Ep. 41: CancerX: Reducing incidence, burden, and disparities in cancer care

The Latest Dose

Cancer is a leading cause of death worldwide, accounting for nearly 10 million deaths in 2020. President Biden has reignited the Cancer Moonshot initiative and set a new national goal: “if we work together, we can cut the death rate from cancer by at least 50% over the next 25 years and improve the experience of people and their families living with and surviving cancer”. “To achieve [the cancer moonshot goals], we must amplify digital innovation,” stated Dr. Catharine Young, Assistant Director of Cancer Moonshot Engagement and Policy, White House Office of Science and Technology. CancerX, an initiative to rapidly accelerate the pace of cancer innovation in the U.S., will harness the power of innovation to reduce the burden of cancer for all people. Oracle is excited and honored to join Cancer Moonshot's new CancerX public-private partnership. In this episode Jennifer Goldsack, Chief Executive Officer at Digital Medicine Society (DiMe), Santosh Mohan, Vice President, Digital at Moffitt Cancer Center with Moffitt Cancer Center, and Stephen Konya, Senior Advisor to the Deputy National Coordinator, and Innovation Portfolio Lead for the Office of the National Coordinator for Health IT (ONC) will share more about Cancer Moonshot, CancerX and the importance of digital innovation to achieve the goals. -------------------------------------------------------- Episode Transcript:

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Hi, everyone, and welcome to the latest dose, the podcast that explores the depth of innovation and human compassion in clinical research. I'm your host, Katherine Vandebelt, global vice president of Clinical Innovation at Oracle Health Sciences. Cancer is a leading cause of death worldwide, accounting for nearly 10 million deaths in 2020, President Biden has reignited the Cancer Moonshot and set a new national goal.

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If we work together, we can cut the death rate from cancer by at least 50% over the next 25 years and improve the experience of people and their families living with and surviving cancer. In response to the White House Cancer Moonshot, CancerX is formed, an initiative to rapidly accelerate the pace of cancer innovation in the United States.

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CancerX will harness the power of innovation to reduce the burden of cancer for all people. Oracle is excited and honored to join Cancer's Moonshot New CancerX Public Private Partnership. Here with me today to share more about these inspirational initiatives, our Jennifer Goldsack, Santosh Mohan, and Stephen Konya. Jennifer, Jen, Goldsack is the CEO of the Digital Medicine Society, also known as DIME.

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Jen's research focuses on applied approaches to the safe, effective, and equitable use of digital technologies to improve health, health care and health research. Jen is a member of the roundtable on Genetics and Precision Health at the National Academies of Science, Engineering and Medicine. Jen serves on the World Economic Forum Global Leadership Council on Mental Health. Previously, Jen spent several years developing and implementing projects with Clinical Trials Transformation Initiative, also known as CTTI.

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This is a public private partnership co-founded by Duke University and the FDA. Jen conducted research at the hospital of the University of Pennsylvania, helped launch the Value Institute, a pragmatic research and innovation center embedded in the large academic medical center in Delaware. Jen earned her master's degree in chemistry from the University of Oxford, England, her master's in history and sociology of medicine from the University of Pennsylvania and her MBA from George Washington University.

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Jen is a retired athlete, formerly a Pan American Games champion, Olympian, and world champion silver medalist. Santosh Mohan, vice president of digital at Moffitt Cancer Center, is also with us today. Santosh brings more than 15 years of digital health and health information technology experience to this role. Previously, he served as the managing director of the Innovation Hub at Brigham and Women's Hospital, where he led digital transformation through the use, development, evaluation and commercialization of digital health applications.

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Throughout his career, Santosh has worked to leverage data and analytics to create and design new programs and digital abilities, with a strong focus on emerging technology to advance care and improve the clinician and patient experience. Santosh holds a master’s degree in clinical informatics from Duke University’s Fuqua School of Business and a bachelor’s degree in bioinformatics from Vellore Institute of Technology in India.

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Santosh is a certified professional in healthcare information and Management Systems, a member of American Medical Informatics Association, a senior member and fellow of the Healthcare Information and Management Systems Society, known also as HIMMS. You will also hear from Stephen Konya, the senior advisor to the Deputy National Coordinator and the Innovation Portfolio Lead for the Office of the National Coordinator for Health I.T., also known as ONC, which is part of the U.S. Department of Health and Human Services, HHS.

