At the Hematology/Oncology Pharmacy Association 2025 Annual Conference, Oncology Practice Management spoke with Iman Ahmed, PharmD, BCOP, Clinical Pharmacist Specialist, Ambulatory Hematology, at the University of Michigan, Rogel Cancer Center, Ann Arbor, MI, about how social determinants of health affect health inequities in hematologic malignancies and the provider’s role in mitigating these disparities, including research, advocacy, and the development of oncology-specific tools. Her data were presented at the conference.
Transcript
Oncology Practice Management: Can you discuss the disparities in hematologic malignancies, including in incidence, treatment, and outcomes?
Iman Ahmed, PharmD, BCOP: That is a great question, and one that I spend a lot of time in my presentation discussing, but I’ll try to highlight a few for you. I will begin first by saying social determinants of health [SDOH] are essentially the conditions in which people work, learn, grow, and live, and these conditions can have a significant effect on a patient’s outcome.
Some disparities that exist, specifically in the hematologic malignancy world, for example, leukemia: there are a few studies that show that Black and Hispanic patients have worse outcomes, regardless of age,…treatments given, which is disheartening, because it makes you wonder, why? If these patients—we’ve grown significantly in providing novel treatments in leukemia and survival overall has improved—what’s the reason that a certain group is essentially benefiting over another?
When you dissect those data, it all leads back to the SDOH issues that patients can experience: the challenges, social needs they have. There are a few studies that I highlight that show that patients who have transportation issues, patients who live a certain percentage below the poverty line, [have] low education, terrible insurance, tend to have worse outcomes. And this is essentially what SDOH is defined as. It’s looking at a patient’s education level, healthcare access, their economic ability, and a few other bullets. But leukemia definitely has a lot of health disparities.
Alternatively, if you look at the myeloma world, CAR T has really changed the treatment landscape for myeloma patients. It has overall response rates in the high 90s. But when you look at centers or areas that have access to CAR T, that has such a high response rate, only 36% of minority patients even have access to this in a clinical trial. So that’s not good, right? You have such great options. How come everybody can’t access it? These are some of the disparities that I’m highlighting on Saturday.
One also that I remember is that there’s multicenter research that came out from Chicago that looked at specifically leukemic patients. If they accounted for structural racism—which they defined as patients who live a certain percentage below the poverty line, low education, how much money they make, and essentially those who live in segregated areas, like predominantly White or predominantly Black—they found that when you actually adjusted for structural racism, it mediated nearly all of the health disparities with Black versus White or Hispanic versus White, which I think says a lot. This information and this research, I think, just barely sheds a light that disparities exist. I think we still have a long way to go though. There’s such variability in the data that are available, the definitions that are available, and so we still have a long way to go.
Oncology Practice Management: What role can the pharmacist play in mitigating these disparities for patients with hematologic malignancies?
Dr Ahmed: I think pharmacists will play, or can play, a huge role in allowing us to have SDOH targetable actions in order to achieve health equity. Why I think pharmacists: we practice evidence-based medicine, we do a lot of research. We are at the forefront of patient care, and I think we’re a profession that’s just multifaceted. I say that to say, when you look at some of the CDC directives in order to achieve health equity, one of the major ones is data and surveillance. I can cite so many different research studies and data that are available, but they’re all variable in definitions, they’re variable in how the studies are conducted. So we need to do better, as a larger group, to make sure that we’re conducting well-defined studies to figure out how we can achieve health equity, how we can appropriately define these end points, and the definitions of what structural racism means. I think pharmacists can really help in that research aspect.
I think pharmacists also play a huge role in advocacy. In order to relieve the burden of social needs on the institutional scale, local scale, we’ve got to make changes at the policy level. We need to make changes in order to relieve some of the poverty or advocate for policy changes with education, housing quality, economic stability, things like that.
Another aspect that pharmacists can play a key role [in] is that there currently are no tools that are specific to oncology to basically identify which patients have specific social needs. So when patients come into the clinic, there are different needs assessment that can be done, but they’re not specific to oncology. I think that pharmacists can help in developing tools that can be specific to the needs of our oncology patients. And then also, providing resources that patients can use to help their transportation needs, or fill in the educational gap, things like that.
Oncology Practice Management: What are the top 3 takeaways from your presentation that you want your hematology/oncology pharmacy colleagues to know?
Dr Ahmed: That’s a great question. The top 3 points that I would want to say are one, that these disparities actually exist within the hematologic malignancies world, and there’s a lot of evidence that these disparities exist. And I will also say the other key takeaway point is that we need to be able to contribute to the research and data surveillance that are occurring within the SDOH targetable outcomes, then we can make the appropriate step forward. And then lastly, I will say that you do not need to be an SDOH or health equity expert in order to make changes. I think, in the role that we play within the many different professions, advocating for achieving health equity through SDOH targetable efforts and even helping provide resources to patients, providers is more than enough.