MS. CASEY: Welcome to Washington Post Live. I’m Libby Casey, politics and accountability anchor at The Washington Post. This program is part of our Chasing Cancer series, and today we are talking about the impact the coronavirus pandemic has had on cancer patients and the health care workers who care for them.

In a little while we will talk with Howard University President Wayne Frederick, but first I want to introduce Meg Kinnard. She is a politics reporter for the Associated Press and a cancer awareness advocate. Meg, welcome.

MS. KINNARD: Hi, Libby. It is so good to be with you.

MS. CASEY: Yeah, it is great to see you. I want to talk about your journey and how you are doing, but let's start at the beginning. You were diagnosed with breast cancer in February of this year, but you found a lump in your breast four years ago. What did the doctors tell you at that time, and how did it get diagnosed properly this year?

MS. KINNARD: Four years ago, I was only 37, and I wasn't quite to that 40-year age mark that we hear as when women should really become aware of mammograms and start getting tested regularly. But I felt something very small in my left breast, and I requested a mammogram, received it, and was told that I had a calcification, a small calcium deposit that was something we would monitor every 6 months, every 12 months, but that it was something that I shouldn't worry about.

I kept going for those follow-up treatments, and again was told, "Don't worry. This is fine. This could be hormonal. It will go away on its own." It never did, and it became painful, and my skin became bumpy and red. I was still told by my doctors at home, "Don't worry. We're keeping a close eye on this."

Finally, this past February, one of those doctors decided, "You know, we've watched this for long enough," and finally did a biopsy on that area. It came back malignant, and at that time I was diagnosed with invasive ductal carcinoma, which is a very common kind of breast cancer. I was told this is a very typical case and this is no problem, and very not unusual.

But, you know, something in me, I was glad to finally get diagnosed since I had been worried that something was going on, but something in me still kind of wondered. You know, I saw this happening a long time ago. Is this really it?

I got on the start of the treatment path at home, in South Carolina. I did all the tests that come along with the diagnosis. I started chemo on an accelerated timeline, pretty much thanks to having a friend in the hospital system where I was who was able to help Ms. Easterly get all of the preliminary stuff done very quickly. But at the urging of my friends and family, primarily my husband, I sought a second opinion, just to make sure, just to know, you know, this really is the standard, typical cancer case that I had been told it was.

I ended up, in March, coming here to Houston, Texas, to seek a second opinion at MD Anderson Cancer Center at the University of Texas, and at that point, only in March of this year, was my diagnosis made correctly. It wasn't a very typical kind of breast cancer at all. It was inflammatory breast cancer, which is among the rarest, most aggressive forms of the disease. And, quite frankly, it is perhaps something that my doctors at home had never encountered and hadn't seen much of, and so they didn't know it when it became apparent and it was right in front of them.

But thanks to that urging, thanks to seeking that second opinion, I came here to MD Anderson. I am actually speaking to you now in between radiation treatment. I will go back this afternoon for the second in my twice-daily regimen. But since March I have come here to be treated, and I feel that now I'm on the right path, with the right diagnosis, and very aggressive treatment.

MS. CASEY: You know, it's incredible that you got that second opinion, and, in fact, that you were even so persistent, Meg, in just keeping up with medical professionals about that original pebble that you found. What has it been about the people in your life who were urging you to get that second opinion? What was driving them? Like what advice can we all learn from you about when you have to keep asking questions?

MS. KINNARD: I'm very grateful for those folks, particularly my husband, Geoffrey, for encouraging Ms. Easterly to make sure. You know, I thankfully have the ability to come to a place like MD Anderson. I have a flexible employer, the Associated Press, who has been very supportive of me in doing my job, even more remotely than we all had been for the past year and a half, doing my job here from Texas.

But, you know, I think that given how long we had been concerned, that I had been concerned about what I was feeling in my body and still being told by medical professionals that we trusted, that had still managed aspects of my care under the guidance of MD Anderson physicians over the past couple of months, but still, having had that long lag time from when we first became concerned to when the diagnosis actually happened, given that circumstance it ultimately, in retrospect, now seems like it was a no-brainer, to at least seek out another piece of advice, another opinion.