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Stephen is shaping the agency's long term strategy. The primary liaison to the White House Office of Science and Technology Policy. The primary liaison to the external health care startup and investor community. Stephen leads the Digital Health Innovation Workgroup under the Federal Health I.T. Coordinating Council, an interagency collaboration community comprised of innovation representatives from 40 other federal agencies. Previously, Stephen has led several key ONC projects, including the HHS Pandemic X Innovation Accelerator, the National Health I.T. Playbook, the Agency Patient Engagement Playbook for Providers, the Smart App Gallery, the FHIR at Scale Task Force, also known as FAST, and is a founding co-chair of the Together.Health Collaborative Effort. Prior to his position with the federal government,

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Stephen served the state of Illinois in a variety of key positions and diverse responsibilities. Stephen holds a BBA in finance and international business from Loyola, University of Chicago, is fellow and mentor of the Mid-American Regional Public Health Leadership Institute Program at the University of Illinois-Chicago School of Public Health. Welcome, Jen, Santosh and Stephen to the Latest Dose and thank you so much for making time to speak with me today.

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When I hear the word cancer, it elicits fear and anxiety, at least in me. So, researching the cancer trends does not provide me with much comfort. According to the World Health Organization, cancer is a leading cause of death worldwide, accounting for nearly 10 million deaths in 2020. Or stated another way, nearly one in six deaths. It appears that the medical community's understanding of cancer is growing,

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yet the death rate remains so high. What do we need to do differently? Thanks, Katherine. Cancer is out every day at Moffitt. We come face to face with this terrible, very difficult disease. Every single day. But we also see the courage of our patients fighting it. And that really inspires us to bring hope to every patient we serve and deliver to them some of the best outcomes.

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Up to four times the national average. Now, cancer deaths in the US are actually falling, but they're not falling fast enough so the death rate needs to decline by a more rapid percentage to reach the Moonshot goal of reducing cancer deaths by 50% in the next 25 years. It's very clear that we need a multifaceted approach to tackle this complex issue.

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First and foremost, prevention and early detection must be at the forefront, emphasizing lifestyle and behavior changes, like adopting a healthy diet, regular exercise, smoking cessation. All of these can significantly reduce cancer risks. Equally important is promoting awareness about the importance of regular screenings and recognizing early signs and symptoms. And we know that screening rates have declined for all cancers since the pandemic started.

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So, we will likely soon start seeing cancers presenting at more advanced stages requiring longer and more complex treatment, as well as decreasing positive outcomes. This means that we need to move engagement upstream and increase those screening rates. And this is where digital channels can help. We've been at the forefront of prevention and screening for years now, and really the reignited

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Moonshot has been an opportunity for us to accelerate these efforts around re-energizing the community to prioritize cancer screenings. Early interventions can make a world of difference, but prevention and early detection are just the beginning, and they require a lot of behavioral change within our society. And while we advance that, we should also recognize that cancer will continue to occur.

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So, we need to change the trajectory of cancer mortality, not just the incidence with therapeutic advancements, including immunotherapy and especially CAR-T. And therefore, we need to continue investing in cancer research and innovation. And collaboration is really key in this space. Collaboration among academia, with the industry, research institutions and entrepreneurs, it's really vital to expedite progress in this space.

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But progress also means nothing if it is not accessible to everyone. And so, ensuring affordable and accessible cancer care is a must. So again, this is another space where organizations must work together to bridge that gap and provide quality care to all individuals regardless of their socioeconomic background. I feel we also need to take a very patient centered approach, that is crucial.

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Cancer care should encompass more than just medical treatment; which is supported emotionally, it should provide symptom management and certainly address financial toxicity. So, these are all very, very important things that we need to do, to decline, to help that that decline faster, at a faster pace. And we really do need a collaborative effort from everyone.

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Beating cancer truly demands delivery and collaboration, but also bold innovation. And this is where I feel CancerX is creating a dynamic ecosystem where people can come together, organizations can come together, ideas can flourish, expertise and resources can be shared, and innovative solutions can rapidly be developed and equitably deployed to really prevent and cure cancer in this fight.

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Well, thank you for sharing all of that. That's extremely motivating. You mentioned the Moonshot and so I believe the White House Cancer Moonshot has been reignited. So, what I know, you mentioned a couple of things that the Moonshot focusing on, but is it possible that you could actually walk us through what the mission is currently or what it is globally around all of that?

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So, Stephen, is that something you can talk us through? Yes, Katherine, thank you so much for the question because it is important to know how we got to where we are today. So, you know, it was actually in 2006 when the Cancer Moonshot was first launched. And like any Moonshot, you know, dating back to President Kennedy's Moonshot, is all about really how do we refocus everyone's attention, prioritize our resources, and like Santosh mentioned, collaborate together to try to tackle this massive challenge that we're still faced with today.

