY WHAT WE SEE IN OUR RURAL 7795 04:39:01,040 --> 04:39:02,400 COMMUNITIES. 7796 04:39:02,400 --> 04:39:08,760 WE RECRUITED PATIENTS FROM THREE 7797 04:39:08,760 --> 04:39:09,400 AREAS. 7798 04:39:09,400 --> 04:39:10,600 ONE BAPTIST MEMORIAL HEALTHCARE 7799 04:39:10,600 --> 04:39:12,200 IN WESTERN TENNESSEE, BORDERING, 7800 04:39:12,200 --> 04:39:13,560 AGAIN, ON ARKANSAS AND 7801 04:39:13,560 --> 04:39:14,520 MISSISSIPPI, THE SAME PLACE WE 7802 04:39:14,520 --> 04:39:16,800 USE FOR OUR SURVIVORSHIP AND 7803 04:39:16,800 --> 04:39:17,680 THERE WERE SEVEN PRACTICES 7804 04:39:17,680 --> 04:39:18,760 THERE. 7805 04:39:18,760 --> 04:39:22,640 RURAL PRACTICES THAT CONTRIBUTED 7806 04:39:22,640 --> 04:39:25,760 PATIENTS AND BALLAD HEALTH ON 7807 04:39:25,760 --> 04:39:27,360 THE EASTERN SIDE OF THE STATE 7808 04:39:27,360 --> 04:39:29,440 WHICH ALSO HAS SOME CLINICS IN 7809 04:39:29,440 --> 04:39:32,240 WEST VIRGINIA THAT ARE ALL RUR 7810 04:39:32,240 --> 04:39:35,480 RURAL. 7811 04:39:35,480 --> 04:39:36,600 WE ALSO RECRUITED PATIENTS WHO 7812 04:39:36,600 --> 04:39:39,120 LIVE IN RURAL AREAS AND ACTUALLY 7813 04:39:39,120 --> 04:39:40,480 TRAVEL MANY MILES TO GET TO 7814 04:39:40,480 --> 04:39:41,720 NASHVILLE FOR CARE, AND YOU CAN 7815 04:39:41,720 --> 04:39:44,200 SEE ON THE BOTTOM HOW FAR SOME 7816 04:39:44,200 --> 04:39:46,600 OF THESE PATIENTS TRAVEL, ONE 7817 04:39:46,600 --> 04:39:47,880 WAY, FOR THEIR CANCER CARE. 7818 04:39:47,880 --> 04:39:49,920 SO THIS IS A POPULATION WHERE 7819 04:39:49,920 --> 04:39:55,520 YOU THINK TO HAVE -- IS REALLY 7820 04:39:55,520 --> 04:39:57,160 GOING TO MAKE A DIFFERENCE. 7821 04:39:57,160 --> 04:39:58,920 DEMOGRAPHICS OF THIS POPULATION 7822 04:39:58,920 --> 04:40:00,440 ARE ACTUALLY VERY SIMILAR TO THE 7823 04:40:00,440 --> 04:40:03,120 DEMOGRAPHICS OF A VERY SMALL 7824 04:40:03,120 --> 04:40:06,080 PILOT POPULATION. 7825 04:40:06,080 --> 04:40:07,600 MORE INSURED, HIGHER INCOME THAN 7826 04:40:07,600 --> 04:40:09,200 A LOT OF RURAL POPULATIONS IN 7827 04:40:09,200 --> 04:40:10,600 THE COUNTRY, SO WE NEED TO JUST 7828 04:40:10,600 --> 04:40:11,880 TAKE THAT INTO ACCOUNT AS WE 7829 04:40:11,880 --> 04:40:12,840 LOOK AT OUR RESULTS GOING 7830 04:40:12,840 --> 04:40:19,720 FORWARD. 7831 04:40:19,720 --> 04:40:21,360 IN TERMS OF TELEHEALTH 7832 04:40:21,360 --> 04:40:22,120 EXPERIENCE, TWO THIRDS HAVE 7833 04:40:22,120 --> 04:40:24,280 NEVER USED TELEHEALTH BEFORE BUT 7834 04:40:24,280 --> 04:40:25,720 IN TERMS OF WHO DID, THOUGH, 7835 04:40:25,720 --> 04:40:26,920 THEY RATED IT VERY GOOD. 7836 04:40:26,920 --> 04:40:29,000 JUST A FEW OF THE RESULTS. 7837 04:40:29,000 --> 04:40:30,080 THE EDUCATIONAL NEEDS OF THE 7838 04:40:30,080 --> 04:40:34,000 PATIENTS, WE LOOKED BEFORE AND 7839 04:40:34,000 --> 04:40:35,360 AFTERWARDS, NOT A LOT OF 7840 04:40:35,360 --> 04:40:35,760 DIFFERENCE. 7841 04:40:35,760 --> 04:40:37,680 A LITTLE BIT OF IMPROVEMENT. 7842 04:40:37,680 --> 04:40:41,920 THE SAME WAS TRUE FOR EMOTIONAL 7843 04:40:41,920 --> 04:40:43,800 NEEDS, A LITTLE BIT OF 7844 04:40:43,800 --> 04:40:45,080 IMPROVEMENT AFTER INTERVENTION, 7845 04:40:45,080 --> 04:40:46,840 AND SIMILAR TRENDS WERE NOTED 7846 04:40:46,840 --> 04:40:48,040 FOR FINANCIAL NEEDS, 7847 04:40:48,040 --> 04:40:48,680 TRANSPORTATION, PERSONAL NEEDS, 7848 04:40:48,680 --> 04:40:53,280 AND WELLNESS NEEDS. 7849 04:40:53,280 --> 04:40:54,840 BECAUSE WE HAD A BUNCH OF 7850 04:40:54,840 --> 04:40:56,280 EDUCATION AROUND COMMUNICATION, 7851 04:40:56,280 --> 04:40:58,800 WE ALSO ASKED PATIENTS ABOUT 7852 04:40:58,800 --> 04:40:59,800 COMMUNICATING WITH THEIR 7853 04:40:59,800 --> 04:41:02,560 HEALTHCARE TEAM, AND AFTER THE 7854 04:41:02,560 --> 04:41:03,920 INTERVENTION, ALMOST ALL THE 7855 04:41:03,920 --> 04:41:05,320 PATIENTS REPORTED THEIR 7856 04:41:05,320 --> 04:41:06,160 COMMUNICATION WITH THEIR 7857 04:41:06,160 --> 04:41:07,720 HEALTHCARE TEAM BEING VERY GOOD 7858 04:41:07,720 --> 04:41:12,040 OR EXCELLENT. 7859 04:41:12,040 --> 04:41:13,360 SO WHAT WE'VE LEARNED FROM THESE 7860 04:41:13,360 --> 04:41:15,440 SET OF EXPERIENCES IS ALTHOUGH 7861 04:41:15,440 --> 04:41:16,600 TELEHEALTH HAS THE OPPORTUNITY 7862 04:41:16,600 --> 04:41:19,960 TO REALLY DECREASE DISPARITIES 7863 04:41:19,960 --> 04:41:25,880 AND INCREASE REACH IS NOT 7864 04:41:25,880 --> 04:41:27,520 UNIVERSALLY EMBRACED BY PATIENTS 7865 04:41:27,520 --> 04:41:28,280 OR PROVIDERS. 7866 04:41:28,280 --> 04:41:29,160 COMPETING PRIORITIES HAVE BEEN 7867 04:41:29,160 --> 04:41:31,280 THE NUMBER ONE REASON THAT HAVE 7868 04:41:31,280 --> 04:41:33,760 INTERVENED WITH THE ABILITY TO 7869 04:41:33,760 --> 04:41:34,320 PARTICIPATE IN TELEHEALTH. 7870 04:41:34,320 --> 04:41:36,120 THAT'S TRUE FOR THE PROVIDERS, 7871 04:41:36,120 --> 04:41:37,760 BUT IT'S ALSO TRUE FOR THE 7872 04:41:37,760 --> 04:41:38,400 PATIENTS, THAT'S SOME OF THE 7873 04:41:38,400 --> 04:41:39,600 OTHER FEEDBACK WE GOT FROM THE 7874 04:41:39,600 --> 04:41:39,960 PATIENTS. 7875 04:41:39,960 --> 04:41:40,760 WE JUST DON'T HAVE THE TIME. 7876 04:41:40,760 --> 04:41:42,400 WE GO IN, WE SEE OUR DOCTOR, WE 7877 04:41:42,400 --> 04:41:43,840 GET OUT, WE DON'T HAVE THE TIME 7878 04:41:43,840 --> 04:41:50,520 FOR ALL THIS OTHER STUFF. 7879 04:41:50,520 --> 04:41:51,840 SO THEIR LIVED EXPERIENCES ARE 7880 04:41:51,840 --> 04:41:53,280 GUIDING WHAT THEY'RE ABLE TO DO. 7881 04:41:53,280 --> 04:41:56,480 WE NEED TO CONTINUE TO BUILD 7882 04:41:56,480 --> 04:41:57,160 BIDIRECTIONAL RELATIONSHIPS WITH 7883 04:41:57,160 --> 04:41:58,200 OUR COMMUNITY TO OPTIMALLY 7884 04:41:58,200 --> 04:41:59,280 DELIVER CARE, AND WE NEED TO 7885 04:41:59,280 --> 04:42:01,680 WORK WITH THE COMMUNITY ABOUT 7886 04:42:01,680 --> 04:42:03,240 OTHER WAYS TO IMPROVE TELEHEALTH 7887 04:42:03,240 --> 04:42:03,560 SERVICES. 7888 04:42:03,560 --> 04:42:04,840 I DON'T THINK WE SHOULD, YOU 7889 04:42:04,840 --> 04:42:06,360 KNOW, KIND OF THROW AWAY THE -- 7890 04:42:06,360 --> 04:42:08,240 WHAT IS IT, THE BABY WITH THE 7891 04:42:08,240 --> 04:42:09,440 BATHWATER, WHATEVER THAT SAYING 7892 04:42:09,440 --> 04:42:09,800 IS. 7893 04:42:09,800 --> 04:42:11,960 BUT I DO THINK THAT WE HAVE TO 7894 04:42:11,960 --> 04:42:14,360 THINK MORE BROADLY ABOUT USING 7895 04:42:14,360 --> 04:42:15,920 TELEHEALTH AND NOT JUST SAYING 7896 04:42:15,920 --> 04:42:16,720 TELEHEALTH IS GREAT, AND WE'RE 7897 04:42:16,720 --> 04:42:18,360 GOING TO INCREASE REACH BY USING 7898 04:42:18,360 --> 04:42:19,760 IT. 7899 04:42:19,760 --> 04:42:23,000 I'D LIKE TO THANK MY 7900 04:42:23,000 --> 04:42:23,680 CO-INVESTIGATORS. 7901 04:42:23,680 --> 04:42:25,400 I'VE GOT A GREAT TEAM AND AN 7902 04:42:25,400 --> 04:42:28,440 AMAZING RESEARCH TEAM WHO REALLY 7903 04:42:28,440 --> 04:42:30,240 REACHED OUT AND ENROLLED THESE 7904 04:42:30,240 --> 04:42:31,440 PATIENTS AND HELPED WITH ALL THE 7905 04:42:31,440 --> 04:42:34,840 DATA COLLECTION. 7906 04:42:34,840 --> 04:42:36,400 OF COURSE FUNDING FROM THE 7907 04:42:36,400 --> 04:42:37,000 NATIONAL CANCER INSTITUTE AND 7908 04:42:37,000 --> 04:42:37,760 OUR STUDY PARTICIPANTS. 7909 04:42:37,760 --> 04:42:39,080 THANK YOU FOR YOUR ATTENTION, 7910 04:42:39,080 --> 04:42:40,040 AND I'M HAPPY TO TAKE ANY 7911 04:42:40,040 --> 04:42:41,760 QUESTIONS. 7912 04:42:41,760 --> 04:42:51,320 [APPLAUSE] 7913 04:42:51,320 --> 04:42:54,160 >>HELLO. 7914 04:42:54,160 --> 04:42:55,400 MARKITA LEWIS FROM NORTHWESTERN 7915 04:42:55,400 --> 04:42:56,240 UNIVERSITY. 7916 04:42:56,240 --> 04:43:00,680 SUPER EXCITED ABOUT THIS TOPIC. 7917 04:43:00,680 --> 04:43:03,960 ALSO INTERESTED IN RURAL CANCER 7918 04:43:03,960 --> 04:43:04,280 SURVIVES. 7919 04:43:04,280 --> 04:43:05,760 I HAVE TWO QUESTIONS FOR YOU. 7920 04:43:05,760 --> 04:43:07,160 THE FIRST QUESTION IS, I LOVE 7921 04:43:07,160 --> 04:43:11,720 HOW YOU ENDED THE PRESENTATION 7922 04:43:11,720 --> 04:43:13,720 ADDRESSING COMMUNITY. 7923 04:43:13,720 --> 04:43:14,720 ESPECIALLY TALKING ABOUT 7924 04:43:14,720 --> 04:43:15,760 SUPPORTIVE CARE SERVICES. 7925 04:43:15,760 --> 04:43:16,840 AND YOU RAILROAD MENTIONED THAT 7926 04:43:16,840 --> 04:43:18,920 FOLKS WERE TRAVELING OVER 7927 04:43:18,920 --> 04:43:21,360 50 MILES TO GET TO THEIR 7928 04:43:21,360 --> 04:43:22,880 CLINICAL INSTITUTION. 7929 04:43:22,880 --> 04:43:24,880 WITH THAT BEING SAID, WHAT WERE 7930 04:43:24,880 --> 04:43:28,080 SOME OF THE WAYS THAT YOU ARE 7931 04:43:28,080 --> 04:43:29,920 CONNECTING FOLKS TO SERVICES, 7932 04:43:29,920 --> 04:43:30,920 SUPPORTIVE CARE SERVICES, THAT 7933 04:43:30,920 --> 04:43:32,680 WERE CLOSER TO THEM? 7934 04:43:32,680 --> 04:43:34,680 THAT'S MY FIRST QUESTION. 7935 04:43:34,680 --> 04:43:37,240 MY SECOND QUESTION IS, I 7936 04:43:37,240 --> 04:43:38,240 THINK -- I DON'T REMEMBER WHO 7937 04:43:38,240 --> 04:43:40,000 WAS THE PILOT OR IF IT WAS 7938 04:43:40,000 --> 04:43:42,880 ENCORE, BUT I THINK THERE WAS AN 7939 04:43:42,880 --> 04:43:43,960 ANALYSIS OF SOME CLINICAL 7940 04:43:43,960 --> 04:43:45,520 VARIABLES SUCH AS FOLLOW-UP 7941 04:43:45,520 --> 04:43:47,800 CARE, AND I WAS WONDERING, WERE 7942 04:43:47,800 --> 04:43:51,040 YOU ABLE TO ACTUALLY INVESTIGATE 7943 04:43:51,040 --> 04:43:53,760 IF TELEHEALTH INCREASED ANY KIND 7944 04:43:53,760 --> 04:43:57,040 OF TREATMENT OUTCOMES OR 7945 04:43:57,040 --> 04:43:59,080 CLINICAL CARE OUTCOMES. 7946 04:43:59,080 --> 04:43:59,920 >>GREAT QUESTION. 7947 04:43:59,920 --> 04:44:02,880 SO FOR THE FIRST QUESTION, WHAT 7948 04:44:02,880 --> 04:44:04,200 WE'VE -- WHAT WE DID WITH 7949 04:44:04,200 --> 04:44:08,000 ACTUALLY BOTH STUDIES IS WE 7950 04:44:08,000 --> 04:44:11,040 CONNECTED PATIENTS WITH PATIENT 7951 04:44:11,040 --> 04:44:13,400 NAVIGATORS IN THEIR OWN CENTERS, 7952 04:44:13,400 --> 04:44:16,800 AND WE ALSO GAVE THEM VIRTUAL 7953 04:44:16,800 --> 04:44:19,880 ACCESS TO VANDERBILT INGRAM 7954 04:44:19,880 --> 04:44:21,520 CANCER CENTER NAVIGATORS WHO 7955 04:44:21,520 --> 04:44:22,720 WORKED VIRTUALLY BUT LIVE IN 7956 04:44:22,720 --> 04:44:24,040 THAT AREA IN THOSE COMMUNITIES. 7957 04:44:24,040 --> 04:44:27,800 SO WE HAVE NAVIGATORS -- BECAUSE 7958 04:44:27,800 --> 04:44:29,240 OF OUR CATCHMENT AREA BEING SO 7959 04:44:29,240 --> 04:44:31,360 WIDE, ALL OF OUR NAVIGATORS DO 7960 04:44:31,360 --> 04:44:34,160 NOT SIT IN NASHVILLE. 7961 04:44:34,160 --> 04:44:35,800 THEY ARE ACTUALLY ACROSS THE 7962 04:44:35,800 --> 04:44:37,080 STATE AND THEY WORK VIRTUALLY 7963 04:44:37,080 --> 04:44:39,280 AND THEY WORK WITH POPULATIONS 7964 04:44:39,280 --> 04:44:40,480 IN THOSE COMMUNITIES. 7965 04:44:40,480 --> 04:44:47,280 SO WE WERE ABLE TO PUT -- HOOK 7966 04:44:47,280 --> 04:44:48,280 UP PATIENTS WITH THE NAVIGATORS 7967 04:44:48,280 --> 04:44:49,800 IN THOSE AREAS WHO COULD THEN 7968 04:44:49,800 --> 04:44:50,920 FIND THEM SERVICES. 7969 04:44:50,920 --> 04:44:54,040 AND IN TERMS OF FOLLOW-UP 7970 04:44:54,040 --> 04:44:55,800 SERVICES, THAT IS SOMETHING THAT 7971 04:44:55,800 --> 04:44:57,800 WE ARE CURRENTLY EVALUATING ON 7972 04:44:57,800 --> 04:45:02,280 THE ENCORE STUDY, IS TO SEE HOW 7973 04:45:02,280 --> 04:45:03,040 ADHERENT PATIENTS WERE WITH 7974 04:45:03,040 --> 04:45:04,240 THEIR CANCER TREATMENT AND SEE 7975 04:45:04,240 --> 04:45:07,880 IF THE INTERVENTIONS MADE A 7976 04:45:07,880 --> 04:45:10,760 DIFFERENCE, AND FOR OUR 7977 04:45:10,760 --> 04:45:15,120 SURVIVORSHIP PILOT, WE ACTUALLY 7978 04:45:15,120 --> 04:45:18,240 HAD 85% OF OUR PARTICIPANTS 7979 04:45:18,240 --> 04:45:19,880 FOLLOW THE EXACT RECOMMENDATIONS 7980 04:45:19,880 --> 04:45:21,640 THAT WERE IN THEIR SURVIVORSHIP 7981 04:45:21,640 --> 04:45:22,880 CARE PLAN, AND WHEN THEY HAD 7982 04:45:22,880 --> 04:45:23,880 TROUBLE FOLLOWING IT, THEY 7983 04:45:23,880 --> 04:45:25,360 CALLED THE NAVIGATOR WHO THEN 7984 04:45:25,360 --> 04:45:26,800 CALLED US TO SAY, HELP US, WE 7985 04:45:26,800 --> 04:45:28,000 WANT TO FOLLOW THESE 7986 04:45:28,000 --> 04:45:35,960 RECOMMENDATIONS. 7987 04:45:35,960 --> 04:45:40,360 >>HI, SHA THANK YOU FOR YOUR T. 7988 04:45:40,360 --> 04:45:40,880 THIS WAS GREAT. 7989 04:45:40,880 --> 04:45:43,800 I THINK THAT -- YOU'RE RIGHT, I 7990 04:45:43,800 --> 04:45:45,000 THINK TELEHEALTH CAN REALLY 7991 04:45:45,000 --> 04:45:46,480 INCREASE THE REACH WE HAVE WITH 7992 04:45:46,480 --> 04:45:48,520 PATIENTS IN A WAY. 7993 04:45:48,520 --> 04:45:52,120 BUT I WANTED TO HAVE A QUESTION 7994 04:45:52,120 --> 04:45:54,240 ABOUT WAYS IN WHICH WE CAN 7995 04:45:54,240 --> 04:45:55,040 IMPROVE TELEHEALTH. 7996 04:45:55,040 --> 04:45:57,320 WAS THERE ANY DISCUSSION AMONGST 7997 04:45:57,320 --> 04:45:58,320 YOUR PARTICIPANTS ABOUT HOW TO 7998 04:45:58,320 --> 04:45:59,640 MAKE IT MORE ACCESSIBLE FOR 7999 04:45:59,640 --> 04:46:01,880 PEOPLE WITH DISABILITIES, 8000 04:46:01,880 --> 04:46:03,320 ESPECIALLY FOLKS WHO HAVE 8001 04:46:03,320 --> 04:46:06,160 COGNITIVE DELAY DUE TO TREATMENT 8002 04:46:06,160 --> 04:46:09,400 AND/OR FATIGUE AND WAYS IN WHICH 8003 04:46:09,400 --> 04:46:11,320 WE COULD IMPROVE THAT? 8004 04:46:11,320 --> 04:46:12,960 >>GOOD QUESTION. 8005 04:46:12,960 --> 04:46:14,200 SO TWO THINGS. 8006 04:46:14,200 --> 04:46:16,600 ONE, FOR THE STUDY, WE OFFERED 8007 04:46:16,600 --> 04:46:17,920 ALL PARTICIPANTS WHO WERE 8008 04:46:17,920 --> 04:46:21,880 PARTICIPATING IN TO HAVE LIKE 8009 04:46:21,880 --> 04:46:24,400 LITERALLY AN ONLINE TUTORIAL OF 8010 04:46:24,400 --> 04:46:28,520 HOW TO USE THE SYSTEM, AND SOME 8011 04:46:28,520 --> 04:46:30,560 PEOPLE DID TAKE US UP ON THAT. 8012 04:46:30,560 --> 04:46:32,000 SOME PEOPLE DEFINITELY SAID THAT 8013 04:46:32,000 --> 04:46:33,520 THEY WERE JUST -- IT WAS JUST 8014 04:46:33,520 --> 04:46:39,160 TOO CONFUSING TO THEM SO THAT IS 8015 04:46:39,160 --> 04:46:40,480 ACTUALLY ONE OF THE AREAS WE'RE 8016 04:46:40,480 --> 04:46:42,160 EXPLORING IN OUR FOCUS GROUPS 8017 04:46:42,160 --> 04:46:46,760 THAT ARE GOING ON AS WE SPEAK TO 8018 04:46:46,760 --> 04:46:48,400 SAY OKAY, HOW DO WE MAKE THIS 8019 04:46:48,400 --> 04:46:48,640 SIMPLER? 8020 04:46:48,640 --> 04:46:50,120 AND THERE MAY BE SIMPLER WAYS. 8021 04:46:50,120 --> 04:46:53,120 MAYBE WE NEED TO BE MORE SIMPLE 8022 04:46:53,120 --> 04:46:55,320 AND USE JUST A PHONE AND NOT 8023 04:46:55,320 --> 04:46:56,800 HAVE -- EVEN THOUGH WE THINK THE 8024 04:46:56,800 --> 04:46:58,920 FACE-TO-FACE IS SO IMPORTANT, 8025 04:46:58,920 --> 04:47:00,400 CAN WE USE A PHONE, CAN WE USE 8026 04:47:00,400 --> 04:47:02,400 SOMETHING SIMILAR, LIKE 8027 04:47:02,400 --> 04:47:06,600 FACETIME, WHICH IS EASIER FOR 8028 04:47:06,600 --> 04:47:08,560 MANY PEOPLE THAN ZOOM OR TEAMS, 8029 04:47:08,560 --> 04:47:10,760 INCLUDING ME SOMETIMES. 8030 04:47:10,760 --> 04:47:14,600 ESPECIALLY TEAMS. 8031 04:47:14,600 --> 04:47:17,080 SO -- BUT WE'RE EXPLORING THAT 8032 04:47:17,080 --> 04:47:18,960 IN MORE DEPTH BECAUSE WE KNOW 8033 04:47:18,960 --> 04:47:20,240 THERE ARE BETTER WAS I AND WE 8034 04:47:20,240 --> 04:47:21,800 WANT THEM TO TELL US THE WAYS. 8035 04:47:21,800 --> 04:47:23,000 THE OTHER THING THAT ALSO CAME 8036 04:47:23,000 --> 04:47:24,280 UP WAS WE WERE CONCERNED THAT 8037 04:47:24,280 --> 04:47:26,600 PEOPLE DIDN'T HAVE BROADBAND 8038 04:47:26,600 --> 04:47:28,400 ACCESS OR A DEVICE, AND AS PART 8039 04:47:28,400 --> 04:47:31,160 OF THE STUDY, WE PROVIDED THAT 8040 04:47:31,160 --> 04:47:32,680 TO THE PATIENT SO THAT WAS NOT A 8041 04:47:32,680 --> 04:47:34,320 BARRIER TO THEM PARTICIPATING. 8042 04:47:34,320 --> 04:47:44,560 >>THANK YOU. 8043 04:47:46,120 --> 04:47:47,560 >>THANK YOU. 8044 04:47:47,560 --> 04:47:48,160 EXPANDING ON THE POINT YOU HAD 8045 04:47:48,160 --> 04:47:49,320 ABOUT BROADBAND, THAT'S 8046 04:47:49,320 --> 04:47:49,960 SOMETHING THAT'S REALLY 8047 04:47:49,960 --> 04:47:50,440 IMPORTANT TO ME. 8048 04:47:50,440 --> 04:47:52,640 SO IN CERTAIN SEGMENTS OF RURAL 8049 04:47:52,640 --> 04:47:53,880 ILLINOIS, IT ACTUALLY HAS WORSE 8050 04:47:53,880 --> 04:47:55,400 ACCESS TO INTERNET THAN BEING ON 8051 04:47:55,400 --> 04:47:58,480 A PLANE. 8052 04:47:58,480 --> 04:47:59,720 IF YOU CAN ALL APPRECIATE THAT. 8053 04:47:59,720 --> 04:48:01,080 THERE'S NO RECEPTION. 8054 04:48:01,080 --> 04:48:02,840 AND WE'VE DONE A STUDY WHERE 8055 04:48:02,840 --> 04:48:04,880 WE'VE ASSESSED ACCESS TO 8056 04:48:04,880 --> 04:48:06,200 SMARTPHONES, ACCESS TO DEVICES 8057 04:48:06,200 --> 04:48:06,920 AND THE LIKE. 8058 04:48:06,920 --> 04:48:09,560 PEOPLE HAVE THEM, BUT THEIR 8059 04:48:09,560 --> 04:48:10,960 HOMES AND WHERE THEY'RE LOCATED 8060 04:48:10,960 --> 04:48:12,960 DOES NOT -- LIKE THERE'S NO 8061 04:48:12,960 --> 04:48:13,520 RECEPTION FOR THAT BEAUTIFUL 8062 04:48:13,520 --> 04:48:14,120 PHONE. 8063 04:48:14,120 --> 04:48:16,120 AND RELATED TO THAT, A NUMBER OF 8064 04:48:16,120 --> 04:48:17,440 OUR DIGITAL HEALTH APPS, BECAUSE 8065 04:48:17,440 --> 04:48:19,880 WE WANT THEM TO BE VISUALLY 8066 04:48:19,880 --> 04:48:21,440 APPEALING, WE WANT THEM TO BE 8067 04:48:21,440 --> 04:48:22,960 BEAUTIFUL, WE WANT THEM TO MAYBE 8068 04:48:22,960 --> 04:48:24,560 BE HIGH-TECH, TAKE UP A LOT OF 8069 04:48:24,560 --> 04:48:25,040 DATA. 8070 04:48:25,040 --> 04:48:26,840 SO I AM CURIOUS ABOUT HOW YOUR 8071 04:48:26,840 --> 04:48:30,600 CANCER CENTERS, OUTREACH AND 8072 04:48:30,600 --> 04:48:32,000 ENGAGEMENT TEAM IS WORKING 8073 04:48:32,000 --> 04:48:35,880 TOWARDS OUR ADVOCATING FOR JUST 8074 04:48:35,880 --> 04:48:38,520 WIDESPREAD ACCESS TO BROADBAND 8075 04:48:38,520 --> 04:48:40,400 TO SUPPORT RURAL POPULATIONS. 8076 04:48:40,400 --> 04:48:42,000 BECAUSE ALL CANCER CENTERS 8077 04:48:42,000 --> 04:48:43,080 COMMITTED TO RURAL COMMUNITIES 8078 04:48:43,080 --> 04:48:44,040 SHOULD BE INVOLVED IN THIS 8079 04:48:44,040 --> 04:48:45,120 FIGHT, BECAUSE CURRENTLY ACCESS 8080 04:48:45,120 --> 04:48:48,040 TO DATA IS NOT CONSIDERED A 8081 04:48:48,040 --> 04:48:48,520 RIGHT. 8082 04:48:48,520 --> 04:48:51,320 >>WE COMPLETELY AGREE, AND THE 8083 04:48:51,320 --> 04:48:52,760 TELEHEALTH TEAM AT VANDERBILT IS 8084 04:48:52,760 --> 04:48:54,480 ACTUALLY WORKING VERY CLOSELY, 8085 04:48:54,480 --> 04:48:57,400 TRYING TO ADVOCATE AT THE STATE 8086 04:48:57,400 --> 04:49:01,000 LEGISLATURE LEVEL TO MANDATE 8087 04:49:01,000 --> 04:49:02,000 BROADBAND ACCESS ACROSS OUR 8088 04:49:02,000 --> 04:49:05,240 STATE SO EVERYBODY HAS EQUAL 8089 04:49:05,240 --> 04:49:06,440 ACCESS TO CARE. 8090 04:49:06,440 --> 04:49:08,400 SO WE'RE NOT -- WE HAVEN'T BEEN 8091 04:49:08,400 --> 04:49:11,640 SUCCESSFUL YET, BUT WE ARE 8092 04:49:11,640 --> 04:49:13,040 WORKING ON THAT AND I COMPLETELY 8093 04:49:13,040 --> 04:49:14,280 AGREE THAT THERE NEEDS TO BE 8094 04:49:14,280 --> 04:49:18,960 BETTER WAYS AND WE ACTUALLY -- 8095 04:49:18,960 --> 04:49:21,680 AS WE DESIGN THIS, WE BROUGHT IN 8096 04:49:21,680 --> 04:49:24,160 PEOPLE FROM THESE COMMUNITIES TO 8097 04:49:24,160 --> 04:49:25,520 TRY TO TROUBLESHOOT BEFORE WE 8098 04:49:25,520 --> 04:49:27,080 EVEN STARTED WHAT SOME OF THOSE 8099 04:49:27,080 --> 04:49:28,480 PROBLEMS ARE, AND NOW AS WE GO 8100 04:49:28,480 --> 04:49:29,600 THROUGH OUR FOCUS GROUPS, WE'LL 8101 04:49:29,600 --> 04:49:31,360 BE GETTING MORE INFORMATION, AND 8102 04:49:31,360 --> 04:49:34,640 THEN BRINGING IT BACK REALLY TO 8103 04:49:34,640 --> 04:49:37,280 LEGISLATORS TO SAY WE NEED TO DO 8104 04:49:37,280 --> 04:49:39,240 THIS, YOU KNOW, THIS IS A PLACE 8105 04:49:39,240 --> 04:49:40,000 WHERE MAYBE THE GOVERNMENT NEEDS 8106 04:49:40,000 --> 04:49:43,040 TO STEP IN, AND REALLY HELP 8107 04:49:43,040 --> 04:49:45,040 BUILD BETTER INFRASTRUCTURE 8108 04:49:45,040 --> 04:49:47,280 ACROSS OUR STATES AND ACROSS OUR 8109 04:49:47,280 --> 04:49:47,800 RURAL AREAS. 8110 04:49:47,800 --> 04:49:50,760 I CANNOT AGREE MORE. 8111 04:49:50,760 --> 04:49:53,120 >>I HAVE ONE QUESTION, AND IT 8112 04:49:53,120 --> 04:49:54,200 RELATES TO THE DISTANCE YOU 8113 04:49:54,200 --> 04:49:55,320 SHOWED THAT SOME OF THESE 8114 04:49:55,320 --> 04:49:58,080 PATIENTS COME REALLY FAR TO GET 8115 04:49:58,080 --> 04:50:00,680 IN-PERSON CARE. 8116 04:50:00,680 --> 04:50:02,960 SO IN TERMS OF TAKING UP 8117 04:50:02,960 --> 04:50:04,720 TELEHEALTH, IS THE DISTANCE AN 8118 04:50:04,720 --> 04:50:06,200 IMPORTANT FACTOR OR ARE OTHER 8119 04:50:06,200 --> 04:50:07,600 FACTORS MORE IMPORTANT THAT 8120 04:50:07,600 --> 04:50:08,720 PEOPLE WOULD ENGAGE IN 8121 04:50:08,720 --> 04:50:09,720 TELEHEALTH ?L 8122 04:50:09,720 --> 04:50:16,200 >>SO WHAT WE ACTUALLY HAVE SEEN 8123 04:50:16,200 --> 04:50:18,200 IS, INTERESTINGLY ENOUGH FOR 8124 04:50:18,200 --> 04:50:19,920 CLINICAL CARE, IT THE PATIENTS 8125 04:50:19,920 --> 04:50:22,080 WHO LIVE CLOSEST TO US WHO ARE 8126 04:50:22,080 --> 04:50:22,800 UTILIZING TELEHEALTH MORE THAN 8127 04:50:22,800 --> 04:50:24,640 THE PATIENT WHO LIVE FURTHER 8128 04:50:24,640 --> 04:50:32,560 AWAY FROM US. 8129 04:50:32,560 --> 04:50:33,760 WHICH IS COUNTERINTUITIVE TO 8130 04:50:33,760 --> 04:50:34,720 WHAT WE WOULD THINK. 8131 04:50:34,720 --> 04:50:35,880 NOW THERE ARE CERTAINLY SOME 8132 04:50:35,880 --> 04:50:37,440 THAT LIVE FAR AWAY THAT THINK 8133 04:50:37,440 --> 04:50:38,680 IT'S GREAT, BUT A LOT OF THE 8134 04:50:38,680 --> 04:50:42,800 PATIENTS WH JUST SAY I'M JUST GG 8135 04:50:42,800 --> 04:50:44,120 TO GET IN THE CAR AND I'M JUST 8136 04:50:44,120 --> 04:50:45,120 GOING TO GO. 8137 04:50:45,120 --> 04:50:47,760 SO IT IS VERY INTERESTING THAT 8138 04:50:47,760 --> 04:50:49,440 IT'S NOT NECESSARILY THE PEOPLE 8139 04:50:49,440 --> 04:50:50,800 WHO LIVE FURTHEST AWAY THAT ARE 8140 04:50:50,800 --> 04:50:55,760 TAKING ADVANTAGE OF IT. 8141 04:50:55,760 --> 04:50:57,280 >>I JUST HAD A QUICK QUESTION 8142 04:50:57,280 --> 04:50:58,920 ON THE RELATIONSHIP OF THE 8143 04:50:58,920 --> 04:50:59,920 INSTITUTION WITH THOSE THAT WERE 8144 04:50:59,920 --> 04:51:00,680 FARTHER OUT. 8145 04:51:00,680 --> 04:51:02,520 AND DID YOU HAVE ANY TYPE OF 8146 04:51:02,520 --> 04:51:05,840 MEASUREMENT TO KNOW HOW MUCH 8147 04:51:05,840 --> 04:51:08,400 TRUST OR HOW MUCH THEY HAD EVEN 8148 04:51:08,400 --> 04:51:11,040 INTERACTED WITH VANDERBILT, WITH 8149 04:51:11,040 --> 04:51:13,120 THE INSTITUTION FOR THEM TO EVEN 8150 04:51:13,120 --> 04:51:18,920 THINK ABOUT GETTING SUPPORT? 8151 04:51:18,920 --> 04:51:21,640 >>O OH, THE PATIENTS? 8152 04:51:21,640 --> 04:51:22,440 >>MM-HMM. 8153 04:51:22,440 --> 04:51:24,280 >>SO THESE ARE AFFILIATES. 8154 04:51:24,280 --> 04:51:26,880 WE'VE HAD A 10-YEAR RELATIONSHIP 8155 04:51:26,880 --> 04:51:27,920 WITH THESE INSTITUTIONS, 8156 04:51:27,920 --> 04:51:29,240 INCLUDING BRINGING SOME OF OUR 8157 04:51:29,240 --> 04:51:31,360 PEOPLE OUT THERE, WE BRING 8158 04:51:31,360 --> 04:51:35,120 PROGRAMS OUT THERE ALL THE TIME, 8159 04:51:35,120 --> 04:51:37,120 SO WE HAVE A GOOD RELATIONSHIP 8160 04:51:37,120 --> 04:51:40,560 WITH THESE INSTITUTIONS, AND, 8161 04:51:40,560 --> 04:51:41,360 THEREFORE, WITH THEIR CLINICS. 8162 04:51:41,360 --> 04:51:43,800 AT THE VERY BEGINNING, WE 8163 04:51:43,800 --> 04:51:46,200 ACTUALLY WENT OUT TO THEM, TO 8164 04:51:46,200 --> 04:51:48,960 THE PLACES, AND SET IT UP, THEN 8165 04:51:48,960 --> 04:51:52,320 PANDEMIC HIT AND EVERYTHING SHUT 8166 04:51:52,320 --> 04:51:53,880 DOWN, BUT OUR GOAL NOW IS NOW 8167 04:51:53,880 --> 04:51:55,120 THAT THINGS HAVE SETTLED DOWN, 8168 04:51:55,120 --> 04:51:56,960 IS TO ACTUALLY CIRCLE BACK 8169 04:51:56,960 --> 04:51:59,240 AROUND AND GO TO THE CLINICS 8170 04:51:59,240 --> 04:52:00,800 AGAIN AND TALK TO THE PATIENT 8171 04:52:00,800 --> 04:52:02,080 AND WE'RE HOPEFULLY GOING TO GET 8172 04:52:02,080 --> 04:52:06,040 SOME OF THAT INFORMATION FROM 8173 04:52:06,040 --> 04:52:08,280 THE FOCUS GROUPS TO SEE IF MAYBE 8174 04:52:08,280 --> 04:52:13,120 WE NEEDED TO ESTABLISH MORE. 8175 04:52:13,120 --> 04:52:14,600 THIS WAS HINDERED BY THE FACT 8176 04:52:14,600 --> 04:52:16,640 THAT WE PLAN TO DO MORE IN 8177 04:52:16,640 --> 04:52:19,400 PERSON UP FRONT AND THIS PROJECT 8178 04:52:19,400 --> 04:52:21,040 STARTED VERY SOON AFTER PANDEMIC 8179 04:52:21,040 --> 04:52:26,120 UNFORTUNATELY. 8180 04:52:26,120 --> 04:52:27,320 >>SO THIS WAS OUR LAST 8181 04:52:27,320 --> 04:52:28,840 QUESTION, SO THANK YOU SO MUCH, 8182 04:52:28,840 --> 04:52:29,840 DR. FRIEDMAN, FOR THIS GREAT 8183 04:52:29,840 --> 04:52:30,240 PRESENTATION. 8184 04:52:30,240 --> 04:52:39,880 [APPLAUSE] 8185 04:52:39,880 --> 04:52:42,480 NOW THE SECOND SPEAKER, 8186 04:52:42,480 --> 04:52:43,120 DR. JOSEPHINE FELICIANO. 8187 04:52:43,120 --> 04:52:45,320 SHE'S PROFESSOR OF ONCOLOGY AT 8188 04:52:45,320 --> 04:52:48,960 JOHN HOPKINS AND SHE'S ALSO THE 8189 04:52:48,960 --> 04:52:51,560 MEDICAL DOCTOR FOR -- ONCOLOGY 8190 04:52:51,560 --> 04:52:53,200 PROGRAM AT THE BAY VIEW MEDICAL 8191 04:52:53,200 --> 04:52:55,080 CENTER, AND SHE HAS A 8192 04:52:55,080 --> 04:52:56,360 LONG-STANDING INTEREST IN CANCER 8193 04:52:56,360 --> 04:52:59,800 HEALTH DISPARITIES. 8194 04:52:59,800 --> 04:53:03,640 AND HAS ALSO DONE SOME WORK ON 8195 04:53:03,640 --> 04:53:05,040 TELEHEALTH ISSUES IN THE COVID 8196 04:53:05,040 --> 04:53:05,240 AREA. 8197 04:53:05,240 --> 04:53:06,960 THANK YOU SO MUCH FOR COMING AND 8198 04:53:06,960 --> 04:53:10,280 TELLING US ABOUT YOUR EXPERIENCE 8199 04:53:10,280 --> 04:53:13,120 WITH TELEHEALTH AND HEALTH 8200 04:53:13,120 --> 04:53:21,200 DISPARITIES. 8201 04:53:21,200 --> 04:53:21,880 >>THANK YOU. 8202 04:53:21,880 --> 04:53:23,480 CAN EVERYONE HEAR ME OKAY? 8203 04:53:23,480 --> 04:53:23,960 GREAT. 8204 04:53:23,960 --> 04:53:26,200 SO THANK YOU FOR THE 8205 04:53:26,200 --> 04:53:26,800 INTRODUCTION. 