The Future Design of Cancer Patient Advocacy is Here

Speaker 1:

Rethinking Healthcare takes more than disruption. It takes more than thought leaders. It takes change makers and doers. That's who we'll be speaking to on the Healthcare Rethink Podcast. Giving you, our dedicated listeners, a rich body of insights to make your own change. This is the Healthcare Rethink Podcast.

Brian Urban:

[00:00:30]

Yes, this is the Healthcare Rethink Podcast. I'm your host, Brian Urban. And today, third time's a charm on starting our recording here. Thank you for being so patient, Dr. Arif Kamal, the Chief Patient Officer of the one and only American Cancer Society. Thank you for joining us today, Dr. Kamal.

Dr. Arif Kamal:

My pleasure. Third time's a charm.

Brian Urban:

[00:01:00]

We get off to these starts, but you know what? It makes the episode even more rich and intriguing. So I'm so excited to have you on the show. We've had to bounce around some schedules, but you have a very interesting track to your background and to your work not only in caregiving, but also patient advocacy for those going through the very challenging cancer journey in the United States. And then your reach does go far beyond as well. And to start off our show, I want to get to know who Arif Kamal is. You don't wake up and become the Chief Patient Officer of American Cancer Society. How did this journey begin for you and tell us a little bit about your work today.

[00:01:30]

Dr. Arif Kamal:

[00:02:00]

Sure thing. I think that all of us wear multiple hats, right? Whatever we do personally, professionally, it's hard to define a person by just one role or one title. So the culmination here is this. When I was in high school, my mom was diagnosed with breast cancer. That to me immediately was this pivotal moment where I said, "Well, I want to be in the cancer space." And as she went through her treatment journey and ultimately things didn't go the way we wanted them to go, so she entered hospice and lost her battle with cancer. I made it very clear that my life's mission was to improve the experience for people and their families that are going through a cancer journey.

[00:02:30]

That to me means very quite simply more and to better days. It's a combination of both. And to reflect that in my clinical practice as a medical oncologist, I also pursued additional training in what is called palliative care. I was the first ever palliative care fellow at the Mayo Clinic in Rochester, Minnesota. And it was my real, genuine hunger to understand how better to promote people's quality of life. And that is both patients and their caregivers and frankly their communities that they live in as well. And so that focus on quality of life brought me to a point where I built my career around paying attention to the experience. What makes it go well, what makes it not go well?

[00:03:00]

[00:03:30]

And if people could name or describe what the right experience looks like, then this is what it would look like. And as I've talked to my patients over the years, we've voiced that in several different ways. It might be, what does a good day look like for you? I might ask them, when you think about the future, what do you hope for the most? And as we take and channel that energy, what does a good day look like? What are you hopeful for? You can turn that into programming. And I've been so privileged to take this inaugural role at the ACS as the Chief Patient Officer to put into action what I've heard as a clinician, what I experienced as a bereaved son and what I know as a patient advocate, standing shoulder to shoulder with my teammates at ACS to understand what does that better experience look like.

[00:04:00]

Fundamentally, I believe that we exist as an organization at the American Cancer Society to reduce suffering from cancer. And I believe it's in our grasp to be able to do that. We do that in two primary ways. The first is to reduce death from cancer by focusing on helping people reduce the risk factors that lead to cancer and to help them get screened for cancer so they can find it early. The second part of that is to reduce suffering from cancer by increasing quality of life. And that's paying attention to the experience both during the journey itself and afterwards and to survivorship. And that's why there's a focus on things like connection, loneliness, social isolation, food insecurity, and other things.

[00:04:30]

As my patients have told me in my clinical experience, "Having the diagnose of cancer might not be the worst thing that's going to happen over the next couple of years of my life. That in fact, my ability to not be with my children or grandchildren, to not be there for my partner, to feel isolated during this period of time, to experience bankruptcy or significant symptoms might actually be worse than the diagnosis itself." And so that brings us back to what we use as the north Star in the American Cancer Study, which is the patient and their caregiver and what makes their quality of life better.