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So, in 2016, when they launched the Cancer Moonshot, then Vice President Biden was put in charge of it. And it was a very personal story to him and something that he was very passionate about. Fast forward to now President Joseph Biden. The president has now reignited that Cancer Moonshot to build upon what was originally launched in 2015. The idea is really around two things at this point.

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Number one, as Santosh just mentioned, we need to reduce the death rate for cancer by 50% in the next 25 years. That is the huge Herculean task that we have before us. And while, though it seems like it's a very difficult task, I think it is very realistic. As Santosh mentioned, the current death rate is going in the right direction at a rate about 2.3%.

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But we need to drop that to 2.7. Recently, the National Cancer Institute released a study in a report that said we could accelerate that death rate to dropping it at 2.7% in order to achieve that target of a 50% reduction in death rates by in 25 years. So that's the number one thing we're focused on. And that's going to take everybody working together, not just, you know, industry, who's already begun to answer the call of the Moonshot organizations like Moffitt and DIME working Together and many others throughout the country all collaborating.

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And then on the government side, you know, we're not alone. We need or we need to also work together across federal agencies and do it in partnership with organizations like Moffitt and DIME and others. And that's really where CancerX is just becoming a vehicle for that collaboration. We will get into that a little bit. The amount of response that we've seen so far has been amazing.

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But, but, again, it's really about reducing that death rate. The second key area of the Moonshot that we're also focused on, that the president has mentioned as part of this reignited Moonshot is all around how can we help patients and their families and their caregivers navigate the complexities and the challenges of a cancer diagnosis, and going through that treatment and essentially, you know, dealing with all the challenges that come along with that, including things like financial toxicity, what they believe Jen's going to cover in a little bit here.

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But, but the idea that it's not just about developing new drugs or new diagnostics, but really, we also need digital tools and other solutions that can help manage the complexities of cancer care and helping those families navigate and go through that with at least disruption as possible. We know that often the concerns around the complexity of the care and the cost of the care can lead to people avoiding getting screened.

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They don't want to know if they have something because they're afraid of getting that bad outcome of hearing that they do have cancer because now they've got to deal with it financially or emotionally or other things. So, if we can figure out a best way to make that more, more friendly, and easier to try to minimize the amount of adverse impact it has and to try to reduce some of that fear and anxiety around what it's like to go through a diagnosis of treatment of cancer.

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I think that could also severely help us in getting, you know, encouraging more patients to do go get screened early and then to help them navigate that. Well, those are very lofty and inspiring goals to decrease the death rate and to also make it significantly easier for people to move through any diagnosis, whether it's cancer or others, it's very stressful, very daunting, and takes usually a community to deal with that.

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So that is awesome! And thank you for your leadership and thank you for your commitment to bring these changes to the United States. So, when I was reading about the Moonshot and when I was reading about you mentioned CancerX Stephan, Dr. Katherine Young, I believe she's the assistant director of Cancer Moonshot Engagement and policy, and she works at the White House Office of Science and Technology Policy.

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She shared in March this year, so 2023, “ To achieve the Cancer Moonshot goals, we must amplify digital innovation, which is the mission of our newly formed CancerX”. So, you mentioned that Jen can talk a bit about CancerX. How did CancerX come about? And will you share more about the mission of CancerX?

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Yeah. Happy to, Katherine. The CancerX was announced by the White House on the one year anniversary of the reignited Moonshot. So, February 2023, was that one year anniversary and it was announced as a public private partnership with the goal of harnessing the power of innovation to support and drive towards the achievement of the reignited Cancer Moonshot goals.

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So, February was that announcement. We are very proud between the Digital Medicine Society and Moffitt Cancer Center to have a history of pre-competitive, multi-stakeholder set of research and implementation at the intersection of innovation and oncology. And so, we were privileged to have the opportunity to host CancerX alongside our colleagues at the Federal Government with Stephen Konya as lead from ONC, but also from the office of the Assistant Secretary for Health and the White House of course.

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The mission is we have come together, to state it is, to unite to diverse and inclusive community of stakeholders, to rapidly develop and equitably deploy innovative solutions that can prevent and cure cancer. That mission is wholly in support of the Moonshot goals that Santosh and Stephen describe so well. And we are incredibly proud to have just announced over 90 members, including Oracle, Katherine, who has come to the table, raised their hand, and said they want to work with us.

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They want to join the charge to harness the power of innovation, to reduce the burden of cancer for all people. So that's a little bit about the history and also our exceptional partners who share this vision. So, wow, 90 members already! That is fantastic! That's I think it reflects the decision making from our colleagues at the White House to structure CancerX as a public private partnership, bringing the very best of government and expertise and capacity together with cutting edge research and sort of clinical knowledge from the private sector.