8206 04:53:26,800 --> 04:53:28,520 MY NAME IS JOY FELICIANO. 8207 04:53:28,520 --> 04:53:30,320 I'M A MEDICAL THORACIC 8208 04:53:30,320 --> 04:53:30,880 ONCOLOGIST. 8209 04:53:30,880 --> 04:53:33,960 I CONSIDER MYSELF MOSTLY A 8210 04:53:33,960 --> 04:53:35,240 CLINICIAN, AND I AM VERY HUMBLED 8211 04:53:35,240 --> 04:53:37,840 TO BE INVITED TO GIVE THIS TALK 8212 04:53:37,840 --> 04:53:38,840 TODAY. 8213 04:53:38,840 --> 04:53:40,480 I'M HOPING THAT WITH SOME OF THE 8214 04:53:40,480 --> 04:53:43,120 DATA THAT I PRESENT, I CAN SORT 8215 04:53:43,120 --> 04:53:46,120 OF GIVE A MORE PERSONAL SLANT ON 8216 04:53:46,120 --> 04:53:47,720 WHY ALL OF THE WORK THAT YOU'RE 8217 04:53:47,720 --> 04:53:50,040 DOING AND ALL OF THE 8218 04:53:50,040 --> 04:53:50,720 COLLABORATIONS THAT WE'RE 8219 04:53:50,720 --> 04:53:52,640 FORMING ACTUALLY IMPACT THE 8220 04:53:52,640 --> 04:53:55,560 PATIENTS I SEE, OUR FAMILY 8221 04:53:55,560 --> 04:53:56,960 MEMBERS, AND ALL THE PEOPLE THAT 8222 04:53:56,960 --> 04:53:59,280 MIGHT BE AFFECTED BY HEALTH 8223 04:53:59,280 --> 04:54:03,560 INEQUITIES. 8224 04:54:03,560 --> 04:54:04,960 TODAY I'LL TALK A LITTLE BIT 8225 04:54:04,960 --> 04:54:06,440 ABOUT TELEMEDICINE ENGAGEMENT TO 8226 04:54:06,440 --> 04:54:07,640 REDUCE DISPARITIES, BUT ALSO 8227 04:54:07,640 --> 04:54:09,080 WANTED TO FOCUS ON OUR 8228 04:54:09,080 --> 04:54:11,640 EXPERIENCE DURING THE COVID 8229 04:54:11,640 --> 04:54:13,280 PANDEMIC IN THE VERY BEGINNING 8230 04:54:13,280 --> 04:54:16,280 TO ALSO EMPHASIZE WHAT CAN GO 8231 04:54:16,280 --> 04:54:18,680 WRONG WHEN WE CAN'T THOUGHTFULLY 8232 04:54:18,680 --> 04:54:19,720 IMPLEMENT SOME OF THE 8233 04:54:19,720 --> 04:54:22,920 INTERVENTIONS THAT WE'RE TRYING. 8234 04:54:22,920 --> 04:54:24,520 SO I'LL GO OVER TELEHEALTH 8235 04:54:24,520 --> 04:54:25,440 ENGAGEMENT AND THE 8236 04:54:25,440 --> 04:54:26,880 OPPORTUNITIES, KIND OF EXPAND ON 8237 04:54:26,880 --> 04:54:28,080 SOME OF THE WORK THAT HAS 8238 04:54:28,080 --> 04:54:29,640 ALREADY BEEN DISCUSSED, BUT THEN 8239 04:54:29,640 --> 04:54:31,200 ALSO FOCUS ON SOME OF THE 8240 04:54:31,200 --> 04:54:34,400 CHALLENGES THAT WE HAVE FACED, 8241 04:54:34,400 --> 04:54:36,200 AND I THINK MANY CLINICIANS ARE 8242 04:54:36,200 --> 04:54:40,160 FACING WITH IMPLEMENTATION OF 8243 04:54:40,160 --> 04:54:41,440 TELEHEALTH, TALK A LITTLE BIT 8244 04:54:41,440 --> 04:54:44,080 ABOUT OUR EXPERIENCE AND TO 8245 04:54:44,080 --> 04:54:45,440 SOMEONE'S QUESTION ABOUT 8246 04:54:45,440 --> 04:54:47,880 ASSOCIATION WITH CANCER 8247 04:54:47,880 --> 04:54:51,920 OUTCOMES, TRYING TO SHOW THAT 8248 04:54:51,920 --> 04:54:53,160 OUR LIMITED ACCESS OR A 8249 04:54:53,160 --> 04:54:57,720 PATIENT'S INABILITY TO ACCESS 8250 04:54:57,720 --> 04:54:59,000 CARE MAY INDEED HAVE AN 8251 04:54:59,000 --> 04:55:00,200 IMPORTANT IMPACT NEGATIVELY ON 8252 04:55:00,200 --> 04:55:02,000 CANCER OUTCOMES, AND THEN 8253 04:55:02,000 --> 04:55:02,720 CONSIDERATIONS FOR PRACTICE AND 8254 04:55:02,720 --> 04:55:04,960 POLICY FOR IMPLEMENTATION AND 8255 04:55:04,960 --> 04:55:07,080 EXPANSION OF TELEHEALTH IN A 8256 04:55:07,080 --> 04:55:08,840 FAIR AND EQUITABLE WAY. 8257 04:55:08,840 --> 04:55:11,240 SO AS WE'VE ALL TALKED ABOUT AND 8258 04:55:11,240 --> 04:55:13,640 SEEN, DISPARITIES IN ONCOLOGY 8259 04:55:13,640 --> 04:55:15,520 CAN IMPACT ALL PHASES OF THE 8260 04:55:15,520 --> 04:55:17,480 CANCER SPECTRUM, FROM RISK 8261 04:55:17,480 --> 04:55:20,480 FACTORS OF DEVELOPING CANCER TO 8262 04:55:20,480 --> 04:55:23,280 SCREENING, DIAGNOSIS, TREATMENT, 8263 04:55:23,280 --> 04:55:24,440 AND ULTIMATELY AFFECTING CANCER 8264 04:55:24,440 --> 04:55:26,920 OUTCOMES SUCH AS SURVIVAL. 8265 04:55:26,920 --> 04:55:28,600 AND WHILE TELEHEALTH BEGAN AS A 8266 04:55:28,600 --> 04:55:30,480 WAY TO INCREASE ACCESS TO CARE 8267 04:55:30,480 --> 04:55:36,560 FROM A DISTANCE, AND TO IDEALLY 8268 04:55:36,560 --> 04:55:37,560 EXPAND CARE FOR PEOPLE WHO MAY 8269 04:55:37,560 --> 04:55:39,560 NOT HAVE ACCESS, WE HAVE SEEN 8270 04:55:39,560 --> 04:55:41,520 SOME CHALLENGES. 8271 04:55:41,520 --> 04:55:43,320 SOME OF THE WAYS THAT WE 8272 04:55:43,320 --> 04:55:45,000 THINK -- OR THAT WE'VE SEEN 8273 04:55:45,000 --> 04:55:46,480 TELEMEDICINE CAN POTENTIALLY 8274 04:55:46,480 --> 04:55:49,120 REDUCE DISPARITIES IS TO 8275 04:55:49,120 --> 04:55:50,480 INCREASE COMMUNICATION BETWEEN 8276 04:55:50,480 --> 04:55:53,400 CENTERS WITH DIFFERENT RESOUR 8277 04:55:53,400 --> 04:55:54,240 RESOURCES, SO FOR EXAMPLE, 8278 04:55:54,240 --> 04:55:55,280 DISCUSSIONS OF THE MOLECULAR 8279 04:55:55,280 --> 04:55:57,760 TUMOR BOARD THAT DR. FRIEDMAN IS 8280 04:55:57,760 --> 04:55:58,240 STUDYING. 8281 04:55:58,240 --> 04:56:00,240 ACCESS TO SUBSPECIALTY CARE, 8282 04:56:00,240 --> 04:56:01,840 SIMILARLY WITH THE MOLECULAR 8283 04:56:01,840 --> 04:56:04,240 TUMOR BOARDS. 8284 04:56:04,240 --> 04:56:06,760 EDUCATION AND SCREENING, AND 8285 04:56:06,760 --> 04:56:09,720 THEN ALSO ACCESS TO CLINICAL 8286 04:56:09,720 --> 04:56:11,320 TRIALS, AS WE'RE ALL TRYING TO 8287 04:56:11,320 --> 04:56:13,760 EXPAND OUR REACH. 8288 04:56:13,760 --> 04:56:18,400 NOW THERE ARE WAYS THAT IMPROVED 8289 04:56:18,400 --> 04:56:21,160 ACCESS TO TELEMEDICINE FOR LOW 8290 04:56:21,160 --> 04:56:24,040 RESOURCE SITES IN SUBSPECIALTY 8291 04:56:24,040 --> 04:56:25,720 CARE CAN IMPROVE CANCER 8292 04:56:25,720 --> 04:56:27,920 SCREENING, FOR EXAMPLE, AND 8293 04:56:27,920 --> 04:56:28,200 DIAGNOSIS. 8294 04:56:28,200 --> 04:56:32,040 SO SOME EXAMPLES OF THIS, IN 8295 04:56:32,040 --> 04:56:34,200 TANZANIA, THERE'S A PROGRAM 8296 04:56:34,200 --> 04:56:36,400 USING TRANSMISSION OF DIGITAL 8297 04:56:36,400 --> 04:56:39,760 IMAGES FOR A PROGRAM CALLED "MY 8298 04:56:39,760 --> 04:56:45,760 SKIN," WHERE PARENTS WITH A 8299 04:56:45,760 --> 04:56:47,320 ALBINISM, A VERY STIGMATIZED 8300 04:56:47,320 --> 04:56:49,000 CONDITION IN TANZANIA, CAN BE 8301 04:56:49,000 --> 04:56:50,360 SCANNED FOR SKIN CANCER AND 8302 04:56:50,360 --> 04:56:52,480 THOSE IMAGES CAN BE TRANSMITTED 8303 04:56:52,480 --> 04:56:53,800 TO SUBSPECIALISTS. 8304 04:56:53,800 --> 04:56:54,640 SIMILARLY, THERE'S PROGRAMS 8305 04:56:54,640 --> 04:56:57,640 WHERE DIGITAL IMAGING, FOR 8306 04:56:57,640 --> 04:57:00,040 EXAMPLE, OF CERVICAL CANCER 8307 04:57:00,040 --> 04:57:02,520 SCREENING AND PAP SMEARS CAN BE 8308 04:57:02,520 --> 04:57:03,920 EVALUATED CENTRALLY TO IMPROVE 8309 04:57:03,920 --> 04:57:07,240 THE DIAGNOSIS OF CERVICAL CANCER 8310 04:57:07,240 --> 04:57:07,640 SCREENING. 8311 04:57:07,640 --> 04:57:09,600 AND A LITTLE BIT CLOSER TO HOME 8312 04:57:09,600 --> 04:57:14,280 IN PHILADELPHIA, FOR EXAMPLE, 8313 04:57:14,280 --> 04:57:16,480 DR. IRKMAN, WHO'S A THORACIC 8314 04:57:16,480 --> 04:57:19,680 SURGEON IN PHILADELPHIA, HAD 8315 04:57:19,680 --> 04:57:21,400 IMPLEMENTED A SINGLE SCREENING 8316 04:57:21,400 --> 04:57:23,840 FOR LUNG CANCER FOR PATIENTS 8317 04:57:23,840 --> 04:57:26,880 DURING THE COVID PANDEMIC AND 8318 04:57:26,880 --> 04:57:29,920 SHOWED THAT ALTHOUGH THE TOTAL 8319 04:57:29,920 --> 04:57:32,040 NUMBERS OF LUNG CANCER SCREENING 8320 04:57:32,040 --> 04:57:35,040 WAS REDUCED BY TELEHEALTH VERSUS 8321 04:57:35,040 --> 04:57:37,440 IN PERSON, OF THE PEOPLE WHO 8322 04:57:37,440 --> 04:57:39,360 WERE SCREENED FOR LUNG CANCER, 8323 04:57:39,360 --> 04:57:42,960 THEY SHOWED SIMILAR RATES OF 8324 04:57:42,960 --> 04:57:45,920 STAGE OF CANCER DIAGNOSIS, 8325 04:57:45,920 --> 04:57:47,560 POSITIVE SCREEN RATES, ET 8326 04:57:47,560 --> 04:57:48,760 CETERA, DEMONSTRATING THE 8327 04:57:48,760 --> 04:57:50,640 FEASIBILITY THAT TELEHEALTH CAN 8328 04:57:50,640 --> 04:57:51,920 ALLOW FOR SOME OF THESE 8329 04:57:51,920 --> 04:57:56,400 SCREENING OPPORTUNITIES. 8330 04:57:56,400 --> 04:57:57,520 TELEHEALTH CAN ALSO ALLOW FOR 8331 04:57:57,520 --> 04:57:59,160 ACCESS TO SUBSPECIALTY CARE AND 8332 04:57:59,160 --> 04:58:00,560 CONSOLIDATION OF CARE, 8333 04:58:00,560 --> 04:58:02,720 PARTICULARLY FOR THINGS SUCH AS 8334 04:58:02,720 --> 04:58:04,440 RARE CANCERS, SO FOR EXAMPLE, 8335 04:58:04,440 --> 04:58:07,400 THE ROYAL MARSTON HOSPITAL IS A 8336 04:58:07,400 --> 04:58:08,840 SPECIALTY SITE FOR SARCOMA 8337 04:58:08,840 --> 04:58:11,080 MANAGEMENT AND TREATMENT IN THE 8338 04:58:11,080 --> 04:58:13,720 U.K., AND WHAT THEY SHOWED IS 8339 04:58:13,720 --> 04:58:18,560 THAT PATIENTS WHO WERE OPEN TO 8340 04:58:18,560 --> 04:58:19,840 TELEHEALTHCARE AT A DISTANCE HAD 8341 04:58:19,840 --> 04:58:22,360 HIGH LEVELS OF SATISFACTION, AIM 8342 04:58:22,360 --> 04:58:23,960 SORRY IT'S A SMALL GRAPH, BUT 8343 04:58:23,960 --> 04:58:26,960 THESE ARE SORT OF THE SURVEYS OF 8344 04:58:26,960 --> 04:58:29,000 PATIENT EXPERIENCE AND THEIR 8345 04:58:29,000 --> 04:58:30,680 SATISFACTION WITH TELEHEALTHCARE 8346 04:58:30,680 --> 04:58:41,120 FOR FOLLOW-UP OF SARCOMAS. 8347 04:58:42,720 --> 04:58:43,440 THERE'S GUIDELINES BY MENTORING 8348 04:58:43,440 --> 04:58:48,600 AND SUPPORTING OTHER CLINICIANS. 8349 04:58:48,600 --> 04:58:50,280 FOR EXAMPLE, THIS IS A 8350 04:58:50,280 --> 04:58:51,680 TELEMEDICINE MENTORING APPROACH 8351 04:58:51,680 --> 04:58:53,960 CALLED PROJECT ECHO, WHICH 8352 04:58:53,960 --> 04:58:57,960 ALLOWS FOR DIDACTIC AND TEACHING 8353 04:58:57,960 --> 04:59:00,760 SESSIONS FOR CASE PRESENTATIONS 8354 04:59:00,760 --> 04:59:05,880 FOR CANCER, FOR SMALLER CANCER 8355 04:59:05,880 --> 04:59:08,680 CENTERS IN THE COMMUNITY TO WORK 8356 04:59:08,680 --> 04:59:10,240 WITH ACADEMIC CANCER SITES TO 8357 04:59:10,240 --> 04:59:13,120 DISCUSS TUMORS, DISCUSS CASES, 8358 04:59:13,120 --> 04:59:16,280 AND UNDERSTAND WHAT GUIDELINE 8359 04:59:16,280 --> 04:59:17,080 CONCORDANT RECOMMENDATIONS MIGHT 8360 04:59:17,080 --> 04:59:18,600 BE. 8361 04:59:18,600 --> 04:59:23,720 AND THEN FINALLY, WE ALSO SEE 8362 04:59:23,720 --> 04:59:24,400 THAT TELEHEALTH HAS AN 8363 04:59:24,400 --> 04:59:26,320 OPPORTUNITY TO PROVIDE ACCESS TO 8364 04:59:26,320 --> 04:59:26,960 CLINICAL TRIALS. 8365 04:59:26,960 --> 04:59:28,760 ONE OF OUR CHALLENGES AS 8366 04:59:28,760 --> 04:59:31,480 CLINICAL INVESTIGATORS IS THAT 8367 04:59:31,480 --> 04:59:32,600 OFTENTIMES WE'RE STRUGGLING WITH 8368 04:59:32,600 --> 04:59:35,440 HOW DO WE BRING THE RESEARCH TO 8369 04:59:35,440 --> 04:59:38,600 OUR PATIENTS SO ONE EXAMPLE OF 8370 04:59:38,600 --> 04:59:40,960 THIS IS THE AUSTRALIAN MODEL, 8371 04:59:40,960 --> 04:59:41,840 TELETRIAL MODEL WHERE THEY'RE 8372 04:59:41,840 --> 04:59:44,240 USING A HUB AND SPOKE MODEL OF 8373 04:59:44,240 --> 04:59:45,760 THE HUB BEING THE PRIMARY SITE 8374 04:59:45,760 --> 04:59:48,240 FOR THE CLINICAL TRIAL, BUT THEN 8375 04:59:48,240 --> 04:59:52,200 PATIENTS CAN BE TREATED AND 8376 04:59:52,200 --> 04:59:54,240 EVALUATED IN SATELLITE SITES 8377 04:59:54,240 --> 04:59:56,320 WITH ALL OF THE INFORMATION AND 8378 04:59:56,320 --> 04:59:58,920 FEEDBACK COMING BACK TO THAT HUB 8379 04:59:58,920 --> 05:00:07,560 FOR DISCUSSION AND ASSESSMENT. 8380 05:00:07,560 --> 05:00:08,440 THERE'S ALSO BEEN EXAMPLES WHERE 8381 05:00:08,440 --> 05:00:09,560 CLINICAL TRIAL ACCRUAL HAS BEEN 8382 05:00:09,560 --> 05:00:11,200 SHOWN TO BE FEASIBLE, SO THIS 8383 05:00:11,200 --> 05:00:14,720 STUDY, FOR EXAMPLE, IN PATIENTS 8384 05:00:14,720 --> 05:00:16,440 WHO ARE OFFERED TELEHEALTH 8385 05:00:16,440 --> 05:00:18,240 VERSUS IN-PERSON FOR AN INITIAL 8386 05:00:18,240 --> 05:00:21,560 BREAST CANCER CONSULTATION 8387 05:00:21,560 --> 05:00:22,760 DURING A PERIOD WHERE THERE WAS 8388 05:00:22,760 --> 05:00:24,360 A PROSPECTIVE STUDY SHOWED THAT 8389 05:00:24,360 --> 05:00:26,440 DESPITE THE DIFFERENCES IN 8390 05:00:26,440 --> 05:00:28,960 PREFERENCE BETWEEN TELEHEALTH 8391 05:00:28,960 --> 05:00:33,760 AND IN PERSON VISITS, PATIENTS 8392 05:00:33,760 --> 05:00:35,480 WHO WERE OFFERED THIS TRIAL 8393 05:00:35,480 --> 05:00:36,560 ENROLLED AT SIMILAR RATES 8394 05:00:36,560 --> 05:00:38,000 WHETHER IT WAS TELEHEALTH VERSUS 8395 05:00:38,000 --> 05:00:38,440 IN PERSON. 8396 05:00:38,440 --> 05:00:40,200 SO AGAIN KIND OF DEMONSTRATING 8397 05:00:40,200 --> 05:00:42,040 THAT CLINICAL TRIAL 8398 05:00:42,040 --> 05:00:43,240 OPPORTUNITIES EXIST WITH THE 8399 05:00:43,240 --> 05:00:50,560 EXPANSION OF TELEHEALTH. 8400 05:00:50,560 --> 05:00:51,840 WHICH FEEL MANY OF THESE 8401 05:00:51,840 --> 05:00:52,960 INTERVENTIONS MIGHT BE HELPING 8402 05:00:52,960 --> 05:00:53,680 PATIENTS IN WAYS THAT MIGHT BE 8403 05:00:53,680 --> 05:00:56,040 DIFFICULT TO QUANTIFY, SUCH AS 8404 05:00:56,040 --> 05:00:57,880 INCLUSION OF FAMILY AND 8405 05:00:57,880 --> 05:00:58,480 CAREGIVERS, INCREASING 8406 05:00:58,480 --> 05:01:00,320 SUPPORTIVE CARE, REDUCING TRAVEL 8407 05:01:00,320 --> 05:01:00,760 TIME. 8408 05:01:00,760 --> 05:01:03,320 MANY OF OUR PATIENTS EXPERIENCE, 8409 05:01:03,320 --> 05:01:05,600 YOU KNOW, FINANCIAL CHALLENGES 8410 05:01:05,600 --> 05:01:06,800 AND THE EXPENSE OF GOING BACK 8411 05:01:06,800 --> 05:01:08,680 AND FORTH TO DIFFERENT CLINICS 8412 05:01:08,680 --> 05:01:10,560 OR DIFFERENT APPOINTMENTS CAN 8413 05:01:10,560 --> 05:01:12,560 POTENTIALLY BE REDUCED WITH THE 8414 05:01:12,560 --> 05:01:13,920 EXPANSION OF TELEHEALTH. 8415 05:01:13,920 --> 05:01:15,760 AND SO THERE'S MANY 8416 05:01:15,760 --> 05:01:20,840 OPPORTUNITIES TO SHOW THAT CAN O 8417 05:01:20,840 --> 05:01:22,040 CARE, BUT I WANTED TO TALK A 8418 05:01:22,040 --> 05:01:25,160 LITTLE BIT ABOUT THE BARRIERS TO 8419 05:01:25,160 --> 05:01:26,680 THE IMPLEMENTATION AND 8420 05:01:26,680 --> 05:01:27,480 ENGAGEMENT, PARTICULARLY THAT 8421 05:01:27,480 --> 05:01:28,640 WE'VE SEEN DURING COVID, WHEN 8422 05:01:28,640 --> 05:01:30,640 MOST OF US HAD TO RAPIDLY EXPAND 8423 05:01:30,640 --> 05:01:34,720 THE USE OF TELEHEALTH. 8424 05:01:34,720 --> 05:01:36,280 SO SOME OF THE POTENTIAL 8425 05:01:36,280 --> 05:01:37,760 BARRIERS THAT WE'LL TALK ABOUT 8426 05:01:37,760 --> 05:01:41,600 WAS THAT RAPID IMPLEMENTATION 8427 05:01:41,600 --> 05:01:43,360 REALLY EXACERBATED AND 8428 05:01:43,360 --> 05:01:45,160 HIGHLIGHTED CURRENT DISPARITIES. 8429 05:01:45,160 --> 05:01:46,600 SO THESE WEREN'T NECESSARILY 8430 05:01:46,600 --> 05:01:47,440 DISPARITIES THAT JUST DEVELOPED, 8431 05:01:47,440 --> 05:01:49,120 BUT RATHER THAT THESE 8432 05:01:49,120 --> 05:01:50,120 HIGHLIGHTED WHAT WE ALREADY KNEW 8433 05:01:50,120 --> 05:01:50,840 WAS THERE. 8434 05:01:50,840 --> 05:01:55,800 SOME OF THAT'S RELATED TO LOW 8435 05:01:55,800 --> 05:01:57,200 UPTAKE, THE DIGITAL DIVIDE WHICH 8436 05:01:57,200 --> 05:02:00,680 IS KIND OF A COMPOSITE SCORE AS 8437 05:02:00,680 --> 05:02:05,280 WELL AS BROADBAND ACCESS AND 8438 05:02:05,280 --> 05:02:06,320 WIFI ACCESS. 8439 05:02:06,320 --> 05:02:09,320 AND WHAT WE SAW AND WHAT MANY 8440 05:02:09,320 --> 05:02:11,680 CENTERS SAW DURING COVID WAS 8441 05:02:11,680 --> 05:02:13,640 THAT COVID RESULTED IN A RAPID 8442 05:02:13,640 --> 05:02:14,960 IMPLEMENTATION OF TELEHEALTH. 8443 05:02:14,960 --> 05:02:17,760 YOU CAN SEE HERE THIS IS FROM 8444 05:02:17,760 --> 05:02:19,960 THE UNIVERSITY OF MICHIGAN, 8445 05:02:19,960 --> 05:02:21,600 WHERE THEY EVALUATED ALL OF THE 8446 05:02:21,600 --> 05:02:23,800 VISITS IN THE ONCOLOGY CENTER, 8447 05:02:23,800 --> 05:02:27,160 BOTH MEDICAL ONCOLOGY, RADIATION 8448 05:02:27,160 --> 05:02:28,200 ONCOLOGY, SURGICAL ONCOLOGY, AND 8449 05:02:28,200 --> 05:02:32,960 YOU CAN SEE THAT BETWEEN MARCH, 8450 05:02:32,960 --> 05:02:34,280 ESSENTIALLY MID MARCH, ALL OF A 8451 05:02:34,280 --> 05:02:35,760 SUDDEN YOU WENT FROM ZERO 8452 05:02:35,760 --> 05:02:38,000 TELEHEALTH VISITS TO, YOU KNOW, 8453 05:02:38,000 --> 05:02:40,920 HUNDREDS OF -- AND THOUSANDS OF 8454 05:02:40,920 --> 05:02:42,000 TELEHEALTH VISITS AT A TIME. 8455 05:02:42,000 --> 05:02:43,440 AND WHAT THESE INVESTIGATORS 8456 05:02:43,440 --> 05:02:45,520 WANTED TO IDENTIFY WERE SOME OF 8457 05:02:45,520 --> 05:02:48,000 THE BARRIERS OR CLINICAL AND 8458 05:02:48,000 --> 05:02:50,520 DEMOGRAPHIC FACTORS THAT WERE 8459 05:02:50,520 --> 05:02:52,360 ASSOCIATED WITH THE SUCCESS OF A 8460 05:02:52,360 --> 05:02:54,440 TELEHEALTH VISIT. 8461 05:02:54,440 --> 05:02:56,880 AND AS MANY PEOPLE HAVE 8462 05:02:56,880 --> 05:03:01,680 IDENTIFIED, THEY ALSO FOUND THAT 8463 05:03:01,680 --> 05:03:03,760 RACE, RURAL POPULATIONS, 8464 05:03:03,760 --> 05:03:07,120 INSURANCE STATUS, PARTICULARLY 8465 05:03:07,120 --> 05:03:09,960 MEDICAID OR MEDICARE INSURANCE, 8466 05:03:09,960 --> 05:03:12,480 WAS ASSOCIATED WITH A LOWER 8467 05:03:12,480 --> 05:03:15,000 LIKELIHOOD OR A HIGHER ODDS OF 8468 05:03:15,000 --> 05:03:16,280 AN UNSUCCESSFUL TELEHEALTH 8469 05:03:16,280 --> 05:03:18,360 VISIT. 8470 05:03:18,360 --> 05:03:19,680 SO HIGHLIGHTING SOME OF THE 8471 05:03:19,680 --> 05:03:20,760 DISPARITIES THAT MANY OF YOU 8472 05:03:20,760 --> 05:03:23,440 HAVE ALSO SHOWN IN YOUR WORK. 8473 05:03:23,440 --> 05:03:25,600 FROM A CLINICAL AND HEALTH 8474 05:03:25,600 --> 05:03:26,960 SYSTEM STANDPOINT, WE SAW A LOT 8475 05:03:26,960 --> 05:03:28,600 OF BARRIERS. 8476 05:03:28,600 --> 05:03:29,880 MANY OF THE CLINIC WORKFLOWS 8477 05:03:29,880 --> 05:03:32,040 WERE DESIGNED FOR IN-PERSON 8478 05:03:32,040 --> 05:03:35,080 VISITS, SO THINGS, FOR EXAMPLE, 8479 05:03:35,080 --> 05:03:37,400 VITAL SIGNS, THOSE WERE DESIGNED 8480 05:03:37,400 --> 05:03:39,120 FOR IN PERSON. 8481 05:03:39,120 --> 05:03:41,000 MEDICAL RECONCILIATIONS, THE 8482 05:03:41,000 --> 05:03:42,880 SYSTEMS CAN BE COMPLEX. 8483 05:03:42,880 --> 05:03:44,920 SOMETIMES OUR CARE INVOLVES -- I 8484 05:03:44,920 --> 05:03:47,560 HAVE, FOR EXAMPLE, A 8485 05:03:47,560 --> 05:03:48,440 MULTIDISCIPLINARY CLINIC WHERE 8486 05:03:48,440 --> 05:03:51,800 WE HAVE RADIATION ONCOLOGY, 8487 05:03:51,800 --> 05:03:53,360 PALLIATIVE CARE, PULMONARY, ALL 8488 05:03:53,360 --> 05:03:54,560 IN ONE CLINIC, AND SOMETIMES 8489 05:03:54,560 --> 05:03:55,960 THESE VISIT MIGHT BE 8490 05:03:55,960 --> 05:03:59,120 REQUIRING -- OR MIGHT BE 8491 05:03:59,120 --> 05:04:01,760 IMPACTING MULTIPLE VISITS AT ONE 8492 05:04:01,760 --> 05:04:02,120 TIME. 8493 05:04:02,120 --> 05:04:04,480 THEY ALSO REQUIRE ACCESS IN 8494 05:04:04,480 --> 05:04:07,920 DIGITAL LITERACY. 8495 05:04:07,920 --> 05:04:09,440 IN TERMS OF POPULATION 8496 05:04:09,440 --> 05:04:10,760 READINESS, WE SAW THAT MANY OF 8497 05:04:10,760 --> 05:04:11,840 OUR PATIENTS WEREN'T READY FOR 8498 05:04:11,840 --> 05:04:13,480 THE IMPLEMENTATION OF 8499 05:04:13,480 --> 05:04:14,760 TELEHEALTH, PARTICULARLY OLDER 8500 05:04:14,760 --> 05:04:16,680 PATIENT POPULATIONS, OR THOSE 8501 05:04:16,680 --> 05:04:18,400 WHO ARE LACKING BROADBAND AND 8502 05:04:18,400 --> 05:04:19,560 INTERNET ACCESS. 8503 05:04:19,560 --> 05:04:21,200 AND THEN TO SOMEONE'S POINT 8504 05:04:21,200 --> 05:04:22,640 ABOUT PATIENTS WITH OTHER NEEDS, 8505 05:04:22,640 --> 05:04:25,480 THERE WERE CHALLENGES WITH 8506 05:04:25,480 --> 05:04:28,760 THINGS SUCH AT HEARING IMPAIRED 8507 05:04:28,760 --> 05:04:30,360 OPPORTUNITIES OR TRANSLATORS 8508 05:04:30,360 --> 05:04:32,640 AVAILABLE BY TELEHEALTH, FURTHER 8509 05:04:32,640 --> 05:04:34,000 SORT OF ALIENATING SOME OF THESE 8510 05:04:34,000 --> 05:04:36,280 PATIENTS. 8511 05:04:36,280 --> 05:04:37,800 AND ALSO WHAT WE SAW IS THAT AT 8512 05:04:37,800 --> 05:04:39,240 A POLICY LEVEL, THERE WERE 8513 05:04:39,240 --> 05:04:42,240 FACTORS THAT REALLY HELPED TO 8514 05:04:42,240 --> 05:04:43,920 WIDEN THESE DISPARITIES. 8515 05:04:43,920 --> 05:04:45,680 FOR EXAMPLE, REIMBURSEMENT 8516 05:04:45,680 --> 05:04:47,640 MODELS REALLY PRIORITIZE 8517 05:04:47,640 --> 05:04:51,760 IN-PERSON VISITS. 8518 05:04:51,760 --> 05:04:53,720 I, FOR EXAMPLE, AS A PHYSICIAN 8519 05:04:53,720 --> 05:04:56,080 AT A CLINIC, WE'RE REALLY 8520 05:04:56,080 --> 05:04:57,120 ENCOURAGED TO AVOID TELEHEALTH 8521 05:04:57,120 --> 05:04:58,520 BECAUSE IT DOESN'T GET 8522 05:04:58,520 --> 05:05:00,200 REIMBURSED IN THE SAME WAY, WE 8523 05:05:00,200 --> 05:05:01,760 CAN'T CHARGE THE SAME SORT OF 8524 05:05:01,760 --> 05:05:03,160 FACILITY FEES, WHICH ALSO HAVE 8525 05:05:03,160 --> 05:05:06,560 IMPACT ON THE RESOURCES FOR THE 8526 05:05:06,560 --> 05:05:07,720 HOSPITAL, AS WELL AS LOWER 8527 05:05:07,720 --> 05:05:09,000 REIMBURSEMENT FOR AUDIO VISITS. 8528 05:05:09,000 --> 05:05:11,160 SO THERE'S A LACK OF PARITY FOR 8529 05:05:11,160 --> 05:05:15,760 THE TYPE OF TELEHEALTH 8530 05:05:15,760 --> 05:05:16,640 INTERVENTION THAT WE'RE TALKING 8531 05:05:16,640 --> 05:05:16,840 ABOUT. 8532 05:05:16,840 --> 05:05:18,240 SO I WANTED TO BRING IT BACK A 8533 05:05:18,240 --> 05:05:21,560 LITTLE BIT TO A CLINICAL 8534 05:05:21,560 --> 05:05:24,280 EXPERIENCE WITH OUR TELEHEALTH 8535 05:05:24,280 --> 05:05:25,160 EXPERIENCE DURING COVID. 8536 05:05:25,160 --> 05:05:26,760 I THINK IT WAS MARCH 16TH WHERE 8537 05:05:26,760 --> 05:05:27,440 EVERYTHING SHUT DOWN. 8538 05:05:27,440 --> 05:05:28,720 I THOUGHT MY KIDS WOULD JUST 8539 05:05:28,720 --> 05:05:30,600 HAVE A FEW EXTRA DAYS OF SPRING 8540 05:05:30,600 --> 05:05:35,440 BREAK BUT THAT WASN'T THE CASE. 8541 05:05:35,440 --> 05:05:37,520 SO I WANTED TO GIVE YOU AN IMAM 8542 05:05:37,520 --> 05:05:38,520 OF ONE OF MY PATIENTS. 8543 05:05:38,520 --> 05:05:41,280 HE'S A 60-YEAR-OLD BLACK PATIENT 8544 05:05:41,280 --> 05:05:42,600 WHO HAS WELL CONTROLLED HIV. 8545 05:05:42,600 --> 05:05:45,000 HE'S HAD HIV FOR OVER 20 YEARS. 8546 05:05:45,000 --> 05:05:46,520 HE RECEIVES HIS CARE ACROSS TOWN 8547 05:05:46,520 --> 05:05:47,240 AT THE UNIVERSITY OF MARYLAND 8548 05:05:47,240 --> 05:05:48,840 AND IF YOU'RE NOT FAMILIAR WITH 8549 05:05:48,840 --> 05:05:49,800 BALTIMORE, THERE'S EAST 8550 05:05:49,800 --> 05:05:50,920 BALTIMORE AND WEST BALTIMORE, 8551 05:05:50,920 --> 05:05:54,840 AND THERE'S A MAIN ROAD THAT 8552 05:05:54,840 --> 05:05:55,640 SPLITS THE TWO AND UNIVERSITY OF 8553 05:05:55,640 --> 05:05:57,280 MARYLAND IS ON THE OTHER SIDE OF 8554 05:05:57,280 --> 05:05:58,560 THAT ROAD, SO IT CAN BE 8555 05:05:58,560 --> 05:06:00,080 CHALLENGING FOR PATIENTS TO GET 8556 05:06:00,080 --> 05:06:03,480 TO AND FROM THE DIFFERENT SITES. 8557 05:06:03,480 --> 05:06:04,400 HE RELIES ON PUBLIC 8558 05:06:04,400 --> 05:06:05,120 TRANSPORTATION. 8559 05:06:05,120 --> 05:06:05,840 HE RELIES ON A BUS. 8560 05:06:05,840 --> 05:06:06,600 HE LIVES ALONE. 8561 05:06:06,600 --> 05:06:09,200 HE HAS A BROTHER IN NEW JERSEY 8562 05:06:09,200 --> 05:06:10,600 WHO OCCASIONALLY CAN VISIT BUT 8563 05:06:10,600 --> 05:06:12,400 IF YOU RECALL DURING COVID, WE 8564 05:06:12,400 --> 05:06:14,560 COULDN'T HAVE PATIENTS OR PEOPLE 8565 05:06:14,560 --> 05:06:16,200 COME FROM ACROSS STATE. 8566 05:06:16,200 --> 05:06:18,160 HE HAS A FLIP PHONE, AND HE HAS 8567 05:06:18,160 --> 05:06:21,040 NO WIFI ACCESSIBLE DEVICE. 8568 05:06:21,040 --> 05:06:22,640 AND HIS TREATMENT WAS 8569 05:06:22,640 --> 05:06:24,520 CHALLENGING BECAUSE HE WAS 8570 05:06:24,520 --> 05:06:25,920 UNDERGOING DAILY CHEMO RADIATION 8571 05:06:25,920 --> 05:06:28,800 FOR A LOCALLY ADVANCED 8572 05:06:28,800 --> 05:06:31,320 ESOPHAGEAL CANCER, STARTING IN 8573 05:06:31,320 --> 05:06:32,080 FEBRUARY 2020, WHICH MEANT THAT 8574 05:06:32,080 --> 05:06:36,520 HIS TREATMENT WAS GOING ON 8575 05:06:36,520 --> 05:06:38,120 THROUGH MARCH OF 2020, SO HIS 8576 05:06:38,120 --> 05:06:38,840 TREATMENT UNFORTUNATELY HIT 8577 05:06:38,840 --> 05:06:40,040 RIGHT IN THE MIDDLE OF WHEN 8578 05:06:40,040 --> 05:06:41,960 EVERYTHING REALLY SHUT DOWN. 8579 05:06:41,960 --> 05:06:44,560 AND WHAT HAPPENED WITH HIM IS -- 8580 05:06:44,560 --> 05:06:46,760 AND I'LL SHOW SOME OF THE DATA 8581 05:06:46,760 --> 05:06:51,120 LATER, IS THAT HE ENDED UP 8582 05:06:51,120 --> 05:06:52,440 MISSING ALL OF HIS TELEHEALTH 8583 05:06:52,440 --> 05:06:53,000 APPOINTMENTS. 8584 05:06:53,000 --> 05:06:54,400 WE WOULD TRY TO REACH BY 8585 05:06:54,400 --> 05:06:54,720 TELEPHONE. 8586 05:06:54,720 --> 05:06:56,640 HE WAS STILL GETTING HIS 8587 05:06:56,640 --> 05:06:57,720 RADIATION, BUT THEN THERE WASN'T 8588 05:06:57,720 --> 05:07:00,960 THAT SORT OF ASSESSMENT OF HIM 8589 05:07:00,960 --> 05:07:02,040 REGULARLY TO KNOW IF HE WAS 8590 05:07:02,040 --> 05:07:04,880 ACTUALLY DOING OKAY. 8591 05:07:04,880 --> 05:07:08,080 HE ENDED UP IN THE HOSPITAL FOR 8592 05:07:08,080 --> 05:07:09,560 DEHYDRATION AND ENDED UP NEEDING 8593 05:07:09,560 --> 05:07:14,040 A FEEDING TUBE, AND HE'S OKAY 8594 05:07:14,040 --> 05:07:15,160 NOW, BUT IT WAS A VERY 8595 05:07:15,160 --> 05:07:16,120 CHALLENGING PERIOD FOR HIM. 8596 05:07:16,120 --> 05:07:18,880 AND SO SIMILAR TO OTHER 8597 05:07:18,880 --> 05:07:20,800 INVESTIGATORS, OUR EXPERIENCE 8598 05:07:20,800 --> 05:07:21,800 WITH TELEHEALTH WAS VERY SIMILAR 8599 05:07:21,800 --> 05:07:27,400 TO WHAT I SHOWED BEFORE. 8600 05:07:27,400 --> 05:07:29,240 WHERE WE HAD NO TELEHEALTH 8601 05:07:29,240 --> 05:07:31,280 PLATFORM PRIOR TO MARCH OF 2020. 8602 05:07:31,280 --> 05:07:33,760 AND ALL OF A SUDDEN, THIS IS A 8603 05:07:33,760 --> 05:07:37,560 GRAPH OF OUR TOTAL VISITS, SO ON 8604 05:07:37,560 --> 05:07:39,840 AVERAGE, WE HAVE, PRIOR TO 8605 05:07:39,840 --> 05:07:41,160 COVID, OVER A THOUSAND VISITS IN 8606 05:07:41,160 --> 05:07:42,000 OUR CLINIC PER MONTH. 8607 05:07:42,000 --> 05:07:43,680 AND YOU CAN SEE THE ORANGE LINE 8608 05:07:43,680 --> 05:07:46,360 IS THE PERCENTAGE OF 8609 05:07:46,360 --> 05:07:48,600 TELEMEDICINE. 8610 05:07:48,600 --> 05:07:50,320 SO WITHIN A MONTH, WE WENT FROM 8611 05:07:50,320 --> 05:07:53,200 ZERO TO 85% TELEMEDICINE VISITS. 