Brian Urban:

[00:05:00]

[00:05:30]

Wow. I love the key phrase that I heard, which was reduced suffering. And it's the common thread we all share within our human condition. We all experience a suffering or struggle at some point in our existence, whether it's continued or if it's episodic in some nature. In terms of healthcare, what you've done, I think your voice at ASC has been so inspiring. There's a bunch of really good talks that you've done. If you simply search Arif Kamal, it'll pop up for our audience. And I just love the strength that you have within your voice to share the story that you experienced with your mother. I too lost a loved one, a parent.

[00:06:00]

I lost my father 20 years ago, prostate cancer. He was 75. And when we think about prostate cancer, breast cancer, we think about colorectal cancer. They're so very common of a certain population in age that you look back and how is that not caught? How is that not prevented? But we've advanced so much today and ASC has been around for 111 years. So what have you experienced in your time as Chief Patient Officer in the evolution of American Cancer Society?

Dr. Arif Kamal:

[00:06:30]

I mean, we are at a remarkable inflection point in cancer. I remember when I first came into the oncology profession, my fellow colleagues in residency training we're going into cardiology, they're going into endocrinology, they're going to infectious disease. And they're like, "Well, we've got all these great new antibiotics. You guys don't have that many new drugs in oncology. We've got these great things we can do to reduce heart disease and oncology seems frankly kind of a sad place to practice as a doctor." And there was absolutely a time where you could count on one hand the number of treatments you might have for any even common cancer.

[00:07:00]

And there was a time where we were measuring progress in weeks. We were measuring new drugs and FDA approvals and single digits per year. And we were lamenting at the idea that there is this epidemiological scourge called cancer and that we couldn't bend the survival curve. The high watermark for that was really in the early nineties where since then, we found the cancer mortality rate to be overall down by about a third. And we believe that further progress, so it gets down to about half of what it was in the early nineties, is within grasp. Now, how does that happen? It happens because of where we've made progress, particularly in the last 10 years.

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There was a time, for example, where we were given chemotherapy to kill all cells. Now we give, for most cancers in the first line setting, much more targeted treatments. There was a time where being recruited into a clinical trial was considered a Hail Mary, the [inaudible 00:07:48]. Let's see if something works and hope and pray that it does. Now, for many people, participation in clinical trials is about being first in line to access innovation. That there's been enough pre-trial testing to know that it's personalized to you, and we have a good guess that it might work.

[00:08:30]

I think the other things we are recognizing increasingly too is that the experience matters. And it matters not just from, I would say kind of a touchy-feely perspective, which is great if we can support qualities of life, but people always said to me, "But most people just want to live longer and are agnostic to the quality." I think we've learned, not just my clinical experience, but I think we've learned as a field that the experience matters. That in fact, people want more days and they want better days, and they don't want a choice between the two.

[00:09:00]

And that idea where we say that it's table stakes, that you have to have both means there's been a lot of innovation in the experience, a lot of attention to side effects and the quality of life things all at the same time. So that as we make progress, both ideas make progress, that we will lead to more days, but they will be better at the same time. And as we put R&D dollars into new drugs, we'll put R&D dollars into better drugs, kinder drugs, more compassionate approaches to care that don't sacrifice time. But may in fact promote time because people have the things they want to live and thus feel the ability to live longer during the experience.

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Brian Urban:

[00:10:00]

Everything that you said is, I feel very revolutionary for what a patient advocacy, caregiver advocacy organization, a nonprofit organization stands for. I don't think you would've... I wouldn't have heard these words uttered maybe 10, 15 years ago from someone at a nonprofit that does the work that you all do. I think you've come to a really mature space where you said it. Table stakes. We have to have more days, more time, and better days, better time. And I think you having that as a foundation has only helped accelerate the innovation, the reach that you all have in terms of research and access.