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This is how we are going to achieve the goals of the Moonshot. This is how we are going to harness the power of innovation. And I think it speaks to the industry's commitment as well as government's commitment, that we have this kind of engagement right out of the gates. So, I read that CancerX is using a three pronged approach to generate this impact.

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So, is there important scope of these three prongs that are important for people to understand? And what will this mean for physicians? And you've already talked very clearly about the importance of patients. So, what does this mean for physicians and patients? Maybe I'll give a quick overview and then ask Stephen to talk more about the vision for the accelerator and Santosh to pick up the implications for sort of clinicians as these are his partners every day over at Moffitt.

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So, you're exactly right, Katherine. When we when we were thinking about as a team how we would structure CancerX, we wanted to do several things. One, we wanted to create a structure that provided a truly big tent environment for stakeholders from across industry, academia, and government to come together and contribute their knowledge and expertise in an optimized way.

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We also wanted to make sure that we were structured to be as productive as possible. Harnessing the power of innovation to improve the lives of people with cancer and the goals of the Moonshots mean that we have to make sure that all of our efforts are optimized. So essentially, we set up this CancerX to be run by the community with the 91 members that we were just discussing, really helping drive the strategic direction and the tangible activities almost operate as a flywheel.

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So ,you can imagine this evidence generation engine where we are conducting pre-competitive research around topics that are defined by the CancerX community to make sure that we can actually articulate and demonstrate what good looks like as we innovate in cancer prevention and research. Then we think about this as we think about defining what good looks like.

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We also have to make sure that there are the skills and capacity in the market to actually be able to deliver on that. That's the purpose of the rolling series of accelerator cohorts. And so, Stephen will talk more about that. And then finally, it's one thing to come up with, look here, the methodological best practices, here’s what good implementation looks like, here's an evaluation framework.

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It's great to make sure the industry is prepared, but we know to actually drive definitive change, we also have to show not just tell, but innovation works. And that's the logic behind the demonstration projects that Santosh will cover. So, Stephen, do you want to jump in and talk a little bit more about the vision for the accelerators? Yes, thank you.

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Jennifer. Absolutely. So once, you know, just as Jennifer mentioned, once we have a good idea of what good looks like and what we need to do as far as what are the biggest challenges that need to be tackled based on those pre-competitive evidence generation projects. We then need to provide some sort of a vehicle to help entrepreneurs and innovators work together and develop these solutions to meet that need.

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And so, if you're familiar with the accelerator model, whether it's one that's led by non-for-profit or one that's associated with a corporate entity like a payer or provider or one that's led by the government; you know, this actually isn't our first time we've done a public private partnership in the past, in fact, HHS has led several of them.

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So, we're really trying to build on what we've learned in the past with KidneyX, one of our first significant national public private partnership accelerators. And then after that, we launched LimeX, followed by PandemicX, which is a one year accelerator. The other two are still going. And then now, now we're on to CancerX. So, we've seen kind of what works well and what doesn't work well.

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Generally speaking, when it comes to setting up a public private partnership and running an accelerator, we also know that there's a lot of lessons to be learned from external accelerators, ones that are led by some of those other organizations I mentioned, whether they be an independent non-for-profit arm or a for profit accelerator or even some that are associated with providers or payers or others, and we're taking the best ideas from all of those and putting together to make something that's truly unique for CancerX.

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If you've seen one accelerator, you've seen one. No two are like, they all have some common methodologies as far as how they run it. There's some common core elements. You need to have a strong mentorship core. You need to have some strong curriculum that's built into it. You need to have a clear call to action and an identification of what challenges you're trying to tackle through that accelerator.

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So, what types of solutions are you sourcing for in order to get into such a cohort? And just like Jennifer said, you know, this is going to be a truly inclusive, open, big tent type of opportunities. So, we're doing something not only in a way that's creating an opportunity for anybody to apply to be part of the accelerator, but also trying to figure out how can we make it accessible in some ways to those who don't get into the accelerator. How can we help provide greater clarity around the entire ecosystem for investors, for entrepreneurs, for incubators, for the nations accelerators that want to help support this as well.

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How can we create the platform for all these organizations to collaborate with each other through this effort and to have a good sense of who's doing what, where. How can we make it easier to identify what solutions in entrepreneurs are, in startups already out there building something just to be able to source them, even if they're not the focus of what we are currently sourcing for.