8612 05:07:53,200 --> 05:07:54,600 PREDOMINANTLY THE IN-PERSON 8613 05:07:54,600 --> 05:07:55,720 VISITS, WE WERE TRYING TO DO 8614 05:07:55,720 --> 05:07:57,120 THOSE WHO WERE ON ACTIVE 8615 05:07:57,120 --> 05:07:58,240 THERAPY, BUT IT WAS VERY 8616 05:07:58,240 --> 05:07:58,600 LIMITED. 8617 05:07:58,600 --> 05:08:00,280 WE WERE ALL BEING TOLD, YOU 8618 05:08:00,280 --> 05:08:02,480 KNOW, DON'T COME IN TO CLINIC, 8619 05:08:02,480 --> 05:08:04,320 WE DON'T HAVE ENOUGH PPE, AND SO 8620 05:08:04,320 --> 05:08:05,960 WE REALLY WERE STRUGGLING WITH 8621 05:08:05,960 --> 05:08:07,520 HOW DO WE ACTUALLY IMPLEMENT 8622 05:08:07,520 --> 05:08:08,880 THIS. 8623 05:08:08,880 --> 05:08:11,800 SO WE WANTED TO ALSO LOOK, 8624 05:08:11,800 --> 05:08:15,120 THOUGH, WE KNEW WE WOULD 8625 05:08:15,120 --> 05:08:16,240 PROBABLY IDENTIFY SIMILAR 8626 05:08:16,240 --> 05:08:17,760 DISPARITIES IN TERMS OF 8627 05:08:17,760 --> 05:08:18,400 DEMOGRAPHIC GROUPS WHO MIGHT NOT 8628 05:08:18,400 --> 05:08:19,520 BE ABLE TO ACCESS TELEHEALTH. 8629 05:08:19,520 --> 05:08:21,520 WE WANTED TO ALSO EXPLORE 8630 05:08:21,520 --> 05:08:23,680 WHETHER OR NOT THERE WAS AN 8631 05:08:23,680 --> 05:08:25,200 ASSOCIATION WITH INFERIOR CANCER 8632 05:08:25,200 --> 05:08:26,840 OUTCOMES. 8633 05:08:26,840 --> 05:08:29,600 IT'S A LITTLE BIT CHALLENGING 8634 05:08:29,600 --> 05:08:32,720 SINCE THIS WAS A RETROSPECTIVE 8635 05:08:32,720 --> 05:08:33,720 ANALYSIS IN A SHORT FOLLOW-UP 8636 05:08:33,720 --> 05:08:34,960 TIME PERIOD, BUT WE WANTED TO 8637 05:08:34,960 --> 05:08:37,040 TRY TO LOOK AT SOME OF THE 8638 05:08:37,040 --> 05:08:37,840 SHORT-TERM OUTCOMES THAT MIGHT 8639 05:08:37,840 --> 05:08:40,040 BE IMPORTANT ON LONGER-TERM 8640 05:08:40,040 --> 05:08:40,320 OUTCOMES. 8641 05:08:40,320 --> 05:08:42,480 THINGS SUCH AS HOSPITAL VISITS, 8642 05:08:42,480 --> 05:08:45,520 EMERGENCY ROOM VISITS, WHICH WE 8643 05:08:45,520 --> 05:08:46,680 THINK ARE SIGNS THAT A PATIENT 8644 05:08:46,680 --> 05:08:53,400 MAY NOT BE DOING AS WELL. 8645 05:08:53,400 --> 05:08:55,120 SO WE LOOKED AT ALL OF OUR 8646 05:08:55,120 --> 05:08:56,880 PATIENT VISITS FROM MARCH 1ST TO 8647 05:08:56,880 --> 05:08:57,240 JULY 17, 2020. 8648 05:08:57,240 --> 05:08:59,320 THAT INCLUDED ABOUT 759 PATIENTS 8649 05:08:59,320 --> 05:09:02,000 WITH OVER 2,000 VISITS. 8650 05:09:02,000 --> 05:09:07,000 WE LOOKED AT EACH VISIT AS AN 8651 05:09:07,000 --> 05:09:09,840 ENCOUNTER, SO THERE WERE 679 8652 05:09:09,840 --> 05:09:11,840 IN-PERSON VISITS AND 1352 8653 05:09:11,840 --> 05:09:12,640 TELEHEALTH VISITS. 8654 05:09:12,640 --> 05:09:15,840 AND WE DEFINED A SUCCESSFUL 8655 05:09:15,840 --> 05:09:17,320 TELEHEALTH VISIT BASED ON 8656 05:09:17,320 --> 05:09:19,000 WHETHER OR NOT THE VIDEO WAS 8657 05:09:19,000 --> 05:09:21,440 SUCCESSFUL. 8658 05:09:21,440 --> 05:09:23,360 I MENTION THAT BECAUSE SOME 8659 05:09:23,360 --> 05:09:25,120 STUDIES WILL INCLUDE A TELEPHONE 8660 05:09:25,120 --> 05:09:27,120 ENCOUNTER AS A SUCCESSFUL VISIT. 8661 05:09:27,120 --> 05:09:28,680 WE ELECTED NOT TO INCLUDE THAT 8662 05:09:28,680 --> 05:09:31,440 AS THE REIMBURSEMENT MODEL AND 8663 05:09:31,440 --> 05:09:33,560 THE SORT OF GUIDELINES FOR 8664 05:09:33,560 --> 05:09:35,280 EQUIVALENT CARE WERE TO REALLY 8665 05:09:35,280 --> 05:09:37,560 DO VIDEO AND SO WE COUNTED 8666 05:09:37,560 --> 05:09:39,600 TELEPHONE VISITS AS AN 8667 05:09:39,600 --> 05:09:41,400 UNSUCCESSFUL ATTEMPT. 8668 05:09:41,400 --> 05:09:42,560 AND THE PATIENT SELECTION FOR 8669 05:09:42,560 --> 05:09:45,880 OUR COHORT, YOU CAN SEE WE HAD A 8670 05:09:45,880 --> 05:09:48,640 TOTAL OF 679 IN-PERSON VISITS 8671 05:09:48,640 --> 05:09:50,120 THAT WERE INCLUDED IN THE 8672 05:09:50,120 --> 05:09:55,600 ANALYSIS, AND ABOUT 1261 8673 05:09:55,600 --> 05:09:57,680 TELEHEALTH VISITS THAT WERE 8674 05:09:57,680 --> 05:09:58,120 INCLUDED. 8675 05:09:58,120 --> 05:09:59,600 AND WHEN BROKEN UP INTO 8676 05:09:59,600 --> 05:10:01,360 SUCCESSFUL VERSUS UNSUCCESSFUL 8677 05:10:01,360 --> 05:10:04,640 VIDEO VISITS, WE HAD 717 8678 05:10:04,640 --> 05:10:10,280 SUCCESSFUL VIDEO VISITS, AND 544 8679 05:10:10,280 --> 05:10:11,520 UNSUCCESSFUL VIDEO VISITS. 8680 05:10:11,520 --> 05:10:13,000 LARGELY, THOSE WERE 8681 05:10:13,000 --> 05:10:14,280 TELEPHONE-ONLY, AND THEN A 8682 05:10:14,280 --> 05:10:15,520 SMALLER PROPORTION OF PATIENTS 8683 05:10:15,520 --> 05:10:20,960 WERE NO-SHOWS OR TELEPHONE BUT 8684 05:10:20,960 --> 05:10:22,880 WITH A PARTNER. 8685 05:10:22,880 --> 05:10:25,400 SO WHAT WE IDENTIFIED, AGAIN 8686 05:10:25,400 --> 05:10:27,320 SIMILAR TO MANY INVESTIGATORS 8687 05:10:27,320 --> 05:10:28,480 INCLUDING MANY OF YOU IN THIS M 8688 05:10:28,480 --> 05:10:34,560 RAO, WE IDENTIFIROOM, WE IDENTI, 8689 05:10:34,560 --> 05:10:35,440 INSURANCE STATUS AND ACTUALLY 8690 05:10:35,440 --> 05:10:38,760 MARITAL STATUS WERE HIGHLY 8691 05:10:38,760 --> 05:10:41,000 ASSOCIATED WITH UNSUCCESSFUL 8692 05:10:41,000 --> 05:10:45,000 TELEHEALTH VISITS. 8693 05:10:45,000 --> 05:10:46,240 SO OUR PATIENT POPULATION, WHICH 8694 05:10:46,240 --> 05:10:48,520 IS ABOUT 30% BLACK, THEY HAD 8695 05:10:48,520 --> 05:10:51,200 ABOUT A 38% LOWER LIKELIHOOD OF 8696 05:10:51,200 --> 05:10:52,960 HAVING A SUCCESSFUL TELEHEALTH 8697 05:10:52,960 --> 05:10:54,400 VISIT, AND THOSE WERE MEDICARE 8698 05:10:54,400 --> 05:10:59,840 OR MEDICAID SIMILARLY HAD LOWER 8699 05:10:59,840 --> 05:11:08,160 LIKELY HOODSLIKELIHOODS OF SUCCL 8700 05:11:08,160 --> 05:11:08,960 TELEHEALTH VISITS. 8701 05:11:08,960 --> 05:11:10,080 AGAIN, THIS IS A SHORT PERIOD, 8702 05:11:10,080 --> 05:11:14,000 AND SO WE WERE TRYING TO 8703 05:11:14,000 --> 05:11:16,400 CONSIDER SOME SORT OF SURROGATES 8704 05:11:16,400 --> 05:11:17,840 OF SHORT TERM OUTCOMES AND THOSE 8705 05:11:17,840 --> 05:11:20,040 INCLUDES EMERGENCY ROOM VISITS, 8706 05:11:20,040 --> 05:11:22,800 DEATH, URGENT CARE VISITS AND 8707 05:11:22,800 --> 05:11:25,840 HOSPITALIZATIONS. 8708 05:11:25,840 --> 05:11:27,160 WHAT WE FOUND, AGAIN THIS WAS 8709 05:11:27,160 --> 05:11:29,560 NOT CAUSAL BUT RATHER HYPOTHESIS 8710 05:11:29,560 --> 05:11:30,880 GENERATING WAS THAT SUCCESSFUL 8711 05:11:30,880 --> 05:11:31,680 TELEHEALTH VISITS WERE 8712 05:11:31,680 --> 05:11:33,920 ASSOCIATED WITH A LOWER ODDS OF 8713 05:11:33,920 --> 05:11:38,880 EMERGENCY ROOM VISITS AND DEATH, 8714 05:11:38,880 --> 05:11:45,400 AND MIXED UNSUCCESS OR NO 8715 05:11:45,400 --> 05:11:48,920 SUCCESS VISITS WERE -- IF YOU 8716 05:11:48,920 --> 05:11:50,840 DIDN'T HAVE A SUCCESSFUL -- OR 8717 05:11:50,840 --> 05:11:52,360 IF YOU HAD AN UNSUCCESSFUL 8718 05:11:52,360 --> 05:11:53,960 TELEHEALTH VISIT, AS WELL AS 8719 05:11:53,960 --> 05:11:57,280 HOSPITALIZATIONS. 8720 05:11:57,280 --> 05:11:58,400 SO IN OUR EXPERIENCE, WE FOUND 8721 05:11:58,400 --> 05:11:59,960 THAT THERE WERE DISPARITIES 8722 05:11:59,960 --> 05:12:02,080 ASSOCIATED WITH UNSUCCESSFUL 8723 05:12:02,080 --> 05:12:03,600 TELEHEALTH VISITS. 8724 05:12:03,600 --> 05:12:05,240 AND IMPORTANTLY, THAT 8725 05:12:05,240 --> 05:12:06,000 UNSUCCESSFUL TELEHEALTH VISITS 8726 05:12:06,000 --> 05:12:08,120 MIGHT BE ASSOCIATED WITH POOR 8727 05:12:08,120 --> 05:12:08,720 OUTCOMES. 8728 05:12:08,720 --> 05:12:09,920 THEY ARE ASSOCIATED BUT WHETHER 8729 05:12:09,920 --> 05:12:11,720 OR NOT THEY'RE CAUSAL AND WHAT 8730 05:12:11,720 --> 05:12:13,280 WE CAN DO ABOUT THEM IS WHAT WE 8731 05:12:13,280 --> 05:12:14,760 REALLY NEED TO HAVE A BETTER 8732 05:12:14,760 --> 05:12:16,400 UNDERSTANDING. 8733 05:12:16,400 --> 05:12:17,960 SO WHERE DO WE GO FROM HERE? 8734 05:12:17,960 --> 05:12:19,160 SOME OF THE SUGGESTIONS AND SOME 8735 05:12:19,160 --> 05:12:21,400 OF THE IDEAS THAT CAME OUT OF 8736 05:12:21,400 --> 05:12:23,400 OUR EXPERIENCE WITH CLINICAL 8737 05:12:23,400 --> 05:12:25,000 TELEHEALTH WAS HOW DO WE CHOOSE 8738 05:12:25,000 --> 05:12:28,160 PATIENT FRIENDLY PLATFORMS. 8739 05:12:28,160 --> 05:12:29,240 AS YOU MENTIONED, SOMETIMES 8740 05:12:29,240 --> 05:12:30,360 FACETIME IS EASIER BUT THAT 8741 05:12:30,360 --> 05:12:32,240 MIGHT NOT BE APPROVED BY THE 8742 05:12:32,240 --> 05:12:32,640 HOSPITAL. 8743 05:12:32,640 --> 05:12:35,240 OUR PLATFORM CAN HAVE A LOT OF 8744 05:12:35,240 --> 05:12:37,520 CHALLENGES, EVEN AT OUR OWN 8745 05:12:37,520 --> 05:12:44,640 CENTER, WITH THE WIFI ACCESS. 8746 05:12:44,640 --> 05:12:46,960 ANOTHER AREA MIGHT BE 8747 05:12:46,960 --> 05:12:48,320 CONSIDERING REIMBURSEMENT FOR 8748 05:12:48,320 --> 05:12:51,360 TELEHEALTH VISITS AND ADVOCATING 8749 05:12:51,360 --> 05:12:52,760 FOR PARITY IN TYPES OF VISITS IN 8750 05:12:52,760 --> 05:12:53,760 TERMS OF PAYMENT. 8751 05:12:53,760 --> 05:12:54,800 SUPPORT FOR PATIENT EDUCATION 8752 05:12:54,800 --> 05:12:56,920 AND ASSISTANCE TO ACCESS 8753 05:12:56,920 --> 05:12:57,200 TELEHEALTH. 8754 05:12:57,200 --> 05:13:02,440 IN THE TBININ THE BEGINNING OF R 8755 05:13:02,440 --> 05:13:03,360 THOSE PATIENTS WE WERE CONCERNED 8756 05:13:03,360 --> 05:13:04,840 WOULDN'T BE ABLE TO ACCESS 8757 05:13:04,840 --> 05:13:06,280 TELEHEALTH, IT WAS VERY 8758 05:13:06,280 --> 05:13:08,640 ARBITRARY BUT WE DID HAVE STAFF 8759 05:13:08,640 --> 05:13:09,280 WHO WOULD REALLY SIT AND TRY TO 8760 05:13:09,280 --> 05:13:11,200 TEACH THE PATIENT WHILE THEY 8761 05:13:11,200 --> 05:13:13,240 WERE THERE HOW THEY COULD ACCESS 8762 05:13:13,240 --> 05:13:17,640 THAT WHEN THEY ALSO WENT HOME, 8763 05:13:17,640 --> 05:13:20,160 BUT THAT CAN BE REALLY RESOURCE 8764 05:13:20,160 --> 05:13:21,960 LIMITING AS WELL. 8765 05:13:21,960 --> 05:13:24,640 IN ADDITION, FOR EXAMPLE, WE ARE 8766 05:13:24,640 --> 05:13:26,960 PART OF AN EARLY PALLIATIVE CARE 8767 05:13:26,960 --> 05:13:30,440 STUDY IS THAT STARTED BEFORE THE 8768 05:13:30,440 --> 05:13:33,120 PANDEMIC WHERE PATIENTS ARE 8769 05:13:33,120 --> 05:13:34,280 RANDOMIZED TO TELEHEALTH BY 8770 05:13:34,280 --> 05:13:35,920 VIDEO VERSUS IN-PERSON 8771 05:13:35,920 --> 05:13:37,120 PALLIATIVE CARE, AND AS PART OF 8772 05:13:37,120 --> 05:13:40,200 THAT STUDY, TRAINING ON USING A 8773 05:13:40,200 --> 05:13:43,280 DEVICE AS WELL AS ACCESS TO A 8774 05:13:43,280 --> 05:13:44,800 DEVICE SO EVERYONE WHO DIDN'T 8775 05:13:44,800 --> 05:13:45,920 HAVE ACCESS TO A DEVICE WAS 8776 05:13:45,920 --> 05:13:47,800 GIVEN A DEVICE, SO SOME 8777 05:13:47,800 --> 05:13:49,920 INTERVENTIONS SUCH AS THAT MIGHT 8778 05:13:49,920 --> 05:13:50,720 BE ABLE TO HELP. 8779 05:13:50,720 --> 05:13:52,640 AND THEN AS MANY HAVE MENTIONED 8780 05:13:52,640 --> 05:13:54,600 AS WELL, ACCESS TO VIDEO AND 8781 05:13:54,600 --> 05:13:56,040 INTERNET DEVICES, POTENTIALLY 8782 05:13:56,040 --> 05:13:57,760 HAVING VIDEO HUBS OR OTHER WAYS 8783 05:13:57,760 --> 05:14:00,720 ADVOCATING FOR MORE BROAD 8784 05:14:00,720 --> 05:14:01,360 INTERNET ACCESS. 8785 05:14:01,360 --> 05:14:03,240 AND SO SOME OF OUR LARGE 8786 05:14:03,240 --> 05:14:06,000 ORGANIZATIONS SUCH AS ASCO, OUR 8787 05:14:06,000 --> 05:14:07,520 LARGEST CLINICAL ONCOLOGY 8788 05:14:07,520 --> 05:14:08,840 ORGANIZATION, HAS MADE SOME 8789 05:14:08,840 --> 05:14:10,480 RECOMMENDATIONS IN TERMS OF 8790 05:14:10,480 --> 05:14:12,880 STANDARDIZATION AND PRACTICE FOR 8791 05:14:12,880 --> 05:14:14,400 TELEHEALTH, TRYING TO UNDERSTAND 8792 05:14:14,400 --> 05:14:16,960 WHICH TYPES OF VISITS MIGHT BE 8793 05:14:16,960 --> 05:14:19,880 MORE LIKELY TO BE SUCCESSFUL BY 8794 05:14:19,880 --> 05:14:21,440 TELEHEALTH AND WHICH PATIENTS 8795 05:14:21,440 --> 05:14:25,360 ARE MOST APPROPRIATE, AND ALSO 8796 05:14:25,360 --> 05:14:27,200 TO GIVE SOME GUIDELINES AS TO 8797 05:14:27,200 --> 05:14:29,440 WHAT TYPES OF POSSIBLE USES FOR 8798 05:14:29,440 --> 05:14:30,840 TELEHEALTH MIGHT BE MOST 8799 05:14:30,840 --> 05:14:33,920 APPROPRIATE. 8800 05:14:33,920 --> 05:14:35,440 SO THINGS, FOR EXAMPLE, SUCH AS 8801 05:14:35,440 --> 05:14:36,200 EDUCATION MIGHT BE MORE 8802 05:14:36,200 --> 05:14:37,080 APPROPRIATE THAN ACTIVE 8803 05:14:37,080 --> 05:14:38,760 TREATMENT OR TOXICITY 8804 05:14:38,760 --> 05:14:39,800 MANAGEMENT, SO WE NEED TO FIGURE 8805 05:14:39,800 --> 05:14:41,160 SOME OF THOSE FACTORS OUT AS 8806 05:14:41,160 --> 05:14:45,440 WELL. 8807 05:14:45,440 --> 05:14:46,840 THEN OTHERS HAVE ALSO DISCUSSED 8808 05:14:46,840 --> 05:14:48,080 SOME POLICY RECOMMENDATIONS. 8809 05:14:48,080 --> 05:14:49,800 AGAIN, SORRY IT'S VERY SMALL, 8810 05:14:49,800 --> 05:14:54,160 BUT ADVOCATING AT A POLICY LEVEL 8811 05:14:54,160 --> 05:14:55,920 FOR THINGS SUCH AS MORE BROAD 8812 05:14:55,920 --> 05:14:58,480 ACCESS FOR INTERNET, PAYMENT 8813 05:14:58,480 --> 05:15:00,680 PARITY, AS WELL AS MEDICAL 8814 05:15:00,680 --> 05:15:01,960 LICENSURE, RECIPROCITY, FOR 8815 05:15:01,960 --> 05:15:03,520 EXAMPLE, MIGHT BE OTHER WAYS 8816 05:15:03,520 --> 05:15:06,600 THAT WE CAN INCREASE OUR ACCESS 8817 05:15:06,600 --> 05:15:07,440 FOR TELEHEALTH. 8818 05:15:07,440 --> 05:15:10,560 I KNOW DC, MARYLAND AND 8819 05:15:10,560 --> 05:15:13,320 VIRGINIA, FOR EXAMPLE, HAS JUST 8820 05:15:13,320 --> 05:15:14,200 RELEASED AN ANNOUNCEMENT THAT 8821 05:15:14,200 --> 05:15:16,320 THERE WILL BE RECIPROCITY FOR 8822 05:15:16,320 --> 05:15:17,400 MEDICAL LICENSING, AND THAT CAN 8823 05:15:17,400 --> 05:15:19,800 REALLY IMPACT, YOU KNOW, HOW 8824 05:15:19,800 --> 05:15:21,600 MANY OF OUR PATIENTS WE'RE 8825 05:15:21,600 --> 05:15:22,520 ACTUALLY ABLE TO REACH. 8826 05:15:22,520 --> 05:15:24,480 I KNOW AT HOPKINS, FOR EXAMPLE, 8827 05:15:24,480 --> 05:15:25,560 30% OF OUR PATIENTS COME FROM 8828 05:15:25,560 --> 05:15:27,080 OUT OF STATE, SO THAT MIGHT BE 8829 05:15:27,080 --> 05:15:30,200 AN IMPORTANT AREA AS WELL. 8830 05:15:30,200 --> 05:15:31,920 SO IN CONCLUSION, I THINK WE'VE 8831 05:15:31,920 --> 05:15:35,000 SEEN THAT TELEHEALTH CAN REDUCE 8832 05:15:35,000 --> 05:15:37,080 DISPARITIES IF IMPLEMENTED 8833 05:15:37,080 --> 05:15:38,040 THOUGHTFULLY, BUT IN SCENARIOS 8834 05:15:38,040 --> 05:15:40,680 WHERE WE DIDN'T HAVE ENOUGH TIME 8835 05:15:40,680 --> 05:15:43,400 TO DO THAT, SUCH AS COVID, 8836 05:15:43,400 --> 05:15:44,960 TELEHEALTH MIGHT ALSO EXACERBATE 8837 05:15:44,960 --> 05:15:45,960 AND HIGHLIGHT DISPARITIES THAT 8838 05:15:45,960 --> 05:15:47,640 ARE ALREADY EXISTING. 8839 05:15:47,640 --> 05:15:49,040 AND HOPEFULLY WE CAN COME UP 8840 05:15:49,040 --> 05:15:50,040 WITH OTHER RECOMMENDATIONS FOR 8841 05:15:50,040 --> 05:15:53,480 THE THOUGHTFUL IMPLEMENTATION OF 8842 05:15:53,480 --> 05:15:55,080 TELEHEALTH IN CANCER CARE AND 8843 05:15:55,080 --> 05:15:56,640 THOSE RECOMMENDATIONS ARE 8844 05:15:56,640 --> 05:15:57,240 EVOLVING. 8845 05:15:57,240 --> 05:16:05,520 THANK YOU. 8846 05:16:05,520 --> 05:16:06,680 >>ARE THERE ANY QUESTIONS? 8847 05:16:06,680 --> 05:16:08,000 SO I HAVE ONE QUESTION. 8848 05:16:08,000 --> 05:16:10,520 YOU MENTIONED THIS 8849 05:16:10,520 --> 05:16:12,360 REIMBURSEMENT. 8850 05:16:12,360 --> 05:16:16,280 SSO REIMBURSEMENT MAY JUST NOT E 8851 05:16:16,280 --> 05:16:18,040 ADD GOOSE SO IT HAS NO INCENTIVE 8852 05:16:18,040 --> 05:16:19,920 TO DO IT. 8853 05:16:19,920 --> 05:16:20,200 DOES IT -- 8854 05:16:20,200 --> 05:16:20,480 >>CORRECT. 8855 05:16:20,480 --> 05:16:22,320 SO JUST TO GIVE YOU AN EXAMPLE 8856 05:16:22,320 --> 05:16:24,920 AT OUR HOSPITAL, TELEHEALTH 8857 05:16:24,920 --> 05:16:27,240 VISITS -- SO WE ARE A REGULATED 8858 05:16:27,240 --> 05:16:28,600 CANCER SPACE. 8859 05:16:28,600 --> 05:16:29,480 WE'RE CONNECT TODAY A HOSPITAL. 8860 05:16:29,480 --> 05:16:32,080 AND THERE ARE REIMBURSEMENTS 8861 05:16:32,080 --> 05:16:33,760 FOR, FOR EXAMPLE, A HOSPITAL 8862 05:16:33,760 --> 05:16:35,720 CHARGE WHEN PATIENTS COME IN TO 8863 05:16:35,720 --> 05:16:38,200 A VISIT IN PERSON. 8864 05:16:38,200 --> 05:16:40,880 WHEN THEY GET A TELEHEALTH 8865 05:16:40,880 --> 05:16:44,160 VISIT, WE CAN'T CHARGE THE 8866 05:16:44,160 --> 05:16:44,840 HOSPITAL CHARGE. 8867 05:16:44,840 --> 05:16:47,120 AND SO FOR EXAMPLE, AT OUR 8868 05:16:47,120 --> 05:16:49,640 MEDICAL CENTER, LAST YEAR, 8869 05:16:49,640 --> 05:16:52,160 TELEHEALTH VISITS ALONE 8870 05:16:52,160 --> 05:16:54,760 ACCOUNTED FOR A DECREASE IN OUR 8871 05:16:54,760 --> 05:16:58,680 BUDGET OF OVER $10 MILLION. 8872 05:16:58,680 --> 05:17:01,120 SO THAT HAS BEEN -- AND WHEN WE 8873 05:17:01,120 --> 05:17:02,200 DON'T HAVE THOSE BUDGETS, THEN 8874 05:17:02,200 --> 05:17:04,000 WE ALSO CAN'T HIRE STAFF, WE 8875 05:17:04,000 --> 05:17:06,040 CAN'T HIRE THE RESOURCES THAT WE 8876 05:17:06,040 --> 05:17:06,240 NEED. 8877 05:17:06,240 --> 05:17:09,720 AND SO THERE'S BEEN A LARGE PUSH 8878 05:17:09,720 --> 05:17:11,760 TO REDUCE AND ESSENTIALLY GET 8879 05:17:11,760 --> 05:17:14,840 RID OF TELEHEALTH VISITS, EVEN 8880 05:17:14,840 --> 05:17:15,640 THOUGH THAT'S BECOME REALLY THE 8881 05:17:15,640 --> 05:17:16,960 STANDARD OF CARE. 8882 05:17:16,960 --> 05:17:20,720 AUDIO VISITS PAY CENTS TO THE 8883 05:17:20,720 --> 05:17:24,240 DOLLAR COMPARED TO TELEHEALTH -- 8884 05:17:24,240 --> 05:17:26,200 A VIDEO VISIT OR AN IN-PERSON. 8885 05:17:26,200 --> 05:17:29,080 SO WE ARE ASKED TO NOT DO AUDIO 8886 05:17:29,080 --> 05:17:29,320 VISITS. 8887 05:17:29,320 --> 05:17:31,040 BUT AGAIN, AS YOU CAN SEE, MANY 8888 05:17:31,040 --> 05:17:32,960 OF OUR PATIENTS CAN ONLY ACCESS 8889 05:17:32,960 --> 05:17:34,800 AUDIO, AND I THINK AS 8890 05:17:34,800 --> 05:17:36,240 CLINICIANS, WE FEEL AUDIO IS 8891 05:17:36,240 --> 05:17:38,720 BETTER THAN NOTHING, IF IT MEANS 8892 05:17:38,720 --> 05:17:40,160 NOT HAVING CONTACT WITH THE 8893 05:17:40,160 --> 05:17:41,480 PATIENT. 8894 05:17:41,480 --> 05:17:43,360 >>THANK YOU. 8895 05:17:43,360 --> 05:17:45,200 >>THANK YOU FOR THIS REALLY 8896 05:17:45,200 --> 05:17:46,800 INSIGHTFUL AND THOUGHT-PROVOKING 8897 05:17:46,800 --> 05:17:47,760 PRESENTATION. 8898 05:17:47,760 --> 05:17:48,320 I'M THINKING ABOUT THE STUDY 8899 05:17:48,320 --> 05:17:49,760 THAT YOU HAD PRESENTED WHERE YOU 8900 05:17:49,760 --> 05:17:51,160 HAD COMPARED THE UNSUCCESSFUL 8901 05:17:51,160 --> 05:17:53,000 VISITS TO THE SUCCESSFUL 8902 05:17:53,000 --> 05:17:54,080 TELEHEALTH VISITS AND ONE OF THE 8903 05:17:54,080 --> 05:17:55,600 THINGS THAT YOU HAD NOTED IS 8904 05:17:55,600 --> 05:17:57,600 THAT IN THAT KIND OF 8905 05:17:57,600 --> 05:17:58,920 UNSUCCESSFUL GROUP, A MAJORITY 8906 05:17:58,920 --> 05:18:00,520 OF THOSE WERE THE AUDIO VISITS 8907 05:18:00,520 --> 05:18:02,080 THAT YOU'RE ALLUDING TO RATHER 8908 05:18:02,080 --> 05:18:04,040 THAN NO-SHOWS. 8909 05:18:04,040 --> 05:18:05,560 TO ME, THAT KIND OF IMPLIES WHAT 8910 05:18:05,560 --> 05:18:07,000 THE CONTRAST IS, THAT THE 8911 05:18:07,000 --> 05:18:09,280 CONTRAST IS MORE SO LIKE 8912 05:18:09,280 --> 05:18:11,280 TELEPHONE VERSUS AUDIO VERSUS 8913 05:18:11,280 --> 05:18:12,280 HAVING A VIDEO VISIT. 8914 05:18:12,280 --> 05:18:13,320 SO THINKING ABOUT THAT, IT'S 8915 05:18:13,320 --> 05:18:14,640 PARTICULARLY STRIKING TO ME TO 8916 05:18:14,640 --> 05:18:16,240 SEE THOSE DISPARITIES AND 8917 05:18:16,240 --> 05:18:18,720 OUTCOMES THAT YOU HAVE SHOWED, 8918 05:18:18,720 --> 05:18:20,040 LIKE THE E.D. UTILIZATION AND 8919 05:18:20,040 --> 05:18:21,040 THOSE SORTS OF THINGS. 8920 05:18:21,040 --> 05:18:22,480 SO I'M WONDERING IF YOU COULD 8921 05:18:22,480 --> 05:18:24,160 SPECULATE OR HYPOTHESIZE, WHAT 8922 05:18:24,160 --> 05:18:25,680 WOULD BE SO FOUNDATIONALLY 8923 05:18:25,680 --> 05:18:27,840 DIFFERENT ABOUT AUDIO VERSUS 8924 05:18:27,840 --> 05:18:29,040 TELEHEALTH -- I MEAN, I KNOW YOU 8925 05:18:29,040 --> 05:18:30,240 CAN'T REALLY SAY THAT IT'S 8926 05:18:30,240 --> 05:18:31,240 CAUSAL, BUT THAT'S REALLY 8927 05:18:31,240 --> 05:18:32,880 INTERESTING TO ME THAT IT'S NOT 8928 05:18:32,880 --> 05:18:35,840 NO-SHOW VERSUS VIDEO, IT IS 8929 05:18:35,840 --> 05:18:37,400 MOSTLY AUDIO VERSUS. 8930 05:18:37,400 --> 05:18:38,640 >>SO I THINK SOME OF THE THINGS 8931 05:18:38,640 --> 05:18:41,680 THAT WE HYPOTHESIZE, FOR 8932 05:18:41,680 --> 05:18:43,200 EXAMPLE, YOU KNOW, THE MAJORITY 8933 05:18:43,200 --> 05:18:44,840 OF OUR PATIENTS WHO NEEDED MORE 8934 05:18:44,840 --> 05:18:46,320 THAN ONE FOLLOW-UP IN THAT TIME 8935 05:18:46,320 --> 05:18:47,680 PERIOD WERE PEOPLE ON ACTIVE 8936 05:18:47,680 --> 05:18:49,640 TREATMENT OR HAD RECENTLY 8937 05:18:49,640 --> 05:18:50,720 COMPLETED. 8938 05:18:50,720 --> 05:18:55,760 I THINK MANY TIMES FROM A 8939 05:18:55,760 --> 05:18:56,960 CLINICAL PERSPECTIVE, EVEN JUST 8940 05:18:56,960 --> 05:18:58,160 SEEING WHETHER OR NOT SOMEONE 8941 05:18:58,160 --> 05:19:00,360 CAN WALK INTO A ROOM GIVES US 8942 05:19:00,360 --> 05:19:01,200 ENOUGH INFORMATION TO KNOW, IS 8943 05:19:01,200 --> 05:19:02,160 THIS PERSON SAFE. 8944 05:19:02,160 --> 05:19:04,440 AND I THINK AT LEAST OUR 8945 05:19:04,440 --> 05:19:06,920 CLINICAL GUT OR SUSPICION IS 8946 05:19:06,920 --> 05:19:08,520 THAT JUST BECAUSE WE CAN GET 8947 05:19:08,520 --> 05:19:10,040 SOMEONE ON THE PHONE DOESN'T 8948 05:19:10,040 --> 05:19:11,160 NECESSARILY MEAN THAT THEY'RE 8949 05:19:11,160 --> 05:19:12,920 TELLING US THEY DON'T FEEL GOOD. 8950 05:19:12,920 --> 05:19:14,600 I THINK A LOT OF PATIENTS 8951 05:19:14,600 --> 05:19:17,920 OVERALL LIKE TO PUT ON A MUCH 8952 05:19:17,920 --> 05:19:19,240 MORE OPTIMISTIC FACE WHEN 8953 05:19:19,240 --> 05:19:21,320 TALKING TO THEIR ONCOLOGIST, AND 8954 05:19:21,320 --> 05:19:23,040 IF WE CAN'T PHYSICALLY -- I KNOW 8955 05:19:23,040 --> 05:19:24,800 FOR MYSELF, I CAN TELL A LOT 8956 05:19:24,800 --> 05:19:26,360 MORE JUST BY LOOKING AT THEM, 8957 05:19:26,360 --> 05:19:27,680 YOU KNOW, LOOKING AT THE COLOR 8958 05:19:27,680 --> 05:19:29,760 OF THEIR SKIN, LOOKING AT HOW 8959 05:19:29,760 --> 05:19:31,160 DEHYDRATED THEY ARE, THAT I 8960 05:19:31,160 --> 05:19:32,520 CAN'T NECESSARILY TELL BY VIDEO, 8961 05:19:32,520 --> 05:19:35,000 AND THAT'S SOMETHING THAT WE 8962 05:19:35,000 --> 05:19:36,440 WONDER ABOUT. 8963 05:19:36,440 --> 05:19:38,120 I THINK ALSO, YOU KNOW, AND 8964 05:19:38,120 --> 05:19:42,680 AGAIN, THIS IS NOT CAUSAL, BUT 8965 05:19:42,680 --> 05:19:44,880 THERE'S NO ASSOCIATION, IF 8966 05:19:44,880 --> 05:19:46,160 PEOPLE -- THE PEOPLE WHO ARE 8967 05:19:46,160 --> 05:19:47,840 ABLE TO ACCESS VIDEO, FOR 8968 05:19:47,840 --> 05:19:49,000 EXAMPLE, LIKE WE SAW AN 8969 05:19:49,000 --> 05:19:50,600 ASSOCIATION WITH MARRIED 8970 05:19:50,600 --> 05:19:51,280 PATIENTS. 8971 05:19:51,280 --> 05:19:53,560 YOU KNOW, IS THAT IMPLYING THAT 8972 05:19:53,560 --> 05:19:55,760 MAYBE PEOPLE HAVE MORE FAMILY 8973 05:19:55,760 --> 05:19:57,520 SUPPORT, MORE SUPPORT TO GET 8974 05:19:57,520 --> 05:19:59,560 THROUGH SIDE EFFECTS AND 8975 05:19:59,560 --> 05:20:00,680 TOXICITIES THAT WE CAN'T REALLY 8976 05:20:00,680 --> 05:20:03,840 ASSESS WHEN SOMEONE IS BUY BY 8977 05:20:03,840 --> 05:20:04,520 THEMSELVES. 8978 05:20:04,520 --> 05:20:06,080 BECAUSE ONE THING TOO IS MOST OF 8979 05:20:06,080 --> 05:20:07,360 THOSE TELEPHONE VISITS WAS A 8980 05:20:07,360 --> 05:20:08,240 PATIENT BY HIMSELF. 8981 05:20:08,240 --> 05:20:09,680 AND SO WE THINK THAT THAT'S PART 8982 05:20:09,680 --> 05:20:11,800 OF IT. 8983 05:20:11,800 --> 05:20:16,360 AND THAT'S ALSO ANOTHER REASON 8984 05:20:16,360 --> 05:20:19,280 WHY IDEALLY WE'RE HELPING 8985 05:20:19,280 --> 05:20:22,680 PATIENTS TO GET VIDEO ACCESS, 8986 05:20:22,680 --> 05:20:24,440 BUT IN TELEPHONE, AGAIN, WE 8987 05:20:24,440 --> 05:20:25,960 THINK IT'S PROBABLY BETTER THAN 8988 05:20:25,960 --> 05:20:27,320 NOTHING, BUT I THINK WE REALLY 8989 05:20:27,320 --> 05:20:29,480 NEED TO EMPHASIZE BEING ABLE TO 8990 05:20:29,480 --> 05:20:33,840 SEE OUR PATIENTS. 8991 05:20:33,840 --> 05:20:34,680 >>THANK YOU SO MUCH. 8992 05:20:34,680 --> 05:20:36,280 THIS CONCLUDES THIS SESSION. 8993 05:20:36,280 --> 05:20:37,080 GREAT PRESENTATION. 8994 05:20:37,080 --> 05:20:37,320 THANKS. 8995 05:20:37,320 --> 05:20:43,320 [APPLAUSE] 8996 05:20:43,320 --> 05:20:46,480 I'M NOW HANDING OVER THE FLOOR 8997 05:20:46,480 --> 05:20:50,000 TO DR. BRENDA ADJEI. 8998 05:20:50,000 --> 05:20:51,440 SHE'S THE CHAIR OF THE 8999 05:20:51,440 --> 05:20:55,480 ROUNDTABLE DISCUSSION. 9000 05:20:55,480 --> 05:20:57,000 >>I'M GOING TO ASK THE 9001 05:20:57,000 --> 05:21:05,520 PANELISTS TO PLEASE JOIN ME. 9002 05:21:05,520 --> 05:21:07,040 SO IF PEOPLE WANT TO STAND UP 9003 05:21:07,040 --> 05:21:09,640 AND STRETCH, THIS IS THE FINAL 9004 05:21:09,640 --> 05:21:13,480 SESSION. 9005 05:21:13,480 --> 05:21:14,560 NICE SESSION 15. 9006 05:21:14,560 --> 05:21:15,800 LUCKY NUMBER. 9007 05:21:15,800 --> 05:21:26,200 INTENTIONAL STRETCHES. 9008 05:22:54,880 --> 05:22:57,600 >>SESSION, PRESENTERS, THE 9009 05:22:57,600 --> 05:22:58,600 AUDIENCE, CONFERENCE ORGANIZERS, 9010 05:22:58,600 --> 05:23:00,200 THIS HAS REALLY BEEN A 9011 05:23:00,200 --> 05:23:01,360 PHENOMENAL TWO DAYS OF 9012 05:23:01,360 --> 05:23:02,240 PRESENTATIONS. 9013 05:23:02,240 --> 05:23:06,040 AND I THINK THE PANELISTS AND I, 9014 05:23:06,040 --> 05:23:07,040 AS WE'VE KIND OF CONVERSED OVER 9015 05:23:07,040 --> 05:23:09,160 THE DAY, HAVE REALLY SAID THAT A 9016 05:23:09,160 --> 05:23:11,120 LOT OF THESE PRESENTATIONS AND 9017 05:23:11,120 --> 05:23:11,920 CONVERSATIONS HAVE JUST REALLY 9018 05:23:11,920 --> 05:23:13,560 PROVIDED SOME RICH CONTENT FOR 9019 05:23:13,560 --> 05:23:19,600 DISCUSSION TODAY. 9020 05:23:19,600 --> 05:23:20,920 SO I WANT TO THANK THE 9021 05:23:20,920 --> 05:23:22,840 CONFERENCE ORGANIZERS, THE 9022 05:23:22,840 --> 05:23:26,280 VARIOUS CHAIRS, THE KEYNOTES, 9023 05:23:26,280 --> 05:23:27,600 ADVOCATES WHO SHARED THEIR CARE 9024 05:23:27,600 --> 05:23:29,400 EXPERIENCES, WHO PROVIDED 9025 05:23:29,400 --> 05:23:30,840 CONTEXT THAT INFLUENCED THEIR 9026 05:23:30,840 --> 05:23:34,640 JOURNEY HERE TODAY. 