[00:10:30]

And thinking about access, Dr. Kamal, it seems like everything now in terms of a trend is personalized therapy. It is experience built, it's uncomplicating care, and I guess there's a lot of tech woven into that as well. So what are some of the big trends that you're starting to see, either as feedback from the population of the lives that we serve or what you all are thinking about as a roadmap in the future? I'd love to hear what you're seeing.

Dr. Arif Kamal:

[00:11:00]

Well, our vision is to end cancer as we know it for everyone. And right now there are some pretty significant injustices that we see across the board. For example, it cannot be acceptable that where you live determines if you live. And we see that to be very clear that as my good colleague, Dr. Rob Winn, says that we have to think about someone's ZNA in addition to their DNA. DNA would imply that your biology dictates how something's going to go. And in fact, we know that certain cancers are more aggressive biologically than others because their DNA drives them to be that way.

[00:11:30]

But what we can't be okay with is that if you live one county over from someone else, that your differences in outcomes are justified or okay. And I don't think we can be okay with that. And our vision at the American Cancer Society, which is to end cancer as we know for everyone, recognizes the fact that everyone should have access to high quality, timely cancer care, that everyone should have access to services that does improve their quality of life during a cancer journey, and that everyone should have access to the interventions that prevent cancer in the first place. I think what's shifting here is frankly, messages of hope.

[00:12:00]

[00:12:30]

I mean, one of them is it wasn't long ago where people thought that cancer was either bad luck or bad genes, bad genetics. That I was born into a family that has a lot of cancer, so I need to do some different things. But here we are, but also that it could just be bad luck. That cancer, when I talk to my patients, one of the hardest parts about it is you feel like you have no control because first of all, you didn't even have a voice in getting it, let alone a lot of things that happen afterwards. And as I think we continue to understand what drives cancer, we start to find things that we as average people, not healthcare professionals, can make changes every single day to reduce our risk.

[00:13:00]

So for example, about 42% of all cancers have a modifiable risk factor that we understand to be true. So if you want to reduce your risk of colorectal cancer, you should eat less red meat. You should eat less ultra-processed foods. If you want to reduce your risk of prostate cancer and you are overweight or obese or unhealthy weight, you should try to get that down. I mean, there are things. Now, it is not to imply that losing weight is easy. It is to imply though that five, 10 years ago, we didn't even know you needed to do that. Pancreas cancer was only a matter of bad luck and bad genes.

[00:13:30]

Now, as we start to understand these risk factors, it gives us agency and it gives us control that we've never had before. And those risk factors can be food, diet, lifestyle, exercise. And before it had been don't smoke. And if you are smoking, stop, and that was a great beginning, but there's so much more that we're understanding in this space. There is this ability now to tailor across the board in cancer care to what people are going through. We, for example, at the American Cancer Study built what we believe is the start here, app for a person newly diagnosed with cancer. We call it ACS CARES, C-A-R-E-S.

[00:14:00]

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It stands for community access to resources, education and support. And the idea is that you can come in with the app and get tailored content so you get exactly what you need to learn. So if you're 30 years old, you're going to be suggested to learn about topics like fertility preservation, returning to work, financial security as you're in early parts of your lifetime. Maybe even talking to young children about it because you may have young children, etc. So we tailor content to where people are in their stage of life and their stage of their disease. The second thing we do is we assess people for what's been called health-related social needs.

[00:15:00]

So it's very clear in cancer and many other diseases that the outcomes are 20% predicted by biology, but 80% predicted by the environment that someone lives. It is that we can define what something looks like under a microscope, but you actually need to look at what it looks like in their neighborhood. And that microscopic view is helpful to determine chemotherapy. But that macroscopic view, the neighborhood view is helpful to understand what else we should be doing to get people to the right treatment at the right time. And so we at the American Cancer Society have created assessments for health-related social needs, for example, in the CARES app.

[00:15:30]

So we understand what is keeping you to get to where you need to go. And the way I message that is to say, we are an organization that's pivoting from... Our primary message being you should, which is a powerful message. It's a billboard message. It's a, "You should stop smoking, you should eat better, you should do this." But we are pivoting very deliberately to an organization that goes to a message of, "And this is how. And this is how." While we will always be the voice of others around you should, the evidence shows that you should do this, you should do that.