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We still want to use this as a public utility to make it easier for, say, one cancer center to find a solution, even if that's not something every other cancer center is looking for. So again, it's really being driven by what everybody identifies as the greatest area of need as far as what we're going to source for and then having the most open, collaborative type of environment for actually running the accelerator itself.

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And then what we get out of that accelerator hopefully is a more mature, well-tuned, you know, refined solution to meet the need with access and relationships to potential customers and investors to accelerate the pace of bringing that innovation to market. And that's something that's unique about CancerX when it comes to other initiatives underneath the Cancer Moonshot. You know, if you think about it, just to step back a sense, you know, the Cancer Moonshot is really a call to action, kind of the big picture vision.

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The National Cancer Plan, which was just recently released as well by NCI, is really kind of the strategy of how to achieve that, that big call to action. And I encourage you to look at the eight categories and goals under that national cancer plan. I mean, CancerX is one of the just one of many initiatives that is underneath that that can serve as a vehicle for how do we actually take action and get things done.

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And unique to CancerX is all about how do we provide a platform again for startups, entrepreneurs, innovators, accelerators, bootcamps, you know, investors, how do we provide a forum for them to come together and to collaborate? Not just the research community and others, but really help them come together to accelerate that pace of innovation getting to market. Because it's, you know, we have a lot of great innovations that are being developed throughout the US and the world to deal with the oncology field on diagnostics, therapies, treatments, and there are solutions out there to help on the administrative side of managing care.

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But what we've heard collectively from the cancer centers like Moffitt, and maybe it's interesting to expand upon this, is that in many cases there are ones that aren't tailored enough to their needs and often don't deal with the complexities of cancer care specifically, and they need more of those solutions. S, it's very powerful when you have all these cancer centers working together to say and other institutions and patient navigating organizations and others to community based organizations, all saying with one voice, this is what we need to source.

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And then that sends a signal for entrepreneurs to either pivot or to help raise their hand and say, I've got a solution to that. And then the accelerator helps really vet that opportunity and see like, how real is it and what other support do they need in order to bring it to market at a faster pace than that.

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Otherwise, it's not good enough to have those ideas hopefully make it to market in 5 to 10 years in widespread use. We need to try to accelerate that to being in the market in two years or three years. That way we can really start to make an impact and a dent on that cancer death rate at a much faster clip.

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That was great Stephen. And I'll add that this flywheel from what Jen described with regard to the evidence generation, what Stephen described as the accelerator sort of feeds into them the demonstration projects. We strongly believe that the value that Moffitt and other providers add to this ecosystem, to this flywheel, is really our day to day clinical expertise.

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And our connection to actual clinical care and operations, as well as our familiarity with the business side of care delivery. So CancerX will be opening up this silo of care delivery experts from us, from member sites to the rest of the ecosystem so that we can bring our expertise to the table and bring expertise our other esteemed members and figured out answers to important nitty gritty questions and workflow considerations, not only to encourage, but more importantly, to bring real solutions to life and demonstrate that they can actually work.

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And that's really the beauty of the last piece of demonstration projects so that we show and not just tell or talk about how we are doing this. Well, that's fantastic! And thank you for sharing all that. It's very clear and I've heard everyone sort of mention the importance of digital innovation and leveraging new digital innovation, as I know, and I'm sure all of you know, is a challenge.

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And throughout my pharmaceutical career I have experienced that the challenge and the benefits of embracing new ways of working exist. So, what are the current enablers and blockers to achieve the CancerX mission or what comes out of the accelerator cohorts or what comes out of the pre competitive work? So, Santosh, can you talk a little bit about that since you'd have to implement it in your company and your industry and with your colleagues?

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So, at Moffitt we are always thinking about reimagine changing how we tackle cancer by pairing our expert care with innovative technology. And we think oncology sits squarely at the nexus of technology and humanities. And we see two realities that are world. Reality one is where oncology is leading innovation in research and in care. Because if you think about digital pathology, digital radiology, next gen sequencing, patient reported outcomes, precision treatment approaches, especially those driven by complex data and biomarkers, these are all hallmarks of oncology, but these advances are not the standard of care for everyone.

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So, there's a lot of work to do in advancing the adoption of them. And then there's the other reality where oncology is still playing catch up with digital transformation. Digital innovation is lagging in oncology relative to other therapeutic areas and digital solutions that work very well in other parts of healthcare don't translate so easily to our space. And what would be one appointment in any other health setting is a dozen or a half a dozen appointments in our world on the day of treatment.

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And this makes it really hard for someone to just flip open their phone and be able to book an appointment online. It's complex. It's complex. These are complex challenges. So now more than ever, oncology needs innovators that want to make a meaningful difference.