9027 05:23:34,640 --> 05:23:36,280 AS WELL AS FOR ME, HUMBLED US AS 9028 05:23:36,280 --> 05:23:37,240 WE THINK ABOUT THE TYPE OF 9029 05:23:37,240 --> 05:23:38,840 RESEARCH THAT WE DO AND PUTTING 9030 05:23:38,840 --> 05:23:39,920 NAMES AND FACES TO THE WORK THAT 9031 05:23:39,920 --> 05:23:42,040 WE DO EVERY DAY. 9032 05:23:42,040 --> 05:23:47,240 I WANT TO THINK ALL THE SESSIONR 9033 05:23:47,240 --> 05:23:48,760 PRESENTERS AND PRESENTERS FOR 9034 05:23:48,760 --> 05:23:50,880 SHARING YOUR RESEARCH, 9035 05:23:50,880 --> 05:23:51,760 PERSPECTIVES, AND ALSO YOUR 9036 05:23:51,760 --> 05:23:52,600 PERSEVERANCE IN THIS FIELD. 9037 05:23:52,600 --> 05:23:54,080 IT'S NOT EASY, AND ALL OF THE 9038 05:23:54,080 --> 05:23:55,840 EXPERTS HERE CAN ATTEST, IT 9039 05:23:55,840 --> 05:23:56,920 TAKES A WHILE TO GET TO WHERE 9040 05:23:56,920 --> 05:23:59,560 YOU WANT TO BE ABLE -- YOU CAN 9041 05:23:59,560 --> 05:24:01,080 SHARE WHAT'S HAPPENED IN THE 9042 05:24:01,080 --> 05:24:03,520 PAST AND WHERE YOU WANT TO MOVE 9043 05:24:03,520 --> 05:24:03,760 FORWARD. 9044 05:24:03,760 --> 05:24:05,720 AND OF COURSE THE AUDIENCE BOTH 9045 05:24:05,720 --> 05:24:08,240 IN PERSON AND ONLINE, I 9046 05:24:08,240 --> 05:24:09,560 ENCOURAGE YOU PLEASE TO USE THE 9047 05:24:09,560 --> 05:24:10,840 SESSION TO CONTINUE TO STAY 9048 05:24:10,840 --> 05:24:12,000 ENGAGED AS YOU HAVE. 9049 05:24:12,000 --> 05:24:13,840 SO I WANT TO SHARE JUST A QUICK 9050 05:24:13,840 --> 05:24:14,840 OVERVIEW OF THE SESSION. 9051 05:24:14,840 --> 05:24:17,240 NO SLIDES. 9052 05:24:17,240 --> 05:24:17,560 CONVERSATION. 9053 05:24:17,560 --> 05:24:20,000 I GET TO BE OPRAH MINUS RUNNING 9054 05:24:20,000 --> 05:24:22,160 AROUND WITH THE MIC. 9055 05:24:22,160 --> 05:24:24,320 AND ASK OUR SESSION PANELISTS TO 9056 05:24:24,320 --> 05:24:26,080 REALLY THINK ABOUT SOME CASE 9057 05:24:26,080 --> 05:24:30,960 EXAMPLES AS WE THINK ABOUT 9058 05:24:30,960 --> 05:24:32,120 RACISM AS A DRIVER OF CANCER 9059 05:24:32,120 --> 05:24:33,440 HEALTH DISPARITIES, WHAT DO WE 9060 05:24:33,440 --> 05:24:34,440 KNOW, HOW CAN OUR RESEARCH MAKE 9061 05:24:34,440 --> 05:24:35,640 A DIFFERENCE, AND AS WE'VE 9062 05:24:35,640 --> 05:24:37,680 THOUGHT ABOUT IT, WHERE DO WE GO 9063 05:24:37,680 --> 05:24:38,240 NEXT. 9064 05:24:38,240 --> 05:24:40,000 WHAT ARE SOME OF THOSE ACTIONS 9065 05:24:40,000 --> 05:24:45,920 ACTIONS,THOSE NEXT ACTION STEPSD 9066 05:24:45,920 --> 05:24:46,760 SOLUTIONS. 9067 05:24:46,760 --> 05:24:48,360 SO I PREPARED SOME QUESTION, 9068 05:24:48,360 --> 05:24:52,760 FIRST I'M BRENDA ADJEI IN THE 9069 05:24:52,760 --> 05:24:53,880 HEALTH DELIVERY RESEARCH PROGRAM 9070 05:24:53,880 --> 05:25:00,600 AND I'M GOING TO ALU O AH ALLOWR 9071 05:25:00,600 --> 05:25:02,000 PANELISTS TO INTRODUCE 9072 05:25:02,000 --> 05:25:02,320 THEMSELVES. 9073 05:25:02,320 --> 05:25:05,400 I'M GOING TO ASK DR. ROBERT WINN 9074 05:25:05,400 --> 05:25:06,800 TO INTRODUCE HIMSELF FIRST AND 9075 05:25:06,800 --> 05:25:08,920 I'M GOING TO ASK A SPECIFIC 9076 05:25:08,920 --> 05:25:09,920 QUESTION THAT WILL HELP ORIENT 9077 05:25:09,920 --> 05:25:11,200 YOU GUYS IN INTRODUCTIONS. 9078 05:25:11,200 --> 05:25:14,160 SO DR. ROBERT WINN IS DIRECTOR 9079 05:25:14,160 --> 05:25:16,680 OF THE BCU CANCER CENTER. 9080 05:25:16,680 --> 05:25:17,440 THE FIRST QUESTION THAT ALL OF 9081 05:25:17,440 --> 05:25:18,880 YOU WILL BE ABLE TO ANSWER IS, 9082 05:25:18,880 --> 05:25:21,440 EACH OF YOU BRING A SPECIFIC 9083 05:25:21,440 --> 05:25:22,720 VANTAGE POINT, LIVED EXPERIENCE, 9084 05:25:22,720 --> 05:25:24,280 LEADERSHIP AND SCIENTIFIC 9085 05:25:24,280 --> 05:25:25,600 PERSPECTIVE TO THE FIELD OF 9086 05:25:25,600 --> 05:25:29,120 CANCER DISPARITIES. 9087 05:25:29,120 --> 05:25:30,640 AS YOU THINK ABOUT THOSE VARIOUS 9088 05:25:30,640 --> 05:25:32,800 HATS THAT YOU WEAR, PLEASE SHARE 9089 05:25:32,800 --> 05:25:35,160 WITH US WHO YOU ARE, AND HOW 9090 05:25:35,160 --> 05:25:36,800 THAT HAS CONTRIBUTED TO OR 9091 05:25:36,800 --> 05:25:38,840 INFLUENCED THE FOCUS OF YOUR 9092 05:25:38,840 --> 05:25:40,200 RESEARCH PROGRAM AND THE 9093 05:25:40,200 --> 05:25:41,760 EVOLUTION OF YOUR RESEARCH 9094 05:25:41,760 --> 05:25:43,280 PROGRAM. 9095 05:25:43,280 --> 05:25:43,720 >>SURE. 9096 05:25:43,720 --> 05:25:45,040 THANK YOU. 9097 05:25:45,040 --> 05:25:50,320 I'M ROB WINN, CANCER CENTER 9098 05:25:50,320 --> 05:25:53,560 DIRECTOR, SINCE 1974. 9099 05:25:53,560 --> 05:25:55,880 ME RESEARCH INTEREST HAS ALWAYS 9100 05:25:55,880 --> 05:25:57,440 BEEN TRANS SIGNALING 9101 05:25:57,440 --> 05:25:58,480 TRANSDUCTION, RNA BINDING 9102 05:25:58,480 --> 05:25:59,040 PROTEIN AND OTHER THINGS. 9103 05:25:59,040 --> 05:26:03,400 BUT THE WHO I AM HAS ALWAYS BEEN 9104 05:26:03,400 --> 05:26:05,040 THAT STRUGGLE IN THE CRUX OF MY 9105 05:26:05,040 --> 05:26:05,960 EDUCATION WHEN I LEFT MY 9106 05:26:05,960 --> 05:26:06,320 NEIGHBORHOOD. 9107 05:26:06,320 --> 05:26:08,600 I AM THE PRODUCT OF -- I'M A 9108 05:26:08,600 --> 05:26:09,560 HEADSTART KID, VERY PROUD TO BE 9109 05:26:09,560 --> 05:26:10,760 A HEADSTART KID. 9110 05:26:10,760 --> 05:26:13,640 I AM PART OF THAT GENERATION 9111 05:26:13,640 --> 05:26:15,080 THAT WAS BORN TO TEENAGE MOMS 9112 05:26:15,080 --> 05:26:16,240 THAT ULTIMATELY WERE CONSIDERED 9113 05:26:16,240 --> 05:26:17,520 TO BE THROWAWAY KIDS. 9114 05:26:17,520 --> 05:26:19,600 WHEN PEOPLE ASK ME WHY AND WHAT 9115 05:26:19,600 --> 05:26:21,320 IS MY RESEARCH ABOUT, MY 9116 05:26:21,320 --> 05:26:22,880 RESEARCH IS NOT ABSTRACT. 9117 05:26:22,880 --> 05:26:24,840 MY RESEARCH IS NOT THEORETICAL. 9118 05:26:24,840 --> 05:26:26,200 THE RESEARCH THAT I DID AND THE 9119 05:26:26,200 --> 05:26:28,840 REASON WHY I'VE CHOSEN THIS PATH 9120 05:26:28,840 --> 05:26:30,240 OF APPLIED SCIENCE IS TO APPLY 9121 05:26:30,240 --> 05:26:31,680 EVERYTHING THAT I COULD LEARN TO 9122 05:26:31,680 --> 05:26:33,280 MAKING SURE THAT MY COMMUNITIES 9123 05:26:33,280 --> 05:26:35,400 ARE BETTER. 9124 05:26:35,400 --> 05:26:37,160 THE REALITY IS, IF PEOPLE SAY 9125 05:26:37,160 --> 05:26:39,120 WELL, WHO I AM, PART OF THE WHO 9126 05:26:39,120 --> 05:26:41,680 I AM IS REALLY -- COMES OUT OF 9127 05:26:41,680 --> 05:26:43,240 GETTING MY CARE FROM THE 9128 05:26:43,240 --> 05:26:44,680 FEDERALLY QUALIFIED HEALTH 9129 05:26:44,680 --> 05:26:45,960 CENTERS, PART OF IT IS 9130 05:26:45,960 --> 05:26:46,760 UNDERSTANDING THAT PEOPLE SAW 9131 05:26:46,760 --> 05:26:48,640 THINGS IN ME BEFORE I SAW IT IN 9132 05:26:48,640 --> 05:26:49,520 MYSELF, WHICH MEANS THAT THERE 9133 05:26:49,520 --> 05:26:51,840 WAS AN OBLIGATION TO THEN GIVE 9134 05:26:51,840 --> 05:26:52,200 BACK. 9135 05:26:52,200 --> 05:26:56,760 AND THE OTHER HALF OF THIS WAS 9136 05:26:56,760 --> 05:26:59,040 THAT LIVE -- IN MY COMMUNITY IS 9137 05:26:59,040 --> 05:27:01,200 THE MISSING MILLION, THE MISSING 9138 05:27:01,200 --> 05:27:02,280 MILLIONS OF FOLKS WHO WE DON'T 9139 05:27:02,280 --> 05:27:03,800 TALK ABOUT WHO LIVE IN THESE 9140 05:27:03,800 --> 05:27:04,680 INVISIBLE COMMUNITIES. 9141 05:27:04,680 --> 05:27:06,440 SO AT THE CORE I WANTED TO DO, 9142 05:27:06,440 --> 05:27:07,200 WHETHER IT WAS RNA BINDING 9143 05:27:07,200 --> 05:27:10,960 PROTEIN OR THE EVOLUTION, 9144 05:27:10,960 --> 05:27:12,360 EXTENSION AND ENHANCEMENT OF 9145 05:27:12,360 --> 05:27:13,280 SCIENCE AND UNDERSTANDING THAT 9146 05:27:13,280 --> 05:27:16,760 SCIENCE ALONE WITHOUT AN IMPACT 9147 05:27:16,760 --> 05:27:18,280 IS COOL BUT DON'T MEAN A WHOLE 9148 05:27:18,280 --> 05:27:19,640 LOT TO ME OR THE PEOPLE WHO I 9149 05:27:19,640 --> 05:27:20,800 GREW UP WITH. 9150 05:27:20,800 --> 05:27:23,160 SO MY SCIENCE IS REALLY ABOUT 9151 05:27:23,160 --> 05:27:24,360 NOT CHASING SO MUCH ACADEMIC 9152 05:27:24,360 --> 05:27:25,840 EXCELLENCE AS IT IS CHASING 9153 05:27:25,840 --> 05:27:29,760 ACADEMIC RELEVANCE. 9154 05:27:29,760 --> 05:27:31,840 >>I TOLD YOU. 9155 05:27:31,840 --> 05:27:32,440 WOW! 9156 05:27:32,440 --> 05:27:32,960 NEXT. 9157 05:27:32,960 --> 05:27:36,040 LAUREN? 9158 05:27:36,040 --> 05:27:38,880 >>SO I'M LAUREN MCCULLOUGH. 9159 05:27:38,880 --> 05:27:40,280 ASSOCIATE PROFESSOR AT EMORY 9160 05:27:40,280 --> 05:27:44,160 UNIVERSITY AND MEMBER OF THE 9161 05:27:44,160 --> 05:27:45,240 WINSHIP CANCER INSTITUTE, 9162 05:27:45,240 --> 05:27:47,760 SCIENTIFIC DIRECTOR O AT THE 9163 05:27:47,760 --> 05:27:48,480 AMERICAN CANCER SOCIETY. 9164 05:27:48,480 --> 05:27:49,800 I INTRODUCED MYSELF A LITTLE BIT 9165 05:27:49,800 --> 05:27:51,960 YESTERDAY. 9166 05:27:51,960 --> 05:27:57,120 AND YOU KNOW, THE WORK THAT I DO 9167 05:27:57,120 --> 05:27:59,800 WAS 100% BORN OUT OF WATCHING MY 9168 05:27:59,800 --> 05:28:01,200 FATHER BE DIAGNOSED WITH AND 9169 05:28:01,200 --> 05:28:01,960 STRUGGLE WITH CANCER BEFORE HE 9170 05:28:01,960 --> 05:28:06,240 VERY QUICKLY PASSED. 9171 05:28:06,240 --> 05:28:07,640 AND SITTING IN CLASSES, I WAS 9172 05:28:07,640 --> 05:28:09,760 PRE-MED AND SAYING, YOU KNOW, 9173 05:28:09,760 --> 05:28:11,680 IT'S CHEMISTRY, PHYSICS, THIS 9174 05:28:11,680 --> 05:28:13,080 BIOLOGY DOESN'T CAPTURE WHAT I 9175 05:28:13,080 --> 05:28:13,960 SEE EVERY DAY IN MY 9176 05:28:13,960 --> 05:28:14,640 NEIGHBORHOOD. 9177 05:28:14,640 --> 05:28:15,640 IT DOESN'T CAPTURE THE 9178 05:28:15,640 --> 05:28:17,600 EXPERIENCE THAT WE WENT THROUGH 9179 05:28:17,600 --> 05:28:19,280 WITH HIS DIAGNOSIS AND HIS 9180 05:28:19,280 --> 05:28:21,200 OUTCOME, AND WANTING TO PROVIDE 9181 05:28:21,200 --> 05:28:22,760 AN AVENUE FOR PEOPLE THAT LOOKED 9182 05:28:22,760 --> 05:28:24,640 LIKE ME, PEOPLE THAT LOOKED LIKE 9183 05:28:24,640 --> 05:28:28,920 HIM, TO HAVE AN EXPERIENCE OF 9184 05:28:28,920 --> 05:28:29,600 BETTER OUTCOMES. 9185 05:28:29,600 --> 05:28:31,600 SO MY WORK LARGELY FOCUSES ON 9186 05:28:31,600 --> 05:28:33,200 CANCER HEALTH EQUITY, 9187 05:28:33,200 --> 05:28:34,840 PARTICULARLY AMONG BLACK WOMEN 9188 05:28:34,840 --> 05:28:39,360 AND BREAST CANCER, AND ONE 9189 05:28:39,360 --> 05:28:40,680 PARTICULAR STUDY HAS LED ME DOWN 9190 05:28:40,680 --> 05:28:43,000 THIS PATH, AND IT WAS PUBLISHED 9191 05:28:43,000 --> 05:28:45,560 IN 2019, JNCI CANCER SPECTRUM, 9192 05:28:45,560 --> 05:28:47,040 WHEN WE FOUND THAT BLACK WOMEN 9193 05:28:47,040 --> 05:28:50,560 WHO ARE OF HIGHER SES HAD TWICE 9194 05:28:50,560 --> 05:28:52,200 THE LIKELIHOOD OF DYING COMPARED 9195 05:28:52,200 --> 05:28:54,800 TO WHITE WOMEN OF HIGHER SES. 9196 05:28:54,800 --> 05:28:56,080 AND WHEN YOU THINK ABOUT THAT 9197 05:28:56,080 --> 05:28:57,760 AND WHEN I SHARE THAT RESULT, 9198 05:28:57,760 --> 05:28:59,240 PEOPLE ARE SOMETIMES BAFFLED 9199 05:28:59,240 --> 05:29:00,960 LIKE, YOU KNOW, THESE WOMEN HAVE 9200 05:29:00,960 --> 05:29:01,960 THE INCOME, THEY HAVE THE 9201 05:29:01,960 --> 05:29:03,800 EDUCATION, THEY LIVE IN THE 9202 05:29:03,800 --> 05:29:05,280 NEIGHBORHOOD, WHY ARE THEY DYING 9203 05:29:05,280 --> 05:29:07,040 TWICE AS MUCH AS THEIR WHITE 9204 05:29:07,040 --> 05:29:08,120 COUNTERPARTS? 9205 05:29:08,120 --> 05:29:13,240 AND IT WAS JANUARY OF 2021 WHEN 9206 05:29:13,240 --> 05:29:13,920 I ENDED UP IN THE HOSPITAL WITH 9207 05:29:13,920 --> 05:29:16,360 A MAJOR MEDICAL EMERGENCY AND 9208 05:29:16,360 --> 05:29:17,440 ALMOST DIED BECAUSE I COULD NOT 9209 05:29:17,440 --> 05:29:18,280 GET THE CARE THAT I NEEDED. 9210 05:29:18,280 --> 05:29:20,640 AND I VERY MUCH QUICKLY REALIZED 9211 05:29:20,640 --> 05:29:23,360 THAT IF IT HADN'T BEEN FOR MY 9212 05:29:23,360 --> 05:29:24,560 POSITION AT EMORY AND THE 9213 05:29:24,560 --> 05:29:25,440 ABILITY TO CALL MY COLLEAGUES 9214 05:29:25,440 --> 05:29:26,920 THAT CAME DOWN AND GOT ME OUT OF 9215 05:29:26,920 --> 05:29:28,880 THE ER AND GOT ME DIAGNOSED INTO 9216 05:29:28,880 --> 05:29:34,280 EMERGENCY SURGERY, THE SURGEON 9217 05:29:34,280 --> 05:29:34,800 SAID FOUR MORE HOURS AND I 9218 05:29:34,800 --> 05:29:35,520 WOULDN'T HAVE MADE IT. 9219 05:29:35,520 --> 05:29:36,560 AND I THINK SITTING IN A 9220 05:29:36,560 --> 05:29:37,840 HOSPITAL FOR A WEEK BY MYSELF, 9221 05:29:37,840 --> 05:29:41,000 BECAUSE IT WAS COVID, I VERY, 9222 05:29:41,000 --> 05:29:43,840 VERY QUICKLY REALIZED THAT MY 9223 05:29:43,840 --> 05:29:45,760 EDUCATION, MY INCOME, MY 9224 05:29:45,760 --> 05:29:47,880 NEIGHBORHOOD DID NOT PROTECT ME, 9225 05:29:47,880 --> 05:29:49,120 DID NOT SHIELD ME FROM THE COLOR 9226 05:29:49,120 --> 05:29:49,880 OF MY SKIN. 9227 05:29:49,880 --> 05:29:52,840 AND SO THAT ISING IS SOMETHING I 9228 05:29:52,840 --> 05:29:54,400 CARRY WITH ME, THAT IS SOMETHING 9229 05:29:54,400 --> 05:29:56,240 THAT IT'S A LENS I USE IN EVERY 9230 05:29:56,240 --> 05:29:58,120 SINGLE STUDY THAT OUR RESEARCH 9231 05:29:58,120 --> 05:30:00,960 GROUP DOES, AND IT IS THE TRUTH 9232 05:30:00,960 --> 05:30:01,960 OF OUR PEOPLE, AND THAT SHOULD 9233 05:30:01,960 --> 05:30:03,680 NOT BE OUR REALITY. 9234 05:30:03,680 --> 05:30:05,960 >>THANK YOU SO MUCH, LAUREN, 9235 05:30:05,960 --> 05:30:12,200 FOR SHARING THAT. 9236 05:30:12,200 --> 05:30:13,800 CHANITA, WHO'S ALSO ONE OF MY 9237 05:30:13,800 --> 05:30:14,480 MENTORS, THANK YOU SO MUCHMENT 9238 05:30:14,480 --> 05:30:15,600 THE FLOOR IS YOURS. 9239 05:30:15,600 --> 05:30:17,520 >>GOOD AFTERNOON, EVERYONE. 9240 05:30:17,520 --> 05:30:18,400 GLAD TO HAVE THIS OPPORTUNITY TO 9241 05:30:18,400 --> 05:30:20,160 BE PART OF THE CLOSING SESSION 9242 05:30:20,160 --> 05:30:22,000 FOR THIS REALLY AMAZING 9243 05:30:22,000 --> 05:30:23,240 CONFERENCE. 9244 05:30:23,240 --> 05:30:25,760 I'M CHANITA HUGHES-HALBERT FROM 9245 05:30:25,760 --> 05:30:26,280 THE UNIVERSITY OF SOUTHERN 9246 05:30:26,280 --> 05:30:28,160 CALIFORNIA. 9247 05:30:28,160 --> 05:30:34,480 AND I'VE BEEN AT USC FOR TWO 9248 05:30:34,480 --> 05:30:35,880 YEARS, ABOUT SIX MONTHS ON THE 9249 05:30:35,880 --> 05:30:38,040 GROUND, SO A RELATIVELY NEW WEST 9250 05:30:38,040 --> 05:30:38,840 COAST TRANSPLANT. 9251 05:30:38,840 --> 05:30:40,160 I LIVED MY WHOLE LIFE ON THE 9252 05:30:40,160 --> 05:30:42,240 EAST COAST, SO YOU SAW ME 9253 05:30:42,240 --> 05:30:46,800 YAWNING UP HERE, WHICH IS I 9254 05:30:46,800 --> 05:30:49,640 GUESS SORT OF THE ACCLAMATION 9255 05:30:49,640 --> 05:30:56,240 PERIOD, BUT ONE OF THE -- TWO 9256 05:30:56,240 --> 05:30:57,480 STORIES, MY COLLEAGUES AND 9257 05:30:57,480 --> 05:30:58,520 FRIENDS ON THE PANEL TODAY 9258 05:30:58,520 --> 05:31:00,840 REALLY JUST REMINDED ME OF, YOU 9259 05:31:00,840 --> 05:31:02,560 KNOW, HOW I CAME TO BE IN THIS 9260 05:31:02,560 --> 05:31:03,720 SPACE. 9261 05:31:03,720 --> 05:31:05,560 SO I'M A BEHAVIORAL SCIENTIST. 9262 05:31:05,560 --> 05:31:09,080 I DID MY TRAINING AT HOWARD 9263 05:31:09,080 --> 05:31:09,760 UNIVERSITY AND BEFORE THAT, I 9264 05:31:09,760 --> 05:31:13,480 WAS AT HAMPTON UNIVERSITY. 9265 05:31:13,480 --> 05:31:16,400 SO REALLY STEEPED IN THE HISTORY 9266 05:31:16,400 --> 05:31:19,880 AND THE EXCELLENCE OF BEING 9267 05:31:19,880 --> 05:31:22,320 TRAINED AND EDUCATED AT AN HBCU 9268 05:31:22,320 --> 05:31:23,880 FOR BOTH UNDERGRAD AND GRADUATE 9269 05:31:23,880 --> 05:31:26,680 WORK. 9270 05:31:26,680 --> 05:31:28,080 I MAJORED IN PSYCHOLOGY BECAUSE 9271 05:31:28,080 --> 05:31:30,680 I REALLY FUNDAMENTALLY WANTED TO 9272 05:31:30,680 --> 05:31:31,480 UNDERSTAND WHY PEOPLE DID THE 9273 05:31:31,480 --> 05:31:35,000 THINGS THAT THEY DID. 9274 05:31:35,000 --> 05:31:39,000 AND THAT HAS ALWAYS BEEN THE 9275 05:31:39,000 --> 05:31:41,760 GROUNDING FOR THE WORK AND MY 9276 05:31:41,760 --> 05:31:44,960 MOTIVATION AND INSPIRATION, 9277 05:31:44,960 --> 05:31:46,840 WHICH HAS GROWN AND EVOLVED AND 9278 05:31:46,840 --> 05:31:48,280 MATURED BASED ON SEVERAL SEMINAL 9279 05:31:48,280 --> 05:31:48,720 EVENT. 9280 05:31:48,720 --> 05:31:50,120 I THINK I SAID THIS YESTERDAY 9281 05:31:50,120 --> 05:31:52,120 AND IT STILL IS TRUE, IT ALWAYS 9282 05:31:52,120 --> 05:31:53,800 BEEN TRUE, IS THAT I REALLY 9283 05:31:53,800 --> 05:31:57,840 ULTIMATELY WANT TO HELP PEOPLE 9284 05:31:57,840 --> 05:31:58,640 AND HELP COMMUNITIES TO NAVIGATE 9285 05:31:58,640 --> 05:32:00,920 THE SITUATIONS THAT THEY FIND 9286 05:32:00,920 --> 05:32:01,240 THEMSELVES IN. 9287 05:32:01,240 --> 05:32:02,800 AND THAT COMES FROM MY OWN 9288 05:32:02,800 --> 05:32:03,760 EXPERIENCES WATCHING FAMILY 9289 05:32:03,760 --> 05:32:07,720 MEMBERS HAVING TO NAVIGATE THEIR 9290 05:32:07,720 --> 05:32:09,560 OWN PARTICULAR HEALTHCARE 9291 05:32:09,560 --> 05:32:10,520 SITUATIONS, ME HAVING TO 9292 05:32:10,520 --> 05:32:13,760 NAVIGATE MY OWN, AND NOW AS A 9293 05:32:13,760 --> 05:32:15,720 MOTHER OF TWO BOYS, HAVING TO 9294 05:32:15,720 --> 05:32:16,800 NAVIGATE THEIRS. 9295 05:32:16,800 --> 05:32:21,680 SO IT IS SOMETHING THAT HAS 9296 05:32:21,680 --> 05:32:23,000 REALLY MOTIVATED AND INSPIRED ME 9297 05:32:23,000 --> 05:32:26,000 TO REALLY WORK TO THINK ABOUT 9298 05:32:26,000 --> 05:32:28,280 AND PARTNER WITH ALL DIFFERENT 9299 05:32:28,280 --> 05:32:31,040 STAKEHOLDERS AROUND HOW WE CAN 9300 05:32:31,040 --> 05:32:34,040 BEST POSITION AND ENABLE OUR 9301 05:32:34,040 --> 05:32:37,200 COMMUNITIES, OUR FAMILY MEMBERS 9302 05:32:37,200 --> 05:32:39,080 TO BE -- TO ADVOCATE FOR 9303 05:32:39,080 --> 05:32:39,600 THEMSELVES. 9304 05:32:39,600 --> 05:32:40,960 I ALSO HAD THE SIMILAR TYPE OF 9305 05:32:40,960 --> 05:32:42,160 EXPERIENCE JUST IN A DIFFERENT 9306 05:32:42,160 --> 05:32:43,640 CONTEXT WHERE I WAS IN THE 9307 05:32:43,640 --> 05:32:44,960 HOSPITAL AND HAD TO LIKE REACH 9308 05:32:44,960 --> 05:32:47,600 OUT TO SOME FRIENDS WHO WERE 9309 05:32:47,600 --> 05:32:48,520 COLLEAGUES WHO WERE IN THE 9310 05:32:48,520 --> 05:32:50,240 HEALTHCARE PROFESSION, AND YOU 9311 05:32:50,240 --> 05:32:51,120 KNOW, THAT IS A MOMENT IN TIME 9312 05:32:51,120 --> 05:32:53,600 WHERE I REALIZED THAT THIS ISN'T 9313 05:32:53,600 --> 05:32:54,960 SOMETHING THAT MOST PEOPLE HAVE 9314 05:32:54,960 --> 05:32:57,120 ACCESS TO. 9315 05:32:57,120 --> 05:32:59,720 AND THAT THAT SHOULDN'T BE THE 9316 05:32:59,720 --> 05:32:59,920 CASE. 9317 05:32:59,920 --> 05:33:01,400 BUT PEOPLE HAVE TO -- I THINK WE 9318 05:33:01,400 --> 05:33:04,440 HAVE TO ENABLE AND EMPOWER 9319 05:33:04,440 --> 05:33:06,720 INDIVIDUALS TO KNOW THAT IT IS 9320 05:33:06,720 --> 05:33:08,800 OKAY TO STOP SOMETHING WE DON'T 9321 05:33:08,800 --> 05:33:11,240 FEEL IS RIGHT. 9322 05:33:11,240 --> 05:33:13,360 AND TO BE THE LOUDEST VOICE IN 9323 05:33:13,360 --> 05:33:14,280 THE ROOM TO GET THE CARE THAT 9324 05:33:14,280 --> 05:33:15,640 YOU NEED WHEN YOU NEED IT. 9325 05:33:15,640 --> 05:33:17,160 AND I DON'T THINK WE HAVE THAT 9326 05:33:17,160 --> 05:33:18,480 SKILLSET YET, SO THAT'S REALLY 9327 05:33:18,480 --> 05:33:19,680 WHAT I'M MOTIVATED BY. 9328 05:33:19,680 --> 05:33:21,160 THE OTHER THING THAT IS REALLY 9329 05:33:21,160 --> 05:33:28,800 NEAR AND DEAR TO MY HEART IS 9330 05:33:28,800 --> 05:33:29,920 BEING A WITNESS TO THE SOCIAL 9331 05:33:29,920 --> 05:33:32,880 CIRCUMSTANCES THAT AFFECT OUR 9332 05:33:32,880 --> 05:33:37,200 COMMUNITIES, AND REALLY TRULY 9333 05:33:37,200 --> 05:33:38,400 HAVING A DESIRE TO BRING THAT 9334 05:33:38,400 --> 05:33:39,280 INTO THE FOREFRONT. 9335 05:33:39,280 --> 05:33:41,280 SO I WAS TRAINED AS A BEHAVIORAL 9336 05:33:41,280 --> 05:33:42,280 SCIENTIST, I PROBABLY KNOW 9337 05:33:42,280 --> 05:33:43,800 ENOUGH ABOUT BASIC SCIENCE 9338 05:33:43,800 --> 05:33:48,080 RESEARCH TO BE DANGEROUS. 9339 05:33:48,080 --> 05:33:49,760 BUT I THINK IT'S REALLY EXCITING 9340 05:33:49,760 --> 05:33:53,760 BECAUSE I DEVELOPED -- WHAT I'M 9341 05:33:53,760 --> 05:33:55,200 REALLY EXCITED ABOUT NOW IN MY 9342 05:33:55,200 --> 05:33:56,920 OWN RESEARCH IS THE OPPORTUNITY 9343 05:33:56,920 --> 05:33:58,640 TO BE PART OF TRANSDISCIPLINARY 9344 05:33:58,640 --> 05:33:59,760 TEAMS THAT REALLY ASK ME 9345 05:33:59,760 --> 05:34:02,400 QUESTIONS ABOUT HOW OUR SOCIAL 9346 05:34:02,400 --> 05:34:03,760 CIRCUMSTANCES ARE IMPACTING OUR 9347 05:34:03,760 --> 05:34:05,160 BIOLOGY, AND THEN VICE VERSA, 9348 05:34:05,160 --> 05:34:06,960 HOW OUR BIOLOGY IS AFFECTING OUR 9349 05:34:06,960 --> 05:34:07,560 SOCIAL CIRCUMSTANCES. 9350 05:34:07,560 --> 05:34:10,600 AND I THINK THOSE ARE JUST SOME 9351 05:34:10,600 --> 05:34:12,960 REALLY AMAZING IMPORTANT 9352 05:34:12,960 --> 05:34:17,440 QUESTIONS THAT WE ARE NOW EYE 9353 05:34:17,440 --> 05:34:20,880 EQUIEQUIPPED AND I THINK SORT OF 9354 05:34:20,880 --> 05:34:21,880 UNIQUELY POSITIONED TO ADDRESS. 9355 05:34:21,880 --> 05:34:22,760 >>SCARLET? 9356 05:34:22,760 --> 05:34:23,520 >>ALL RIGHT. 9357 05:34:23,520 --> 05:34:26,720 WOULD YOU, SOME REALLY AMAZING 9358 05:34:26,720 --> 05:34:29,160 STORIES, AND DEFINITELY 9359 05:34:29,160 --> 05:34:30,600 RESONATED WITH MY ORIGIN STORY. 9360 05:34:30,600 --> 05:34:33,760 SO I AM A FIRST GENERATION 9361 05:34:33,760 --> 05:34:35,640 IMMIGRANT. 9362 05:34:35,640 --> 05:34:36,880 I EMIGRATED FROM TAIWAN IN THE 9363 05:34:36,880 --> 05:34:39,480 EARLY 70s WHEN THE GATES 9364 05:34:39,480 --> 05:34:39,920 OPENED, IF YOU WILL. 9365 05:34:39,920 --> 05:34:42,360 I'M ALSO THE DAUGHTER OF MY 9366 05:34:42,360 --> 05:34:44,040 GRANDMOTHER, WHO I RECENTLY 9367 05:34:44,040 --> 05:34:45,640 LEARNED, THOUGH SHE'S PASSED, 9368 05:34:45,640 --> 05:34:47,640 WAS DIAGNOSED WITH SOME KIND OF 9369 05:34:47,640 --> 05:34:49,480 GI CANCER SOMETIME IN HER ADULT 9370 05:34:49,480 --> 05:34:50,160 LIFE. 9371 05:34:50,160 --> 05:34:51,640 EVERYBODY KNEW ABOUT IT BUT IT 9372 05:34:51,640 --> 05:34:52,480 WAS HUSH-HUSH. 9373 05:34:52,480 --> 05:34:53,640 SHE WAS NOT TOLD ABOUT IT. 9374 05:34:53,640 --> 05:34:54,800 SHE WAS NOT ALLOWED TO KNOW 9375 05:34:54,800 --> 05:34:58,120 ABOUT IT. 9376 05:34:58,120 --> 05:34:59,840 SOMEHOW THE FAMILY RALLIED 9377 05:34:59,840 --> 05:35:01,440 AROUND AND NAVIGATED HER THROUGH 9378 05:35:01,440 --> 05:35:02,040 THAT HEALTHCARE AND TREATMENT 9379 05:35:02,040 --> 05:35:03,080 THAT SHE NEEDED. 9380 05:35:03,080 --> 05:35:05,480 SOUNDS LIKE A MOVIE, RIGHT? 9381 05:35:05,480 --> 05:35:06,880 IT ACTUALLY HAPPENED. 9382 05:35:06,880 --> 05:35:08,120 I SEE A LOT OF ASIAN AMERICANS 9383 05:35:08,120 --> 05:35:10,400 IN THE AUDIENCE NODDING. 9384 05:35:10,400 --> 05:35:11,480 SO THE DISEASE IS STILL VERY 9385 05:35:11,480 --> 05:35:12,880 MUCH A CULTURAL STIGMA. 9386 05:35:12,880 --> 05:35:14,040 I'VE HAD A NUMBER OF OTHER 9387 05:35:14,040 --> 05:35:16,800 FAMILY MEMBERS DIAGNOSED WITH 9388 05:35:16,800 --> 05:35:20,080 CANCER, STILL VERY HUSH-HUSH, 9389 05:35:20,080 --> 05:35:21,760 AND YOU KIND OF START TO THINK 9390 05:35:21,760 --> 05:35:23,280 ABOUT HOW THAT CULTURAL STIGMA 9391 05:35:23,280 --> 05:35:27,360 IS REALLY PRESENTING AS SORT OF 9392 05:35:27,360 --> 05:35:28,680 INVISIBILITY OF THE BURDEN OF 9393 05:35:28,680 --> 05:35:31,160 THE DISEASE AMONG OUR 9394 05:35:31,160 --> 05:35:35,160 COMMUNITIES. 9395 05:35:35,160 --> 05:35:38,720 I GRAW UP LIVING IN CENTRAL AND 9396 05:35:38,720 --> 05:35:40,560 EASTERN WASHINGTON, SPOKANE, 9397 05:35:40,560 --> 05:35:42,160 WASHINGTON, ACTUALLY, WHERE 9398 05:35:42,160 --> 05:35:45,840 ASIAN AMERICANS AR ARE VERY MUCN 9399 05:35:45,840 --> 05:35:46,840 THE MINORITY. 9400 05:35:46,840 --> 05:35:47,720 YOU DID EVERYTHING YOU COULD TO 9401 05:35:47,720 --> 05:35:51,360 FIT IN, STAY INTO YOURSELF, 9402 05:35:51,360 --> 05:35:52,240 UNDER THE RADAR. 9403 05:35:52,240 --> 05:35:54,040 THEN I MOVED TO BERKELEY OF ALL 9404 05:35:54,040 --> 05:35:55,200 PLACES WHERE IT WAS JUST LIKE 9405 05:35:55,200 --> 05:35:56,640 THE COMPLETE OPPOSITE AND WAS 9406 05:35:56,640 --> 05:35:58,920 PUT INTO -- WAS IN AN 9407 05:35:58,920 --> 05:36:00,840 ENVIRONMENT WHERE WE CELEBRATED 9408 05:36:00,840 --> 05:36:03,400 OUR ETHNIC ORIGIN AND OUR 9409 05:36:03,400 --> 05:36:05,120 CULTURE AND WE SHOUTED IT LOUD 9410 05:36:05,120 --> 05:36:05,480 AND PROUD. 9411 05:36:05,480 --> 05:36:07,040 SO THIS PARTICULAR LIVED 9412 05:36:07,040 --> 05:36:09,560 EXPERIENCE HAS REALLY SHAPED MY 9413 05:36:09,560 --> 05:36:11,120 INTERESTS AND APPRECIATION FOR 9414 05:36:11,120 --> 05:36:13,760 THE ROLE OF STRUCTURAL AND 9415 05:36:13,760 --> 05:36:14,440 SOCIAL FACTORS. 9416 05:36:14,440 --> 05:36:16,200 I WAS PRE-MED IN COLLEGE AND 9417 05:36:16,200 --> 05:36:17,800 ALSO SITTING IN THESE BIOLOGY 9418 05:36:17,800 --> 05:36:19,680 AND CHEMISTRY CLASSES AND 9419 05:36:19,680 --> 05:36:23,440 PHYSICS CLASSES, WONDERED HOW DO 9420 05:36:23,440 --> 05:36:25,560 SOCIAL EXPERIENCES REALLY FACTOR 9421 05:36:25,560 --> 05:36:27,960 IN TO ALL OF THIS, HOW THIS 9422 05:36:27,960 --> 05:36:31,840 BEING A MEDICAL PROVIDER, HOW IS 9423 05:36:31,840 --> 05:36:33,480 THAT GOING TO EQUIP ONE TO DEAL 9424 05:36:33,480 --> 05:36:34,880 WITH THESE CIRCUMSTANCES THAT 9425 05:36:34,880 --> 05:36:39,440 ARE SO IMPORTANT TO INDIVIDUALS 9426 05:36:39,440 --> 05:36:40,120 AS THEY'RE DIAGNOSED WITH 9427 05:36:40,120 --> 05:36:41,400 DISEASE ARE ABLE TO LIVE A 9428 05:36:41,400 --> 05:36:42,680 HEALTHY LIFE, ET CETERA. 9429 05:36:42,680 --> 05:36:44,360 SO THAT'S WHEN I DISCOVERED -- I 9430 05:36:44,360 --> 05:36:46,400 TOOK MY FIRST SOCIAL EPI CLASS 9431 05:36:46,400 --> 05:36:47,200 AT UNIVERSITY OF MICHIGAN, WHERE 9432 05:36:47,200 --> 05:36:53,240 I DID MY MASTERS WITH SHERMAN 9433 05:36:53,240 --> 05:36:55,320 JAMES, AND IT WAS EYE OPENING. 