[00:16:00]

That we will be a problem-solving organization, that we will stand shoulder to shoulder with other people to help reduce their knowledge gaps, but also help them get to where they need to go. So I'll give you an example. One of the primary reasons that one of the studies showed that people don't get to mammograms is because of food insecurity. So for the people that need to understand what a mammogram is and why it's helpful to them, great, we're going to teach them. For health systems that need to understand how to get more people, let's say populations of color, for example, in their doors to get a mammogram done, we will help them do that with technical assistance.

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For the patient who goes, "Okay, yeah, I agree, I need a mammogram. But the thing is, if I take a day off from work, my lost income will mean that I will not be able to put food on my table. What are you going to do for me there?" And what we're positioning ourselves as the American Cancer to do, not only by ourselves, but through collaborations and partnerships, imagine corporate partnerships and other ways, is to say, "Okay, and this is how we'll help you get access to food during that day." So [inaudible 00:16:59] there's not a trade-off between the two things.

And I think that, and this is how pivot is so important for us, that even though we are 113 year old organization, that that is recognizing that we're going to meet people where they are. Because for some people where they are is a knowledge gap and we'll teach them. But for many other people, where they are is a logistical gap, a resource gap, a financial gap, and we're going to help them in that way too.

[00:17:30]

Brian Urban:

[00:18:00]

I love it because you're going from literacy to action. I have to go back to something that you said earlier because when I recall looking at documents we had in front of us when my father was diagnosed with cancer, it was all very baseline education. Chest, here's how it works. Where do you go? Who can you call for navigation? Your health plan? But now, if it's tailored information like you're saying with the CARES app, it's specific to someone's life scenario, at least age-specific or family-specific or economic [inaudible 00:18:03]. That goes way beyond just baseline literacy of being diagnosed with the disease and what happens now, it's, "Here's what you need to do now."

[00:18:30]

I love that because it's probably very engaging, not just very informative, but it feeds into where we are as a society of how we consume information now. And that I think is such a world of difference from a hundred-plus-year-old advocacy, literacy, education organization to now you're taking action. That's just amazing. Dr. Kamal, you said something about clinical trials earlier. So Walgreens of retail is one of the last standing organizations sitting in clinical trials and still developing a lot of different access points for those to come into clinical trials. No longer is a Hail Mary shot, like you described earlier.

[00:19:00]

Now a new proven access point for you to start to be a part of innovation. So what are you seeing in terms of now clinical trial diversity exploding in your space? Is this something that you're very close to right now or you're starting to influence from ASC?

Dr. Arif Kamal:

[00:19:30]

We are. I think that there's a couple of things we're recognizing. One is the barriers are really multi-stakeholder, right? So if you are a patient understanding that clinical trials are not rooted in randomness, in early stage exploration, in improving the knowledge of the sponsor and the agnostic to the experience of the participant in the trial. That all that is somewhat older thinking is just a message we have to get out to people because the average person is not paying attention to the clinical trial space.

[00:20:00]

I think the second part is from a clinician perspective, is really helping clinicians talk about the value and the importance of clinical trials. And particularly as an additional option to things that they may offer and what's on the table. I think the other part, as I mentioned, is really recognizing these logistical barriers. I mean, for some people to get to a clinical trial, they may live in San Antonio but need to get to New York City. Well, that's a lot easier said than done. A person really has to think about how they're going to travel, where they're going to stay.

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For us, our vision is that those folks get to stay, for example, at the Hope Lodge in New York City. Our Hope Lodge program, which we have 31 brick and mortar facilities across the country. The idea there is to close those geographic gaps in terms of accessing high quality care. And for many people, that is going to be a clinical trial. I mean, to me, as I talked about zip code and the ZNA dictating outcomes, that has to do with where you're born and where you live. Well, if you live in rural Texas, you should still be able to access cutting-edge treatment. It just means you might have to fly.