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And there are so many opportunities for innovative action. Cancer diagnosis must be early and accurate, which means we need consistent improvement of new diagnostics technologies. Treatment is highly complex, highly variable, which means new technology innovations must also simultaneously simplify the process. They must break away the administrative work from the providers and aid the patients, because throughout this process, which is often traumatic for patients, we also must be able to help care staff better support the recovery.

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So, there's so many ways in which digital innovation can actually make a difference. And I think CancerX is really creating that ecosystem and the power to bring together a diverse and inclusive community of pioneers, all shared, all driven by the shared commitment to advance the goals of the Moonshot. So, a lot of work ahead of us, especially to harness the power of digital innovation to push the boundaries of cancer care.

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Just wanted to add to that from the government side. You know, when we think of historically, what are some of the major blockers for any, any innovation, you know, area in health care, it's typically been around the challenges of interoperability. You know, you have great digital solutions and tools that are being built, whether they're on the clinical side or whether they're on the administrative side.

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And either they can't get access to the data they need to prove that their tools work, especially SOGI data and REL data and other things like that that help us be able to analyze its impact on different patient populations to make sure that it has an equitable outcome when it's deployed in different scenarios. A well as actually being able to have this, these tools get implemented and connect the systems to both, you know, receive data that it needs to continue operating as well as feeding that data back into the systems.

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And that's been a challenge for years for any area of health care that you can think of. And oncology is no different in that. But on the enabler side, one of the things that we're excited about at HHS is the progress we made over the past several years on implementing the 21st Century Cures Act. And so again, this gets back to why is this now the right time to have the reignited Cancer Moonshot really take off with something like CancerX

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Well, frankly, a part of it is because of the fact that it's going to be much easier for the data to flow in the directions that it needs to because of the 21st Century Cures Act. We've got one major provision at LONC that we're responsible for implementing that will take place at the end of this calendar year.

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But otherwise, we've done a lot of work to both standardize the data and better formats through USCDI, the US coordinator for interoperability to make that data, you know, at a base level available for all these different scenarios. And we're also looking at expanding into areas where what we call USCDI plus, it's been announced that we're also focused on doing that specifically for cancer to make sure that that we can, you know, have the right types of data standards in place to support these innovative solutions and so on.

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So, we're really at this critical juncture now, this pivot point. And when it comes to interoperability, to the access to the data and the ability to share the data in the ways that these innovators need it in order to be effective and in order to ensure that they have equitable health care outcomes and experiences and access to care and cost of care and all those other things that are important to helping families navigate care. We really believe we're providing that foundation as a nation when it comes to access to all of that data, because it's not just been ONC alone.

00;34;40;29 - 00;35;01;26

The C stands for Coordinator, and we've been working very closely with our colleagues at the FDA, at the CMS and many other agencies with the Federal Health Coordinating Council to ensure that we're advancing interoperability. And again, we're at a place in time in history where those challenges, those blockers in the past aren't going to be quite what they used to be and

00;35;01;26 - 00;35;28;17

I'm really excited about enabling a whole new era of innovation based on that advanced interoperability. Yhat is extremely motivating. And it's great to hear that things are coming together that allow us to be very successful in achieving the mission and the goals. One of the phrases that I hear from everybody and most recently from Santosh and yourself, Stephen, is equity and another phrase is all Americans

00;35;28;17 - 00;36;04;20

So when I think about, you know, we are focusing on these types of goals, a quote came to mind from the White House Cancer Moonshot coordinator Dr. Danielle Carnival and she said that “President Biden's vision for ending cancer as we know it is building on the progress we've made with an all hands on deck effort to develop new ways to prevent, detect and treat cancer and ensure that the tools we have and those we develop along the way reach all Americans.”

00;36;04;20 - 00;36;39;23

So, I'm going to focus on the word all. So, I'm trying to reconcile it with what I read and learn about health disparities, which you guys have already mentioned. So how me we understand, how are we going to ensure the tools reach all Americans? It's such a great question, and I'm delighted, Katherine, that you honed in on the necessity of making sure that all of these innovations are accessible to effective end and built for all Americans.

00;36;39;23 - 00;37;07;09

And I think, I think there are two interesting things to discuss here. Firstly, the digitization of health care, public health, clinical research provides a once in a lifetime opportunity for us to redefine what it means to care for people in the digital era and insist that every solution and every innovation that we advance works equally well for all individuals.