I initially came here hoping and thinking, like many do when they seek a second opinion, that this would be an affirmation of my previous diagnosis, that this would be, okay, well, you've already received this information about your diagnosis, and here at the most prestigious and best cancer center in the United States we agree with what your doctors are already saying. So, you know, go forth, you have our blessing. Everything is in line with what you've already been told. That is what I was hoping for, and that's what people come to places like MD Anderson hoping to hear.

And unfortunately for me, and about 50 percent of people who do seek that second opinion, that is not what I heard. That was very difficult, and it was difficult for me, for my husband, for our whole family. But thank goodness that we were able to do that, because it turns out the treatment protocols for that rare, aggressive cancer that I do have, for inflammatory breast cancer, are very different than they are for the standard type of cancer that we thought I had in the beginning. And thank goodness I am able to do those treatments and do those protocols here at MD Anderson.

MS. CASEY: It's also, Meg, that you were fortunate that you have a flexible employer and you have the financial means to get yourself to Houston for that second opinion. So many people are putting off preventative care right now, and even taking those initial steps because of financial hits that they've taken during the coronavirus pandemic or fears about entering into medical facilities. How do you deal with this diagnosis and treatment right now in the midst of this pandemic?

MS. KINNARD: You are absolutely right that there are so many things that we've put off, care-wise and health-wise, over the past year and a half, because of everything else that is swirling around us. For me there are multi facets to the difficulty and the, I guess, wear and tear mentally that doing all of this in the pandemic really puts on.

For one, hospital systems, when I was diagnosed back in March, February and March, were already dealing with a lot of stresses from the pandemic, and so just entering into a very active participant into the health care system at that point, when all of that was already going on, that was just kind of an underlying theme to everything.

But put on top of that, these were the first trips that we've taken since the pandemic began early last year, and the first time I'm getting on an airplane is not only during the pandemic but while I've got cancer, and also going to get a second opinion. All of those things at once are kind of a lot.

Also, put with that, going to appointments alone. Yes, my husband came to Houston with me just about every time that I've come for follow-ups, and certainly for that first trip, but he couldn't come into the facility with me. He was there on Facetime. But when I got that news of that standard cancer you thought you had, nope, that's not at all it, you have this other far more severe case, I was still physically alone without my caregiver or without my support system.

And so at that point we were staying in an apartment about a mile from the clinic, and I made that walk back--I will never forget it--crying, wondering what all this would mean for me, for my family, and I made that walk alone. And just the mental wear and tear that that put on me, and on him not being able to be there for me, that was another difficulty.

The last piece of that, that I think kind of rounds out the mental health stresses that I've been experiencing, and I'm sure thousands of other patients are as well, when I had my surgery last month, here at MD Anderson, it was very complex, it was very, very complicated, and it was very, very long. It went about 12 hours, all told, so long that my husband, who had been able to come to be with me, to see me off into the O.R., had to leave the hospital because due to coronavirus restrictions, which absolutely are understandable in health care institutions, and we respect them very much, but due to those restrictions he had to leave. And so when I did wake up from surgery, when I came out of anesthesia, I was alone. Yes, there were plenty of health care providers there, but my support system, you know, the person who is with me on this journey, just as much as I am, wasn't allowed to be there.

And that wasn't necessarily stressful for me as much as it was for him. And when we finally had that phone call, when I came out of anesthesia and we were able to connect, the first words out of his mouth where, "I want you to know I only left because I had to, because they physically made me leave. I didn't want to leave you there by yourself."

All of these things are just small pieces of what it's like to go through something like this during the pandemic. Obviously, we need to be careful, and the restrictions are there for a reason. But it's just one more part of it that makes it difficult.

MS. CASEY: And despite that isolation you've shared your story. You've sort of burst through that pandemic bubble we're all in by being very open about your experiences. You've shared them on Twitter with followers, you're doing interviews with people like us, and you're keeping a journal. Why is it important for you to document and share your story with all of us?

MS. KINNARD: There are many pieces to it, one of which it's cathartic to me. I feel like it helps me, as a writer, to be able to chronicle a lot of what I'm feeling and experiencing, some of it privately, but some of it with others.

But more so than that, there is a huge piece of me that has been so impressed by the outpouring, not just of support for me that I get but the feedback I get from people who are thanking me, when I do post something publicly or say something about what I'm going through, because they are experiencing it too, and in large part due to the isolation that so many of us feel during the pandemic, they have been enduring it alone.