And for that person who has to fly, we can help them get there and give them a place to stay. So overall, we're thinking about access to any kind of treatment, including clinical trials, who those people are and what we can do to help solve that problem.

Brian Urban:

[00:21:30]

I love that because that's probably been the biggest barrier aside from learning of clinical trials of what one could participate in, is the economic challenges of someone being able to afford going on the flight or not having food for themselves or their family initially. They're not going to go into a trial if they can't feed themselves or family and how you get access to those things. And you're talking my language, all the socioeconomic challenges we have, the social health barriers.

[00:22:00]

Did you ever think that, and this is... We will go back years for Dr. Kamal's brain here. Did you ever think going into ASC you would be addressing social determinants of health? Is that something that you had a vision before working in oncology that you would take into this role? I want to get your perspective on that.

Dr. Arif Kamal:

 [00:22:30]

[00:23:00]

I think for the American Cancer Society, it is being opportunistic in the season of where we are. A focus on health-related social needs 10 years ago wouldn't have been the right place to be. The reason is we have shifted from an availability of innovation problem to, in many cases, an accessibility of innovation problem. And the difference is key. So availability is does something exist? Is there a third-line treatment for melanoma? Is there a new type of way to provide radiation that's more precise? Let's take proton therapy as an example. Is there, that's an availability question. That's where R&D is extraordinarily important.

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10 years ago, I would've said the compelling problem of our time is we don't have things that are kinder or gentler, more specific. So we need to create them and that's where we need to put our energy. I think in many ways, not in all cancers, we've got some important places we still need to make some progress, but today for many patients I talk to, the problem is accessibility. "Dr. Kamal, I heard about this fancy stuff that exists, I just can't get to it. I heard about these cool things that they're doing on this coast, that coast or wherever. I just can't get to it. I heard about these things that are saving other people's lives, but my insurance doesn't cover it."

[00:24:00]

Right? That's an accessibility question. And so the season that we're in right now, I believe this very intentional pivot to pay attention to health related social needs is exactly what we have to do because I think the injustice is when there's a differential between what you could do and what you can. What you could do is give this great thing to this wonderful person that you met. What you can do is not give it to them because of this, this and this reason. And I think for where we are right now, the differential between what you could do and what you actually can do is way too wide of a gap.

[00:24:30]

And closing that gap means we have to be paying attention to these other issues that are financial, logistical, relational, so on and so forth. I think there's some other things that are just happening in the world and in society that we're paying attention to that apply to cancer in a way that we might not have thought out about before. For example, the current Surgeon General Dr. Vivek Murthy has paid a lot of attention to social isolation and loneliness, which we recognize during the Covid pandemic only broad. And as social media is proliferated, we've recognized really quickly that the number of friends you might have on a social media platform is not necessarily indicative of the amount of social support you might feel.

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That they're not necessarily synonymous with each other. And we've started to do some myth busting. So for example, our data at the American Cancer Society demonstrates that people who go through a cancer journey are more likely to have their social isolation get worse, not better. And that's important to name, because as I talk to people, most people think, they have this vision that Sue got cancer, and Sue reached out to her friends who all just started bringing over meals. And I call it the lasagna problem. There's a stack of lasagnas on Friday night, and Sue has so many friends with lasagnas and salads, she doesn't know what to do with herself.

[00:26:00]

And in fact, she's like, "If people could care less, actually that would be helpful." Hyperbolic on purpose, because we all know that very few people actually have this problem, particularly as cancer continues to involve to be more like a chronic illness than a short-term illness. That the price of progress is people live longer and better and it's great, but the price of that is that the toxicities that can occur can start to accumulate. That people's financial resilience at three months or six months is different than at three years or six years. That we might all think to ourselves, "Well, okay, I could do some slightly unnatural things.