00;37;07;11 - 00;37;40;24

So it is in fact, you mentioned very correctly, the challenges we face with health equity and health disparities, a lack of inclusion in the health care and research in public health spaces, currently. What we are laser focused on at CancerX and with our 90 plus partners is at every juncture are we advancing practices and science and approaches that work equally well for every American?

00;37;40;25 - 00;38;11;28

Are we thinking about insisting as table stakes that considerations related to equity and inclusion are baked into the development of these new solutions, new approaches, new incentive structures that will fundamentally change care? And that is a theme that will be woven throughout all of our work and all of our decision making in CancerX, as it should be for any innovator in the health care environment today.

00;38;12 – 00;39;08

And we can point at a very tangible example too. So, we discussed the flywheel, we discussed the structure of CancerX. We begin with evidence generation engine, then we have the accelerator, rolling series of accelerators, then we have our demonstration projects to show not just tell these new approaches work. But it is not my accident that the first project we have on deck is focused on advancing digital innovation in cancer care and research, to improve equity and reduce financial toxicity. For us there was never a question that this will be our primary area of focus when we launched CancerX and the findings from this inaugural project will be translated, embraced, and adopted across the portfolio. Equity and inclusion must be the cornerstone of all the work that we do to innovate in the way we care for people with cancer.

00;38;09 – 00;39;38

Jennifer is 100% accurate and corrected in what stated there. And thank you for that Jennifer and I am glad that we have partners like you and Moffitt to work with, it is so critical. Because as President Biden stated, we do need to have a greater focus on equity for all, especially in the area healthcare because we know if they look at the statistics, it is not equitable as far as the access to care, the cost care, and the outcomes of the care, often aren’t equitable across different populations.

00;39;39 - 00;40;03

And so although you hear this come down from the top of the administration into every agency that is focused on equity, one thing that my boss, here at ONC, the National Coordinator himself, Micky Tripathi, since day one of his appointment when he came to the agency, he made it very clear to everybody at ONC that he was going to focused on and once of his significant legacies at ONC was going to be having us focus on health equity by design.

00;40;04 – 00;40;40

And when I say by design, it is really about how do you factor in health equity and the considerations of equity into everything we do. Whether it is designing a policy, a program, executing that program, thinking of the impact of the stakeholders of that program, how the money is spent, etc.. You are always thinking about is this going to have an equitable impact. And not only how this can have a positive impact on improving equity but also is there a risk at this having some adverse impact on equity some unintended consequences that we didn’t mean to have that can actually set up backwards when it comes to equity.

00;40;41 – 00;41;25

And so we been very intentional on that ever since Mickey has taken over the agency, in fact one of the initiatives I mentioned earlier when we launched the PandemicX initiative accelerator which again is the one year accelerator based on funding we had through the Cares Act during the pandemic We made sure we actually took what Micky said to heart and thought through while designing the accelerator, how can we factor in equity into this. And we did it in a number of ways. One example was we made sure that we had all the right people at the table and we are doing that now with CancerX as well. You see the representatives in the announcement of the inaugural membership of the 80 to 90 organizations.

00;41;26 - 00;41;51

You are going to see every different type of organization you can think of, from biopharma to hospitals to investors to government, non-for-profit, to community-based care centers, patient navigators, patient advocacy organizations, patient themselves. The idea is that we have a seat at the table for everybody and that ensures that we have an equal voice that can help us identify when we’re getting off course or off path or not taking certain groups into consideration.

00;41;52 - 00;42;19

That is number 1 and number 2 is we make that we actually factor in antibias training into the selection of what companies go into the accelerator and that is something we are planning to replicate through this accelerator as well. How can we make sure that those who are scoring and deciding which companies get in the accelerator itself are not letting bias creep in and making sure that again we’re giving all organization a fair shake at being part of this.

00;42;20 - 00;42;52

Another factor was during PandemicX, we asked companies that were applying to answer simple question in their application which was how are you designing your solution to reach communities that historically don’t have solutions built for them and to take their own cultural needs and challenges into consideration. So how are they designing them to be impactful in all communities not just one demographic in their backyard that may be easy to access to test it on.

00;42;53 - 00;43;13

So, and are they being inclusive in the design of that solution. So, these are some of the small ways we can nudge the industry into being more equitable. But specifically, for CancerX and its accelerator there are intentional ways we can make sure that not only are we doing are part but also encouraging others who are participating in the effort to do their part in ensuring they are focused on equity.