9434 05:36:55,320 --> 05:36:57,160 I SAT IN THE AUDIENCE AND I JUST 9435 05:36:57,160 --> 05:36:59,440 WITH CRIED BECAUSE IT WAS 9436 05:36:59,440 --> 05:37:01,080 FINALLY -- HERE'S ACTUALLY A 9437 05:37:01,080 --> 05:37:02,360 FIELD THAT'S PUTTING TOGETHER 9438 05:37:02,360 --> 05:37:04,080 ALL THESE SORT OF VAGUE CONCEPTS 9439 05:37:04,080 --> 05:37:05,840 THAT I'VE BEEN SORT OF GRAPPLING 9440 05:37:05,840 --> 05:37:06,640 WITH IN MY LEARNING. 9441 05:37:06,640 --> 05:37:09,920 SO FROM THAT POINT ON, I SHIF 9442 05:37:09,920 --> 05:37:11,800 SHIFTED -- I PIVOTED AWAY FROM 9443 05:37:11,800 --> 05:37:13,680 MEDICINE TOWARDS EPIDEMIOLOGY. 9444 05:37:13,680 --> 05:37:15,800 I WOULD NOT SAY I'M A SOCIAL 9445 05:37:15,800 --> 05:37:17,360 EPIDEMIOLOGIST BY ANY MEANS, BUT 9446 05:37:17,360 --> 05:37:19,720 I AM VERY INTERESTED IN STUDYING 9447 05:37:19,720 --> 05:37:21,840 SOCIAL CAUSES AND SOCIAL 9448 05:37:21,840 --> 05:37:22,720 PHENOMENON AND THESE TYPES OF 9449 05:37:22,720 --> 05:37:24,400 LIVED EXPERIENCES AS THEY IMPACT 9450 05:37:24,400 --> 05:37:29,560 UPON OUR DIVERSE COMMUNITIES. 9451 05:37:29,560 --> 05:37:31,280 >>THANK YOU. 9452 05:37:31,280 --> 05:37:32,640 SO WHAT I'M GOING TO DO IS I'M 9453 05:37:32,640 --> 05:37:33,960 GOING TO ASK THEM A SET OF 9454 05:37:33,960 --> 05:37:34,840 QUESTIONS, THEY'LL GO THROUGH 9455 05:37:34,840 --> 05:37:36,600 AND THEN WITHIN EACH ROUND OR 9456 05:37:36,600 --> 05:37:38,720 AFTER EACH ROUND, WE CAN GO TO 9457 05:37:38,720 --> 05:37:40,280 THE AUDIENCE AND I'LL CHECK 9458 05:37:40,280 --> 05:37:40,840 SLIDO. 9459 05:37:40,840 --> 05:37:42,680 SO WE'RE GOING TO GO TO THE NEXT 9460 05:37:42,680 --> 05:37:44,000 SET, THAT'S JUST INTRO, AND THEN 9461 05:37:44,000 --> 05:37:45,120 IF PEOPLE HAVE QUESTIONS, WE'LL 9462 05:37:45,120 --> 05:37:46,120 GO THERE, OKAY? 9463 05:37:46,120 --> 05:37:49,840 SO THE NEXT QUESTION, AND WE'RE 9464 05:37:49,840 --> 05:37:50,680 GOING TO KIND OF GO IN A 9465 05:37:50,680 --> 05:37:51,760 DIFFERENT ORDER, SCARLETT, 9466 05:37:51,760 --> 05:37:52,880 YOU'LL START THIS ROUND. 9467 05:37:52,880 --> 05:37:54,360 THERE'S A SAYING WE CAN'T CHANGE 9468 05:37:54,360 --> 05:37:57,640 WHAT WE DON'T MEASURE. 9469 05:37:57,640 --> 05:37:58,720 PLEASE SHARE YOUR EXPERIENCES 9470 05:37:58,720 --> 05:37:59,960 ABOUT WHAT WE KNOW ABOUT RACISM 9471 05:37:59,960 --> 05:38:02,840 AS A DRIVER OF CANCER HEALTH 9472 05:38:02,840 --> 05:38:04,600 DISPARITIES, AND WHAT ARE SOME 9473 05:38:04,600 --> 05:38:05,680 CRITICAL RESEARCH GAPS IN TERMS 9474 05:38:05,680 --> 05:38:08,520 OF MEASUREMENT AND ANALYSIS? 9475 05:38:08,520 --> 05:38:09,680 AND IF PEOPLE COULD BUILD ON 9476 05:38:09,680 --> 05:38:10,720 EACH OTHER'S COMMENTS, THAT 9477 05:38:10,720 --> 05:38:11,440 WOULD BE GREAT. 9478 05:38:11,440 --> 05:38:15,840 >>YEAH, THAT'S A BIG QUESTION. 9479 05:38:15,840 --> 05:38:16,920 I WANT TO SORT OF SHIFT THIS 9480 05:38:16,920 --> 05:38:17,720 BECAUSE I THINK THERE'S 9481 05:38:17,720 --> 05:38:18,480 ACTUALLY -- THERE'S ANOTHER 9482 05:38:18,480 --> 05:38:19,920 SAYING THAT I THINK IS PERTINENT 9483 05:38:19,920 --> 05:38:23,200 HERE THAT I RECENTLY HEARD, AND 9484 05:38:23,200 --> 05:38:24,840 THAT SAYING IS THAT WHEN WE TALK 9485 05:38:24,840 --> 05:38:26,600 ABOUT RACIAL DISPARITIES, WE'RE 9486 05:38:26,600 --> 05:38:28,760 REALLY TALKING ABOUT RACISM. 9487 05:38:28,760 --> 05:38:31,400 BUT WHILE WE HAVE, I THINK, 9488 05:38:31,400 --> 05:38:36,280 DOCUMENTED AND AMPLY, YOU KNOW, 9489 05:38:36,280 --> 05:38:37,800 SHOWN WITH LOTS OF DATA, THAT 9490 05:38:37,800 --> 05:38:39,240 THERE ARE PERSISTENT CANCER 9491 05:38:39,240 --> 05:38:42,680 HEALTH DISPARITIES BY 9492 05:38:42,680 --> 05:38:43,320 RACE/ETHNICITY, WE ACTUALLY HAVE 9493 05:38:43,320 --> 05:38:46,480 HARDLY ANY DATA, EMPIRICAL DATA, 9494 05:38:46,480 --> 05:38:52,280 QUANTITATIVE DATA, QUALITATIVE 9495 05:38:52,280 --> 05:38:54,000 DATA, SO THERE'S A BIG DATA GAP 9496 05:38:54,000 --> 05:38:55,640 ESPECIALLY AT THE STRUCTURAL OR 9497 05:38:55,640 --> 05:38:57,040 INSTITUTIONAL LEVEL. 9498 05:38:57,040 --> 05:38:59,680 I GUESS YOU HEARD OVER YESTERDAY 9499 05:38:59,680 --> 05:39:01,520 ESPECIALLY RESEARCH ON 9500 05:39:01,520 --> 05:39:04,200 STRUCTURAL RACISM AND CANCER IS 9501 05:39:04,200 --> 05:39:05,080 ONLY RECENTLY EMERGING, AND WITH 9502 05:39:05,080 --> 05:39:06,760 EVERY STUDY THAT COMES OUT, 9503 05:39:06,760 --> 05:39:12,440 WE'RE REALLY LEARNING ABOUT THE 9504 05:39:12,440 --> 05:39:13,600 NUANCES AND HOW BEST TO MEASURE 9505 05:39:13,600 --> 05:39:15,520 STRUCTURAL AND INSTITUTIONAL 9506 05:39:15,520 --> 05:39:17,680 RACISM AS WELL AS RACISM 9507 05:39:17,680 --> 05:39:18,320 EXPERIENCE AT DIFFERENT LEVELS 9508 05:39:18,320 --> 05:39:21,720 AND ITS IMPACTS ACROSS DIFFERENT 9509 05:39:21,720 --> 05:39:22,040 POPULATIONS. 9510 05:39:22,040 --> 05:39:23,320 SO I THINK THAT'S A KEY GAP. 9511 05:39:23,320 --> 05:39:25,080 I THINK ANOTHER KEY RESEARCH GAP 9512 05:39:25,080 --> 05:39:27,480 IS UNDERSTANDING THE MULTILEVEL 9513 05:39:27,480 --> 05:39:29,520 MECHANISMS, SO WHAT'S OCCURRING 9514 05:39:29,520 --> 05:39:30,360 AT THE NEIGHBORHOOD LEVEL, 9515 05:39:30,360 --> 05:39:33,760 WHAT'S OCCURRING AT THE 9516 05:39:33,760 --> 05:39:36,000 INDIVIDUAL LEVEL, WHAT'S 9517 05:39:36,000 --> 05:39:37,520 OCCURRING WITH COMMUNITIES, 9518 05:39:37,520 --> 05:39:40,960 WHAT'S OCCURRING IN OUR BODIES, 9519 05:39:40,960 --> 05:39:45,440 BY WHICH STRUCTURAL FACTORS AND 9520 05:39:45,440 --> 05:39:46,520 DETERMINANTS ARE IMPACTING UPON 9521 05:39:46,520 --> 05:39:47,440 OUR HEALTH. 9522 05:39:47,440 --> 05:39:48,840 I THINK REALLY CRITICAL GAPS, 9523 05:39:48,840 --> 05:39:50,080 WE'RE TALKING ABOUT, WE'RE 9524 05:39:50,080 --> 05:39:51,280 SHIFTING, WE'RE MOVING THE 9525 05:39:51,280 --> 05:39:52,280 CONVERSATION TOWARDS POLICIES, 9526 05:39:52,280 --> 05:39:53,760 IS THE NEED TO BRIDGE THE 9527 05:39:53,760 --> 05:39:55,520 RESEARCH WITH POLICY 9528 05:39:55,520 --> 05:39:55,880 IMPLICATIONS. 9529 05:39:55,880 --> 05:39:58,320 FOR ME THIS IS A REALLY 9530 05:39:58,320 --> 05:39:59,560 UNCOMFORTABLE SPACE BECAUSE I'M 9531 05:39:59,560 --> 05:40:01,440 TRAINED AS A -- CLASSICALLY 9532 05:40:01,440 --> 05:40:03,480 TRAINED AS AN EPIDEMIOLOGIST. 9533 05:40:03,480 --> 05:40:04,840 I DON'T THINK I TOOK A SINGLE 9534 05:40:04,840 --> 05:40:05,280 POLICY CLASS. 9535 05:40:05,280 --> 05:40:06,360 SO I'M KIND OF LEARNING BY 9536 05:40:06,360 --> 05:40:06,680 DOING. 9537 05:40:06,680 --> 05:40:08,560 I'M REACHING OUT TO PEOPLE WHO 9538 05:40:08,560 --> 05:40:13,760 DO THE POLICY, AND TO UNDERSTAND 9539 05:40:13,760 --> 05:40:15,520 HOW ARE MY RESEARCH FINDINGS 9540 05:40:15,520 --> 05:40:20,600 ABLE TO BEST EFFECT A POLICY. 9541 05:40:20,600 --> 05:40:22,040 AND I THINK ESSENTIAL TO THIS IS 9542 05:40:22,040 --> 05:40:23,560 BEING ABLE TO ENGAGE WITH THESE 9543 05:40:23,560 --> 05:40:24,200 PEOPLE FROM THE OTHER 9544 05:40:24,200 --> 05:40:27,960 DISCIPLINES TO WORK WITH US TO 9545 05:40:27,960 --> 05:40:29,080 CONDUCT, FOR EXAMPLE, AND I HAVE 9546 05:40:29,080 --> 05:40:30,520 TO THANK VANESSA SHEPPARD, I 9547 05:40:30,520 --> 05:40:32,760 DON'T KNOW IF SHE'S IN THE 9548 05:40:32,760 --> 05:40:33,640 AUDIENCE, FOR INSIGHT THROUGH 9549 05:40:33,640 --> 05:40:34,800 OUR CONVERSATION THIS MORNING. 9550 05:40:34,800 --> 05:40:36,880 IT MAY BE HARD, I'VE HEARD A LOT 9551 05:40:36,880 --> 05:40:39,360 OF COMMENTS FROM NAYSAYERS TO 9552 05:40:39,360 --> 05:40:41,760 SAY WHY ARE YOU STUDYING 9553 05:40:41,760 --> 05:40:42,400 STRUCTURAL RACISM? 9554 05:40:42,400 --> 05:40:45,760 WE KNOW THAT EXISTS, WE KNOW 9555 05:40:45,760 --> 05:40:50,440 THAT'S AN UPSTREAK FA UPSTREAM T 9556 05:40:50,440 --> 05:40:51,400 WE'RE NEVER GOING TO CHANGE IT. 9557 05:40:51,400 --> 05:40:53,000 WELL, THE MORE EMPIRICAL 9558 05:40:53,000 --> 05:40:54,040 EVIDENCE, THE MORE WE CAN BUILD 9559 05:40:54,040 --> 05:40:55,760 A CASE, AND I THINK MODELING 9560 05:40:55,760 --> 05:40:57,480 THESE QUASI EXPERIMENTAL STUDIES 9561 05:40:57,480 --> 05:40:58,480 IS A WAY TO GET US THERE. 9562 05:40:58,480 --> 05:41:00,960 IF WE ARE ABLE TO CHANGE THIS 9563 05:41:00,960 --> 05:41:04,360 PART, THIS PARTICULAR POLICY, 9564 05:41:04,360 --> 05:41:05,680 THIS CAN AFFECT AND RESULT IN 9565 05:41:05,680 --> 05:41:07,320 THIS PARTICULAR HEALTH OUTCOME. 9566 05:41:07,320 --> 05:41:10,600 AND THEN THE FINAL PLUG I WILL 9567 05:41:10,600 --> 05:41:12,360 MAKE IS THAT, YES, YOU HEARD 9568 05:41:12,360 --> 05:41:13,360 ALSO FROM SOMEBODY THAT MANY OF 9569 05:41:13,360 --> 05:41:15,160 US IN OUR PROFESSIONAL 9570 05:41:15,160 --> 05:41:17,800 CAPACITIES ARE NOT ABLE TO DO 9571 05:41:17,800 --> 05:41:19,400 THE A WORD, ADVOCATE. 9572 05:41:19,400 --> 05:41:20,880 BUT AS INDIVIDUALS, WE CAN 9573 05:41:20,880 --> 05:41:25,840 ADVOCATE. 9574 05:41:25,840 --> 05:41:27,240 >>I'LL BUILD ON THAT TO SAY A 9575 05:41:27,240 --> 05:41:29,240 COUPLE OF THINGS. 9576 05:41:29,240 --> 05:41:31,880 ONE I AGREE WITH THE STATEMENT, 9577 05:41:31,880 --> 05:41:33,200 IT'S DIFFICULT TO ADDRESS 9578 05:41:33,200 --> 05:41:34,440 SOMETHING AND INTERVENE IF YOU 9579 05:41:34,440 --> 05:41:35,640 CAN'T MEASURE IT. 9580 05:41:35,640 --> 05:41:38,440 SO I DO AGREE WITH THAT. 9581 05:41:38,440 --> 05:41:39,440 AND I'LL JUST -- ONE OF THE 9582 05:41:39,440 --> 05:41:42,720 THINGS THAT I THINK ABOUT IS, I 9583 05:41:42,720 --> 05:41:45,320 THINK IT WAS 1999 WHEN I SAW THE 9584 05:41:45,320 --> 05:41:48,000 FIRST REPORT ABOUT BLACK/WHITE 9585 05:41:48,000 --> 05:41:50,000 DIFFERENCES IN BREAST CANCER 9586 05:41:50,000 --> 05:41:51,400 INCIDENCE AND MORTALITY. 9587 05:41:51,400 --> 05:41:57,760 AND THAT REPORT, I THINK WAS 9588 05:41:57,760 --> 05:41:58,720 INSTRUMENTAL BECAUSE FOR THE 9589 05:41:58,720 --> 05:42:02,840 FIRST TIME THAT I HA WAS MADE AE 9590 05:42:02,840 --> 05:42:05,560 WHEN YOU SAW THE NUMBERS AND YOU 9591 05:42:05,560 --> 05:42:06,960 SAW THE DIFFERENCES, AND USING 9592 05:42:06,960 --> 05:42:08,560 THAT AS THE FOUNDATION TO MAKE 9593 05:42:08,560 --> 05:42:12,720 AN ARGUMENT ABOUT WHERE AND HOW 9594 05:42:12,720 --> 05:42:16,960 ADDITIONAL EFFORTS NEEDED TO BE 9595 05:42:16,960 --> 05:42:18,520 MADE TO ADDRESS RACIAL 9596 05:42:18,520 --> 05:42:19,200 DIFFERENCES, AND I THINK THAT 9597 05:42:19,200 --> 05:42:21,280 WAS THE FIRST TIME THAT WE 9598 05:42:21,280 --> 05:42:21,800 STARTED THINKING ABOUT AND 9599 05:42:21,800 --> 05:42:25,200 HAVING A FRAMEWORK FOR 9600 05:42:25,200 --> 05:42:26,080 DISPARITIES. 9601 05:42:26,080 --> 05:42:31,200 STEEIVE THOSTEVEN THOMAS, I THIT 9602 05:42:31,200 --> 05:42:32,600 THE UNIVERSITY OF MARYLAND NOW, 9603 05:42:32,600 --> 05:42:34,320 HAS DONE REALLY NICE WORK TO 9604 05:42:34,320 --> 05:42:34,960 DESCRIBE SORT OF DIFFERENT 9605 05:42:34,960 --> 05:42:38,200 PHASES OF RESEARCH IN DISPARITY. 9606 05:42:38,200 --> 05:42:39,320 THE FIRST ONE BEING ABOUT 9607 05:42:39,320 --> 05:42:41,080 DESCRIBING THE NATURE AND 9608 05:42:41,080 --> 05:42:42,440 DISTRIBUTION OF THE PROBLEMS, 9609 05:42:42,440 --> 05:42:44,520 LOOKING AT BLACK/WHITE RACIAL 9610 05:42:44,520 --> 05:42:48,120 GROUP DIFFERENCES, I THINK 9611 05:42:48,120 --> 05:42:48,920 INDENSE IN MORTALITY ACCORDING 9612 05:42:48,920 --> 05:42:50,640 TO HIS WORK IS THE FIRST PHASE. 9613 05:42:50,640 --> 05:42:51,480 THE SECOND PHASE IS 9614 05:42:51,480 --> 05:42:53,160 UNDERSTANDING WHY THOSE 9615 05:42:53,160 --> 05:42:55,120 DISPARITIES EXIST, THE THIRD 9616 05:42:55,120 --> 05:42:57,320 PHASE IS DEVELOPING 9617 05:42:57,320 --> 05:43:00,120 INTERVENTIONS OR SOLUTIONS TO 9618 05:43:00,120 --> 05:43:01,400 ADDRESS THOSE DIFFERENCES AND 9619 05:43:01,400 --> 05:43:02,640 THEN THE FOURTH PHASE IS SORT OF 9620 05:43:02,640 --> 05:43:05,560 WHERE WE ARE NOW, SORT OF 9621 05:43:05,560 --> 05:43:09,120 BUILDING AND TRANSITIONING 9622 05:43:09,120 --> 05:43:10,240 EVIDENCE-BASED INTERVENTIONS 9623 05:43:10,240 --> 05:43:14,280 INTO POLICY AND INTO PRACTICE. 9624 05:43:14,280 --> 05:43:16,600 SO I THINK WE'RE SORT OF AT 9625 05:43:16,600 --> 05:43:18,000 PHASE ONE IN SOME WAYS WITH 9626 05:43:18,000 --> 05:43:18,920 STRUCTURAL RACISM. 9627 05:43:18,920 --> 05:43:20,920 WE KNOW IT EXISTS, I THINK TO ME 9628 05:43:20,920 --> 05:43:24,720 IN MY VIEW, UNDERSTANDING THE 9629 05:43:24,720 --> 05:43:28,760 IMPACT OF STRUCTURAL RACISM IS 9630 05:43:28,760 --> 05:43:30,480 WHERE I THINK WE NEED TO GO 9631 05:43:30,480 --> 05:43:33,760 BECAUSE I THINK THERE ARE THE 9632 05:43:33,760 --> 05:43:34,600 PLACE-BASED MEASURES CAN HELP US 9633 05:43:34,600 --> 05:43:36,040 UNDERSTAND THE HISTORICAL 9634 05:43:36,040 --> 05:43:37,800 EFFECT, THE HISTORICAL PRACTICE 9635 05:43:37,800 --> 05:43:39,040 OF STRUCTURAL RACISM, BUT WE 9636 05:43:39,040 --> 05:43:40,840 NEED TO UNDERSTAND, I THINK, A 9637 05:43:40,840 --> 05:43:45,960 LITTLE BIT MORE OF WHERE AND HOW 9638 05:43:45,960 --> 05:43:47,400 LIVING WITHIN A SYSTEM OF 9639 05:43:47,400 --> 05:43:49,120 STRUCTURAL RACISM HAS HAD ITS 9640 05:43:49,120 --> 05:43:50,920 IMPACT, BOTH IN TERMS OF ACCESS 9641 05:43:50,920 --> 05:43:52,640 TO CARE, I THINK IT'S A LITTLE 9642 05:43:52,640 --> 05:43:54,600 DIFFERENT THAN SAYING, YOU KNOW, 9643 05:43:54,600 --> 05:43:57,400 ONE GROUP HAS GREATER DIFFICULTY 9644 05:43:57,400 --> 05:43:58,560 RECEIVING CARE VERSUS THE OTHER. 9645 05:43:58,560 --> 05:44:00,880 I THINK IT'S MORE THAN 9646 05:44:00,880 --> 05:44:01,840 DESCRIBING THE DIFFERENCES, BUT 9647 05:44:01,840 --> 05:44:04,640 REALLY UNDERSTANDING WHY AND HOW 9648 05:44:04,640 --> 05:44:05,520 THAT IS THE CASE. 9649 05:44:05,520 --> 05:44:08,000 SO I THINK THE MECHANISM WORK 9650 05:44:08,000 --> 05:44:11,040 IS -- IF I THINK ABOUT IT AS A 9651 05:44:11,040 --> 05:44:12,320 DIAGRAM IS REALLY TRYING TO 9652 05:44:12,320 --> 05:44:14,160 UNDERSTAND THE MECHANISM. 9653 05:44:14,160 --> 05:44:17,760 SO I DON'T -- I THINK THAT 9654 05:44:17,760 --> 05:44:19,560 STRUCTURAL RACISM HAS BEEN A 9655 05:44:19,560 --> 05:44:23,120 REALLY IMPORTANT FRAMING FOR US 9656 05:44:23,120 --> 05:44:24,600 TO GUIDE OUR EFFORT IN SAYING 9657 05:44:24,600 --> 05:44:26,280 OKAY, THIS IS WHAT WE'RE TRYING 9658 05:44:26,280 --> 05:44:29,760 TO UNDERSTAND. 9659 05:44:29,760 --> 05:44:31,560 AND NOW I THINK -- NOW THAT WE 9660 05:44:31,560 --> 05:44:33,560 HAVE THE TOOLS TO SAY, OKAY, 9661 05:44:33,560 --> 05:44:35,560 THIS IS HOW THE IMPACT OF THE 9662 05:44:35,560 --> 05:44:38,560 POLICIES AND THE PRACTICES THAT 9663 05:44:38,560 --> 05:44:40,400 HAVE BEEN PUT IN PLACE FOR SUCH 9664 05:44:40,400 --> 05:44:43,200 A LONG PERIOD OF TIME, 9665 05:44:43,200 --> 05:44:47,280 UNDERSTAND THE IMPACT BOTH AT AN 9666 05:44:47,280 --> 05:44:48,640 INDIVIDUAL AND A COMMUNITY AND 9667 05:44:48,640 --> 05:44:50,120 AS WELL AS HEALTHCARE SYSTEMS, I 9668 05:44:50,120 --> 05:44:51,880 DON'T THINK WE REALLY KNOW THE 9669 05:44:51,880 --> 05:44:53,400 IMPACT THAT THESE POLICIES HAVE 9670 05:44:53,400 --> 05:44:56,120 ON HEALTHCARE SYSTEMS AND HOW IT 9671 05:44:56,120 --> 05:45:00,760 DRIVING THE POLICIES AROUND 9672 05:45:00,760 --> 05:45:02,080 WHOSE REIMBURSEMENT PRACTICES, 9673 05:45:02,080 --> 05:45:03,760 INSURANCE COVERAGE, THE PAYOR 9674 05:45:03,760 --> 05:45:07,720 DISTRIBUTION MIX, ROB CAN TALK 9675 05:45:07,720 --> 05:45:09,320 ABOUT THIS WITH MORE INSIGHT 9676 05:45:09,320 --> 05:45:10,280 THAN I PROBABLY CAN, BUT I THINK 9677 05:45:10,280 --> 05:45:11,840 THOSE ARE THE THINGS THAT I'M 9678 05:45:11,840 --> 05:45:14,800 BEING TOLD ABOUT NOW THAT 9679 05:45:14,800 --> 05:45:16,800 HEALTHCARE SYSTEMS ARE BEING -- 9680 05:45:16,800 --> 05:45:18,400 ARE CONCERNED ABOUT. 9681 05:45:18,400 --> 05:45:21,440 BECAUSE AT THE END OF THE DAY, I 9682 05:45:21,440 --> 05:45:25,840 THINK IT'S -- HEALTHCARE HAS 9683 05:45:25,840 --> 05:45:26,320 CHANGED. 9684 05:45:26,320 --> 05:45:27,440 AND I'D LOVE TO HEAR FROM THE 9685 05:45:27,440 --> 05:45:32,280 AUDIENCE, I MEAN, IT'S A 9686 05:45:32,280 --> 05:45:33,720 BUSINESS NOW, AND I THINK THE 9687 05:45:33,720 --> 05:45:35,720 WAY WE THINK ABOUT THE BUSINESS 9688 05:45:35,720 --> 05:45:37,920 OF HEALTHCARE, THAT SIDE OF IT 9689 05:45:37,920 --> 05:45:41,320 HAS TO BE INCORPORATED INTO OUR 9690 05:45:41,320 --> 05:45:43,040 THOUGHT PROCESS ABOUT HOW AND 9691 05:45:43,040 --> 05:45:45,720 WHY THAT ALLOWS FOR RACISM AND 9692 05:45:45,720 --> 05:45:47,760 STRUCTURAL RACISM TO BE PART OF 9693 05:45:47,760 --> 05:45:51,080 THAT. 9694 05:45:51,080 --> 05:45:53,840 SO I'LL STOP THERE AND I'LL PASS 9695 05:45:53,840 --> 05:45:55,440 THE MIC TO LAUREN. 9696 05:45:55,440 --> 05:45:57,080 >>I DON'T HAVE A WHOLE LOT TO 9697 05:45:57,080 --> 05:45:58,680 ADD AND WOULD LOVE TO HEAR FROM 9698 05:45:58,680 --> 05:46:03,920 YOU ALL, BUT JUST TO ECHO AN 9699 05:46:03,920 --> 05:46:05,760 IMPORTANT POINT AT SORT OF THIS 9700 05:46:05,760 --> 05:46:06,760 MULTILEVEL PROCESS IN 9701 05:46:06,760 --> 05:46:09,760 STRUCTURES, I THINK A LOT OF US 9702 05:46:09,760 --> 05:46:11,200 PROBABLY BY CONVENIENCE IN DATA 9703 05:46:11,200 --> 05:46:12,200 ACCESSIBILITY CAN LOOK AT THINGS 9704 05:46:12,200 --> 05:46:14,080 FROM VERY HIGH LEVELS IN TERMS 9705 05:46:14,080 --> 05:46:14,920 OF STRUCTURAL RACISM, WHICH I 9706 05:46:14,920 --> 05:46:16,600 THINK IS REALLY IMPORTANT 9707 05:46:16,600 --> 05:46:18,640 BECAUSE THAT'S THE LEVEL WE'D 9708 05:46:18,640 --> 05:46:20,520 IDEALLY LIKE TO INTERVENE ON. 9709 05:46:20,520 --> 05:46:22,600 BUT I THINK OF THIS AS SORT OF A 9710 05:46:22,600 --> 05:46:24,440 TOP-DOWN, BOTTOM-UP APPROACH, 9711 05:46:24,440 --> 05:46:25,760 LIKE WE HAVE STRUCTURAL RACISM 9712 05:46:25,760 --> 05:46:27,840 BUT IT HAS TO BE EXPERIENCED BY 9713 05:46:27,840 --> 05:46:29,240 AN INDIVIDUAL, SO REALLY 9714 05:46:29,240 --> 05:46:32,000 UNDERSTANDING THOSE INDIVIDUAL 9715 05:46:32,000 --> 05:46:34,360 CONTEXTS BY WHICH, YOU KNOW, 9716 05:46:34,360 --> 05:46:37,320 THESE MECHANISMS ACTUALLY 9717 05:46:37,320 --> 05:46:38,600 MANIFEST, PARTICULARLY IN 9718 05:46:38,600 --> 05:46:39,520 CARCINOGENESIS, I THINK IS 9719 05:46:39,520 --> 05:46:41,880 REALLY IMPORTANT, AND GETTING 9720 05:46:41,880 --> 05:46:43,600 DATA IN THAT SORT OF MULTILEVEL 9721 05:46:43,600 --> 05:46:46,560 WAY, I THINK IS REALLY IMPORTANT 9722 05:46:46,560 --> 05:46:47,320 AND SOMETHING THAT I BELIEVE IS 9723 05:46:47,320 --> 05:46:50,400 LARGELY MISSING IN OUR CURRENT 9724 05:46:50,400 --> 05:46:50,720 DATASETS. 9725 05:46:50,720 --> 05:46:55,760 SO JUST UNDERSTANDING TH THAT 9726 05:46:55,760 --> 05:46:57,120 INDIVIDUALS EXPERIENCE RACISM 9727 05:46:57,120 --> 05:46:59,760 THEMSELVES, THEY ARE NESTED 9728 05:46:59,760 --> 05:47:01,480 WITHIN COMMUNITIES, WITHIN LARGE 9729 05:47:01,480 --> 05:47:03,680 HE GEOGRAPHIC AREAS, WITHIN 9730 05:47:03,680 --> 05:47:04,520 THESE FEDERAL POLICIES AND THEN 9731 05:47:04,520 --> 05:47:06,520 ALL OF THESE THINGS ARE 9732 05:47:06,520 --> 05:47:09,560 INTERACTING TOGETHER TO DRIVE 9733 05:47:09,560 --> 05:47:10,520 FOR OUTCOMES FOR RACIAL AND 9734 05:47:10,520 --> 05:47:12,120 ETHNIC MINORITIES. 9735 05:47:12,120 --> 05:47:16,240 SO I'LL STOP THERE. 9736 05:47:16,240 --> 05:47:18,920 >>I WAS GOING TO GET BEYOND THE 9737 05:47:18,920 --> 05:47:19,720 INTERSECTIONALITY TO WHAT I'M 9738 05:47:19,720 --> 05:47:21,320 GOING TO CALL A MASH-UP. 9739 05:47:21,320 --> 05:47:24,160 THIS IS, FOR ME, WHERE LIBERAL 9740 05:47:24,160 --> 05:47:25,880 ARTS EDUCATION AND SCIENCE MEET. 9741 05:47:25,880 --> 05:47:27,400 SO I'M GOING TO GIVE A GENTLE 9742 05:47:27,400 --> 05:47:28,680 PUSHBACK. 9743 05:47:28,680 --> 05:47:30,920 TO A COUPLE CONCEPTS HERE. 9744 05:47:30,920 --> 05:47:33,080 NOT ME. 9745 05:47:33,080 --> 05:47:34,760 ALBERT EINSTEIN, YOU'VE GOT AN 9746 05:47:34,760 --> 05:47:36,280 ARGUMENT, YOU CAN PICK IT UP 9747 05:47:36,280 --> 05:47:38,280 WITH HIM, SAID THAT NOT ALL 9748 05:47:38,280 --> 05:47:39,720 THINGS ARE GOING TO BE COUNTED 9749 05:47:39,720 --> 05:47:41,080 MATTER. 9750 05:47:41,080 --> 05:47:42,160 AND ALL THINGS THAT MATTER CAN 9751 05:47:42,160 --> 05:47:43,240 BE COUNTED. 9752 05:47:43,240 --> 05:47:45,280 SO LET'S STOP THIS RIDICULOUS 9753 05:47:45,280 --> 05:47:48,240 ARTIFICIAL FIGHT WE HAVE BETWEEN 9754 05:47:48,240 --> 05:47:50,000 SCIENCE AND HUMANITIES. 9755 05:47:50,000 --> 05:47:51,080 THE REALITY IS THERE ARE THINGS 9756 05:47:51,080 --> 05:47:53,000 TO BE LEARNED THAT WE MAY NOT 9757 05:47:53,000 --> 05:47:55,160 ACTUALLY HAVE IN A PARTICULAR 9758 05:47:55,160 --> 05:47:56,600 FORM THAT WE ACTUALLY CAN BE 9759 05:47:56,600 --> 05:47:58,480 MADE NOT ONLY AWARE OF BUT TO 9760 05:47:58,480 --> 05:48:00,120 LEARN FROM AND THEN BE ABLE TO 9761 05:48:00,120 --> 05:48:03,840 CREATE FRAMEWORKS THAT FOR YEARS 9762 05:48:03,840 --> 05:48:05,760 WE HAVE DEVISED A WAY OF DOING 9763 05:48:05,760 --> 05:48:06,840 IT, THEREFORE WE SAY THIS IS 9764 05:48:06,840 --> 05:48:08,240 WHAT WE DO. 9765 05:48:08,240 --> 05:48:14,600 SO THIS CRAZINESS FREQUENTLY OF 9766 05:48:14,600 --> 05:48:15,640 COUNTING ALL THESE THINGS, AND 9767 05:48:15,640 --> 05:48:17,320 THEN SAYING WELL, WE CAN'T COUNT 9768 05:48:17,320 --> 05:48:19,160 THEM SO WE CAN'T DO IT, IS A 9769 05:48:19,160 --> 05:48:20,520 POOR EXCUSE FOR DOING WHAT WE'RE 9770 05:48:20,520 --> 05:48:22,760 SUPPOSED TO DOBBING AS ACADEMICS 9771 05:48:22,760 --> 05:48:23,960 ANYWAY, WHICH IS BRINGING ALL 9772 05:48:23,960 --> 05:48:25,400 THESE THINGS TOGETHER FOR SOME 9773 05:48:25,400 --> 05:48:28,560 TRUTH. 9774 05:48:28,560 --> 05:48:29,760 SECOND, I DON'T BELIEVE THAT 9775 05:48:29,760 --> 05:48:31,400 THESE ISSUES ARE IMPOSSIBLE, 9776 05:48:31,400 --> 05:48:35,320 WHICH IS WHY I STOP USING THE 9777 05:48:35,320 --> 05:48:36,440 WORD DETERMINANT AND PICKED UP 9778 05:48:36,440 --> 05:48:37,360 ON USING THE WORD DRIVERS, 9779 05:48:37,360 --> 05:48:38,760 BECAUSE JUST LIKE WE SAID NOBODY 9780 05:48:38,760 --> 05:48:40,360 COULD BREAK THE FIVE MINUTE, 9781 05:48:40,360 --> 05:48:41,280 THEN THEY BROKE IT, BUT THIS IS 9782 05:48:41,280 --> 05:48:41,920 ALL B.S. 9783 05:48:41,920 --> 05:48:44,280 THIS IS A SOCIAL CONSTRUCT THAT 9784 05:48:44,280 --> 05:48:48,560 DID NOT ALWAYS EXIST THAT HAS 9785 05:48:48,560 --> 05:48:50,880 BEEN CREATED AS A RESULT OF -- 9786 05:48:50,880 --> 05:48:52,720 LET'S JUST CALL IT WHAT IT WAS, 9787 05:48:52,720 --> 05:48:54,120 A BUSINESS PROPOSITION, RIGHT? 9788 05:48:54,120 --> 05:48:55,080 DURING THE SLAVE TRADE. 9789 05:48:55,080 --> 05:48:58,360 SO LET'S ACT AS IF WE UNDERSTAND 9790 05:48:58,360 --> 05:48:59,680 THAT SCIENCE DOESN'T EXIST 9791 05:48:59,680 --> 05:49:02,520 WITHOUT HISTORY. 9792 05:49:02,520 --> 05:49:03,600 IT'S WELL ROOTED WITHIN THAT 9793 05:49:03,600 --> 05:49:04,840 HISTORY. 9794 05:49:04,840 --> 05:49:08,840 SO AS I APPROACH THESE THINGS, I 9795 05:49:08,840 --> 05:49:10,040 ACTUALLY THINK THERE'S A 9796 05:49:10,040 --> 05:49:10,640 WONDERFUL OPPORTUNITY NOW TO 9797 05:49:10,640 --> 05:49:12,640 LOOK AT THE ISSUES OF CHASING 9798 05:49:12,640 --> 05:49:17,360 TRUTH BY ALSO UNDERSTANDING THAT 9799 05:49:17,360 --> 05:49:19,480 THE SOCIAL CONSTRUCT OF RACE HAS 9800 05:49:19,480 --> 05:49:20,040 CONSEQUENCES. 9801 05:49:20,040 --> 05:49:20,480 I'VE LIVED IT. 9802 05:49:20,480 --> 05:49:22,680 AS A 10-YEAR-OLD WHO HAD TO GO 9803 05:49:22,680 --> 05:49:24,040 THROUGH FORCED BUSING AND 9804 05:49:24,040 --> 05:49:25,160 EVERYTHING ELSE. 9805 05:49:25,160 --> 05:49:28,000 SO THAT LIVED EXPERIENCE ALSO 9806 05:49:28,000 --> 05:49:31,200 HAS NOW IMPACT ON MY BIOLOGY, 9807 05:49:31,200 --> 05:49:32,720 IMPACT ON THE EPIGENETICS, 9808 05:49:32,720 --> 05:49:33,320 IMPACT ON THE CHOICES THAT I 9809 05:49:33,320 --> 05:49:35,160 COULD MAKE OR IMPACT ON MY 9810 05:49:35,160 --> 05:49:36,440 MENTAL, IMPACT ON ALL THESE 9811 05:49:36,440 --> 05:49:37,200 THINGS. 9812 05:49:37,200 --> 05:49:38,760 THE WONDERFUL PART OF IT IS THAT 9813 05:49:38,760 --> 05:49:40,880 WITH SCIENCE, IT'S AMAZING HOW 9814 05:49:40,880 --> 05:49:43,400 MUCH COURAGE WE LACK. 9815 05:49:43,400 --> 05:49:45,800 WE SAY IT DIFFICULT. 9816 05:49:45,800 --> 05:49:46,720 AS IF IMMUNOTHERAPY WASN'T 9817 05:49:46,720 --> 05:49:48,440 DIFFICULT AND YET WE CHASED IT 9818 05:49:48,440 --> 05:49:49,440 FOR 120 YEARS UNTIL WE COULD 9819 05:49:49,440 --> 05:49:50,920 FIGURE OUT THAT WE HAD A 9820 05:49:50,920 --> 05:49:52,080 CHECKPOINT INHIBITOR AND 9821 05:49:52,080 --> 05:49:53,480 EVERYBODY SAID WELL, OF COURSE, 9822 05:49:53,480 --> 05:49:56,000 NOW WE'RE GOING TO MAKE $600 -- 9823 05:49:56,000 --> 05:49:57,280 STOP PLAYING WITH ME. 9824 05:49:57,280 --> 05:50:00,680 THE REALITY IS, UNDERSTOOD IS 9825 05:50:00,680 --> 05:50:01,760 MESSY. 9826 05:50:01,760 --> 05:50:06,120 THAT'S WHAT WE'RE HERE FOR. 9827 05:50:06,120 --> 05:50:07,760 TO NOT CREATE A VISION OF 9828 05:50:07,760 --> 05:50:09,200 CLEARING UP THE MESS WITHIN A 9829 05:50:09,200 --> 05:50:10,880 FINGER SNAP, BUT TO WORK AND TO 9830 05:50:10,880 --> 05:50:13,080 BUILD AND TO ACTUALLY HAVE BEEN 9831 05:50:13,080 --> 05:50:15,360 A FOUNDATION THAT LEADS TO 9832 05:50:15,360 --> 05:50:16,880 EVERYTHING LIKE ALEXANDER GRAHAM 9833 05:50:16,880 --> 05:50:19,480 BELL WHO THOUGHT ABOUT THE FIRST 9834 05:50:19,480 --> 05:50:21,640 TELEPHONE AND VIDEO TOGETHER AND 9835 05:50:21,640 --> 05:50:24,880 THEN ULTIMATELY GETTING STEVE 9836 05:50:24,880 --> 05:50:26,360 JOBS WHERE WE ACTUALLY HAVE THE 9837 05:50:26,360 --> 05:50:26,800 IPHONES. 