Cover Story

ASCO recognizes the value of diversity with its many facets—race, ethnicity, gender, socioeconomic background, geographic location, interests, etc.—and has implemented a program to increase the diversity of physicians in the oncology workforce. The ASCO Diversity in Oncology Initiative, funded by Susan G. Komen for the Cure^®, consists of three unique awards that offer funding to physicians and medical students with an interest in oncology who self-identify as minorities or who commit to practicing oncology in a medically underserved region of the United States. The program supports the underrepresented physicians establishing themselves in the field of oncology and the underserved patients who desperately need care.

Recruiting the Best—and Keeping Them

The Diversity in Oncology Initiative is designed to facilitate the recruitment and retention of individuals from populations underrepresented in medicine to cancer careers, with particular attention to the development of clinical practitioners and investigators. Three funding opportunities were created to support the program’s goals.

• The Medical Student Rotation provides 8- to 10-week clinical or research oncology rotations for U.S. medical students from underrepresented populations. A mentoring component is included whereby award recipients are paired with a clinical oncologist who provides ongoing academic and career guidance. Award recipents receive a $5,000 stipend for the rotation plus $1,500 for future travel to the AS CO Annual Meeting. An additional $2,000 is provided to the student’s mentor.
• The Resident Travel Award provides financial support for residents from underrepresented populations to attend the AS CO Annual Meeting. The award includes a $1,500 travel advance, complimentary meeting registration, and access to the Annual Meeting housing block and AS CO’s travel agency.
• The Loan Repayment Program provides repayment of qualifying educational debt to oncologists or oncology fellows who commit to practicing oncology in a medically underserved region of the United States (designated by the U.S. Health Resources and Services Administration as a Health Professional Shortage Area or Medically Underserved Area). The program will repay up to $35,000 per year for two years (up to $70,000 total) of qualifying education debt.
• The application for the ASCO Loan Repayment program is currently open. The application is due December 16, 2009.

Making a Difference in Lives of Physicians, Patients

The recipients of these awards represent a spectrum of backgrounds, interests, and experiences, but all share the same desire to improve the quality of care of patients with cancer.

“When I first read my acceptance letter [to the Medical Student Rotation program], I got chills,” Frank Crespo, of The Warren Alpert School of Medicine at Brown University, said. “I had to read the letter three more times before it actually sunk in. I couldn’t believe that I was about to live one of my dreams.”

	Frank Crespo looks forward to interacting with patients when he begins his Medical Student Rotation in November 2009

Mr. Crespo will start his oncology rotation in November 2009 in his hometown at the University of Miami Sylvester Cancer Institute, and he is eager to meet his patients. “I hope to affect their lives and offer them guidance and support through their battle with cancer,” he said. “I also look forward to the abundance of knowledge my mentor, the institution staff, and the patients will provide me.” He hopes that his experiences will help him “to better appreciate how the intricacies of race, nationality, and class affect illness.”

Amanda Adeleye's experience conducting breast cancer research inspired her to apply for the Medical Student Rotation

Amanda Adeleye, of Columbia University, had prior experience with oncology when she applied for the Medical Student Rotation, conducting research on an aggressive subtype of breast cancer. “I could see how what I was doing could help someone down the road, and that was thrilling to me,” she said. “There are so many talented medical students interested in oncology. I’m still trying to figure out how I was so lucky to be selected” for the program.

Ms. Adeleye completed her oncology rotation at Northwestern in summer 2009. “I was most excited to start my research because it was my opportunity to be able to make a difference in the fight against cancer, no matter how small. Great research takes time and I have been working hard to make every minute count,” she said.

Diversity includes a spectrum of attributes and experiences, and Ms. Adeleye defines her own diversity in multiple ways: as the daughter of a Nigerian father and African-American mother; as a scientist who also majored in Classics, which “afforded me the experience of approaching some of the world’s most ancient works with a scientific eye”; and as a dancer and art lover who “appreciates medicine in a unique way—the synchrony in the steps of a procedure and the beauty in the expression of a patient who is a survivor.”

For Kimberly Lockhart, of the University of Arkansas, diversity is about keeping an open mind. “I strive to enrich my life with the awareness, knowledge, and sensitivity of other racial, ethnic, socioeconomic, and cultural groups. I desire to interact and serve people with different values, beliefs and alternative perspectives,” she said. Ms. Lockhart served her Medical Student Rotation at the University of Arkansas for Medical Science/Winthrop P. Rockefeller Cancer Institute during summer 2009.

