Robert Winn: Without ‘high-touch’ strategies, cancer’s breakthroughs will increase disparities

Looking at the dizzying progress in cancer medicine over the last couple of decades, it’s easy to imagine that advances in synthetic biology or immunology will soon help cure or prevent more cancers. But without a strategy to connect “these miracles” to all communities, only some will benefit and others will be left behind, said Robert Winn, the director of the Massey Cancer Center at Virginia Commonwealth University.

“We’re talking about early detection of cancers, multicancer early detection sort of approaches are happening. Where are the discussions of how these get out to the rural communities? The at-risk, underserved communities?” Winn said Wednesday at the 2023 STAT Future Summit. “I’m trying to ring the bell of awareness that as we are making these leaps and bounds within the medical sciences, we also really pay close attention to making sure the distribution of these miracles is more equitable.”

That hasn’t historically been the case with new technology and, Winn said, it still isn’t. As millions of dollars rush into developing AI tools and new immunotherapies, Winn noted that the same attention isn’t afforded to methods known to reduce disparities, such as outreach, infrastructure building, and using navigators to help patients access cancer care. “We are bathed every single day by commercials that talk about how can we use immunotherapy to fight one’s cancer, but you don’t really get to hear about all the things about how we should be equally concerned about how do we pay for navigation, for example. We know navigation works,” Winn said.

The result is that existing health disparities widen as each new technology with the ability to revolutionize cancer care comes into play, Winn said. Turning that future around, Winn said, requires a “high touch” approach — outreach often in the form of in-person contact between researchers or clinicians and community members. Through these interactions and being present with the communities, doctors can cultivate trust and learn more about the barriers their patients face.

High-touch outreach can be as simple as showing up in a neighborhood. Winn, a pulmonary oncologist, periodically takes a “district walk” through his cancer center’s catchment area. On one such walk, in a rural part of Virginia, he learned many residents had never gone to a local health center where they could do cancer screenings. The trouble was that the health center was difficult to find.

“We kept passing this place, and we kept saying, ‘who knows how to get there?’” Winn recalled. It turned out that Virginia regulations prohibited signage for the clinic near highways, so many residents didn’t even know it existed. Working with a state senator and the Virginia departments of health and transportation, Winn got the rule amended.

“We showed them how many community health centers or federally qualified health centers, where most of our rural folks are going, how many more would actually be served if they only knew where the damn place was by simply putting up a sign,” Winn said. “You know, the funny thing is that we get enamored with all the high-tech stuff, but sometimes the low-tech stuff like putting up a freaking sign actually helps. Believe it or not, it gets people in the door.”

At the summit, Winn offered three main strategies that he believed would help guide the future of cancer toward equity. One is changing how clinicians and researchers speak with communities. “Ya’ll got to learn how to talk. I mean talk like real folk. You know, if people don’t know that you care, they don’t really care about how much you know,” he said, adding that doctors must also learn to do more than educate their patients, but listen to their issues and concerns as well. “We have to get more humility in the medical field. The truth of the matter is we don’t listen very well. We don’t ask very well. We’re just crazy, pompous, arrogant — sometimes hubris comes into play when we think we know what’s best for the community.”

The second is getting out into rural, poor, or other disadvantaged communities and inviting people to join clinical trials and offering resources. “We have to work on the fact that we don’t ask. We simply just assume that people don’t either have the means or the family support, and I think that’s some BS,” Winn said. “Just like everyone else, poor people, rural people, people in at-risk communities, all want to actually continue life.”

And finally, Winn said, he wants to train the next generation of researchers and clinicians in both how to design and implement clinical trials as well as the high-touch strategies of outreach and engagement. “If we don’t actually connect the discovery sciences in a more deliberate way to the implementation and health sciences, we will have done everyone a disservice,” he said.

Get all of those things right, Winn said, and the future against cancer already gets closer to looking like a miracle. “If we just give the standard of care right now, make it accessible to most people, then we don’t need a doggone other drug,” he said. “We could reduce right now cancer by 50% in the next 25 years by active navigation, by community activation.”