There are several women with whom I have connected who have been diagnosed over the past year and a half and feel, for whatever reason, they don't have a strong support system with them. They are going to chemo, and they are going alone, and they are worried, and they are confused about whatever side effects they are feeling. Is that something normal? And they are asking their doctors and their health care providers, but we all know whenever there is a difficulty that we experience, if we really want to know what it's like to make it through or to get advice from someone, we go to somebody who's had that same experience, not just an expert in the field.

No shame on the experts. Obviously, we respect them very much. But to talk to somebody who's actually been through chemo, or who's lost her hair, or who's having radiation and wondering, you know, is this what my skin is supposed to feel like. Those kinds of people who have really surfaced and just said, "You know what? Thank you, because I've had these issues too, and I don't feel like I'm so alone."

And so, you know, it's tough for me, as a reporter, to tell anybody's story--to tell my own story, right. Like we're accustomed to talking to other people and to get their information, and to convey that and to elevate that for our audience. For me, this has been flipping the script and talking about myself, which is strange. But I've basically pushed through that and tried to get more comfortable with that, because I have heard from those folks who really said, "You know, thanks. It helps to know that there's somebody else out there who is going through this and who is not afraid to talk about it." And that right there, it comforts me and it actually ends up bringing me a lot of solace in knowing that, you know, if I can help somebody else who is maybe feeling more alone than I am--I am very fortunate and blessed, but if I can, you know, convey that to somebody else then that makes it all worth it.

MS. CASEY: Your openness is also inspiring people to do preventative care, or do self-exams, and so it's having an influence in that way as well.

MS. KINNARD: I have heard from a number of women, many of whom I don't know, and some of my own personal friends who particular, in part--due again to the pandemic--have put off some of those personal care decisions, and mammograms, and follow-up screenings, for a variety of things, just because stuff gets pushed aside or got cancelled last year. And I've heard from them to say, "Thanks for the reminder. I've gone and I've scheduled it." And unfortunately, or fortunately, regardless of really how you want to think about it, I've had several friends come to me and say that they had gone to get that screening, thanks to the constant badgering, I guess, that I do on social media, they've gone to get that screening and several of them have actually been diagnosed with breast cancer, and too, have undergone surgery and are in the next processes of their treatment, radiation and other things.

I'm not trying to pat myself on the back. I don't take credit for them having gotten diagnosed with breast cancer. But I am really thankful to see some of that advocacy already playing out in real time. It's awful for anyone to be diagnosed with something like that, and I certainly wouldn't wish it on anyone, but I am very, very glad to see women I know, and hopefully out there maybe there are some that I'm not aware of, who have been able to say, "You know what? It is time. It's well past time for me to go and get that mammogram."

It's not fun. It's not comfortable. It's not something that we all look forward to. But what we should look forward to is the knowledge that comes thereafter of either, okay, you're all clear and we're confident there's nothing going on, or maybe there is something that we need to take a second look at.

I would say, in addition to that, though, I got mammograms that were deemed okay for four years, until all of a sudden, I didn't. So I'm not saying that, you know, like no one should trust when they get a mammogram or anything from a doctor. I'm not trying to inspire distrust in doctors. I'm the child of two doctors, and I'm very proud of the careers that they had. But I do hope that I can encourage people to at least have a healthy dose of skepticism when it comes to the screening tests that they do get, if they do, if the patient themselves feels that there's something else going on.

Looking back on my own experience, there are pieces of that where if I had spoken up a little bit more loudly or a little earlier, maybe there would have been a different outcome for me. So the biggest thing that I want in any of this is to perhaps inspire that next woman who really thinks that there's something funny going on to ask that next question a little bit earlier, and hopefully she won't end up on the same path that I have.

MS. CASEY: Well you are continuing to report the Associated Press. You post videos and images of yourself exercising. You're a mom of three active kids. There can be a real tendency during this pandemic period to just sort of hunker down and isolate, for all of us. So how are you staying motivated, Meg? How are you staying inspired and sort of not trapped, you know, both by your diagnosis as well as literally trapped by the pandemic?