[00:26:30]

I will liquidate my 401k and I'll do this and I'll do that to get through the next six months so that I can live through this cancer journey." And for many people, it's a hard decision, but that's the thing they have to do. But then I ask you, what happens at six years and where do those relationships go? Where did the lasagnas go at six months? I can tell you from my experience, a few patients are worried about having too many meals come from neighbors at six months, six years, or even 16 years. And so as we're thinking about cancer, we have to now start taking this lens of a chronic illness for many diseases and start to ask ourselves, the programs that we made to help people at six weeks and six months, are they durable?

[00:27:00]

Are they available as people go further into their journey where they may not be completely cured? They're still receiving treatment and still have the worries and the concerns that come along with that, but maybe out of the attention span of those folks who are willing to help for a shorter period of time. And I think that that's really one of those societal questions that we have to address and think about.

Brian Urban:

[00:27:30]

Wow, this is mind-expanding information that you're sharing right now. Because I have never thought about a terminal illness as how it's a chronic illness over time if you're going through treatment. And you come to a place where you're no longer maybe seen as you're terminal, but you're still receiving treatments. And you still need help recovering from a big financial loss or recovering from social isolation or anything that you just mentioned. That is a fascinating perspective to have, Dr. Kamal.

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And I think why your talks are so interesting is because you bring such a unique perspective on it. You're looking at different angles, not purely from a medical science or research, but from an experience and a journey of what the human condition is with suffering through this long term. And to switch gears into maybe more of a lighthearted sense here, you have an awesome talk that you gave at Astro last year in '23. I mentioned this earlier before the recording, but you came out to Taylor Swift and you put on a show. And I think every doctor should have that coming out on stage next time.

[00:29:00]

Any chief medical officer, patient officer out there, if you're listening to this, you better come out to some good walkout music and don't bring a boring talk. It's not my [inaudible 00:28:43] legal experience. And Dr. Kamal, you did that. You talked about knowledge over [inaudible 00:28:49]. And this is a common thing across the society in different regards, but for someone going through cancer, what does that mean and how do you see that in the position that you hold at AMC?

Dr. Arif Kamal:

[00:29:30]

Well, I think that, again, one of the prices of innovation is choice and that it's a good thing that people have a lot more choices, but it also means that for the clinician that's taking care of the patient, there's a lot to cover in a 15, 20 minute visit. And I think for the patient and their caregiver, there's a lot they might have heard about or read or someone told them about that is a lot to bring up in a 15 or 20 minute visit. And so I think that what you're naming here is an additional challenge, which is really around distilling down to what's the right thing to do.

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And from a clinician's perspective, that might be decision support that's helped by AI and other computing methods that really get that wide ocean of knowledge down to a place that's really applicable. Look, if you take all of science that we published in 2024, all scientific articles. And you said 1% had anything to do with cancer, and then you asked a physician to have to read that number of articles, we have to read 50 of them per day for 365 days out of the year. That's a long-winded way of saying that's untenable. But it doesn't mean that what's in those articles is not applicable to what I do every day.

[00:30:30]

It just means that it is logistically actually close to impossible with that. And I think from a patient's perspective, lots of movement that's happening. You hear about in the news and other places too. So there's a ton of excitement, but I think the distillation down to what's the right treatment for me at the right time in the right way, it's really a fundamental question. And I think what you're going to see over the next couple of years are things like multi-cancer early detection tests that are going to say, "Well, look, here's a test and it's going to look for 50 different cancers using a simple blood test."

[00:31:00]

We're not that far away from that actually. And that it's going to then come down to the nature of the relationship between the patient and their clinician. But how do I talk through, is that test right for me? What do we do with the results? And things like that. There's going to be a lot of other examples like that too. I think there's going to be a lot more AI in computing and oncology, but what's not going to be taken away is trust and rapport and compassion that really only humans can bring. And computers might give you an answer, but you're going to need a human to give you that answer to communicate with you, to look at you in the eye and say, "I wish it were different, but I'm here to help."