9838 05:50:26,800 --> 05:50:29,880 QUIT PLAYING WITH ME. 9839 05:50:29,880 --> 05:50:31,120 SO THE BIGGER PICTURE HERE IS 9840 05:50:31,120 --> 05:50:32,760 HOW DO WE BRING ALL OF THESE 9841 05:50:32,760 --> 05:50:33,680 THINGS TOGETHER, HOW DO WE BRING 9842 05:50:33,680 --> 05:50:35,720 THE DATA FOCUS THING, AND IT 9843 05:50:35,720 --> 05:50:38,200 GOOD BECAUSE, AGAIN, DATA IS 9844 05:50:38,200 --> 05:50:40,560 GREAT, BUT THE WAY WE'VE DONE IT 9845 05:50:40,560 --> 05:50:41,800 NOW, WE'VE ACTUALLY BEEN SO PURE 9846 05:50:41,800 --> 05:50:44,080 ABOUT OUR DATA THAT WE ACTUALLY 9847 05:50:44,080 --> 05:50:45,600 HAVE INVISIBLE -- AND WE EVEN 9848 05:50:45,600 --> 05:50:48,800 HAVE COMMUNITIES THAT WE CALL 9849 05:50:48,800 --> 05:50:49,640 NEGLIGIBLE COMMUNITIES, YOU SAY 9850 05:50:49,640 --> 05:50:51,680 WE CAN'T DO ANYTHING, THEY'RE 9851 05:50:51,680 --> 05:50:52,360 NEGLIGIBLE COMMUNITIES. 9852 05:50:52,360 --> 05:50:54,240 THINK ABOUT THAT LANGUAGE IN THE 9853 05:50:54,240 --> 05:50:57,320 CONTEXT OF THE PROMISE OF 9854 05:50:57,320 --> 05:50:57,880 SCIENCE. 9855 05:50:57,880 --> 05:50:59,080 WE'RE TELLING PEOPLE WHAT WE'RE 9856 05:50:59,080 --> 05:51:00,320 GOING TO BE DOING WITH MACHINE 9857 05:51:00,320 --> 05:51:01,440 LEARNING AND A.I. 9858 05:51:01,440 --> 05:51:02,280 WE TELL PEOPLE WHAT WE'RE GOING 9859 05:51:02,280 --> 05:51:04,480 TO BE DOING WITH ALL OUR BIG 9860 05:51:04,480 --> 05:51:04,920 DATA. 9861 05:51:04,920 --> 05:51:06,120 SO WE EITHER HAVE TO FIND THE 9862 05:51:06,120 --> 05:51:07,400 COURAGE TO ACTUALLY DEAL WITH 9863 05:51:07,400 --> 05:51:09,880 THE MESS AND THE MESSINESS, ONE 9864 05:51:09,880 --> 05:51:11,560 OF THEM BEING RACE. 9865 05:51:11,560 --> 05:51:12,560 I DIDN'T CREATE IT. 9866 05:51:12,560 --> 05:51:14,360 IT WAS CREATED. 9867 05:51:14,360 --> 05:51:16,520 AS A RESULT OF BEING CREATED, 9868 05:51:16,520 --> 05:51:17,720 WHAT YOU'RE SEEING ON THE SCREEN 9869 05:51:17,720 --> 05:51:19,160 THAT WE'VE DONE THIS WHOLE THING 9870 05:51:19,160 --> 05:51:21,600 ABOUT HEALTH DISPARITIES IS THAT 9871 05:51:21,600 --> 05:51:22,680 AFRICAN AMERICAN MEN, THE NUMBER 9872 05:51:22,680 --> 05:51:26,840 ONE IN LUNG CANCER, DEATH FROM 9873 05:51:26,840 --> 05:51:28,240 POOR OUTCOMES, AFRICAN AMERICAN 9874 05:51:28,240 --> 05:51:30,600 WOMEN, THAT'S IN PART AN 9875 05:51:30,600 --> 05:51:37,240 INTERESTING EXPERIMENT OF 9876 05:51:37,240 --> 05:51:40,120 WHERE -- ZIP CODE, PLACE AND 9877 05:51:40,120 --> 05:51:42,400 SPACE, THE INTERSECTIONALITY OF 9878 05:51:42,400 --> 05:51:43,360 THAT, BIOLOGY SHOULD ACTUALLY 9879 05:51:43,360 --> 05:51:47,600 EXCITE US, NO T NOT MAKE US RUNY 9880 05:51:47,600 --> 05:51:48,480 BECAUSE IT'S MESSY. 9881 05:51:48,480 --> 05:51:50,560 BY THE WAY I'M NOT HEARING 9882 05:51:50,560 --> 05:51:51,800 ANOTHER THING ABOUT MESS BECAUSE 9883 05:51:51,800 --> 05:51:53,400 WE'VE SPENT MILLIONS AND 9884 05:51:53,400 --> 05:51:54,440 MILLIONS OF DOLLARS FOR AMAZING 9885 05:51:54,440 --> 05:51:56,200 SCIENTISTS TO TALK AND UNRAVEL 9886 05:51:56,200 --> 05:51:58,600 MESSES INCLUDING A.I., BY THE 9887 05:51:58,600 --> 05:51:59,680 WAY, WHICH CLEARLY MIGHT EVEN BE 9888 05:51:59,680 --> 05:52:01,360 A MESS BECAUSE WE DON'T REALLY 9889 05:52:01,360 --> 05:52:02,520 UNDERSTAND WHAT THE HELL WE'RE 9890 05:52:02,520 --> 05:52:03,600 DOING WITH IT RIGHT NOW. 9891 05:52:03,600 --> 05:52:05,640 [LAUGHTER] 9892 05:52:05,640 --> 05:52:09,080 SO LET'S HAVE A DIFFERENT 9893 05:52:09,080 --> 05:52:11,040 CONVERSATION WHEN IT COMES TO 9894 05:52:11,040 --> 05:52:12,520 HEALTH EQUITY AND HEALTH 9895 05:52:12,520 --> 05:52:13,120 DISPARITIES OF ELEVATING THE 9896 05:52:13,120 --> 05:52:17,160 PROBLEMS THAT WE ARE SOLVING FOR 9897 05:52:17,160 --> 05:52:18,040 HUMANITY THROUGH OUR LOVE OF 9898 05:52:18,040 --> 05:52:21,560 SCIENCE. 9899 05:52:21,560 --> 05:52:27,600 [APPLAUSE] 9900 05:52:27,600 --> 05:52:29,960 >>SO THAT WAS ROUND ONE. 9901 05:52:29,960 --> 05:52:34,280 AUDIENCE, COME ON. 9902 05:52:34,280 --> 05:52:37,680 I'M READY, I'M READY. 9903 05:52:37,680 --> 05:52:39,360 >>I THINK BY NOW, EVERYBODY 9904 05:52:39,360 --> 05:52:40,800 KNOWS WHO I AM. 9905 05:52:40,800 --> 05:52:42,000 OBVIOUSLY I WORK WITH THIS 9906 05:52:42,000 --> 05:52:43,920 GENTLEMAN RIGHT HERE. 9907 05:52:43,920 --> 05:52:48,320 SO I GUESS QUESTIONS AND 9908 05:52:48,320 --> 05:52:49,000 COMMENTS. 9909 05:52:49,000 --> 05:52:49,840 YESTERDAY THIS CAME UP, YOU 9910 05:52:49,840 --> 05:52:51,920 KNOW, I THINK SOMEBODY FROM THE 9911 05:52:51,920 --> 05:52:53,440 CHAT SAID SOMETHING ABOUT WHY 9912 05:52:53,440 --> 05:52:54,920 ARE YOU FOCUSING ON STRUCTURAL 9913 05:52:54,920 --> 05:52:55,520 RACISM? 9914 05:52:55,520 --> 05:52:58,880 WHY ARE WE NOT STUDYING WHITE 9915 05:52:58,880 --> 05:52:59,560 SUPREMACY? 9916 05:52:59,560 --> 05:53:01,000 SO THIS CONCEPT OF THAT REALLY 9917 05:53:01,000 --> 05:53:02,280 IS THAT BELIEF SYSTEM THAT WE 9918 05:53:02,280 --> 05:53:05,120 SHOULD BE ADDRESSING, AND I 9919 05:53:05,120 --> 05:53:07,040 WOULD LOVE TO HEAR YOUR MUSINGS 9920 05:53:07,040 --> 05:53:09,880 AROUND THAT AND HOW DO WE SORT 9921 05:53:09,880 --> 05:53:12,200 OF DEAL WITH THAT, AND WHETHER 9922 05:53:12,200 --> 05:53:12,600 THAT'S CHANGEABLE. 9923 05:53:12,600 --> 05:53:14,280 SO WE TALK ABOUT STRUCTURAL 9924 05:53:14,280 --> 05:53:15,880 RACISM, YOU JUST MENTIONED, 9925 05:53:15,880 --> 05:53:17,200 CHANITA THAT, WELL, IT'S NOT 9926 05:53:17,200 --> 05:53:18,720 ABOUT CHANGING IT, IT'S ABOUT 9927 05:53:18,720 --> 05:53:20,880 STUDYING, BUT HOW ABOUT THEN THE 9928 05:53:20,880 --> 05:53:21,200 BELIEF SYSTEM? 9929 05:53:21,200 --> 05:53:22,320 IS THERE AN OPPORTUNITY? 9930 05:53:22,320 --> 05:53:22,880 THAT'S ONE. 9931 05:53:22,880 --> 05:53:24,800 AND THEN TWO, YOU KNOW, TO 9932 05:53:24,800 --> 05:53:27,560 DR. WINN, YOU KNOW, AROUND 9933 05:53:27,560 --> 05:53:29,960 SCIENTISTS GROWING UP AND SORT 9934 05:53:29,960 --> 05:53:32,640 OF BEING SCARED, RIGHT, 9935 05:53:32,640 --> 05:53:33,760 ENVIRONMENT OF TAKING RISKS, 9936 05:53:33,760 --> 05:53:34,760 THERE ARE SOME OF US THAT HAVE 9937 05:53:34,760 --> 05:53:36,160 THE OPPORTUNITY AND THE 9938 05:53:36,160 --> 05:53:37,400 PROTECTION OF WORKING WITH FOLKS 9939 05:53:37,400 --> 05:53:40,240 LIKE YOU THAT ALLOW US TO BE 9940 05:53:40,240 --> 05:53:42,520 BOLD AND BOLD IDEAS THEN CAN 9941 05:53:42,520 --> 05:53:43,600 CREATE BREAKTHROUGHS. 9942 05:53:43,600 --> 05:53:45,600 AND SO IN THE SPIRIT OF THIS 9943 05:53:45,600 --> 05:53:48,160 PANEL BEING ABOUT POLICY AND 9944 05:53:48,160 --> 05:53:49,760 CHANGING POLICIES, HOW DO WE 9945 05:53:49,760 --> 05:53:51,240 SORT OF ADDRESS THAT AND FIGURE 9946 05:53:51,240 --> 05:53:52,960 OUT HOW TO BRING THE NEXT 9947 05:53:52,960 --> 05:53:54,720 GENERATION OF BOLD SCIENTISTS 9948 05:53:54,720 --> 05:53:57,600 WIWITHIN INSTITUTIONS WHERE THEY 9949 05:53:57,600 --> 05:53:59,880 FEEL PROTECTED TO TAKE RISKS, 9950 05:53:59,880 --> 05:54:00,600 PARTICULARLY SCIENTISTS THAT 9951 05:54:00,600 --> 05:54:03,040 LOOK LIKE ME? 9952 05:54:03,040 --> 05:54:04,560 >>YOU TOOK MY LAST QUESTION, 9953 05:54:04,560 --> 05:54:07,200 BUT THAT WAS GOOD. 9954 05:54:07,200 --> 05:54:07,440 [LAUGHTER] 9955 05:54:07,440 --> 05:54:08,960 >>I'LL START. 9956 05:54:08,960 --> 05:54:10,240 I'VE BEEN REFLECTING ON MY 9957 05:54:10,240 --> 05:54:11,320 RESPONSE TO THE QUESTION 9958 05:54:11,320 --> 05:54:12,520 YESTERDAY AND ABOUT THE ISSUE 9959 05:54:12,520 --> 05:54:14,280 AND I GUESS -- AND THE INITIAL 9960 05:54:14,280 --> 05:54:17,800 QUESTION THAT WAS ASKED. 9961 05:54:17,800 --> 05:54:21,200 AND I'LL SAY THIS, MY PERSONAL 9962 05:54:21,200 --> 05:54:23,000 BELIEF IS THAT I CAN'T CHANGE 9963 05:54:23,000 --> 05:54:24,320 WHAT OTHER PEOPLE THINK AND WHAT 9964 05:54:24,320 --> 05:54:25,160 THEY BELIEVE. 9965 05:54:25,160 --> 05:54:30,200 AND I DON'T KNOW THAT IT IS 9966 05:54:30,200 --> 05:54:32,480 WORTH MY TIME AND ENERGY AND OUR 9967 05:54:32,480 --> 05:54:34,000 TIME AND ENERGY TO TRY TO CHANGE 9968 05:54:34,000 --> 05:54:38,400 SOMEONE ELSE'S BELIEFS. 9969 05:54:38,400 --> 05:54:38,760 THAT CAN 9970 05:54:38,760 --> 05:54:42,640 BE SO DEEPLY ROOTED AND HELD 9971 05:54:42,640 --> 05:54:46,400 THAT IT IS, YOU KNOW -- I'M SURE 9972 05:54:46,400 --> 05:54:49,240 ALL OF US CAN REMEMBER, YOU CAN 9973 05:54:49,240 --> 05:54:51,000 ONLY DO WHAT YOU CAN DO AND YOUR 9974 05:54:51,000 --> 05:54:52,280 BEHAVIOR AND YOUR BELIEFS, AND I 9975 05:54:52,280 --> 05:54:57,560 THINK THAT THAT IS A TRUISM, 9976 05:54:57,560 --> 05:54:58,440 THAT IS SOMETHING THAT I THINK 9977 05:54:58,440 --> 05:55:00,120 WE HAVE SEEN, AND I'D LOVE TO 9978 05:55:00,120 --> 05:55:01,760 HEAR COMMENTS, PUSHBACK ABOUT 9979 05:55:01,760 --> 05:55:05,440 THIS, BUT I DON'T KNOW THAT OUR 9980 05:55:05,440 --> 05:55:07,640 EFFORTS OR MY EFFORTS, AND I'LL 9981 05:55:07,640 --> 05:55:08,480 SPEAK FOR MYSELF, THAT MY 9982 05:55:08,480 --> 05:55:09,800 EFFORTS WOULD BE THE BEST SERVED 9983 05:55:09,800 --> 05:55:13,040 TO SOMEONE WHO BELIEVES THAT A 9984 05:55:13,040 --> 05:55:16,440 GROUP OF PEOPLE ARE DEFICIENT 9985 05:55:16,440 --> 05:55:18,000 FOR WHATEVER REASON, AND NOT 9986 05:55:18,000 --> 05:55:19,280 BECAUSE THEY HAVE ANY PROOF BUT 9987 05:55:19,280 --> 05:55:21,240 BECAUSE OF WHAT THEY'VE HEARD, 9988 05:55:21,240 --> 05:55:22,440 READ, OR MISINFORMATION, ALL OF 9989 05:55:22,440 --> 05:55:22,720 IT. 9990 05:55:22,720 --> 05:55:27,480 I MEAN, I DON'T THINK THAT 9991 05:55:27,480 --> 05:55:28,960 OUR -- MY ENERGY, I'LL SAY MY 9992 05:55:28,960 --> 05:55:30,120 ENERGY SHOULD BE USED IN THAT 9993 05:55:30,120 --> 05:55:30,880 WAY. 9994 05:55:30,880 --> 05:55:34,400 I DO THINK WE CAN CHANGE THE 9995 05:55:34,400 --> 05:55:36,880 CONVERSATION AND THE FOCUS BY 9996 05:55:36,880 --> 05:55:39,960 HAVING MORE DIVERSITY AT THE 9997 05:55:39,960 --> 05:55:41,680 TABLE AND HAVING MORE PEOPLE AT 9998 05:55:41,680 --> 05:55:45,800 THE TABLE WHO GIVE US THE 9999 05:55:45,800 --> 05:55:49,240 PROTECTION AND THE GUIDANCE TO 10000 05:55:49,240 --> 05:55:50,840 SAY THIS IS HOW WE'RE GOING TO 10001 05:55:50,840 --> 05:55:52,120 DO IT, WE'RE GOING TO DO IT 10002 05:55:52,120 --> 05:55:53,040 DIFFERENTLY, YOU CAN HAVE YOUR 10003 05:55:53,040 --> 05:55:54,040 BELIEFS BUT WHEN YOU COME TO 10004 05:55:54,040 --> 05:55:55,000 THIS TABLE, THIS IS HOW WE'RE 10005 05:55:55,000 --> 05:55:56,920 GOING TO FUNCTION. 10006 05:55:56,920 --> 05:56:01,720 OUR BELIEFS ARE, YOU KNOW -- AS 10007 05:56:01,720 --> 05:56:04,400 A PSYCHOLOGIST, YOU KNOW, THOSE 10008 05:56:04,400 --> 05:56:06,440 ARE WHAT WE BELIEVE, OUR 10009 05:56:06,440 --> 05:56:08,240 ATTITUDES ARE OUR ATTITUDE, AND 10010 05:56:08,240 --> 05:56:10,000 I THINK THERE ARE THINGS YOU CAN 10011 05:56:10,000 --> 05:56:10,880 MAKE SMALL CHANGES, BUT PEOPLE 10012 05:56:10,880 --> 05:56:12,600 ARE WHO THEY ARE. 10013 05:56:12,600 --> 05:56:17,400 AND I DON'T KNOW THAT WHEN IT 10014 05:56:17,400 --> 05:56:22,000 COMES TO RACE AND RACISM, THAT 10015 05:56:22,000 --> 05:56:24,440 THERE ARE THINGS THAT I THINK 10016 05:56:24,440 --> 05:56:25,320 THEY'RE SMALL CHANGES -- I'M 10017 05:56:25,320 --> 05:56:26,240 GOING TO EDIT MYSELF. 10018 05:56:26,240 --> 05:56:27,920 I THINK THERE ARE WAYS WE CAN 10019 05:56:27,920 --> 05:56:28,640 MAKE SMALL CHANGES BUT IF 10020 05:56:28,640 --> 05:56:31,200 SOMEONE REALLY TRULY BELIEVES, 10021 05:56:31,200 --> 05:56:32,600 THEN -- GO AHEAD, ROB. 10022 05:56:32,600 --> 05:56:34,040 >>I JUST WANTED TO JUMP IN JUST 10023 05:56:34,040 --> 05:56:36,240 A LITTLE BIT AND I THINK THAT 10024 05:56:36,240 --> 05:56:38,720 THIS IS WHERE I HAVE EMBRACED 10025 05:56:38,720 --> 05:56:39,160 THE NEW CHALLENGE. 10026 05:56:39,160 --> 05:56:40,840 AS A CANCER CENTER DIRECTOR, 10027 05:56:40,840 --> 05:56:42,720 WHEN I TOOK OVER, ONE OF THE 10028 05:56:42,720 --> 05:56:46,560 THINGS I THINK I HAD AS A -- AS 10029 05:56:46,560 --> 05:56:48,400 AN ISSUE, WASN'T MY ISSUE, OTHER 10030 05:56:48,400 --> 05:56:49,960 PEOPLE'S ISSUES, WELL, NOW THAT 10031 05:56:49,960 --> 05:56:52,640 HE'S AFRICAN AMERICAN, ALL HE'SS 10032 05:56:52,640 --> 05:56:53,760 GOING TO THINK ABOUT IS AFRICAN 10033 05:56:53,760 --> 05:56:54,000 AMERICANS. 10034 05:56:54,000 --> 05:56:55,080 SO I THOUGHT ABOUT THAT AND 10035 05:56:55,080 --> 05:56:56,040 THOUGHT ABOUT, BOTTOM LINE, WHAT 10036 05:56:56,040 --> 05:56:57,640 DID I REPRESENT AS A CANCER 10037 05:56:57,640 --> 05:56:58,120 CENTER DIRECTOR? 10038 05:56:58,120 --> 05:56:59,200 THE FUN PART WHAT YOU JUST 10039 05:56:59,200 --> 05:57:00,080 TALKED ABOUT, THAT GROUP OF 10040 05:57:00,080 --> 05:57:02,360 PEOPLE WHO ALSO ARE HOLDING ON 10041 05:57:02,360 --> 05:57:04,320 TO BELIEFS OR HOLDING ON TO 10042 05:57:04,320 --> 05:57:05,880 BEHAVIORS OR HOLDING ON TO 10043 05:57:05,880 --> 05:57:08,120 HEALTH BEHAVIORS THAT ALSO CAUSE 10044 05:57:08,120 --> 05:57:09,400 THEM IN SOME WAYS, BECAUSE WE 10045 05:57:09,400 --> 05:57:10,960 ALWAYS TALK ABOUT AFRICAN 10046 05:57:10,960 --> 05:57:13,760 AMERICANS AS BEING -- BUT THOSE 10047 05:57:13,760 --> 05:57:15,360 SAME FOLKS WHO ARE HOLD ON TO 10048 05:57:15,360 --> 05:57:16,760 THAT ACTUALLY ALSO ARE LIVING A 10049 05:57:16,760 --> 05:57:18,560 LIFE THAT WILL ACTUALLY HAVE 10050 05:57:18,560 --> 05:57:20,160 SOME IMPACT ON THEIR BIOLOGY. 10051 05:57:20,160 --> 05:57:21,760 MANY OF, AS WE START THINKING 10052 05:57:21,760 --> 05:57:23,480 ABOUT IN SOME OF THE POOR AREAS 10053 05:57:23,480 --> 05:57:24,240 OF PARTICULARLY FOLKS WHO HOLD 10054 05:57:24,240 --> 05:57:25,000 ON TO THIS. 10055 05:57:25,000 --> 05:57:26,560 SO ONE OF THE ISSUES WE DON'T 10056 05:57:26,560 --> 05:57:29,800 ALSO THINK ABOUT, WE THINK ABOUT 10057 05:57:29,800 --> 05:57:31,480 THIS IS WHY I THINK PLACE AND 10058 05:57:31,480 --> 05:57:32,440 SPACE IS IMPORTANT BECAUSE I 10059 05:57:32,440 --> 05:57:35,040 ALSO THINK ABOUT THOSE PEOPLE IN 10060 05:57:35,040 --> 05:57:38,680 KENTUCKY WHO ARE NOW BEING 10061 05:57:38,680 --> 05:57:41,160 UNDER -- YOU KNOW, 10062 05:57:41,160 --> 05:57:42,880 OVERINFLUENCED IN THEIR CLASS IN 10063 05:57:42,880 --> 05:57:45,160 THE CONTEXT OF EDUCATION, THEIR 10064 05:57:45,160 --> 05:57:47,160 CLASS IN THE CONTEXT OF ACCESS 10065 05:57:47,160 --> 05:57:49,760 TO NOT JOBS ALSO ARE CAUSING 10066 05:57:49,760 --> 05:57:51,000 THEM AND THOSE VERY SAME PEOPLE 10067 05:57:51,000 --> 05:57:52,760 TO HAVE OUTCOMES SIMILAR TO 10068 05:57:52,760 --> 05:57:52,960 MINE. 10069 05:57:52,960 --> 05:57:54,160 SO THE ONE THING THAT I REALLY 10070 05:57:54,160 --> 05:57:55,960 LOVE ABOUT WHAT WE CAN DO IN THE 10071 05:57:55,960 --> 05:57:57,440 CONTEXT OF BRINGING POPULATION 10072 05:57:57,440 --> 05:57:58,680 SCIENCE OR BRINGING ALL THESE 10073 05:57:58,680 --> 05:58:03,200 THINGS TO BEAR IS THAT I THINK 10074 05:58:03,200 --> 05:58:04,200 ALMOST EVERYONE START GETTING A 10075 05:58:04,200 --> 05:58:05,440 LITTLE BIT BETTER WHEN THEY CAN 10076 05:58:05,440 --> 05:58:06,440 SEE THAT THE SCIENCE IS 10077 05:58:06,440 --> 05:58:07,880 IMPACTING THEM MORE FAVORABLY, 10078 05:58:07,880 --> 05:58:09,360 AND WHEN THEY HAVE POLICIES THAT 10079 05:58:09,360 --> 05:58:11,480 ARE ACTUALLY LEADING THEM TO NOT 10080 05:58:11,480 --> 05:58:14,560 BE SORT OF THIS ISSUE OF AND YOU 10081 05:58:14,560 --> 05:58:16,720 GOT SOMETHING BECAUSE OF YOUR 10082 05:58:16,720 --> 05:58:17,840 COLOR AND I DIDN'T GET IT. 10083 05:58:17,840 --> 05:58:19,400 AND SO I DO THINK THAT THERE IS 10084 05:58:19,400 --> 05:58:21,480 A BIGGER THING AT HAND OF HOW DO 10085 05:58:21,480 --> 05:58:24,400 WE BRING POLICIES BEYOND 10086 05:58:24,400 --> 05:58:27,280 POLITICS, HOW DO WE BRING 10087 05:58:27,280 --> 05:58:28,520 POLICIES AND AFFECTING THINGS SO 10088 05:58:28,520 --> 05:58:31,040 WE ARE IMPACTING PLACE AND SPACE 10089 05:58:31,040 --> 05:58:31,680 IN THE CONTEXT OF COMMUNITIES. 10090 05:58:31,680 --> 05:58:33,400 >>I AGREE WITH THAT. 10091 05:58:33,400 --> 05:58:35,920 BUT I THINK IN TERMS OF THE 10092 05:58:35,920 --> 05:58:37,440 QUESTION THAT WAS ASKED 10093 05:58:37,440 --> 05:58:38,640 YESTERDAY IT'S LIKE SHOULDN'T WE 10094 05:58:38,640 --> 05:58:41,640 BE WORKING ON CHANGING WHITE 10095 05:58:41,640 --> 05:58:47,920 SUPREMACY BELIEFS, AND I THINK 10096 05:58:47,920 --> 05:58:49,800 WE CAN TRY DO THAT, BUT I THINK 10097 05:58:49,800 --> 05:58:54,600 PART OF -- I WAS ALSO A PRODUCT 10098 05:58:54,600 --> 05:59:00,320 OF FORCE BESMAN, THE THINGS THAT 10099 05:59:00,320 --> 05:59:01,680 WERE DONE, THE CHANGE IN POLICY 10100 05:59:01,680 --> 05:59:03,400 TO MAKE IT OWE CAN I FOR US TO 10101 05:59:03,400 --> 05:59:04,560 BE AT THE TABLE, I DON'T KNOW. 10102 05:59:04,560 --> 05:59:06,880 I MEAN, I THINK WE CAN BE -- I 10103 05:59:06,880 --> 05:59:08,080 MEAN, I THINK WE -- 10104 05:59:08,080 --> 05:59:10,840 >>BUT THERE MAY BE -- IT MAY BE 10105 05:59:10,840 --> 05:59:12,240 YOU MAY NOT BE AT THAT TABLE BUT 10106 05:59:12,240 --> 05:59:13,440 WE MAY HAVE PEOPLE FROM THOSE 10107 05:59:13,440 --> 05:59:14,240 COMMUNITIES THAT MAY BE 10108 05:59:14,240 --> 05:59:15,520 INTERESTED IN TRYING TO ADDRESS 10109 05:59:15,520 --> 05:59:16,280 THOSE ISSUES. 10110 05:59:16,280 --> 05:59:17,080 THAT'S ALL I'M SAYING. 10111 05:59:17,080 --> 05:59:19,640 >>SO AGAIN, I THINK I'LL SAY 10112 05:59:19,640 --> 05:59:20,760 THIS AND THEN I'LL SHUT UP 10113 05:59:20,760 --> 05:59:22,440 BECAUSE I FEEL LIKE I'M DIGGING 10114 05:59:22,440 --> 05:59:25,240 MYSELF INTO A HOLE BECAUSE IT'S 10115 05:59:25,240 --> 05:59:27,240 ALL ABOUT YOU'RE REALLY SEEING 10116 05:59:27,240 --> 05:59:29,240 THE TRUE CHANITA, WHICH IS, I 10117 05:59:29,240 --> 05:59:31,200 GUESS, MAYBE THE GOAL FOR THIS 10118 05:59:31,200 --> 05:59:32,600 SESSION, WHICH IS -- I'LL 10119 05:59:32,600 --> 05:59:37,800 EMBRACE THAT. 10120 05:59:37,800 --> 05:59:39,600 I THINK THE MORE WE HAVE GREATER 10121 05:59:39,600 --> 05:59:41,440 DIVERSE -- I'LL SAY WHAT I SAID 10122 05:59:41,440 --> 05:59:42,880 YESTERDAY, THE MORE WE HAVE 10123 05:59:42,880 --> 05:59:43,640 GREATER DIVERSITY AROUND THE 10124 05:59:43,640 --> 05:59:44,880 TABLE AND WE CAN DEVELOP 10125 05:59:44,880 --> 05:59:46,920 POLICIES THAT ARE ACTUALLY 10126 05:59:46,920 --> 05:59:49,240 ENFORCEABLE, AND THEN HAVE 10127 05:59:49,240 --> 05:59:50,240 ACCOUNTABILITY FOR THOSE 10128 05:59:50,240 --> 05:59:51,880 POLICIES AND ENFORCEMENT OF 10129 05:59:51,880 --> 05:59:55,880 THOSE POLICIES, I THINK THAT 10130 05:59:55,880 --> 05:59:58,120 YES, THAT IS A STEP IN THE RIGHT 10131 05:59:58,120 --> 05:59:58,960 DIRECTION, BUT I THINK IN TERMS 10132 05:59:58,960 --> 06:00:02,160 OF CHANGING SOMEONE'S LIFE, THE 10133 06:00:02,160 --> 06:00:03,520 SUPREMACY PARTS OF THINGS, I 10134 06:00:03,520 --> 06:00:05,800 THINK THERE'S A LONG WAY TO GO, 10135 06:00:05,800 --> 06:00:07,200 AND I DON'T KNOW THAT THAT'S THE 10136 06:00:07,200 --> 06:00:08,840 BEST WAY FOR US TO SORT OF USE 10137 06:00:08,840 --> 06:00:09,960 OUR COLLECTIVE TIME. 10138 06:00:09,960 --> 06:00:12,320 >>BUT I DON'T THINK THAT THEY 10139 06:00:12,320 --> 06:00:13,000 ARE SEPARATE. 10140 06:00:13,000 --> 06:00:13,400 RIGHT? 10141 06:00:13,400 --> 06:00:16,200 LIKE I THINK THAT STUDY IN 10142 06:00:16,200 --> 06:00:18,600 STRUCTURAL RACISM, IT IS KIND OF 10143 06:00:18,600 --> 06:00:20,640 A FRONT TO THEM, WHICH IS WHY 10144 06:00:20,640 --> 06:00:24,600 THERE'S SO MUCH PUSHBACK ON 10145 06:00:24,600 --> 06:00:25,480 CRITICAL RACE THEORY AND THE 10146 06:00:25,480 --> 06:00:27,000 STUDY OF STRUCTURAL RACISM, 10147 06:00:27,000 --> 06:00:28,000 BECAUSE WE ARE NOW PUSHING THE 10148 06:00:28,000 --> 06:00:29,280 SYSTEM THAT THEY HAVE GOTTEN 10149 06:00:29,280 --> 06:00:33,480 VERY COMFORTAB COMFORTABLE WITH. 10150 06:00:33,480 --> 06:00:34,720 SO WHILE WE'RE NOT SORT OF 10151 06:00:34,720 --> 06:00:36,000 STUDYING THAT PER SE, I DO THINK 10152 06:00:36,000 --> 06:00:37,440 IN A LOT OF WAYS, WE ARE 10153 06:00:37,440 --> 06:00:39,920 CHALLENGING THAT THINKING. 10154 06:00:39,920 --> 06:00:41,280 AND CHALLENGING THE SYSTEM. 10155 06:00:41,280 --> 06:00:45,320 >>I'M GOING TO COME AT YOU FRAY 10156 06:00:45,320 --> 06:00:45,760 HAMPTON. 10157 06:00:45,760 --> 06:00:47,440 I'M GOING TO GET ALL FRED 10158 06:00:47,440 --> 06:00:48,360 HAMPTON WITH YOU. 10159 06:00:48,360 --> 06:00:53,880 ONE OF MY FAVORITE -- FRED 10160 06:00:53,880 --> 06:00:54,440 UNDERSTOOD WHAT HAPPENS IS 10161 06:00:54,440 --> 06:00:56,000 PEOPLE HAVE INCREDIBLE BEHAVIORS 10162 06:00:56,000 --> 06:00:57,120 IF THEY FELT UNHEARD. 10163 06:00:57,120 --> 06:00:59,280 SO FRED WAS ONE OF THE PANTHERS 10164 06:00:59,280 --> 06:01:00,280 WHO TALKED ABOUT POWER TO THE 10165 06:01:00,280 --> 06:01:01,600 PEOPLE AND UNDERSTOOD THAT EVEN 10166 06:01:01,600 --> 06:01:05,120 THOSE PEOPLE IN CENTRAL 10167 06:01:05,120 --> 06:01:07,280 ILLINOIS, THE BIKERS, HE 10168 06:01:07,280 --> 06:01:08,720 ACTUALLY SAID LET'S BRING THEM 10169 06:01:08,720 --> 06:01:10,800 IN BECAUSE WHAT ACTUALLY 10170 06:01:10,800 --> 06:01:12,000 HAPPENS, THEIR STRUGGLE IS 10171 06:01:12,000 --> 06:01:13,160 SIMILAR TO OURS AND ONCE WE CAN 10172 06:01:13,160 --> 06:01:14,360 GET THEM TO UNDERSTAND THAT, SO 10173 06:01:14,360 --> 06:01:15,720 THERE IS AN ELEMENT OF BEING 10174 06:01:15,720 --> 06:01:17,360 ABLE TO UNDERSTAND THAT WE ARE 10175 06:01:17,360 --> 06:01:18,640 ACTUALLY PROBABLY SUFFERING 10176 06:01:18,640 --> 06:01:20,280 BECAUSE WE DID TAKE OUR EYE OFF 10177 06:01:20,280 --> 06:01:21,800 THE BALL, THERE WERE PROGRAMS 10178 06:01:21,800 --> 06:01:23,000 AND POLICIES IN PLACE. 10179 06:01:23,000 --> 06:01:25,760 THIS ISSUE OF MAKING SURE THAT 10180 06:01:25,760 --> 06:01:28,280 ALL PEOPLE, PARTICULARLY ALL 10181 06:01:28,280 --> 06:01:30,680 PEOPLE OF CLASS, PARTICULARLY 10182 06:01:30,680 --> 06:01:32,360 POOR, BECAUSE IF I LOOK AT MY 10183 06:01:32,360 --> 06:01:35,080 NUMBERS, WHETHER YOU'RE POOR 10184 06:01:35,080 --> 06:01:37,200 WHITE OR POOR BLACK, YOU AREN'T 10185 06:01:37,200 --> 06:01:38,160 DOING WELL. 10186 06:01:38,160 --> 06:01:39,480 SOMEBODY IN MISSISSIPPI RIGHT 10187 06:01:39,480 --> 06:01:41,320 NOW IS DOING A WHOLE LOT LESS 10188 06:01:41,320 --> 06:01:42,120 WELL THAN SOMEBODY LIVING RIGHT 10189 06:01:42,120 --> 06:01:43,640 HERE IN D.C. , RIGHT? 10190 06:01:43,640 --> 06:01:44,400 PARTICULARLY IF YOU MATCH UP 10191 06:01:44,400 --> 06:01:44,960 YOUR POOR PEOPLE. 10192 06:01:44,960 --> 06:01:46,520 SO I DO THINK THAT AS WE THINK 10193 06:01:46,520 --> 06:01:48,480 ABOUT RACE, ETHNICITY, PLACE AND 10194 06:01:48,480 --> 06:01:49,800 SPACE AND CLASS, THERE IS AT 10195 06:01:49,800 --> 06:01:53,840 LEAST AN ELEMENT THAT SOMEBODY 10196 06:01:53,840 --> 06:01:55,160 MAY BE ABLE TO ADDRESS THAT 10197 06:01:55,160 --> 06:01:55,360 ISSUE. 10198 06:01:55,360 --> 06:01:57,440 >>FOR SURE, AND I KNOW THERE'S 10199 06:01:57,440 --> 06:02:00,840 A QUESTION OR COMMENT BUT I 10200 06:02:00,840 --> 06:02:02,040 THINK WHAT YOU SAID REALLY 10201 06:02:02,040 --> 06:02:03,200 RESONATES WITH ME ABOUT POWER TO 10202 06:02:03,200 --> 06:02:04,800 THE PEOPLE, AND WE HAVE TO -- 10203 06:02:04,800 --> 06:02:07,520 AND THAT'S WHY FOR ME, I THINK 10204 06:02:07,520 --> 06:02:09,080 COMMUNITY ENGAGEMENT, 10205 06:02:09,080 --> 06:02:11,760 COMMUNITY-BASED RESEARCH REALLY 10206 06:02:11,760 --> 06:02:12,440 RESONATES, BECAUSE THAT IS ABOUT 10207 06:02:12,440 --> 06:02:17,280 US TAKING CONTROL OF OUR OWN 10208 06:02:17,280 --> 06:02:19,360 DESTINY AND OUR OWN IN SORT OF 10209 06:02:19,360 --> 06:02:25,800 DOING FOR OURSELVES WHAT I THINK 10210 06:02:25,800 --> 06:02:26,600 IS REALLY IMPORTANT. 10211 06:02:26,600 --> 06:02:28,520 I MEAN, IT'S REALLY IMPORTANT. 10212 06:02:28,520 --> 06:02:30,400 SO IT'S ABOUT, YOU KNOW, WE 10213 06:02:30,400 --> 06:02:31,360 HAVE -- WE UNDERSTAND WHERE WE 10214 06:02:31,360 --> 06:02:33,760 LIVE, WE UNDERSTAND HOW WE LIVE, 10215 06:02:33,760 --> 06:02:35,920 WE UNDERSTAND OUR NEIGHBORHOODS, 10216 06:02:35,920 --> 06:02:38,640 AND ALL OF US HAVE IDEAS AND 10217 06:02:38,640 --> 06:02:40,880 SOLUTIONS THAT WE'VE EITHER DOP 10218 06:02:40,880 --> 06:02:43,000 AND TRIED AND FAILED, DON AND 10219 06:02:43,000 --> 06:02:44,920 TRIED AND BEEN SUCCESSFUL, SO 10220 06:02:44,920 --> 06:02:47,520 ALL OF THOSE THINGS, YOU KNOW, 10221 06:02:47,520 --> 06:02:48,720 WILL CONTINUE TO MOVE FORWARD, 10222 06:02:48,720 --> 06:02:51,960 AND I DON'T THINK THAT WE HAVE 10223 06:02:51,960 --> 06:02:52,640 EMBRACED OUR COMMUNITIES IN THAT 10224 06:02:52,640 --> 06:02:55,040 WAY AND THE RESEARCH ENTERPRISE, 10225 06:02:55,040 --> 06:02:58,440 AND I THINK THAT THAT IS 10226 06:02:58,440 --> 06:03:00,280 WHERE -- SO I GUESS LET ME SAY 10227 06:03:00,280 --> 06:03:02,200 NOW THAT I'VE HAD A MOMENT TO 10228 06:03:02,200 --> 06:03:06,120 THINK ABOUT IT, I THINK THAT'S 10229 06:03:06,120 --> 06:03:07,360 WHERE I'D RATHER SPEND OUR TIME 10230 06:03:07,360 --> 06:03:08,880 OR I'D RATHER BE PART OF THOSE 10231 06:03:08,880 --> 06:03:10,080 TYPES OF INITIATIVES RATHER THAN 10232 06:03:10,080 --> 06:03:12,520 TRY TO CHANGE WHAT SOMEONE ELSE 10233 06:03:12,520 --> 06:03:13,680 THINKS, BELIEVES OR DOES, WHAT 10234 06:03:13,680 --> 06:03:15,920 CAN WE DO FOR OURSELVES AND HOW 10235 06:03:15,920 --> 06:03:19,880 CAN WE GET IT DONE? 10236 06:03:19,880 --> 06:03:20,400 >>THANK YOU. 10237 06:03:20,400 --> 06:03:22,520 I THINK MY QUESTION IS RELATED 10238 06:03:22,520 --> 06:03:24,680 BUT NOT AT ALL RELATED SO I'M 10239 06:03:24,680 --> 06:03:27,080 GOING TO ACKNOWLEDGE THAT ON 10240 06:03:27,080 --> 06:03:28,880 THERE. 