MS. KINNARD: Well, you hit on it right there, and it's my three active kids. Geoffrey and I have three children--Alex, Hannah, and Adair--and they range in age from 10 up to 17. So they're very busy, and they've got a lot going on, and they are my biggest motivators, because if there's anything that I want to see on the other side of all this it's watching my kids grow up, and it is enjoying the rest of life, and hopefully a very early retirement with my husband, so we can really enjoy everything.

But you're right. Being active has to be a huge part of that, at least to me, because I see physical activity and health and nutrition going hand in hand with the medical treatments that I'm getting. And so, you know, one of the things that was tough in the beginning of the pandemic, if we go even like a year ahead of when I was diagnosed, gyms were shut down, and, you know, physical fitness places weren't deemed to be safe to operate. And so that, for me, as someone who is used to working out and getting a lot of exercise, that was kind of a weird feeling, because I didn't have that place that I was accustomed to going to.

When I got diagnosed, I really had to make sure that I found a place to be physically active, because when I was really trying to kickstart my body and make sure that it was the best possible vessel for chemotherapy, before I had surgery--because I wasn't sure if my tumor had shrunk enough, if I could even get there--I asked MD Anderson to put me in touch with their nutritionists. And one of the things that they really talked me through was making sure that everything I was putting in my body was a really, really good thing, a cancer-fighting thing, but also kind of clearing pathways so the rest of my chemotherapy could be most efficacious. But also staying physically fit, being active, getting that cardiovascular exercise, doing muscle-building, because cancer hates all of that. And I think, for me, I really had to make sure that I was doing as much as I possibly could in those ways then to allow the medicine to do its best job.

So again, going back to my kids, they are my primary motivator, but I also didn't want to just think, okay, well now I'm here for the medicine, and the medicine is just going to do its job. To me that wasn't good enough, because what if my cancer was just being too mean and nasty and the medicine didn't have a clear path to it? So I had to do everything I could to really focus in and make sure that I could be the best possible place for the chemo to be effective and to do its job. And thankfully it did and that worked for me, so that would be another piece of advice that I had for anybody going through this process, is to take the best possible physical care of themselves and then they're the best place for the medicine to work.

MS. CASEY: Well, Meg, thank you so much. It is just a joy to talk with you, a former Washington Post intern, might I add, so it's great to see all that you're doing. Thank you so much, Meg Kinnard. Thanks for sharing your story.

MS. KINNARD: Wonderful, Libby. It's great to be with you.

MS. CASEY: Please stay with. I'll be back in a moment with Howard University President Dr. Wayne Frederick.

[Video plays]

DR. PEREZ: Good afternoon. My name is Omar Perez. I am the Head of Medical Diagnosis with U.S. Medical Affairs at AstraZeneca. I am thrilled to be here today as part of AstraZeneca's Your Cancer program. We believe that redefining cancer care for patients requires going beyond just our medicines and it involves close collaboration with the broader cancer community to pursue our shared goal of one day eliminating cancer as a cause of death.

We know this earmarks 50 years since the passing of the National Cancer Act, a historic milestone that gives us an opportunity to reflect on the incredible advances that have revolutionized cancer care while also charting a path forward for the next 50 years of cancer care amid the COVID-19 pandemic, while at the same time building upon our conservations we started at our last Chasing Cancer summit held in June of this year.

Continuing this momentum starts with understanding the ways in which the COVID pandemic has reshaped cancer care and the continued importance of detecting and treating cancer earlier by expanding access to cancer screening and biomarker tests that allow us to treat cancer with greater precision by tailoring treatments to a patient's genetic profile. Furthermore, we must acknowledge the longstanding barriers many Americans face, particularly among those living with or affected by lung cancer, which continues to be the leading cause of cancer death among both men and women, and which continues to disproportionately impact those from underserved patient communities in terms of diminished quality of life and survival.

Today we are thrilled to spotlight one of the organizations at the very forefront of cancer care. I am pleased to be joined today by Andrea Ferris, President and CEO of the LUNGevity Foundation, one of the nation's leading cancer advocacy organizations focused on improving outcomes for people affected by lung cancer.

Welcome, Andrea.

MS. FERRIS: Thank you, Omar. Thank you for having us.

DR. PEREZ: Absolutely. As we reflect on the impacts of COVID-19, in what ways do you feel those living with cancer have been affected, and what can we learn for the future?