[00:31:30]

And that sort of interface is going to be critical to how we get things done in oncology because at the end of the day, oncologists are not chemotherapists. Our primary job is not to give people chemotherapy. Our primary job, and I say this for the American Cancer Society, but also the ecosystem with oncology, is to reduce suffering. And sometimes, many times that is through using chemotherapy, but not all the time. That in fact, that voice, that attention, being in the room with another person who's going through an experience and listening, being present for that is the intervention.

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And I think for us as the American Cancer Society, this is why we've taken a learner's posture to be good listeners, to be humble and to be reflective and to find our highest and best use in an ecosystem where there's a lot of other great nonprofits as well who we want to partner with and work with. And I think that as we recognize that these problems are increasingly complex, I think we're up for the task. I think we are, and those in the space are up for doing that, but it's recognizing the complexity that exists, recognizing that it's a lot of ways we can lean on machines and AI and apps and other things too.

[00:32:30]

But fundamentally, two people looking each other in the eye is how we're going to solve really important problems. And for us as an organization, we're 3,200 strong, who wake up every single day to look someone else in the eye and figure out how we can help them solve their problem. That's why we exist.

Brian Urban:

[00:33:00]

I love it. If you're not familiar with American Cancer Society, it's now, I think, under such a different leadership lens, not only yourself, but others that you've mentioned here. The impact that you're going to be having is so far beyond what you'd call patient advocacy and caregiver support. I don't even know what you'd call this, but it's an innovation of a particular leap that a lot of other nonprofits have not taken yet.

[00:33:30]

And hopefully they're encouraged to do that with some of the things that you shared here today. And to take us into the future a little bit further, maybe 10 years out, so more of a deeper crystal ball view here. What are you seeing American Cancer Society turning into? What will be the next evolution in the chapter of your 111 plus years of existence?

Dr. Arif Kamal:

[00:34:00]

Well, I think you're going to see us be very agile to a very fast-moving space, a very fast-moving environment. My hope would be that within the next 10 years that we do give mortality down further past the 35% it is now, maybe closer to 50% reduction over time. By that point, we will have multiple blood and other based tests that try to find cancer when it starts at the cellular level, even before it's radiologically apparent, which is what we do when we do screening. I think we're going to understand what are the right policy levers to pull to help make sure that people do get access to all the things that we just mentioned.

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And I do think that we will get the percent of people participating in a clinical trial out of the single digits. And we will learn from what happened in the pediatrics oncology space, which is if you can get the clinical trial participation rate north of 50%, you will start to achieve cure. And that, to me, among the other things I mentioned, is one of those things that history tells us that if you get more people in the trials, you will get more cures. I mean, that's what we found in the pediatric space very clearly. Because in children with cancers, the 80 plus percent during clinical trials and children's cancers in the last 20 years has gone from a overall survival rate of maybe 15 to 20%, right?

[00:35:30]

Because people might remember that kids cancers, there was very little hope about 20 years ago. What changed? What changed is a percentage of those kids that are on clinical trials are now north of 80, 90%. And so that's the lesson we have to learn in the adult world. And I believe that our future, our destiny, that next 10 years is in our hands because it's going to come down to not, again, so much availability, although I think we're going to see a huge change in the number of available drugs and tests, but our success is predicated on accessibility.

As an organization and as a country because innovations on a shelf don't save anyone's life. Innovations in a vein saves people's lives, and we need more of that to happen.

[00:36:00]

Brian Urban:

Wow. I could not be more excited for the continued leadership that you're having in American Cancer Society or your continued talks than you have throughout the country on any given calendar. And just the way that you are framing how you're caring for people through this journey is fascinating. And using that example of pediatric cancer to access the clinical trials to what will hopefully expand to in the future, that in and of itself seems like the big hope that we can all hang on to.

[00:36:30]

And so thankful to have had you on the show. Dr. Arif Kamal, Chief Patient Officer of American Cancer Society. Thank you so much for sharing your voice here today.

Dr. Arif Kamal:

It's a pleasure.

Brian Urban:

And for more exciting insights and experts, please visit us at finthrive.com.