Ms. Lockhart knows firsthand what it means to be an underserved patient. At age 11, she was diagnosed with neurofibroma, a condition which left her “vulnerable, afraid, confused, and embarrassed” for many years, she said. “By the time I was a sophomore undergraduate, I managed to find two physicians willing to carry out the daunting task of removing the tumor and reconstructing my scalp without compensation. I gained not only a better quality of life, but also lifelong relationships with my physicians that inspire me to help others just as I have been helped.”

	Derrick Haslem, MD, returned to his childhood home in rural Utah to provide oncology care to an underserved community as part of the Load Replayment Program

Derrick S. Haslem, MD, of Intermountain Medical Group and a recipient of the Loan Repayment Program, has experienced multiple aspects of diversity. “My family is composed of hardworking blue-collar farmers, ranchers, and construction workers. I lived in the Dominican Republic for two years among extreme poverty and need. I feel like I can really relate to the people who will become my patients,” he said.

Receiving funding from the Loan Repayment Program “was quite a relief to my wife and me, that a substantial portion of student loan debt would be taken care of,” Dr. Haslem said. With the financial burden of loan debt eased, he was able to set up practice in a rural community in St. George, Utah, where he grew up. The coverage area for the practice includes regions of Utah, Nevada, and Arizona.

“The population served includes Native Americans from the Paiute and Navajo tribes, Hispanic immigrants and rural farmers and ranchers, as well as other ‘salt-of-the-earth’ people,” he explained. “Currently, many travel 4.5 hours to Salt Lake City or 1.5 hours to Las Vegas for cancer care—imagine the drain that is for people getting weekly chemotherapy. Another challenge is overcoming some of the distrust people have with the medical community,” exacerbated by the high turnover of medical professionals in the area, he noted. “Because it is somewhat isolated, no one wants to come. I grew up here and know the secrets to this great place, so I was more than willing to return. I hope, because I plan on being here forever, that I can break down some of those barriers.”

Boone W. Goodgame, MD, of Washington University School of Medicine, St. Louis, plans to practice in underserved communities in Missouri as part of the Loan Repayment Program. At Washington University, the primary “safety-net” hospital in the region, he will treat the largest uninsured and underinsured populations in the state. He will also spend one day each week at an outreach clinic in rural Missouri, where patients frequently drive one to two hours for treatment.

His desire to serve an underrepresented population was inspired by his own life experiences. Dr. Goodgame spent his childhood living in Uganda, where his father taught at the nation’s only medical school. “Most of my childhood was spent in a developing country, so I have a balanced outlook on what it means to be advantaged and disadvantaged,” he said. He returned to East Africa during his final year of medical school to work in a hospital in rural Kenya, where he saw “the profound devastation of cancer when health care resources are essentially unavailable.”

He is also guided by his spiritual faith, which “shapes my approach to all areas of life, including my patient interactions and research.” He noted that, in his experience, strong religious beliefs are uncommon in academic medicine but they can be “a common point of connection and support with many of my patients.”

Kenisha Pemberton worked with pediatric patients during her Medical Student Rotation. She applied for the program after witnessing her grandfather's struggle with cancer.

Experiences abroad also contribute to Kenisha Pemberton’s understanding of diversity. Ms. Pemberton, of Florida State University College of Medicine and a recipient of the Medical Student Rotation, has been to England, Costa Rica, Jamaica, and St. Kitts and Nevis. Her travels, along with her study of public health, have “equipped me with the necessary knowledge and skills for working with a diverse oncology population,” she said.

“Witnessing firsthand how my grandfather fought and lost his battle with cancer motivated me to apply for the Medical Student Rotation,” she explained. “I was ecstatic to discover that I was chosen as a recipient.” Ms. Pemberton served her rotation at All Children’s Specialty Care of Tampa this past summer, where she gained “a greater awareness of the impact of cancer in pediatric patients and how physicians and other members of the health care team collaborate to maintain some semblance of a normal childhood for these unique patients.”

	Derrick D. Cox, MD, chose to become an ASCO member after attending the 2009 Annual Meeting on a Resident Travel Award.

An interest in cancer health disparities led Derrick D. Cox, MD, a surgical oncology fellow at Roswell Park Cancer Institute, to apply for the Resident Travel Award. As a recipient, “I feel a tremendous responsibility to make a difference in populations disproportionally affected by cancer,” he said. He applied for the program during his chief resident year in surgery at Georgetown University Hospital.

His experiences at the 2009 ASCO Annual Meeting may help him to achieve his goal. “It was awe-inspiring,” he said, “to see so many people committed to the care of patients with cancer. I enjoyed going to a variety of lectures and presentations, as well as the scientific poster sessions. In addition, I truly enjoyed the Fellows and Active-Junior Lounge and the access to pre-eminent speakers. The knowledge and networking I gained while at the Meeting motivated me to join ASCO [as a member] at the conference.”

