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5 ways to bridge the health equity gap for cancer patients
Christian Dimaano, PhD, MPH is head of regional medical affairs at Mirati. A cancer biologist and public health researcher by training, he is passionate about health equity and improving health outcomes for all cancer patients. Christian completed his oncology training at the Huntsman Cancer Institute and his MPH at the University of Washington. He began his industry R&D career in cancer target identification and validation but transitioned into and moved through various medical affairs and leadership roles over time. Christian also serves as a local volunteer Board member at the American Cancer Society and maintains a faculty appointment in the school of Public Health at the University of Washington.
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ealth care disparities have been documented for decades and reflect longstanding structural and systemic inequities rooted in social and economic issues, racism and discrimination. Narrowing heath disparities is key to improving our nation’s overall health and reducing unnecessary health care costs. Our executive director, head of regional medical affairs, Christian Dimaano shares his perspective on what he feels are the highest barriers to health equity and why it is important to have a thoughtful DE&I strategy when working towards closing the gap and more.
Q: Describe your role at Mirati.
A: At Mirati, I lead our regional medical affairs team, which encompasses our regional medical affairs directors, regional health outcomes directors, and our medical patient advocacy function. From a medical perspective, we engage with various external stakeholders such as key opinion leaders, healthcare providers, payers and population health decision makers, and patient advocacy groups in various capacities of scientific exchange such as providing education, determining potential collaborations, and other clinical and scientific support.
Q: Describe the journey that brought you to Mirati to do what you do today.
A: I started my industry career doing traditional discovery biology work, identifying and validating novel cancer targets for a small biotech company. I eventually shifted from R&D to medical affairs, moving through various roles and leadership responsibilities in both big pharma and medium-sized companies. After spending several years in the bigger pharma world, going back to a smaller biotech setting and being a part of a best-in-industry medical affairs team was attractive to me and led me here to Mirati. Although I’m a cancer biologist by training, a development opportunity afforded me the ability to get additional training in public health and has since inspired me to be an advocate for Health Equity in everything I do.
Q: What is ‘health equity’?
A: As defined by the Centers for Disease Control and Prevention (CDC), ‘health equity’ is when everyone has an equal opportunity to be as healthy as possible. There are many examples of health disparities that exist between different populations of people. Health disparities exist specifically within cancer as well, as certain communities such as Black, Latino, Native American, LGBTQ+, and people with disabilities have been disproportionately burdened by cancer and can experience greater barriers to cancer prevention, treatment and survival.
Q: What are the biggest barriers to health equity, specifically for cancer patients?
A: At Mirati we’re helping to address unmet needs in cancer patients with specific oncogenic drivers, but we also need to think about the non-genetic drivers of health outcomes that may influence a patient’s ability to receive appropriate health care. These issues are complex and have many social, economic, and cultural dimensions. Racism, poverty, limited access to insurance coverage, and earning a non-livable wage can all intersect to determine if one can receive adequate cancer care. Zip code and location of patients also matter; for example, for cancer patients living in a rural setting, transportation and accommodation may be an issue if they are referred to a treatment facility outside of their local community or even their state – especially if the patient doesn’t have the means to travel or afford lodging.
In addition, clinical trials are an important consideration in a cancer patient’s treatment repertoire and as a clinical development company, clinical trials is a large focus here at Mirati. However, it’s been well documented that minority groups, such as Black, Latino, Native American and others are underrepresented in the majority of clinical trials across the country. Race and genetics are both important components of how someone with cancer responds to treatment. Therefore, if we’re not accounting for diverse populations in our clinical trials, any drug once approved, may not be effective as proposed, if the drug has not been robustly tested in specific populations. Indeed, we have seen in the oncology setting more aggressive cancers associated with Black populations where approved treatments are not as effective as they are in their white counterparts.
Q: Why is it important to have a thoughtful DE&I strategy when working towards closing the healthy equity gap for cancer patients?
A: It’s important for all of us at Mirati to be aware of what impacts our patients’ health outcomes. I wish it were as simple as developing a drug and then putting it out there for people who need it. Educating ourselves on these complex issues is key for us to be able to collectively contribute to patient centered solutions. In particular, understanding that a subset of patients may not be receiving appropriate care simply because of the color of their skin or where they happen to live, should inspire us all to want to do more for these patients. There isn’t necessarily a ‘one size fits all’ solution for improving cancer health outcomes, so Mirati must be intentional, thoughtful, and inclusive in our strategic approach if we want to make a true impact on all of the patients we serve.
Q: Share 5 ways to bridge the healthy equity gap for cancer patients.
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Educate yourself on the core issues that drive health inequities.Learn more about the social determinants of health. Think about the everyday challenges a cancer patient goes through and put yourself in the shoes of someone who may have additional burdens on top of dealing with a deadly illness.
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Support Mirati efforts in the outreach and recruitment of diverse patients for our clinical trials.
Keep marginalized patients and the patient voice top of mind when considering clinical trial strategy and operations. If in a role directly applicable, work collaboratively and cross-functionally to determine appropriate trial sites capable of recruiting a diverse population. Take marginalized populations into consideration earlier in the design process of a study. -
Formalize partnerships with organizations and institutions that work with communities impacted by health disparities.
Mirati regularly partners, sponsors, and engages with multiple patient advocacy organizations. If you are in a role that is involved in such decision making, be intentional when selecting new organizations to partner with. Ensure such partnerships and sponsorships at least in part support marginalized communities. -
Volunteer your time with an organization advocating for marginalized patient populations.
Use your volunteer time to directly support advocacy groups and the diverse patients they serve. Try to learn more directly about patient hardship in the community. Be an active participant and do your part to make an impact. -
Support STEM initiatives designed to increase the future number of diverse healthcare providers in the workforce.Serve as a mentor (either formal or informal) to STEM students, be a guest speaker at a career fair or a judge at a local science fair, participate in STEM activities through your alma mater. Support and nurture the development of future healthcare providers with diverse backgrounds.