MS. FERRIS: Wow, that's a big question. I think that there are a lot of things, both in terms of the impact that it's had as well as what we can learn.

You know, many people impacted by lung cancer already feel a tremendous sense of isolation and distress, and the COVID pandemic compounded that. It was a disease, obviously, that affects your lungs, so that, on top of your lung cancer, creates sort of a double impact, if you will.

So I think it has impacted the community from an emotional level. I think it also has impacted the community from a cancer care level as well, in that many people were not going for lung cancer screens. In many communities, a lung cancer screen was considered an optional procedure, if you will, and so they were delaying their screenings. Many people were fearful of going in for a screen. So I think we are going to see that impact probably in 5 or 10 years down the road, of all of these delayed cancer screenings, lung cancer being one of them.

I think also in terms of accessing care people weren't going into the hospitals, they weren't going to see their doctors to get the care that they needed as well.

So I think that the impact of the pandemic has really touched the community very strongly. But on the flip side it also gave us opportunities to learn. How do we connect differently? How do we interact differently? How do we deliver care differently?

So I think that all of these questions that came up out of necessity, and were resolved out of necessity, actually were really good learnings, and I think there's still a lot more that we need to learn and can incorporate into how we care for people diagnosed with lung cancer, and other diseases also.

DR. PEREZ: Incredible perspectives. Now do you think with those learnings that we have also learned a little bit about the access to health care during this time that affected populations differently? And if so, how are ways that we can come together as an oncology community to help address those?

MS. FERRIS: Yeah, and I'd love to get your thoughts on it as well. But, you know, I think that what the COVID pandemic did is it really shone a light on health care disparities, starting with COVID and the pandemic and how it was impacting different communities more adversely than others. But that carries over into pretty much any disease. Lung cancer absolutely is affected by these disparities. And I do think that we all have to come together to try to address it. There is not a one-size-fits-all solution.

Telehealth, while it helps in some circumstances, in others it can create a barrier for people who are not technologically savvy or don't have access to Wi-Fi. It also highlights the fact that people learn differently. We have to provide education and information differently. The website is great, but some people like paper. Some people learn orally or through video.

And so I think that we need to meet people where they are, and the pandemic, what it did is it really shone a light on how important it is to start addressing these. And I think it started a really important dialogue, as well, over the past 18 months, of just how we do that, and, you know, how we work together, how we work with industry, how we work with local partners, how we work with regulators and providers. I think it's important that we all have a role to play and that we all work together in a coordinated way to address things.

But I'd love to get your thoughts on it, on how AstraZeneca is working with it.

DR. PEREZ: Yeah, I would agree with you. I think the pandemic has really shown to us the different avenues or ways not just to access health care but how to really reach patients, and learning about the different populations, of how they go about becoming aware of new medical treatment but also maintaining their current health care by continuing their cancer screenings, and as well, have the knowledge and ability to access biomarker testing when it is appropriate.

And so I think although the pandemic, as difficult as it has been, has shed some light on these new opportunities, we are embracing digital innovation or other ways to reach communities that have not had access to the information in their hand, and hopefully pave the way for new, innovative ways of delivery health care.

MS. FERRIS: [Unclear]

DR. PEREZ: Yeah, thank you.

You mentioned quite a bit about collaboration, and we also believe collaboration is key to fundamentally changing and bringing about benefit to patients. How is LUNGevity partnering with the cancer community to really help address some of these we just touched on today, particularly about earlier diagnosing and access to biomarker testing?

MS. FERRIS: Yeah, I think that's hugely important, and we have a number of projects and initiatives ongoing where we are partnering with other organizations. We have one specifically focused on learning about biomarker testing in underserved populations, both how it's being delivered but also how people are accessing information about it. We are doing the study and the intervention from the patient side of things, and we are partnering with another organization, ACCC, the Association of Community Cancer Centers, to look at the provider side. So then that way I think it is a holistic approach as one possible solution.

We also partner with a lot of local community organizations that are in the communities that we are trying to serve, because they are trusted partners, to understand what additional information they need or that we could provide to help them to then educate the people in their communities. We also partner with hospitals, hospital systems, with regulators, with industry partners as well, because as you rightly said, it takes all of us together to address health care disparities and how people are accessing it.