Renee Funches, MD, of Emory University Hospital, also attended the 2009 Annual Meeting as part of the Resident Travel Award. “This was the first time I had ever been to a conference like this and it was very exciting. It was a great opportunity to explore many areas in oncology that I had not been exposed to much before, such as neuro-oncology, gynecologic oncology, survivor care, and palliative care. My attendance has strengthened my desire to learn all I can in this field during my oncology fellowship to provide my patients with the best and most current treatment modalities,” Dr. Funches said.

Ultimately, the experiences of these medical students, residents, and practitioners will help to bring compassionate and necessary treatment to the most underrepresented patient communities. “There are a lot of areas in this great country that are really lacking in access to care,” Dr. Haslem said. For him, participating in the Diversity in Oncology Initiative underscores “the commitment that AS CO is making to bring quality care to the underserved.”

Why is it so important for the profession of oncology to represent people with diverse origins and experiences? Amanda Adeleye: “In order to practice with compassion, the oncology community must be able to appreciate and incorporate the richness of differences of its patient population. Having a diverse group of health care professionals to provide care increases the probability that patients will be treated by someone who is readily able to understand how the patient’s unique background may be beneficially weaved into a plan to provide the best health care possible. By interacting with people of diverse backgrounds or bringing unique experiences ourselves, we enhance the relationships that we have with our colleagues and patients.” Derrick D. Cox, MD: “Diversity promotes enhanced communication and understanding, which leads to positive patient encounters in the health system and, ultimately, improved outcomes.” Frank Crespo: “Different cultures have varying ideas regarding cancer and life after death. Having an appreciation and respect for different cultures will allow for a truly empathetic evaluation of patients. By approaching patients in a holistic fashion, we can overcome barriers to health care, which may include mistrust of the medical community, fear of dying, and disenfranchisement.” Renee Funches, MD: “People with diverse backgrounds and experiences often bring a unique perspective to patients and their loved ones as they cope with their diagnosis. They may have a better appreciation of the things that are culturally or spiritually important to the patient and their family, which would influence their decisionmaking and coping mechanisms.” Boone W. Goodgame, MD: “When patients see their physicians as real, unique people, it helps them to trust that you have their best interests at heart. Whether experiences and origins are similar or different, they can be used as a point to build common ground. Patients may inherently trust you because [they believe] ‘you’re like me,’ or they might even trust you more if they find that ‘you’re different from me, but you care.’” Derrick S. Haslem, MD: “Every person, no matter what race, gender, or origin, is different. They all have different life experiences from which they base their judgments. The more diverse experiences a provider has, the easier it is for their patients to relate to them, feel comfortable that they are getting genuinely good care, and trust that they will be better off because of it.” Kimberly Lockhart: “Diversity in the profession of oncology provides for an innovative workforce with a unique knowledge base, fresh perspectives, and alternative skills. This blend of characteristics equates to better medical care for patients with cancer.” Kenisha Pemberton: “Cancer has no regard for an individual; it afflicts people from all walks of life. The oncology profession must include persons with diverse origins and experiences to provide superior patient-centered care for an ever-increasing diverse patient population.”

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2009 Diversity in Oncology Initiative Award Recipients ASCO and Susan G. Komen for the Cure® are pleased to recognize the following participants in the 2009 Diversity in Oncology Initiative.* Medical Student Rotation Amanda Adeleye—Columbia University College of Physicians and Surgeons Frank Crespo—The Warren Alpert School of Medicine, Brown University Kimberly Lockhart—University of Arkansas for Medical Sciences Kenisha Pemberton—Florida State University College of Medicine Resident Travel Award Andrew Aguirre, MD, PhD—Massachusetts General Hospital David Chism, MD, MS —University of Medicine and Dentistry of New Jersey/ Robert Wood Johnson Hospital Derrick D. Cox, MD—Georgetown University Hospital Mitzie-Ann Davis, MD—University of Pennsylvania Renee Funches, MD—Emory University Hospital Lisa Garcia, MD—Boston Medical Center Lourdes Mendez, MD, PhD—Cornell University/New York-Presbyterian Hospital Kelvin Moses, MD—Emory University Bridget Oppong, MD—University of Rochester Rhoda Raji, MD—Temple University Hospital Mayra Sanchez, MD—Kansas University Medical Center Zanetta Stewart-Lamar, MD—Wake Forest Baptist Medical Center Veronica Wilson, MD—Baylor University Medical Center Loan Repayment Program Brooke Gillett, DO—Oncology-Hematology Associates of Springfield, Montana Boone W. Goodgame, MD—Washington University School of Medicine, St. Louis Derrick S. Haslem, MD—Intermountain Medical Group, Utah *Institutions as of the time of the recipient’s application.