10241 06:03:28,880 --> 06:03:29,760 I THINK HERE THE LAST TWO DAYS 10242 06:03:29,760 --> 06:03:31,120 AND JUST IN GENERAL, FOLKS WHO 10243 06:03:31,120 --> 06:03:32,920 ARE CANCER EQUITY RESEARCHERS 10244 06:03:32,920 --> 06:03:35,440 OFTEN TALK ABOUT POLICY 10245 06:03:35,440 --> 06:03:36,880 IMPLICATIONS OR THE NEED FOR 10246 06:03:36,880 --> 06:03:38,960 EQUITABLE POLICIES, THE NEED FOR 10247 06:03:38,960 --> 06:03:40,240 JUST POLICIES, AND THEN WE STOP. 10248 06:03:40,240 --> 06:03:41,840 WE DON'T WANT TO ACTUALLY HAVE 10249 06:03:41,840 --> 06:03:42,880 ANY SPECIFICITY BECAUSE THAT'S 10250 06:03:42,880 --> 06:03:44,680 NOT OUR AREA AND THERE IS A 10251 06:03:44,680 --> 06:03:46,640 STIGMA TO BEING AN ADVOCATE, 10252 06:03:46,640 --> 06:03:49,280 RIGHT, AS A SCIENTIST TO USING 10253 06:03:49,280 --> 06:03:51,080 YOUR OBJECTIVITY THAT I THINK IS 10254 06:03:51,080 --> 06:03:53,120 REAL AND MEANINGFUL, AND WE'VE 10255 06:03:53,120 --> 06:03:54,640 SEEN SOME SHIFTS AND SOME 10256 06:03:54,640 --> 06:03:55,040 CHANGES WITH THAT. 10257 06:03:55,040 --> 06:03:57,600 FOR EXAMPLE, OUTREACH AND 10258 06:03:57,600 --> 06:03:59,160 ENGAGEMENT NOW WE HAVE TO HAVE 10259 06:03:59,160 --> 06:04:00,880 POLICY AND ADVOCACY, DATA-DRIVEN 10260 06:04:00,880 --> 06:04:06,080 POLICY AND SAID V ADVOCACY IT 10261 06:04:06,080 --> 06:04:09,000 STRIKES ME AS VERY 10262 06:04:09,000 --> 06:04:10,360 UNIDIRECTIONAL, WITHOUT 10263 06:04:10,360 --> 06:04:11,960 NECESSARILY KNOWING AND 10264 06:04:11,960 --> 06:04:13,240 UNDERSTANDING THE FULL NUANCE OF 10265 06:04:13,240 --> 06:04:15,400 POLICY. 10266 06:04:15,400 --> 06:04:17,000 SO THAT'S A LARGE CONTEXT, YOU 10267 06:04:17,000 --> 06:04:18,640 CAN ERASE ALL OF THAT FROM YOUR 10268 06:04:18,640 --> 06:04:19,520 MEMORY BUT I THINK MY QUESTION 10269 06:04:19,520 --> 06:04:21,280 IS REALLY, HOW DO WE GET 10270 06:04:21,280 --> 06:04:23,800 SPECIFICITY IN OUR POLICY 10271 06:04:23,800 --> 06:04:32,360 IMPLICATIONS AS RESEARCHERS? 10272 06:04:32,360 --> 06:04:36,600 >>I'LL STAWRT START BY SAYING,S 10273 06:04:36,600 --> 06:04:39,200 INTERESTING BECAUSE I THINK THAT 10274 06:04:39,200 --> 06:04:41,200 OUR ROLE, SCIENTISTS' ROLE IN 10275 06:04:41,200 --> 06:04:43,240 POLICY IS TO REALLY BE AT THE 10276 06:04:43,240 --> 06:04:44,640 FOREFRONT OF GENERATING THE DATA 10277 06:04:44,640 --> 06:04:46,120 TO HELP INFORM POLICY AND THEN 10278 06:04:46,120 --> 06:04:50,880 TO BE ABLE TO COMMUNICATE OUR 10279 06:04:50,880 --> 06:04:53,680 RESULTS IN OUR ROLES AT OUR 10280 06:04:53,680 --> 06:04:54,760 ACADEMIC INSTITUTIONS, BUT I 10281 06:04:54,760 --> 06:04:58,080 THINK ACTUALLY HAS MORE POWER IF 10282 06:04:58,080 --> 06:04:59,280 OUR COMMUNITY CONSTITUENTS ARE 10283 06:04:59,280 --> 06:05:01,560 ABLE TO COMMUNICATE THOSE 10284 06:05:01,560 --> 06:05:03,240 RESULTS TO THE ELECTED 10285 06:05:03,240 --> 06:05:03,520 OFFICIALS. 10286 06:05:03,520 --> 06:05:05,160 BECAUSE TO BE HONEST, I MEAN, 10287 06:05:05,160 --> 06:05:06,280 SOME OF THE WORK THAT I WAS 10288 06:05:06,280 --> 06:05:13,200 DOING IN PHILADELPHIA, ONE OF 10289 06:05:13,200 --> 06:05:14,480 OUR PARTNERS SHARED WITH ME, YOU 10290 06:05:14,480 --> 06:05:20,160 KNOW, YOU CAN GO TALK TO YOUR 10291 06:05:20,160 --> 06:05:21,840 PEOPLE IN YOUR ROLE AS FACULTY 10292 06:05:21,840 --> 06:05:23,120 AT AN INSTITUTION, BUT WHAT THEY 10293 06:05:23,120 --> 06:05:24,320 CARE ABOUT FOR YOU IS THAT YOU 10294 06:05:24,320 --> 06:05:25,680 PAY TAXES. 10295 06:05:25,680 --> 06:05:28,840 AND THAT YOU HAVE THE ABILITY TO 10296 06:05:28,840 --> 06:05:31,480 HAVE IMPACT AND INFLUENCE ON 10297 06:05:31,480 --> 06:05:34,440 THEIR ELECTION POTENTIAL OR 10298 06:05:34,440 --> 06:05:35,240 RE-ELECTION POTENTIAL. 10299 06:05:35,240 --> 06:05:36,920 AND I'M NOT SAYING ANYTHING 10300 06:05:36,920 --> 06:05:39,800 NEGATIVE ABOUT PEOPLE WHO ARE IN 10301 06:05:39,800 --> 06:05:41,600 POLITICS, BUT I THINK THEIR 10302 06:05:41,600 --> 06:05:43,880 MOTIVATION AND THEIR 10303 06:05:43,880 --> 06:05:46,280 RESPONSIVENESS WILL BE DRIVEN BY 10304 06:05:46,280 --> 06:05:47,160 PEOPLE WHO ARE COMING TO THEM 10305 06:05:47,160 --> 06:05:51,000 AND SPEAKING AS MEMBERS OF THEIR 10306 06:05:51,000 --> 06:05:51,560 CONSTITUENCY. 10307 06:05:51,560 --> 06:05:54,080 AND THE ACADEMIC INSTITUTIONS, I 10308 06:05:54,080 --> 06:05:55,680 THINK, HAVE GROUPS THAT WORK 10309 06:05:55,680 --> 06:05:57,760 WITH THE ELECTED OFFICIALS IN 10310 06:05:57,760 --> 06:06:00,280 THAT CAPACITY, BUT AS CITIZENS, 10311 06:06:00,280 --> 06:06:01,960 YOU KNOW, WE HAVE A ROLE TO PLAY 10312 06:06:01,960 --> 06:06:07,960 THAT CAN BE -- THAT I DON'T KNOW 10313 06:06:07,960 --> 06:06:08,960 THAT -- I'VE NEVER THOUGHT ABOUT 10314 06:06:08,960 --> 06:06:11,640 IT AS I CAN'T SPEAK AS A 10315 06:06:11,640 --> 06:06:12,400 SCIENTIST ABOUT THE WORK THAT 10316 06:06:12,400 --> 06:06:14,280 I'M DOING BECAUSE I FEEL LIKE 10317 06:06:14,280 --> 06:06:16,640 THAT IS PART OF WHO I AM AS A 10318 06:06:16,640 --> 06:06:18,280 COMMUNITY MEMBER, AS A RESIDENT, 10319 06:06:18,280 --> 06:06:20,920 AS SOMEONE WHO HAS A ROLE AND A 10320 06:06:20,920 --> 06:06:27,240 STAKE IN WHAT HAPPENS WITH THE 10321 06:06:27,240 --> 06:06:28,440 POLICIES AND HOW RESOURCES ARE 10322 06:06:28,440 --> 06:06:28,960 ALLOCATED. 10323 06:06:28,960 --> 06:06:33,320 SO I DON'T SEE THAT AS BEING -- 10324 06:06:33,320 --> 06:06:34,320 IT INTERESTING, I THINK THERE'S 10325 06:06:34,320 --> 06:06:36,000 BEEN A LOT OF CONCERN ABOUT I 10326 06:06:36,000 --> 06:06:37,320 CAN'T ADVOCATE FOR ONE THING OR 10327 06:06:37,320 --> 06:06:39,600 THE OTHER, BUT I FEEL LIKE I CAN 10328 06:06:39,600 --> 06:06:42,200 ADVOCATE AS A MEMBER OF A 10329 06:06:42,200 --> 06:06:42,520 COMMUNITY. 10330 06:06:42,520 --> 06:06:44,400 >>I WAS QUICKLY GOING TO SAY, 10331 06:06:44,400 --> 06:06:46,160 THIS FRAMEWORK OF AN 10332 06:06:46,160 --> 06:06:47,960 ACADEMICALLY RELEVANT LIFE THAT 10333 06:06:47,960 --> 06:06:50,000 I'M PURSUING, SCIENCE SHOULD NOT 10334 06:06:50,000 --> 06:06:52,800 BE AT WAR WITH COMMON SENSE. 10335 06:06:52,800 --> 06:06:54,280 IT JUST SIMPLY SHOULDN'T. 10336 06:06:54,280 --> 06:06:56,040 SCIENCE SHOULD HELP INFORM. 10337 06:06:56,040 --> 06:06:57,680 AND I THINK THAT THAT'S WHAT WE 10338 06:06:57,680 --> 06:06:58,800 DO BETTER. 10339 06:06:58,800 --> 06:07:00,240 I MEAN, WE ARE GOOD AT GIVING 10340 06:07:00,240 --> 06:07:02,720 DATA, GIVING FRAME WORKS, GIVING 10341 06:07:02,720 --> 06:07:03,720 CONCEPTUAL MODELS. 10342 06:07:03,720 --> 06:07:04,720 THAT'S OUR GIFT THAT WE BRING TO 10343 06:07:04,720 --> 06:07:07,160 THE TABLE. 10344 06:07:07,160 --> 06:07:10,720 THE REALITY IS, WE ALSO HAVE TO 10345 06:07:10,720 --> 06:07:11,840 HAVE, AND WHAT WE'VE LACKED, IS 10346 06:07:11,840 --> 06:07:12,560 SOMETIMES THE HUMILITY TO 10347 06:07:12,560 --> 06:07:13,680 UNDERSTAND THAT THAT HAS A 10348 06:07:13,680 --> 06:07:14,040 LIMIT. 10349 06:07:14,040 --> 06:07:15,680 AND THAT WE HAVE TO WORK THEN 10350 06:07:15,680 --> 06:07:18,600 WITH OTHER PEOPLE TO FILL OUT 10351 06:07:18,600 --> 06:07:19,280 THAT TEAM. 10352 06:07:19,280 --> 06:07:20,360 THE BEST EXAMPLE WAS IN CHICAGO 10353 06:07:20,360 --> 06:07:25,800 WHEN WE STARTED COMING UP 10354 06:07:25,800 --> 06:07:27,120 WITH -- WHICH AT THE TIME 10355 06:07:27,120 --> 06:07:27,920 EVERYBODY SAID THAT'S A STUPID 10356 06:07:27,920 --> 06:07:28,400 THING. 10357 06:07:28,400 --> 06:07:30,080 WE CAME UP WITH THIS CONCEPT 10358 06:07:30,080 --> 06:07:34,240 THAT WHY NOT MAKE CANCER 10359 06:07:34,240 --> 06:07:36,160 SNAPSHOT DATA INSTEAD OF ZIP 10360 06:07:36,160 --> 06:07:36,560 CODE? 10361 06:07:36,560 --> 06:07:39,400 WHY NOT JUST USE THE POLITICAL 10362 06:07:39,400 --> 06:07:41,360 DISTRICTS? 10363 06:07:41,360 --> 06:07:43,920 IN CHICAGO THERE WERE 50 WARDS. 10364 06:07:43,920 --> 06:07:45,600 WHY NOT JUST CARVE OUT THE 50 10365 06:07:45,600 --> 06:07:47,320 WARDS AND BE ABLE THEN TO FIGURE 10366 06:07:47,320 --> 06:07:48,840 OUT WHAT THE CANCER WARD WAS FOR 10367 06:07:48,840 --> 06:07:51,040 THAT DISTRICT? 10368 06:07:51,040 --> 06:07:51,560 WHY? 10369 06:07:51,560 --> 06:07:53,720 ONE, BECAUSE IT REALLY ALLOWED 10370 06:07:53,720 --> 06:07:54,400 ME TO THINK ABOUT COMMUNITY 10371 06:07:54,400 --> 06:07:55,160 INTERVENTIONS IN A DIFFERENT 10372 06:07:55,160 --> 06:07:56,840 WAY. 10373 06:07:56,840 --> 06:07:59,560 TWO, IT BROUGHT ON JUST NOT THE 10374 06:07:59,560 --> 06:08:02,840 POLITICIANS, BUT THE COMMUNITY 10375 06:08:02,840 --> 06:08:04,080 ASSETS THAT WERE THERE TO HAVE A 10376 06:08:04,080 --> 06:08:08,000 DISCUSSION NOW ABOUT HOW THIS 10377 06:08:08,000 --> 06:08:12,800 DATA WHICH WAS INVISIBLE TO THEM 10378 06:08:12,800 --> 06:08:13,840 CAN NOW HAVE A BASELINE 10379 06:08:13,840 --> 06:08:14,120 DISCUSSION. 10380 06:08:14,120 --> 06:08:15,880 WHEN YOU GET TO THE SPECIFICITY, 10381 06:08:15,880 --> 06:08:17,600 SOMETIMES IT'S NOT SO MUCH THE 10382 06:08:17,600 --> 06:08:19,120 SPECIFICITY, WE DIDN'T EVEN GET 10383 06:08:19,120 --> 06:08:22,320 TO FIRST BASE TO EVEN DRIVE 10384 06:08:22,320 --> 06:08:23,880 ANYTHING ON THE HILL TO POLICY. 10385 06:08:23,880 --> 06:08:25,320 SO I WOULD ACTUALLY ARGUE THAT 10386 06:08:25,320 --> 06:08:26,560 ONE OF THE THINGS WE SHOULD DO 10387 06:08:26,560 --> 06:08:27,920 AS SCIENTISTS IS THAT WE ALWAYS 10388 06:08:27,920 --> 06:08:31,760 HAVE BELIEVED THAT WE ARE AT 10389 06:08:31,760 --> 06:08:40,840 THIS MIDEVIL UNIVERSITY OF 10390 06:08:40,840 --> 06:08:41,760 BELONGIA -- THAT'S A DIFFERENT 10391 06:08:41,760 --> 06:08:42,440 SORT OF CONVERSATION FOR A 10392 06:08:42,440 --> 06:08:43,080 DIFFERENT TIME. 10393 06:08:43,080 --> 06:08:44,760 ALL OF A SUDDEN WE KIND OF FIND 10394 06:08:44,760 --> 06:08:46,160 RELIGION ABOUT HOW WE 10395 06:08:46,160 --> 06:08:47,600 ACTUALLY -- WELL, SCIENCE IN IT, 10396 06:08:47,600 --> 06:08:49,200 AND THAT'S USUALLY NOT DRIVEN BY 10397 06:08:49,200 --> 06:08:50,880 DATA, SOMETIMES IT'S DATA BUT 10398 06:08:50,880 --> 06:08:52,040 IT'S DRIVEN BY A PASSION. 10399 06:08:52,040 --> 06:08:54,040 SO QUIT, AGAIN, TALKING AND 10400 06:08:54,040 --> 06:08:57,120 LYING TO OURSELVES. 10401 06:08:57,120 --> 06:08:59,160 THERE IS, HOWEVER, A LIMIT TO 10402 06:08:59,160 --> 06:09:01,960 BEING ABLE TO FIEND THE BALANCE. 10403 06:09:01,960 --> 06:09:04,120 IN AN ACADEMICALLY RELATIVE 10404 06:09:04,120 --> 06:09:05,240 MODEL, YOU'RE USING THE BEST OF 10405 06:09:05,240 --> 06:09:06,960 US WHICH IS GENERATING DATA, 10406 06:09:06,960 --> 06:09:09,560 WHERE IT ACTUALLY HAS ITS 10407 06:09:09,560 --> 06:09:10,680 LIMITATION AND THEN BRINGING ON 10408 06:09:10,680 --> 06:09:11,600 OUR PARTNERS. 10409 06:09:11,600 --> 06:09:12,880 THAT, TO ME, SEEMS TO ME THAT IF 10410 06:09:12,880 --> 06:09:14,760 WE WERE TO ROLL OUT THAT MODEL, 10411 06:09:14,760 --> 06:09:16,480 WE MAY EVEN BE ABLE TO BUILD 10412 06:09:16,480 --> 06:09:17,480 MORE PUBLIC TRUST AS WE'RE 10413 06:09:17,480 --> 06:09:19,480 MOVING ALONG OF WHY THE SCIENCE 10414 06:09:19,480 --> 06:09:20,080 BENEFITS THEM AND HOW THE 10415 06:09:20,080 --> 06:09:25,720 SCIENCE CAN BETTER INFORM. 10416 06:09:25,720 --> 06:09:27,240 >>IF I CAN JUST COMMENT BRIEFLY 10417 06:09:27,240 --> 06:09:28,720 ON THAT COMMENT, I ACTUALLY 10418 06:09:28,720 --> 06:09:31,320 STRUGGLE WITH THAT, BECAUSE I 10419 06:09:31,320 --> 06:09:32,760 FEEL AS EPIDEMIOLOGISTS, WE ARE 10420 06:09:32,760 --> 06:09:34,720 TRAINED TO BE SO PRECISE. 10421 06:09:34,720 --> 06:09:35,960 WE COLLECT EVERY VARIABLE TO THE 10422 06:09:35,960 --> 06:09:37,320 EXTENT WE CAN UNDER THE SUN, WE 10423 06:09:37,320 --> 06:09:41,800 INCLUDE THEM IN OUR MODELS, ARE 10424 06:09:41,800 --> 06:09:43,200 THEY CONFOUNDERS, MEDIATORS, BUT 10425 06:09:43,200 --> 06:09:44,760 MY CHALLENGE IN TERMS OF HOW IS 10426 06:09:44,760 --> 06:09:45,960 THAT POLICY RELEVANT IS THAT 10427 06:09:45,960 --> 06:09:49,320 THERE'S TOO MUCH PRECISION THE 10428 06:09:49,320 --> 06:09:50,600 THERE. 10429 06:09:50,600 --> 06:09:52,240 I ACTUALLY WAS JUST INVOLVED IN 10430 06:09:52,240 --> 06:09:53,880 THE PAST FEW MONTHS ON HELPING 10431 06:09:53,880 --> 06:09:55,720 TO REWRITE THE CANCER REPORTING 10432 06:09:55,720 --> 06:09:59,440 REGISTRY LAW IN CALIFORNIA, AND 10433 06:09:59,440 --> 06:10:02,040 I THINK THEIR LAWYERS -- THE 10434 06:10:02,040 --> 06:10:02,880 POLICY PEOPLE ARE STRIKING, 10435 06:10:02,880 --> 06:10:04,760 QUESTIONING ME, WHY ARE YOU 10436 06:10:04,760 --> 06:10:05,480 USING THESE WORDS? 10437 06:10:05,480 --> 06:10:07,280 WELL, WHY DO YOU HAVE AN 10438 06:10:07,280 --> 06:10:08,040 EPIDEMIOLOGIST HELPING YOU WRITE 10439 06:10:08,040 --> 06:10:11,520 THIS LANGUAGE? 10440 06:10:11,520 --> 06:10:11,840 [LAUGHTER] 10441 06:10:11,840 --> 06:10:14,640 WE GOT TO A MI MIDDLE GROUND, BT 10442 06:10:14,640 --> 06:10:15,760 IT LOST A LOT OF THE PRECISION 10443 06:10:15,760 --> 06:10:17,200 THAT I HAD INITIALLY TRIED TO 10444 06:10:17,200 --> 06:10:18,120 PUT IN THERE. 10445 06:10:18,120 --> 06:10:19,360 SO I DON'T KNOW HOW TO NAVIGATE 10446 06:10:19,360 --> 06:10:21,120 THAT. 10447 06:10:21,120 --> 06:10:23,000 >>BUT I THINK THAT'S WHY YOU 10448 06:10:23,000 --> 06:10:25,120 HAVE MULTIPLE DIFFERENT TYPES OF 10449 06:10:25,120 --> 06:10:27,640 EXPERTISE AT THE TABLE, PAU BECE 10450 06:10:27,640 --> 06:10:28,440 I CERTAINLY APPRECIATE YOUR 10451 06:10:28,440 --> 06:10:29,920 STRUGGLE, BUT I WOULD AGREE, I 10452 06:10:29,920 --> 06:10:34,680 MEAN, I THINK THAT WITH ROB'S 10453 06:10:34,680 --> 06:10:36,440 POINT, WE CAN PROVIDE DATA AND I 10454 06:10:36,440 --> 06:10:39,000 THINK WHAT WE -- AND THE GROUP I 10455 06:10:39,000 --> 06:10:40,360 HAVEN'T SEEN HERE IS LIKE THE 10456 06:10:40,360 --> 06:10:41,200 COMMUNICATION EXPERTS WHO CAN 10457 06:10:41,200 --> 06:10:44,880 HELP US WITH COMMUNICATING AND 10458 06:10:44,880 --> 06:10:48,200 TRANSLATING OUR INFORMATION AND 10459 06:10:48,200 --> 06:10:48,600 SCIENTIFIC FINDINGS. 10460 06:10:48,600 --> 06:10:51,240 IT IS A SCIENCE, AND I DON'T 10461 06:10:51,240 --> 06:10:53,200 KNOW THAT -- I HAVEN'T SEEN THAT 10462 06:10:53,200 --> 06:10:54,640 DISCUSSED IN THIS ROOM, BUT IT 10463 06:10:54,640 --> 06:10:55,000 IS A SCIENCE. 10464 06:10:55,000 --> 06:10:59,800 AND I THINK THAT WHILE 10465 06:10:59,800 --> 06:11:04,400 THERE'S -- WHERE THERE'S A VERY 10466 06:11:04,400 --> 06:11:08,800 IMPORTANT ROLE FOR PRECISION, 10467 06:11:08,800 --> 06:11:10,480 ALSO BY BEING SO PRECISE, WHAT 10468 06:11:10,480 --> 06:11:11,880 DID YOU JUST SAY, WHAT DOES IT 10469 06:11:11,880 --> 06:11:12,360 REALLY MEAN. 10470 06:11:12,360 --> 06:11:14,120 AND I THINK THAT THAT IS WHERE 10471 06:11:14,120 --> 06:11:16,760 WE ALL MIGHT STRUGGLE A LITTLE 10472 06:11:16,760 --> 06:11:19,480 BIT, WHERE -- AND I'LL JUST SAY 10473 06:11:19,480 --> 06:11:21,120 I HAVE THE SAME STRUGGLE BECAUSE 10474 06:11:21,120 --> 06:11:22,440 I WANT TO BE FACTUALLY CORRECT 10475 06:11:22,440 --> 06:11:26,440 AND PRECISE, BUT ALSO RELEVANT, 10476 06:11:26,440 --> 06:11:29,880 AND I THINK WE ALL -- MANY OF US 10477 06:11:29,880 --> 06:11:33,280 HAVE TO FIND THAT SORT OF -- 10478 06:11:33,280 --> 06:11:34,280 THAT BALANCE FOR OURSELVES. 10479 06:11:34,280 --> 06:11:36,280 >>YOU KNOW, I THINK THE ISSUE 10480 06:11:36,280 --> 06:11:37,160 IS, YOU KNOW, IN PART WE'RE 10481 06:11:37,160 --> 06:11:38,800 TRYING TO BE PRECISE BECAUSE OF 10482 06:11:38,800 --> 06:11:42,680 THE FACT THAT FOR A LOT OF 10483 06:11:42,680 --> 06:11:46,880 TOPICS IT'S SENSATIONALIZED IN 10484 06:11:46,880 --> 06:11:49,320 THE MEDIA, THINGS GET OUT OF 10485 06:11:49,320 --> 06:11:49,760 CONTROL. 10486 06:11:49,760 --> 06:11:50,440 THINK AS A SCIENTIFIC COMMUNITY, 10487 06:11:50,440 --> 06:11:52,200 WE HAVE TO FIND BETTER, MORE 10488 06:11:52,200 --> 06:11:55,080 EFFICIENT WAYS SORT OF TO MANAGE 10489 06:11:55,080 --> 06:12:01,000 THAT MESSAGE, AND I ALSO BELIEVE 10490 06:12:01,000 --> 06:12:03,240 THAT TO NOT INSERT OUR BIASES IS 10491 06:12:03,240 --> 06:12:04,240 JUST A FALLACY. 10492 06:12:04,240 --> 06:12:06,880 RIGHT? 10493 06:12:06,880 --> 06:12:08,600 WE ACKNOWLEDGE THEM, WE TRY AND 10494 06:12:08,600 --> 06:12:09,840 CORRECT FOR THEM, WE ARE PEOPLE. 10495 06:12:09,840 --> 06:12:11,720 WE ALL HAVE POSITIONS, WE ALL 10496 06:12:11,720 --> 06:12:12,320 HAVE PERSPECTIVES. 10497 06:12:12,320 --> 06:12:14,120 THAT'S A PART OF IT, RIGHT? 10498 06:12:14,120 --> 06:12:16,200 AND SO TO SHUT THAT PART OFF IS 10499 06:12:16,200 --> 06:12:18,040 NOT BEING COMPLETELY LIKE YOUR 10500 06:12:18,040 --> 06:12:20,800 TRUE SCIENTIFIC SELF. 10501 06:12:20,800 --> 06:12:22,240 AND I THINK EVEN WITH SCIENTIFIC 10502 06:12:22,240 --> 06:12:22,920 COMMUNICATION, ET CETERA, I 10503 06:12:22,920 --> 06:12:24,160 THINK WE ALL NEED TO WORK 10504 06:12:24,160 --> 06:12:25,440 TOGETHER AS A COMMUNITY, BUT I 10505 06:12:25,440 --> 06:12:27,080 THINK THE COMMUNITY MEMBERS 10506 06:12:27,080 --> 06:12:27,840 THEMSELVES, IF YOU WORK WITH 10507 06:12:27,840 --> 06:12:29,200 COMMUNITY PARTNERS, IT'S AMAZING 10508 06:12:29,200 --> 06:12:30,360 WHAT THEY CAN DO. 10509 06:12:30,360 --> 06:12:32,120 IT'S AMAZING THE REACH THAT THEY 10510 06:12:32,120 --> 06:12:34,640 HAVE AND SO MY SOLUTION IS 10511 06:12:34,640 --> 06:12:36,640 ALWAYS HAVE COMMUNITY PARTNERS 10512 06:12:36,640 --> 06:12:38,160 FROM THE BEGINNING, FROM 10513 06:12:38,160 --> 06:12:40,440 DESIGNING THE RESEARCH ALL THE 10514 06:12:40,440 --> 06:12:42,080 WAY THROUGH DISSEMINATION. 10515 06:12:42,080 --> 06:12:44,160 AND I LIKE YOUR IDEA ABOUT 10516 06:12:44,160 --> 06:12:46,800 THE -- YOU KNOW, MAKING THE 10517 06:12:46,800 --> 06:12:48,360 GEOGRAPHIC LINES RELEVANT. 10518 06:12:48,360 --> 06:12:50,160 IN GEORGIA, WE DO THINGS BY 10519 06:12:50,160 --> 06:12:50,760 COUNTY BECAUSE THAT'S WHAT 10520 06:12:50,760 --> 06:12:51,360 EVERYBODY DOES. 10521 06:12:51,360 --> 06:12:53,160 BUT WE ALSO DO IT BY PUBLIC 10522 06:12:53,160 --> 06:12:53,560 HEALTH DISTRICTS. 10523 06:12:53,560 --> 06:12:55,320 SO THAT WE CAN GO BACK TO THE 10524 06:12:55,320 --> 06:12:57,600 DPH AND SAY THIS DISTRICT IS 10525 06:12:57,600 --> 06:12:58,280 UNDERPERFORMING. 10526 06:12:58,280 --> 06:12:59,360 RIGHT? 10527 06:12:59,360 --> 06:13:01,160 AND WHAT THEY HAVE DONE WITH OUR 10528 06:13:01,160 --> 06:13:02,800 DATA IS THAT HAS DRIVEN THEIR 10529 06:13:02,800 --> 06:13:04,440 RESOURCE ALLOCATION TO THE 10530 06:13:04,440 --> 06:13:05,840 VARIOUS DISTRICTS, AND SO WE 10531 06:13:05,840 --> 06:13:07,280 THINK ABOUT THINGS THAT MAKE 10532 06:13:07,280 --> 06:13:09,440 SENSE FOR THE SCIENCE FOR, YOU 10533 06:13:09,440 --> 06:13:10,880 KNOW, AGGREGATING DATA AND META 10534 06:13:10,880 --> 06:13:12,280 ANALYSES AND ALL OF THIS STUFF, 10535 06:13:12,280 --> 06:13:13,360 BUT I THINK WHEN YOU'RE DOING 10536 06:13:13,360 --> 06:13:14,320 YOUR SCIENCE IN A PARTICULAR 10537 06:13:14,320 --> 06:13:16,000 PLACE LIKE I AM, ALSO THINKING 10538 06:13:16,000 --> 06:13:18,080 WHAT'S RELEVANT FOR THAT 10539 06:13:18,080 --> 06:13:19,720 TRANSLATION TO ACTUALLY HOLD 10540 06:13:19,720 --> 06:13:20,920 SOMEONE ACCOUNTABLE, RIGHT? 10541 06:13:20,920 --> 06:13:23,760 IF THERE'S NO ACCOUNTABLE PARTY, 10542 06:13:23,760 --> 06:13:25,240 NOBODY IS GOING DO ANYTHING. 10543 06:13:25,240 --> 06:13:26,880 >>MAKE IT NOT JUST USEFUL, BUT 10544 06:13:26,880 --> 06:13:27,640 MAKE IT USABLE. 10545 06:13:27,640 --> 06:13:28,760 >>USABLE. 10546 06:13:28,760 --> 06:13:32,400 >>USABLE, RIGHT. 10547 06:13:32,400 --> 06:13:36,120 >> 10548 06:13:36,120 --> 06:13:39,800 >>PLEAS SAY YOUR NAME. 10549 06:13:39,800 --> 06:13:40,920 >>THANK YOU FOR THIS 10550 06:13:40,920 --> 06:13:41,840 OPPORTUNITY. 10551 06:13:41,840 --> 06:13:42,440 IT'S A GREAT TALK. 10552 06:13:42,440 --> 06:13:44,680 SO I JUST WANT TO REMIND 10553 06:13:44,680 --> 06:13:47,400 EVERYBODY WE ARE ACTUALLY ALL 10554 06:13:47,400 --> 06:13:47,720 AFRICANS. 10555 06:13:47,720 --> 06:13:50,360 WE HAVE AFRICAN AS OUR ANCESTRAL 10556 06:13:50,360 --> 06:13:51,480 GENOME. 10557 06:13:51,480 --> 06:13:53,520 I AM AFRICAN, AND SO ARE ANY OF 10558 06:13:53,520 --> 06:13:57,600 THE BLUE-EYED BLOND HAIRED WHITE 10559 06:13:57,600 --> 06:14:00,120 CAUCASIAN FACULTY IN HERE. 10560 06:14:00,120 --> 06:14:03,080 SO I FEEL NOT ONLY THIS 10561 06:14:03,080 --> 06:14:05,160 IMPORTANT PROBLEM NEEDS TO BE 10562 06:14:05,160 --> 06:14:07,800 ADDRESSED BY YOU, THE BRILLIANT 10563 06:14:07,800 --> 06:14:09,000 WOMEN, WE ALMOST LOSE TWO OF 10564 06:14:09,000 --> 06:14:10,600 THEM DUE TO THE STRUCTURAL 10565 06:14:10,600 --> 06:14:12,840 RACISM IN HERE, BUT I JUST WANT 10566 06:14:12,840 --> 06:14:17,120 TO CALL FOR ACTION FOR THE WHITE 10567 06:14:17,120 --> 06:14:19,280 FACULTY OR ASIAN FACULTY OR ANY 10568 06:14:19,280 --> 06:14:22,720 OTHER FACULTY WHO IS NON- -- 10569 06:14:22,720 --> 06:14:24,320 LIKE AFRICAN AMERICAN, PLEASE 10570 06:14:24,320 --> 06:14:26,360 JOIN THE FIGHT, WE REALLY NEED 10571 06:14:26,360 --> 06:14:27,720 TO ADDRESS THIS ISSUE BECAUSE 10572 06:14:27,720 --> 06:14:30,120 THE RACISM IS REALLY STUPID, IT 10573 06:14:30,120 --> 06:14:31,360 DOES NOT MAKE SENSE AT ALL, 10574 06:14:31,360 --> 06:14:33,800 THERE'S NO BIOLOGICAL OR GENETIC 10575 06:14:33,800 --> 06:14:34,960 JUSTIFICATION FOR IT. 10576 06:14:34,960 --> 06:14:37,400 WE ARE ALL -- WE ALL HAVE A 10577 06:14:37,400 --> 06:14:39,600 GREAT-GRANDMOTHER NAMED LUCY. 10578 06:14:39,600 --> 06:14:41,880 SO WE ALL COME FROM HER, SO 10579 06:14:41,880 --> 06:14:44,360 THEREFORE, THERE'S NO 10580 06:14:44,360 --> 06:14:46,480 DISCRIMINATING AGAINST OUR AN 10581 06:14:46,480 --> 06:14:50,320 SES STR STRAL GENOME, IT DOESN'T 10582 06:14:50,320 --> 06:14:50,680 MAKE SENSE. 10583 06:14:50,680 --> 06:14:55,200 SO THEREFORE, PLEASE, ALL OF US 10584 06:14:55,200 --> 06:14:56,760 TOGETHER WE CAN ADDRESS THIS 10585 06:14:56,760 --> 06:14:57,400 PROBLEM AND MAKE EVERYBODY'S 10586 06:14:57,400 --> 06:14:58,680 LIFE BETTER IN THIS GREAT 10587 06:14:58,680 --> 06:14:59,360 COUNTRY. 10588 06:14:59,360 --> 06:15:00,280 THE RICHEST COUNTRY IN THE 10589 06:15:00,280 --> 06:15:00,760 WORLD. 10590 06:15:00,760 --> 06:15:01,760 WE CAN DO BETTER. 10591 06:15:01,760 --> 06:15:02,480 WE SHOULD DO BETTER. 10592 06:15:02,480 --> 06:15:02,920 THANK YOU. 10593 06:15:02,920 --> 06:15:05,480 >>THANK YOU SO MUCH. 10594 06:15:05,480 --> 06:15:12,000 SO 30 SECONDS, EVERYBODY. 10595 06:15:12,000 --> 06:15:13,320 WHAT DO WE TELL THE NEXT 10596 06:15:13,320 --> 06:15:15,080 GENERATION? 10597 06:15:15,080 --> 06:15:15,520 30 SECONDS. 10598 06:15:15,520 --> 06:15:17,120 WHILE I'M TALKING, THINK ABOUT 10599 06:15:17,120 --> 06:15:17,560 YOUR 30 SECONDS. 10600 06:15:17,560 --> 06:15:18,200 >>30 SECONDS. 10601 06:15:18,200 --> 06:15:18,840 I GOT ONE FOR YOU. 10602 06:15:18,840 --> 06:15:20,400 IT'S THE SAME THING THAT WE 10603 06:15:20,400 --> 06:15:21,840 ACTUALLY SHOULD BE ENCOURAGING 10604 06:15:21,840 --> 06:15:28,120 OUR YOUNG PEOPLE, I JUST HEARD 10605 06:15:28,120 --> 06:15:28,880 THIS, INNOVATION IS REALLY 10606 06:15:28,880 --> 06:15:30,440 SEEING WHAT EVERYBODY ELSE SEES, 10607 06:15:30,440 --> 06:15:31,480 BUT THINKING ABOUT IT 10608 06:15:31,480 --> 06:15:31,960 DIFFERENTLY. 10609 06:15:31,960 --> 06:15:33,560 WHEN IT COMES TO HEALTH 10610 06:15:33,560 --> 06:15:34,840 DISPARITIES, LET'S THINK ABOUT 10611 06:15:34,840 --> 06:15:39,160 THIS DIFFERENT, UNLESS THAT -- 10612 06:15:39,160 --> 06:15:40,360 NOT ELEVATED BUT LET'S GET REAL 10613 06:15:40,360 --> 06:15:41,160 WITH WHAT WE JUST HEARD ABOUT 10614 06:15:41,160 --> 06:15:44,040 ALL OF US BY EMBRACING THIS AS A 10615 06:15:44,040 --> 06:15:44,720 SCIENCE, WE CAN HELP OUT NOT 10616 06:15:44,720 --> 06:15:46,160 JUST ME, BUT ALL OF US. 10617 06:15:46,160 --> 06:15:49,960 >>THANK YOU. 10618 06:15:49,960 --> 06:15:52,480 LAUREN? 10619 06:15:52,480 --> 06:15:55,480 >>SO I THINK COORDINATION, 10620 06:15:55,480 --> 06:15:56,840 COOPERATION AND COLLABORATION. 10621 06:15:56,840 --> 06:15:58,480 YOU KNOW, AS SCIENTISTS, 10622 06:15:58,480 --> 06:16:00,320 ESPECIALLY IN ACADEMIC CENTERS, 10623 06:16:00,320 --> 06:16:02,120 A LOT OF WHAT WE DO COMES FROM 10624 06:16:02,120 --> 06:16:03,440 WHAT NIH PUTS OUT THERE. 10625 06:16:03,440 --> 06:16:03,880 RIGHT? 10626 06:16:03,880 --> 06:16:09,280 SO WE NEED -- WE NEED THE RFAs 10627 06:16:09,280 --> 06:16:11,520 TO DO THE WORK THAT WE SAY IS 10628 06:16:11,520 --> 06:16:13,320 IMPORTANT, AND THEN AS A 10629 06:16:13,320 --> 06:16:14,680 SCIENTIFIC COMMUNITY, I THINK WE 10630 06:16:14,680 --> 06:16:16,080 JUST OPERATE IN SILOS JUST WAY 10631 06:16:16,080 --> 06:16:16,760 TOO MUCH. 10632 06:16:16,760 --> 06:16:18,040 THERE NEEDS TO BE MORE 10633 06:16:18,040 --> 06:16:19,320 COORDINATION, MORE 10634 06:16:19,320 --> 06:16:20,520 COLLABORATION, AMONG US, AND 10635 06:16:20,520 --> 06:16:22,120 WITH THE COMMUNITY MEMBERS. 10636 06:16:22,120 --> 06:16:24,000 IF THEY'RE NOT A PART OF YOUR 10637 06:16:24,000 --> 06:16:25,280 RESEARCH, THEN YOU ARE NOT DOING 10638 06:16:25,280 --> 06:16:26,440 RESEARCH FOR THEM. 10639 06:16:26,440 --> 06:16:28,680 SO I JUST -- EVERY RESEARCH 10640 06:16:28,680 --> 06:16:31,440 STUDY NEEDS TO HAVE SOMEONE THAT 10641 06:16:31,440 --> 06:16:33,080 LOOKS LIKE THE PEOPLE YOU ARE 10642 06:16:33,080 --> 06:16:33,760 STUDYING, WITH THOSE 10643 06:16:33,760 --> 06:16:34,720 EXPERIENCES. 10644 06:16:34,720 --> 06:16:36,040 >>THANK YOU FOR DRIVING THAT 10645 06:16:36,040 --> 06:16:40,280 HOME TOO. 10646 06:16:40,280 --> 06:16:43,320 >>I MEAN, DITTO. 10647 06:16:43,320 --> 06:16:47,320 [LAUGHTER ?C] 10648 06:16:47,320 --> 06:16:54,760 AND I THINK DR. TANG SAID 10649 06:16:54,760 --> 06:16:55,760 EVERYTHING I WOULD HAVE SAID. 10650 06:16:55,760 --> 06:16:56,600 >>AWESOME. 