I think the other thing that you had mentioned was screening as well, and for lung cancer screening, while, you know, there's a very defined population who is eligible for the screening, even within that there's a very low uptake in it. And we all need to work together to try to explain and to make people understand that screening can save your life. Lung cancer is not a death sentence anymore, with all the advancements that are happening, and it's hugely important to find it early, if possible.

DR. PEREZ: Agree, and AstraZeneca collaborating with not just the oncology community centers but also through our advocacy channels as well as through our educational channels is definitely of importance.

MS. FERRIS: Yeah.

DR. PEREZ: So as we reflect on the progress of the last 50 years following the National Cancer Act being signed into law, and any areas where we still need to increase access to the latest targeted therapies that help revolutionize cancer treatment for patients living with this devastating disease, and we are encouraged that we are making progress towards our vision of redefining cancer care and improving survivability for all patients, given the COVID-19 pandemic.

To learn more about AstraZeneca's commitment to catalyze change alongside the oncology community please visit YourCancer.org.

Thank you to The Washington Post for hosting this timely forum, and to Andrea Ferris for the enlightening discussion we had today.

MS. FERRIS: Thank you for having me and giving us the opportunity to have this conversation.

DR. PEREZ: Absolutely. The work that she and the LUNGevity Foundation do to improve the quality of life for people affected by lung cancer is tremendous.

And now I'll turn it back over to The Washington Post.

[Video plays]

MS. CASEY: Welcome back. I'm Libby Casey. My next guest is Dr. Wayne Frederick, President of Howard University. He also serves as the distinguished Charles R. Drew Professor of Surgery and as a practicing surgeon.

Dr. Frederick, welcome to Washington Post Live.

DR. FREDERICK: Thanks for having me.

MS. CASEY: The Director of the National Cancer Institute, Ned Sharpless, came on this program back in June and said that there has been a 95 percent decrease in cancer screenings across the board since the pandemic started, and that the impact on cancer care is even worse than the Institute had predicted it could be.

So what has been the impact on your patients? What are you seeing?

DR. FREDERICK: Yeah, you know, we are seeing something similar at Howard University Hospital, where the majority of our patients are African American. We have seen a significant decrease in screening mammographies, and especially if you look at the three-month period between June and September of 2021, and you try to compare that to June of 2019 to September of 2019, you would expect to see an increase, because during 2020 we had such a decrease that women who would have missed their annual mammograms, you would expect them to be coming back, plus women who are now getting into that age group, you would be trying to capture them. So you really should be expecting an increase, and instead we are still seeing a significant decrease. So it is consistent with what NCI is saying, and I think it is going to have a significant impact on cancer care and cancer outcomes.

MS. CASEY: Do you have suggested solutions or answers to how more people can be motivated to get those screenings and get that attention that could be preventative?

DR. FREDERICK: Yeah. You know, I think we have to be innovative. Part of it is we have to bring, I think, some of these screenings to patients. So, for instance, in colorectal cancer you have the opportunity to do a fecal test in which people can collect some of their stool, mail it in, and that could be an initial screening tool. We have mammography units that are part mobile, I think, taking those out into communities and meeting patients where they are. The fear and concern about coming into hospitals with COVID is a substantial one, and so we want to get patients out there.

Doing screenings for prostate cancer, while we know that PSA acknowledges rectal exam is an imprecise modality, at least in the interim we need to be using some of these.

So I think we have to get innovative about how do we bring these tests and these screenings out to patients. We have to encourage things like self-breast examinations, as an example. So we really need to be getting the word out that these things are done, and what people can do on their own to increase their chance of detection.

MS. CASEY: Well before the pandemic, cancer mortality rates were at an all-time low in the United States. Do you have a sense of how these delayed screenings and care could impact the mortality rates for cancer, looking, let's say, five years ahead?

DR. FREDERICK: You know, some of the national organizations that look at these datasets are predicting as many as 10,000 cancer deaths as a result of these delayed screenings. I can tell you already what I am seeing in my patients are patients that are showing up with much more advanced disease, because they have delayed and hesitated going to the doctor to check on something that wasn't right. And again, that need and fear and also what we have found, as a medical community trying to keep people away from our hospitals, especially because of the strain at this point on the health care system, has kept patients away, and that's unfortunate, because with that [unclear] disease the outcome, unfortunately, is going to be worse.