00;43;14 - 00;44;17

Thanks Stephen, that was beautifully said and I will add, Katherine, that as we look ahead at the work that we have to accomplish with CancerX we’ll also be focusing on how to harness digital channels and digital innovation to help extend the best specialist care and clinical trial opportunities to all cancer patients, regardless of their place. Especially in ways that can reduce the cost of travel to specialist treatment centers and trial sites and really thinking about reducing the disparities in access to that best possible treatment no matter what their zip code is and what their income levels are. So, these are important ways in which digital can be an enabler and so we are going to explore it through that lens even more critically as we make progress through CancerX.

00;44;18 - 00;44;46

But also making sure we do not create a digital divide. This has been fantastic and our time has gone so quickly and I imagine minds thinking about how I can be involved, what can I do I am sure a lot, or I believe in a lot of our listeners it’s going to spark some thoughts and considerations, and so, I am going to end us with sort of three quick questions. And I will start with Stephen, so, how can people learn more about Cancer Moonshot where should they go?

00;44;47 - 00;45;43

For the Cancer Moonshot you can certainly go just google White House Cancer Moonshot if you like there is a primary landing page there that explains the background, everything we talked about earlier, it also has great examples of where the private sector and others outside of government have stepped up to start to answer the call of the Cancer Moonshot. In fact there is even a place where patient, caregivers, providers, anybody who is doing any work in the cancer space or dealing with a cancer diagnosis in their family or themselves can actually submit their stories of the challenges, testimonials of their experiences, of their hope, their progress, And so we certainly encourage because we know this is very personal to everybody and it is hard to be in any room and not find someone who has had their lives or families’ lives impacted by cancer. So, We want to hear more stories as that helps us again make sure that we take everybody’s needs into consideration

00;45;44 - 00;46;28

And when it comes to CancerX specifically, it is easy we have a website CancerX.health and all the information on CancerX including an option for how to submit your interest to join and be part of it and basically it asked you a few questions on is there any type of resource that you would like to contribute to be part of CancerX. Whether that is data, time, money, etc., there is an interest form you can fill out and I know the DIME team, Jennifer and her team have been amazing at following up nearly a 1000 plus organizations who has filled out this form already, it has really truly been an amazing response that we have seen.

00;46;29 - 00;46;48

CancerX.health is the main website for CancerX itself. Thank you and I would love to hear from Santosh and Jennifer, can anyone participate so we heard that everyone having a seat at the table we heard about non-profits and organizations in health but can anyone participate. So, I will start with you Jennifer and Santosh, you can finish us off.

00;46;49 - 00;47;55

Anyone who share our passion for the goals of Cancer Moonshot and is working in either oncology or in innovation is more than welcome to come to the table. Kathy it is important to note the way CancerX is structured currently we are convening at the organizational level as opposed to the individual level that relates to both to project participating and CancerX membership. however, as the program continues to evolve and we continue to introduce our accelerator cohort and that programming as we move toward demonstration projects there will be opportunities for individuals down the line. However, currently we are keen to welcome any organization who shares as I said shares our passion, dedication, and commitment to the mission. It is an extraordinary and exceptional group of leaders that have put their hands up as part of the founding members cohort pulled their chair to the table saying we want to contribute our knowledge, our expertise and collectively work towards the lofty goal of reducing the number of deaths of cancer by 50%.

00;47;56 - 00;48;13

Just as Stephen has said anyone who is interested can jump on the CancerX website at CancerX.health sign up for more information about membership and subscribe to the newsletter so that they get first-hand knowledge and updates about where we are in pursuit of our goals.

00;48;14 - 00;49;20

Very nicely said Jennifer and really our vision always, all along has been in that beating cancer requires collaboration as we shared earlier so we need everyone to join us as Jennifer said we are open all like-minded innovators. All of us have been touched by some form of this disease in some way and it continues to take form us and we have to stop that and we can do that together. So CancerX is for doctors, developers, designers, entrepreneurs, for the scientific community, certainly for the industry innovators, investors. We are fortunate to have government support and encouragement for this initiative. So, it is all about coming together so that we can bring more limitless creativity more entrepreneurial spirit so that we have more opportunity to push the boundaries and really turn some of these aspirations into action and end cancer as we know it.

00;49;21 - O0;49;42

Thank you, Santosh, thank you, Stephen, thank you, Jennifer for joining us today. Thank you for sharing this great work that is underway associated with Cancer Moonshot, CancerX and providing our listeners with information about how to learn more, how to get involved. I greatly appreciate you taking the time and I wish you a great day.

O0;49;43 – 00;50;11

Thank you. Thank you it has been fun. Thank you for listening to the Latest Dose, the podcast that explores the depths of innovation and human compassion in clinical research. Before you go, show us some love by subscribing and make sure to look for us next month. Goodbye. [Music]