10651 06:16:56,600 --> 06:16:58,440 THANK YOU. 10652 06:16:58,440 --> 06:17:01,640 >>I THINK THAT WE ARE ACTUALLY 10653 06:17:01,640 --> 06:17:03,880 SO MUCH FARTHER DOWN THAT ROAD 10654 06:17:03,880 --> 06:17:05,800 TODAY, THANKS TO PEOPLE HERE AT 10655 06:17:05,800 --> 06:17:08,280 THIS TABLE FOR HELPING TO OPEN 10656 06:17:08,280 --> 06:17:11,600 THAT GATE FOR US AND OUR NEXT 10657 06:17:11,600 --> 06:17:12,480 GENERATION, AND A THINK A BIG 10658 06:17:12,480 --> 06:17:14,640 PART OF THAT IS HAVING PEOPLE IN 10659 06:17:14,640 --> 06:17:17,680 LEADERSHIP WHO LOOK LIKE US BUT 10660 06:17:17,680 --> 06:17:19,560 ALSO APPRECIATE AND ARE WILLING 10661 06:17:19,560 --> 06:17:21,480 TO ADVOCATE AND PUT THEIR, YOU 10662 06:17:21,480 --> 06:17:23,320 KNOW -- THEIR VOICES TO ADVOCATE 10663 06:17:23,320 --> 06:17:26,880 FOR THESE ISSUES. 10664 06:17:26,880 --> 06:17:28,440 SO I THINK TO THE EXTENT THAT WE 10665 06:17:28,440 --> 06:17:30,080 CAN ALSO ALL PUT OUR EFFORTS 10666 06:17:30,080 --> 06:17:32,120 BEHIND MAKING SURE THE PEOPLE IN 10667 06:17:32,120 --> 06:17:33,240 LEADERSHIP, WHATEVER TYPE OF 10668 06:17:33,240 --> 06:17:34,240 LEADERSHIP FORUM YOU'RE THINKING 10669 06:17:34,240 --> 06:17:38,160 ABOUT, PEOPLE IN LEADERSHIP 10670 06:17:38,160 --> 06:17:39,280 ESPOUSE THESE VALUES AND WILL 10671 06:17:39,280 --> 06:17:40,360 ADVOCATE FOR THESE ISSUES TO 10672 06:17:40,360 --> 06:17:44,000 KEEP THAT GATE OPEN. 10673 06:17:44,000 --> 06:17:45,520 >>COULD I REAL QUICK SAY LET ME 10674 06:17:45,520 --> 06:17:47,640 TAKE THAT FURTHER IN OUR 10675 06:17:47,640 --> 06:17:48,560 LEADERSHIP, LET'S TALK ABOUT THE 10676 06:17:48,560 --> 06:17:49,480 NIH. 10677 06:17:49,480 --> 06:17:50,680 I'M GOING TO TALK ABOUT THE NIH 10678 06:17:50,680 --> 06:17:51,920 FOR A SECOND. 10679 06:17:51,920 --> 06:17:52,560 HERE HERE'S THE DEAL. 10680 06:17:52,560 --> 06:17:54,120 WE HAVE TWO MISSIONS. 10681 06:17:54,120 --> 06:17:55,760 NOT MY MISSIONS. 10682 06:17:55,760 --> 06:17:58,040 WRITTEN TO DISCOVER NEW 10683 06:17:58,040 --> 06:17:59,240 FUNDAMENTAL KNOWLEDGE, BUT 10684 06:17:59,240 --> 06:18:01,000 SOMEHOW THAT SECOND SENTENCE 10685 06:18:01,000 --> 06:18:03,480 ABOUT HEALTH OUTCOME GOT 10686 06:18:03,480 --> 06:18:05,200 DROPPED. 10687 06:18:05,200 --> 06:18:06,440 IF SOMEBODY ASKED ME ABOUT WHAT 10688 06:18:06,440 --> 06:18:08,680 THE NIH STOOD FOR, AROUND BASIC 10689 06:18:08,680 --> 06:18:10,440 AND DISCOVERY, HI NO IDEA THAT 10690 06:18:10,440 --> 06:18:12,200 WRITTEN IN THE ORIGINAL MISSION 10691 06:18:12,200 --> 06:18:14,400 STATEMENT IS ALSO AN EQUAL 10692 06:18:14,400 --> 06:18:17,040 EMPHASIS ON HEALTH OUTCOMES. 10693 06:18:17,040 --> 06:18:18,240 LET US ALL LIVE TO THE MISSION 10694 06:18:18,240 --> 06:18:19,880 THAT WAS ACTUALLY STATED, I 10695 06:18:19,880 --> 06:18:21,240 THINK WE'RE GOING TO BE ALL 10696 06:18:21,240 --> 06:18:21,440 RIGHT. 10697 06:18:21,440 --> 06:18:24,280 >>AND I WILL JUST -- I NOW 10698 06:18:24,280 --> 06:18:26,440 THOUGHT OF WHAT I WANT TO SAY. 10699 06:18:26,440 --> 06:18:30,960 [LAUGHTER] 10700 06:18:30,960 --> 06:18:32,920 >>THERE'S NO QUESTION, RACISM 10701 06:18:32,920 --> 06:18:34,200 IS A DRIVER OF MANY HEALTH 10702 06:18:34,200 --> 06:18:36,440 DISPARITIES, AND WE COULD GO ON 10703 06:18:36,440 --> 06:18:39,840 BUT WE HAVE TO CONCLUDE. 10704 06:18:39,840 --> 06:18:41,320 WE HAVE ONE MORE SPEAKER. 10705 06:18:41,320 --> 06:18:43,640 FIRST APPLAUSE TO ALL OF THEM, 10706 06:18:43,640 --> 06:18:43,920 OKAY? 10707 06:18:43,920 --> 06:18:54,120 [APPLAUSE] 10708 06:18:54,960 --> 06:18:58,560 I'M GOING TO SHIFT TO DR. GLENN 10709 06:18:58,560 --> 06:19:01,280 MERLINO, PLEASE STAY. 10710 06:19:01,280 --> 06:19:06,080 MR. MERLINO, HOW THE INTRAMURAL 10711 06:19:06,080 --> 06:19:16,440 RESEARCH PROGRAM -- 10712 06:19:19,080 --> 06:19:20,360 >>ALL RIGHT. 10713 06:19:20,360 --> 06:19:21,440 HI. 10714 06:19:21,440 --> 06:19:23,960 SO THANKS FOR STAYING. 10715 06:19:23,960 --> 06:19:27,440 FIRST I'D LIKE TO REALLY, ON 10716 06:19:27,440 --> 06:19:30,960 BEHALF OF THOMAS AND ALL THE 10717 06:19:30,960 --> 06:19:32,080 LEADERSHIP, WE HEARD ABOUT HOW 10718 06:19:32,080 --> 06:19:33,040 IMPORTANT THAT S TO THANK YOU 10719 06:19:33,040 --> 06:19:34,520 ALL FOR HAVING ME COME AND SAY 10720 06:19:34,520 --> 06:19:35,360 SOME CLOSING REMARKS. 10721 06:19:35,360 --> 06:19:40,800 AND I'D ALSO LIKE TO SAY THIS 10722 06:19:40,800 --> 06:19:42,360 HAS BEEN A TERRIFIC SYMPOSIUM. 10723 06:19:42,360 --> 06:19:43,400 THIS LAST DISCUSSION WAS 10724 06:19:43,400 --> 06:19:44,480 AMAZING. 10725 06:19:44,480 --> 06:19:46,320 AND I COULD HAVE HAD IT GO ON, 10726 06:19:46,320 --> 06:19:48,640 SORRY, BECAUSE IT WAS REALLY 10727 06:19:48,640 --> 06:19:51,200 VALUABLE. 10728 06:19:51,200 --> 06:19:52,480 LET ME START WITH MANY THANKS. 10729 06:19:52,480 --> 06:19:54,120 I'D LIKE TO THANK THE ORGANIZING 10730 06:19:54,120 --> 06:19:55,400 COMMITTEE, STEFAN FOR INVITING 10731 06:19:55,400 --> 06:19:56,520 ME TO COME AND TALK, BUT THIS 10732 06:19:56,520 --> 06:19:59,080 HAS BEEN AN AMAZING GROUP AND 10733 06:19:59,080 --> 06:20:01,520 THEY REALLY HAVE PUT TOGETHER A 10734 06:20:01,520 --> 06:20:02,800 WONDERFUL PROGRAM, AND ALSO FOR 10735 06:20:02,800 --> 06:20:07,640 THE CONFERENCE, PLANNING STAFF, 10736 06:20:07,640 --> 06:20:09,400 JULIA AND CHRIS RIVERA AND THE 10737 06:20:09,400 --> 06:20:10,360 I.T. TEAM FOR MAKING THIS ALL 10738 06:20:10,360 --> 06:20:10,680 HAPPEN. 10739 06:20:10,680 --> 06:20:12,440 SO LET GIVE A ROUND OF APPLAUSE 10740 06:20:12,440 --> 06:20:12,800 TO EVERYBODY. 10741 06:20:12,800 --> 06:20:17,800 [APPLAUSE] 10742 06:20:17,800 --> 06:20:19,920 I DO WANT TO NOTE THAT THIS HAS 10743 06:20:19,920 --> 06:20:20,920 BEEN SUPPORTED BY A NUMBER OF 10744 06:20:20,920 --> 06:20:22,240 DIFFERENT INTERESTS AND WORKING 10745 06:20:22,240 --> 06:20:24,000 GROUPS WHICH HAS REALLY HELPED 10746 06:20:24,000 --> 06:20:24,560 MAKE IT HAPPEN. 10747 06:20:24,560 --> 06:20:25,800 TO I JUST WANTED TO SAY A FEW 10748 06:20:25,800 --> 06:20:26,080 WORD. 10749 06:20:26,080 --> 06:20:28,600 I WANTED TO BASICALLY ASSURE YOU 10750 06:20:28,600 --> 06:20:30,280 THAT CCR LEADERSHIP IS 10751 06:20:30,280 --> 06:20:33,680 ABSOLUTELY COMMITTED TO DEIA AND 10752 06:20:33,680 --> 06:20:34,480 INCLUSION. 10753 06:20:34,480 --> 06:20:36,440 WE WANT TO MAKE A FULLY 10754 06:20:36,440 --> 06:20:38,080 EQUITABLE WORK ENVIRONMENT. 10755 06:20:38,080 --> 06:20:41,160 WE WANT TO HAVE A DIVERSE CANCER 10756 06:20:41,160 --> 06:20:42,160 WORKFORCE, IT LOOKS LIKE THE 10757 06:20:42,160 --> 06:20:43,160 UNITED STATES. 10758 06:20:43,160 --> 06:20:45,000 WE WANT TO IMPROVE HEALTH 10759 06:20:45,000 --> 06:20:46,320 DISPARITIES RESEARCH THROUGHOUT 10760 06:20:46,320 --> 06:20:49,280 AND PATIENT REPRESENTATION IN 10761 06:20:49,280 --> 06:20:50,000 CLINICAL TRIALS. 10762 06:20:50,000 --> 06:20:51,840 SO HOW WILL WE DO THIS? 10763 06:20:51,840 --> 06:20:53,720 WE'RE GOING TO TRY TO USE A 10764 06:20:53,720 --> 06:20:54,320 NUMBER OF DIFFERENT METHODS. 10765 06:20:54,320 --> 06:20:56,800 OF COURSE WE WANT TO RECRUIT 10766 06:20:56,800 --> 06:20:58,080 TALENTED PEOPLE INTO THE PROGRAM 10767 06:20:58,080 --> 06:21:00,880 THAT WILL BE CREATING AND 10768 06:21:00,880 --> 06:21:05,720 EXPANDING, WE'D LIKE TO ALSO GET 10769 06:21:05,720 --> 06:21:06,880 MORE INTO EDUCATION SO PEOPLE 10770 06:21:06,880 --> 06:21:08,080 REALLY UNDERSTAND WHAT'S GOING 10771 06:21:08,080 --> 06:21:09,320 ON. 10772 06:21:09,320 --> 06:21:10,160 COLLABORATION AND ADD MORE 10773 06:21:10,160 --> 06:21:12,040 RESOURCES. 10774 06:21:12,040 --> 06:21:13,240 AND YOU KNOW, THE COLLABORATION 10775 06:21:13,240 --> 06:21:17,160 IS GOING TO GO FULL SPEED ALL 10776 06:21:17,160 --> 06:21:17,960 AROUND, THAT'S THE WAY IT WILL 10777 06:21:17,960 --> 06:21:18,200 WORK. 10778 06:21:18,200 --> 06:21:20,200 SO I WANT TO TELL YOU A LITTLE 10779 06:21:20,200 --> 06:21:20,840 BIT ABOUT THE EFFORTS. 10780 06:21:20,840 --> 06:21:23,480 WE TALKED ABOUT NIH, NIH HAS ITS 10781 06:21:23,480 --> 06:21:23,840 OWN EFFORTS. 10782 06:21:23,840 --> 06:21:27,520 LET ME JUST FOCUS FIRST ON 10783 06:21:27,520 --> 06:21:28,040 NCI-WIDE. 10784 06:21:28,040 --> 06:21:30,080 WE HAD NED SHARPLESS WHEN HE WAS 10785 06:21:30,080 --> 06:21:31,280 HERE DEVELOP AN EQUITY AND 10786 06:21:31,280 --> 06:21:31,680 INCLUSION PROGRAM. 10787 06:21:31,680 --> 06:21:34,600 IT'S NOW CHAIRED BY MONICA 10788 06:21:34,600 --> 06:21:36,480 BERTAGNOLLI, WHO IS OF COURSE 10789 06:21:36,480 --> 06:21:38,720 THE NCI DIRECTOR NOW AND 10790 06:21:38,720 --> 06:21:40,040 PAULETTE GRAY IS THE CO-CHAIR, 10791 06:21:40,040 --> 06:21:41,640 AND THE MEMBERS OF THAT 10792 06:21:41,640 --> 06:21:43,720 COMMITTEE ARE ACTUALLY REALLY A 10793 06:21:43,720 --> 06:21:44,320 STAR-STUDDED GROUP. 10794 06:21:44,320 --> 06:21:47,000 AND UNDER THAT ARE FIVE HARD 10795 06:21:47,000 --> 06:21:48,560 WORKING GROUPS, AND THEY 10796 06:21:48,560 --> 06:21:50,440 REPRESENT ALL THE THINGS THAT WE 10797 06:21:50,440 --> 06:21:52,880 ALL THINK ARE IMPORTANT IN TERMS 10798 06:21:52,880 --> 06:21:55,960 OF HEALTH DISPARITIES, DEIA AND 10799 06:21:55,960 --> 06:21:56,760 SCIENCE. 10800 06:21:56,760 --> 06:21:58,040 SO THE FIRST ONE HAS TO DO WITH 10801 06:21:58,040 --> 06:22:00,560 ENHANCING RESEARCH TO ADDRESS 10802 06:22:00,560 --> 06:22:02,080 EXACTLY WHAT THIS WHOLE 10803 06:22:02,080 --> 06:22:03,440 SYMPOSIUM WAS ON WITH HEALTH 10804 06:22:03,440 --> 06:22:04,160 DISPARITIES. 10805 06:22:04,160 --> 06:22:05,080 A SECOND ONE HAS TO DO WITH 10806 06:22:05,080 --> 06:22:08,000 REALLY MAKING THE PEOPLE AND THE 10807 06:22:08,000 --> 06:22:09,240 THOUGHTS AND EVERYTHING THAT 10808 06:22:09,240 --> 06:22:12,240 GOES ON IN CANCER RESEARCH LOOK 10809 06:22:12,240 --> 06:22:16,520 LIKE, AGAIN, THE UNITED STATES. 10810 06:22:16,520 --> 06:22:18,760 THE THIRD ONE IS REALLY 10811 06:22:18,760 --> 06:22:20,480 PROMOTING MORE INTRAFACING, FOR 10812 06:22:20,480 --> 06:22:22,200 INTRAMURAL PEOPLE, EQUITABLE AND 10813 06:22:22,200 --> 06:22:23,320 INCLUES SIEVE COMMUNITY. 10814 06:22:23,320 --> 06:22:24,560 WE'D LIKE TO IMPROVE THE CULTURE 10815 06:22:24,560 --> 06:22:25,560 HERE AND MAKE IT SOMETHING THAT 10816 06:22:25,560 --> 06:22:26,840 EVERYBODY IN THE COUNTRY CAN 10817 06:22:26,840 --> 06:22:28,200 LOOK AT AND BE PROUD. 10818 06:22:28,200 --> 06:22:31,920 ANOTHER GROUP HAS TO DO WITH 10819 06:22:31,920 --> 06:22:32,480 SYSTEMATIC TRACKING AND 10820 06:22:32,480 --> 06:22:33,040 EVALUATION. 10821 06:22:33,040 --> 06:22:34,040 WE JUST TALKED ABOUT THIS. 10822 06:22:34,040 --> 06:22:35,200 WE WANT TO COUNT THINGS SO WE 10823 06:22:35,200 --> 06:22:37,240 KNOW WE'RE DOING IT RIGHT. 10824 06:22:37,240 --> 06:22:38,560 EVEN IF SOME PEOPLE THINK THAT'S 10825 06:22:38,560 --> 06:22:41,440 NOT ENOUGH, WHICH IT'S NOT. 10826 06:22:41,440 --> 06:22:42,960 AND THEN THE OTHER WORKING GROUP 10827 06:22:42,960 --> 06:22:44,160 DEALS WITH COMMUNICATION, 10828 06:22:44,160 --> 06:22:45,680 OUTREACH AND JUST MAKING SURE 10829 06:22:45,680 --> 06:22:49,120 EVERYBODY KNOWS WHAT'S GOING ON. 10830 06:22:49,120 --> 06:22:52,080 WITHIN CCR ITSELF, WE TRY TO DO 10831 06:22:52,080 --> 06:22:52,800 THINGS IN THREE BUCKETS. 10832 06:22:52,800 --> 06:22:55,840 WE HAVE FEWER BUCKETS. 10833 06:22:55,840 --> 06:22:58,040 THE FIRST ONE HAS TO DO WITH 10834 06:22:58,040 --> 06:23:00,840 DIVERSE -- BASICALLY DEIA AND 10835 06:23:00,840 --> 06:23:01,480 TRYING TO CREATE THAT KIND OF 10836 06:23:01,480 --> 06:23:01,800 ENVIRONMENT. 10837 06:23:01,800 --> 06:23:02,800 WE WANT TO ENHANCE 10838 06:23:02,800 --> 06:23:04,480 COMMUNICATION, WE WANT TO MAKE 10839 06:23:04,480 --> 06:23:07,720 RESOURCES AND TRAINING IMPROVED 10840 06:23:07,720 --> 06:23:09,000 AND AVAILABLE TO ALL STAFF, AND 10841 06:23:09,000 --> 06:23:10,400 IMPORTANTLY, WE WANT TO HOLD THE 10842 06:23:10,400 --> 06:23:13,480 STAFF ACCOUNTABLE, AND THAT'S 10843 06:23:13,480 --> 06:23:15,480 REALLY A HARD THING, A VERY 10844 06:23:15,480 --> 06:23:16,680 DIFFICULT THING, AND WE WANT TO 10845 06:23:16,680 --> 06:23:19,320 DO IT IN TWO WAYS, AS PART OF 10846 06:23:19,320 --> 06:23:21,840 OUR OWN SITE VISITS, WHICH YOU 10847 06:23:21,840 --> 06:23:23,520 KNOW, AS MOST OF YOU HERE KNOW 10848 06:23:23,520 --> 06:23:24,920 AND EXTRAMURAL PEOPLE SHOULD 10849 06:23:24,920 --> 06:23:25,840 HAVE HEARD ABOUT, THERE IS 10850 06:23:25,840 --> 06:23:28,360 SECTIONS NOW WHERE YOU HAVE TO 10851 06:23:28,360 --> 06:23:31,680 WRITE DOWN EXACTLY WHAT YOU ARE 10852 06:23:31,680 --> 06:23:33,120 DOING TO DEAL WITH DEA AND TO 10853 06:23:33,120 --> 06:23:34,880 IMPROVE THE CULTURE IN YOUR LAB. 10854 06:23:34,880 --> 06:23:38,480 THE SECOND ONE IS TO DIVERSIFY 10855 06:23:38,480 --> 06:23:39,960 THE WORKFORCE, AND WE'VE TALKED 10856 06:23:39,960 --> 06:23:40,440 ABOUT THAT. 10857 06:23:40,440 --> 06:23:41,560 WE WANT TO EXPAND THE 10858 06:23:41,560 --> 06:23:42,960 REPRESENTATION OF 10859 06:23:42,960 --> 06:23:43,920 UNDERREPRESENTED GROUPS AND THE 10860 06:23:43,920 --> 06:23:45,880 TRAINING PROGRAMS. 10861 06:23:45,880 --> 06:23:47,080 I CURE WOULD BE THE JEWEL IN 10862 06:23:47,080 --> 06:23:48,680 THAT AND I'LL COME TO THAT IN A 10863 06:23:48,680 --> 06:23:48,920 SECOND. 10864 06:23:48,920 --> 06:23:50,640 WE WANT TO PROVIDE SUPPLEMENTARY 10865 06:23:50,640 --> 06:23:52,360 POSITIONS FOR UNDERREPRESENTED 10866 06:23:52,360 --> 06:23:52,720 GROUPS. 10867 06:23:52,720 --> 06:23:55,520 GIVE THEM EQUAL OPPORTUNITIES TO 10868 06:23:55,520 --> 06:23:56,880 HAVE THE EXPERIENCE OF BEING AT 10869 06:23:56,880 --> 06:23:59,760 THE NIH AND THE CCR AND TO DO 10870 06:23:59,760 --> 06:24:00,400 RESEARCH HERE. 10871 06:24:00,400 --> 06:24:02,960 AND TO INTENSIFY RESEARCH 10872 06:24:02,960 --> 06:24:04,920 OUTREACH, EXCUSE ME, FOR 10873 06:24:04,920 --> 06:24:05,880 TRAINEES AND FACULTY 10874 06:24:05,880 --> 06:24:06,560 RECRUITMENT. 10875 06:24:06,560 --> 06:24:08,000 AND THE THIRD ONE REALLY DEALS 10876 06:24:08,000 --> 06:24:10,280 WITH, AGAIN, WITH THE SYMPOSIUM 10877 06:24:10,280 --> 06:24:12,240 HERE, HEALTH DISPARITIES 10878 06:24:12,240 --> 06:24:13,760 RESEARCH, WE HAVE CREATED THE 10879 06:24:13,760 --> 06:24:15,120 STEERING COMMITTEE TO COORDINATE 10880 06:24:15,120 --> 06:24:17,640 THE EFFORTS OF THIS REGARD, AND 10881 06:24:17,640 --> 06:24:19,480 ALSO TO HAVE MORE ACCESS IN 10882 06:24:19,480 --> 06:24:21,640 TERMS OF OUR TRIALS AT THE 10883 06:24:21,640 --> 06:24:23,680 CLINICAL CENTER. 10884 06:24:23,680 --> 06:24:26,880 BOTH DCG AND CCR BOTH HAVE NEW 10885 06:24:26,880 --> 06:24:27,760 FELLOWSHIPS AND GRANT 10886 06:24:27,760 --> 06:24:29,640 MECHANISMS, AND WE'D LIKE TO 10887 06:24:29,640 --> 06:24:31,240 ENHANCE OUR RECRUITMENT OF 10888 06:24:31,240 --> 06:24:33,160 HEALTHCARE DELIVERY AND CANCER 10889 06:24:33,160 --> 06:24:34,320 DISPARITIES PROGRAM, LEADERSHIP 10890 06:24:34,320 --> 06:24:37,400 AND FACULTY. 10891 06:24:37,400 --> 06:24:38,960 SO THE TRAINING HERE RUNS THE 10892 06:24:38,960 --> 06:24:40,200 GAMUT. 10893 06:24:40,200 --> 06:24:41,240 WE HAVE FROM SOUP TO NUTS. 10894 06:24:41,240 --> 06:24:42,480 WE HAVE SOME VERY NICE HIGH 10895 06:24:42,480 --> 06:24:44,240 SCHOOL PROGRAMS. 10896 06:24:44,240 --> 06:24:46,520 THIS ONE, THE WERNER KERSTEN IS 10897 06:24:46,520 --> 06:24:47,120 IN FREDERICK. 10898 06:24:47,120 --> 06:24:48,760 IT'S ACTUALLY WONDERFUL. 10899 06:24:48,760 --> 06:24:50,280 AND THEN WHEN YOU GET TO 10900 06:24:50,280 --> 06:24:52,320 COLLEGE, MOST OF WHAT WE HAVE 10901 06:24:52,320 --> 06:24:54,320 HERE IS THE SIRM INTERN PROGRAM. 10902 06:24:54,320 --> 06:24:56,280 WHEN YOU GRADUATE, THERE'S AN 10903 06:24:56,280 --> 06:24:59,400 OPPORTUNITY FOR POSTBACS TO COME 10904 06:24:59,400 --> 06:25:00,560 AND WE HAVE A VERY STRONG 10905 06:25:00,560 --> 06:25:01,720 POSTBAC PROGRAM AND ALSO 10906 06:25:01,720 --> 06:25:03,720 GRADUATE STUDENTS, WE CAN'T GIVE 10907 06:25:03,720 --> 06:25:06,520 A DEGREE, CAN'T CONFER A DEGREE 10908 06:25:06,520 --> 06:25:08,560 HERE, BUT IN CONCERT WITH LOCAL 10909 06:25:08,560 --> 06:25:10,840 COMMUNITIES, INSTITUTIONS LIKE 10910 06:25:10,840 --> 06:25:12,200 GEORGE WASHINGTON, GEORGETOWN, 10911 06:25:12,200 --> 06:25:13,920 HOPKINS AND MARYLAND, PEOPLE 10912 06:25:13,920 --> 06:25:15,280 COME HERE TO DO THEIR TRAINING. 10913 06:25:15,280 --> 06:25:18,560 AND THEN AFTER THAT, OF COURSE, 10914 06:25:18,560 --> 06:25:19,480 THERE'S POSTDOCTORAL 10915 06:25:19,480 --> 06:25:20,640 FELLOWSHIPS, CLINICAL 10916 06:25:20,640 --> 06:25:22,080 FELLOWSHIPS AND THEN RESEARCH 10917 06:25:22,080 --> 06:25:23,320 FELLOWS. 10918 06:25:23,320 --> 06:25:25,440 AND THE ICURE PROGRAM REALLY 10919 06:25:25,440 --> 06:25:27,600 ENEXANSES FROM POSTBACS THROUGH 10920 06:25:27,600 --> 06:25:29,360 POSTDOCS. 10921 06:25:29,360 --> 06:25:32,480 THE ICURE PROGRAM REALLY TAKES 10922 06:25:32,480 --> 06:25:34,760 OFF FROM THE CURE PROGRAM, WHICH 10923 06:25:34,760 --> 06:25:36,120 IS EXTRAMURAL, IT'S OVER 20 10924 06:25:36,120 --> 06:25:37,720 YEARS OLD, IT'S AN AMAZING 10925 06:25:37,720 --> 06:25:39,000 SUCCESS, AND WHAT WE'VE TRIED TO 10926 06:25:39,000 --> 06:25:42,040 DO IN THE INTRAMURAL PROGRAM IS 10927 06:25:42,040 --> 06:25:44,960 ENHANCE RESEARCH WORKFORCE 10928 06:25:44,960 --> 06:25:48,360 DIVERSITY THROUGH THE I CURE 10929 06:25:48,360 --> 06:25:49,440 GOALS, PROMOTE CAREER 10930 06:25:49,440 --> 06:25:50,440 ADVANCEMENT OF THE SCHOLARS AND 10931 06:25:50,440 --> 06:25:52,160 FOSTER AN INCLUSIVE ENVIRONMENT 10932 06:25:52,160 --> 06:25:53,040 IN THE NCI COMMUNITY. 10933 06:25:53,040 --> 06:25:55,280 AND WE'VE RECENTLY INCREASED THE 10934 06:25:55,280 --> 06:25:56,880 I CURE PROGRAM, AND WE HOPE TO 10935 06:25:56,880 --> 06:25:58,480 DO SO MORE IN THE FUTURE. 10936 06:25:58,480 --> 06:26:00,280 IF YOU HAVE ANY QUESTIONS ABOUT 10937 06:26:00,280 --> 06:26:02,280 I CURE, YOU CAN CONTACT DRS. 10938 06:26:02,280 --> 06:26:07,200 ADAMS AND CALZOLA ABOUT THAT. 10939 06:26:07,200 --> 06:26:11,120 IN IS JTHIS IS JUST A SNAPSHOT W 10940 06:26:11,120 --> 06:26:12,640 THE TRAINING GOES BROADLY. 10941 06:26:12,640 --> 06:26:14,560 WE HAVE ALL DIFFERENT TYPES FOR 10942 06:26:14,560 --> 06:26:15,440 WHAT POSITION YOU'RE IN 10943 06:26:15,440 --> 06:26:16,160 CURRENTLY, YOU CAN BE 10944 06:26:16,160 --> 06:26:17,560 COMPETITIVE AND YOU CAN JOIN. 10945 06:26:17,560 --> 06:26:18,880 THEY HAVE DIFFERENT START DATES 10946 06:26:18,880 --> 06:26:19,800 FOR DIFFERENT TIMES AND 10947 06:26:19,800 --> 06:26:21,080 DIFFERENT DURATIONS. 10948 06:26:21,080 --> 06:26:22,680 IF YOU HAVE MORE QUESTIONS, YOU 10949 06:26:22,680 --> 06:26:24,320 CAN GO TO THESE SITES. 10950 06:26:24,320 --> 06:26:26,720 FURTHERMORE, THERE'S ADDITIONAL 10951 06:26:26,720 --> 06:26:28,720 RESOURCES HERE TO HELP IN MANY 10952 06:26:28,720 --> 06:26:29,080 DIFFERENT WAYS. 10953 06:26:29,080 --> 06:26:32,560 ONE TO ONE SESSIONS WITH A 10954 06:26:32,560 --> 06:26:33,520 TRAINING DIRECTOR IS AVAILABLE. 10955 06:26:33,520 --> 06:26:35,480 THERE'S LEADERSHIP PROGRAMS. 10956 06:26:35,480 --> 06:26:36,880 WE WANT TO GET PEOPLE INTO 10957 06:26:36,880 --> 06:26:38,400 LEADERSHIP WHO DON'T -- AND 10958 06:26:38,400 --> 06:26:39,160 HAVEN'T HAD THE OPPORTUNITY UP 10959 06:26:39,160 --> 06:26:39,720 TO NOW. 10960 06:26:39,720 --> 06:26:42,080 IT'S A MAJOR, MAJOR EFFORT ON 10961 06:26:42,080 --> 06:26:42,960 OUR PART. 10962 06:26:42,960 --> 06:26:45,160 AND FELLOW-LED GROUPS AND 10963 06:26:45,160 --> 06:26:46,080 COMMUNITY BUILDING ACTIVITIES 10964 06:26:46,080 --> 06:26:47,680 ARE AVAILABLE, AND CAREER 10965 06:26:47,680 --> 06:26:49,120 EXPLORATION OPPORTUNITIES. 10966 06:26:49,120 --> 06:26:51,400 SO LET ME JUST SORT OF CLOSE 10967 06:26:51,400 --> 06:26:52,280 WITH THE OPPORTUNITIES HERE. 10968 06:26:52,280 --> 06:26:54,000 THIS IS A LITTLE BIT OF THE 10969 06:26:54,000 --> 06:26:54,520 HIGHER LEVEL. 10970 06:26:54,520 --> 06:26:56,240 THE SENIOR INVESTIGATOR ARE THE 10971 06:26:56,240 --> 06:26:58,640 TENURED INVESTIGATORS, THE PIs 10972 06:26:58,640 --> 06:26:59,120 HERE. 10973 06:26:59,120 --> 06:27:03,080 PACBASIC AND TRANSLATIONAL CANCR 10974 06:27:03,080 --> 06:27:04,840 RESEARCH, OF COURSE ALSO 10975 06:27:04,840 --> 06:27:05,120 CLINICAL. 10976 06:27:05,120 --> 06:27:06,200 THE MAJOR MECHANISM THAT WE 10977 06:27:06,200 --> 06:27:08,120 BRING ON NEW TENURE TRACKS IS 10978 06:27:08,120 --> 06:27:12,000 THE STAT PLAN. 10979 06:27:12,000 --> 06:27:13,200 MAN, A VERY PRESTIGIOUS 10980 06:27:13,200 --> 06:27:14,640 AND VERY COMPETITIVE PROGRAM 10981 06:27:14,640 --> 06:27:15,640 THAT TAKES ALL KINDS OF 10982 06:27:15,640 --> 06:27:16,280 APPLICATIONS. 10983 06:27:16,280 --> 06:27:17,560 PEOPLE WHO COME INTO THIS 10984 06:27:17,560 --> 06:27:18,520 PROGRAM GET A LITTLE BIT MORE TO 10985 06:27:18,520 --> 06:27:19,960 GET STARTED. 10986 06:27:19,960 --> 06:27:23,440 ON THE CLINICAL SIDE, WE HAVE 10987 06:27:23,440 --> 06:27:25,000 LASKER CLINICAL RESEARCH 10988 06:27:25,000 --> 06:27:26,120 SCHOLARS AND A PHYSICIAN 10989 06:27:26,120 --> 06:27:27,000 SCIENTIST EARLY INVESTIGATOR 10990 06:27:27,000 --> 06:27:31,200 PROGRAM OR THE PEE PROGRAM. 10991 06:27:31,200 --> 06:27:32,840 IN THE CLINICAL SIDE WE HAVE A 10992 06:27:32,840 --> 06:27:33,840 VERY NICE PIPELINE FOR PEOPLE 10993 06:27:33,840 --> 06:27:35,800 AND YOU CAN GET IN AT EVERY 10994 06:27:35,800 --> 06:27:37,000 DIFFERENT LESM AND PROGRESS. 10995 06:27:37,000 --> 06:27:38,240 THE PEOPLE WHO ARE IN THIS 10996 06:27:38,240 --> 06:27:40,080 PIPELINE STAY HERE BECAUSE IT 10997 06:27:40,080 --> 06:27:41,000 REALLY IS A TERRIFIC PLACE TO 10998 06:27:41,000 --> 06:27:41,280 WORK. 10999 06:27:41,280 --> 06:27:43,200 AND THEN FINALLY, WHEN HANNAH 11000 06:27:43,200 --> 06:27:44,200 VALANTINE WAS HERE, SHE WENT 11001 06:27:44,200 --> 06:27:45,600 BACK TO STANFORD A FEW YEARS 11002 06:27:45,600 --> 06:27:48,920 AGO, SHE ESTABLISHED THE 11003 06:27:48,920 --> 06:27:49,720 DISTINGUISHED SCHOLARS PROGRAM 11004 06:27:49,720 --> 06:27:51,640 AND THE INVESTIGATORS HERE 11005 06:27:51,640 --> 06:27:53,960 MOSTLY ARE COMING FROM THE 11006 06:27:53,960 --> 06:27:55,600 STATMAN SEARCH, WHEN YOU COME IN 11007 06:27:55,600 --> 06:27:56,960 YOU'RE SUCCESSFUL AND YOU WORK 11008 06:27:56,960 --> 06:27:59,520 AT THE NCI OR ANY OTHER 11009 06:27:59,520 --> 06:28:03,040 INSTITUTE AT THE NIH, YOU HAVE A 11010 06:28:03,040 --> 06:28:04,360 DE "I" STATEMENT THAT YOU MAKE, 11011 06:28:04,360 --> 06:28:06,320 AND PEOPLE WHO ARE REALLY -- I 11012 06:28:06,320 --> 06:28:08,440 MEAN, NOT LIKE I HAD TWO 11013 06:28:08,440 --> 06:28:10,000 STUDENTS ONCE, THIS IS WHAT 11014 06:28:10,000 --> 06:28:11,200 THEY'RE PASSIONATE ABOUT, THIS 11015 06:28:11,200 --> 06:28:12,520 IS HOW THEY'VE LIVED THEIR LIFE 11016 06:28:12,520 --> 06:28:14,120 AND THIS IS WHAT THEY WANT TO DO 11017 06:28:14,120 --> 06:28:15,200 IN THE FUTURE. 11018 06:28:15,200 --> 06:28:17,360 THESE PEOPLE COMPETE TO GET INTO 11019 06:28:17,360 --> 06:28:18,640 THIS PROGRAM AND USUALLY 10 TO 11020 06:28:18,640 --> 06:28:20,560 12 PEOPLE GET IN, AND THEY ACT 11021 06:28:20,560 --> 06:28:22,120 AS A COHORT AND THEY GO 11022 06:28:22,120 --> 06:28:23,360 THROUGHOUT THEIR EARLY CAREER AS 11023 06:28:23,360 --> 06:28:25,600 A COHORT, THEY HAVE VERY SIMILAR 11024 06:28:25,600 --> 06:28:27,240 ACTIVITY OR IDENTICAL ACTIVITIES 11025 06:28:27,240 --> 06:28:29,520 IN SOME CASES, AND THEY STAY 11026 06:28:29,520 --> 06:28:29,760 TOGETHER. 11027 06:28:29,760 --> 06:28:31,160 IT FORMS A NETWORK REALLY FOR 11028 06:28:31,160 --> 06:28:32,200 THEIR WHOLE CAREER. 11029 06:28:32,200 --> 06:28:33,520 SO WE'RE VERY PROUD OF THAT 11030 06:28:33,520 --> 06:28:35,600 PROGRAM AND IT'S ACTUALLY HELPED 11031 06:28:35,600 --> 06:28:37,920 ON OUR RECRUITMENT TREMENDOUSLY 11032 06:28:37,920 --> 06:28:41,440 FOR UNDERGRADUATE -- SORRY -- 11033 06:28:41,440 --> 06:28:42,080 UNDERREPRESENTED GROUPS. 11034 06:28:42,080 --> 06:28:43,760 SO LET ME CLOSE AND SAY THAT I 11035 06:28:43,760 --> 06:28:45,760 CAN'T WAIT FOR THE FIFTH 11036 06:28:45,760 --> 06:28:46,040 SYMPOSIUM. 11037 06:28:46,040 --> 06:28:49,360 I THINK THIS WAS TREMENDOUS. 11038 06:28:49,360 --> 06:28:53,200 STEFAN, EVERYBODY INVOLVED, AND 11039 06:28:53,200 --> 06:28:54,560 I THINK THIS HAS BEEN A GREAT 11040 06:28:54,560 --> 06:28:54,840 TWO DAYS. 11041 06:28:54,840 --> 06:28:56,120 I WANT TO REMIND EVERYBODY THAT 11042 06:28:56,120 --> 06:28:59,360 WE THINK THAT A MAJOR GOAL IS TO 11043 06:28:59,360 --> 06:28:59,760 CROSS-COLLABORATE. 11044 06:28:59,760 --> 06:29:03,040 WE DO IT WITHIN NCI, DIFFERENT 11045 06:29:03,040 --> 06:29:03,920 DIVISIONS WITHIN NIH INSTITUTES 11046 06:29:03,920 --> 06:29:05,240 AND THERE'S A LOT OF THEM. 11047 06:29:05,240 --> 06:29:07,240 AND THEN WITH OUR PARTNERS IN 11048 06:29:07,240 --> 06:29:08,680 THE EXTRAMURAL COMMUNITY. 11049 06:29:08,680 --> 06:29:10,840 SO A BIG THANK YOU TO THE 11050 06:29:10,840 --> 06:29:12,440 KEYNOTES, TO ALL THE SPEAKERS, 11051 06:29:12,440 --> 06:29:13,760 TO THE CHAIRS, TO THE 11052 06:29:13,760 --> 06:29:15,160 PARTICIPANTS, I'D LIKE TO 11053 06:29:15,160 --> 06:29:16,480 PARTICULARLY THANK THE 11054 06:29:16,480 --> 06:29:18,240 EXTRAMURAL PEOPLE WHO'VE COME, 11055 06:29:18,240 --> 06:29:19,960 GIVEN TALKS AND PARTICIPATED, 11056 06:29:19,960 --> 06:29:21,120 AND A BIG SHOUT OUT FOR THE 11057 06:29:21,120 --> 06:29:22,560 CANCER SURVIVORS THAT ARE HERE 11058 06:29:22,560 --> 06:29:23,880 TODAY. 11059 06:29:23,880 --> 06:29:27,840 SO AGAIN, LET ME AGAIN THANK 11060 06:29:27,840 --> 06:29:28,200 EVERYBODY. 11061 06:29:28,200 --> 00:00:00,000 [APPLAUSE]