MS. CASEY: Well, let's talk about that issue, Dr. Frederick, this issue of hospitals being so full in some parts of the country where we're seeing these COVID cases surges. And now, of course, we're seeing unvaccinated patients fill some hospitals. How concerned are you about cancer patients having these lifesaving treatments postponed because hospitals are just overextended? So we are not even talking about someone being concerned or wary of going in. We're talking about the hospitals saying, "We just can't see you right now."

DR. FREDERICK: Yeah, I am very concerned, actually, because if you think about it there is a ripple effect. There is also national data that shows that more people died at home during the months of the pandemic in March of 2020, up through this past summer, than did in the corresponding 12 to 15 months. And now that suggests that people were not getting treatments for a wide variety of diseases, which, as you would imagine, would include cancer, heart disease, and other types of diseases.

In patients with cancer, in particular, not getting chemotherapy that's scheduled, not getting an operation in a timely fashion, all of those things can make a significant difference, and take someone with a Stage I disease that has a much better prognosis all the way to a Stage IV that has a very poor prognosis. And so those are the types of things that will accelerate.

We also have an aging population as well, and as we think about that we are expecting that the incidence of cancer will go up. While the treatments are getting better, cancer being the number one cause of death, overtaking heart disease, is a reality. And so having a circumstance in which you will be going through a significant period of time, 18 months and ongoing, where people have delayed getting screened could prove to be catastrophic.

MS. CASEY: Well, Dr. Frederick, hospitals are having to make some very tough decisions right now about how they accommodate cancer patients and other non-COVID emergencies as they cope with these COVID case surges. How does a hospital make decisions? You know, we are seeing some doctors at a breaking point, saying, you know, "I'm at my wits end because the people who are coming in are unvaccinated, whereas, you know, we've got people who are suffering from cancer who can't even come in to have a necessary, lifesaving surgical procedure right now."

DR. FREDERICK: Yeah, and that's the difficulty of this situation, right? We live in an ecosystem that is interdependent, way more interdependent than I think we are sometimes willing to admit, and that is the unfortunate part of what has taken place with this pandemic. So that everybody's behavior, while we think of personal choice, it actually does have an impact on others, because if you choose not to be vaccinated then there are a series of other things that you must do to avoid getting sick. And when you do, if large numbers of people who are unvaccinated get sick, it does stress the hospital system, and making those decisions is tough. You have an emergency room that's overwhelmed. You have hospitals and ICUs that are overwhelmed, ventilators that are being used. And during the pandemic, for long periods of time, our hospital decided to delay surgeries. So I had a couple of major cancer operations to do that I waited some six to eight weeks to do.

Now, you know, I am hopeful that those patients will still have a very good outcome, but there is no predicting what that delay could lead to, and that's a tough decision to make, you know, for someone who, when we know we have a treatment, we have a vaccine, it's tough. And it's tough for health care workers who are burning the wick, as it were, in both ends, doing everything possible to keep everyone alive, to also see that the behavior of some is affecting others and causing others to have very poor outcomes, including fatalities. And that's tough, you know.

And on top of that I think there's a layer of politics associated with it, and in medicine, you know, patients come to the emergency room, all you see is their humanity. And so it's very, very tough to operate and make those decisions.

MS. CASEY: Let's go back to preventative care. You wrote an op-ed in February saying that missed preventative care is endangering minority communities in particular, and the pandemic has highlighted and exacerbated longstanding racial disparities in health care. What is at the heart of these inequities?

DR. FREDERICK: You know, a lot of it has to do with, I would say we have structural issues within our systems. So the first one is access. Structurally, if you look at the way we are set up--so if you look at certain ZIP codes, you look at the average income, and then you look at what we have in terms of health care resources and stuff, around those neighborhoods, we immediately recognize that they are underserved, and that even for patients who want to do the right thing their access is not there. There is not somewhere that is easily accessible for them to go get screened. They are not working in jobs where health insurance comes along with it. All of those things decrease their access to good health care.

On top of that are the other issues of how do we then ensure that those patients are getting all of the things that can impact their social determinants of health, and that includes transportation, it includes nutrition. So we do have full-service groceries, where they can get fresh fruits and vegetables, or are there a preponderance of corner stores that are supply high-sugary drinks, fatty fried foods, et cetera? And then you put all of those things together and you begin to realize that it's much larger ecosystem, much more complicated that maintains the health of certain individuals at a lower rate.

As a matter of fact, if you look at the life expectancy of a White male in America to an African American male, it's the widest gap that you have in life expectancy. That gap began to close slowly, partly because of better care to African Americans but also because of a strange phenomenon in which we started to see increasing deaths among White Americans, mainly younger White Americans related to the opioid crisis and alcoholism and suicide, et cetera.

During this pandemic, it appears that we may have erased that gain, as it were, and that that gap may actually widen because of the disproportionate impact that COVID had. And then, obviously, we don't know what the long-term impacts are from COVID as a disease.

And so we really can be getting into a circumstance where over the next 5 to 10 years the outcomes for African Americans, in particular, with respect to health issues, could really deteriorate, and that's something that I think as a country, as an economy we are going to have to look at those long-term impacts.

MS. CASEY: Well, you are training the next generation of doctors at Howard University Medical School, and health care workers have been pushed to the brink. We were just talking a moment ago about the challenges of dealing with COVID. But, of course, they are also dealing with, you know, the racial disparities that you're talking about, as they just start their careers and think about how they're going to help create healthy communities.

How are you preparing students to practice medicine in, let's hope for a post-COVID era, can we call it, Dr. Frederick, even knowing that, you know, another pandemic may lie ahead in our future?

DR. FREDERICK: I attended medical school at Howard, actually, from 1990 to 1994. One of the things that impressed me during that and my surgical training was the HIV epidemic. I remember looking at the disproportionate impact, not quite understanding it, not quite understanding why so many African Americans seemed to be impacted, not understanding all of the structural things around it, because that's not what was taught in medical school at that time. We learned about the disease process, I knew what type of virus it was, and what we would have to do to take care of patients, you know, and the usual diseases that they would present with, but the social determinants of it just wasn't there.

And I think that what you see now in medical education is a very strong curriculum that speaks to that issue, especially at Howard University. We really try to emphasize to young medical students that you have to look at patients holistically. So it's great to tell, you know, a patient that goes home after an operation to make sure they eat healthy, whatever that means, but then they cannot understand that they live in a ZIP code where there are only two full-service groceries. You know, they don't have access to that is something else.

I, myself, took care of a patient when I first came back to Howard who was 40, had breast cancer, five kids, and after her operation had to get chemo, and the first day, she didn't show up. And I called her and she said, "Dr. Frederick, I am sorry. I had to make a decision. Today I am wage worker. I had to go to work today, when I look at the bills that I have coming, so I can't make my chemotherapy appointment." And that's tough. That's not something I learned in medical school. It's something that I think medical schools today are learning. I also think that they are making choices as to where they practice as a result, the altruism they bring to us. As they've learned about the challenges to that altruism, as it were, I believe they are going to go out and do the right thing, unpack their suitcases where they're most needed.

MS. CASEY: Well you and three other HBCU presidents came together to write an op-ed in The Washington Post last month, and, in fact, you are the leader of the nation's only four historically black medical schools. And here's the headline: "For the sake of black people's health we are mandating COVID-19 vaccines for all our medical students." What led you to that decision, to institute that vaccine mandate?

DR. FREDERICK: You know, when I saw the data of the disparity between who was being vaccinated and who wasn't, I recognized that we were getting in trouble, and getting in trouble very fast. As the vaccine rollout occurred, the groups that lagged significantly were African Americans, Hispanics, Native Americans, and Republicans. Those are the four groups that really had a significant lag. And I thought that unless we stepped in and made it clear that we are concerned enough about our own that our students, our faculty, our staff are mandated to be vaccinated because [unclear] is very small and we have lost such a disproportionate number of people already, and as I said before, we don't know what chronic illnesses they are going to take with them as a result of COVID, that we had to do something right then and there.

And what you've seen now is I think the gap has closed with African Americans--not all the way--but the gap is still there. And there's more to be done. We're going to continue to push the message out about getting vaccinated. And as I try to tell people I speak to about being vaccinated, I'm not trying to coerce anybody into getting a vaccine, but I want to make myself available to answer any question you may have, because I am convinced that if you get your questions answered and you get information, you will make the right choice and get vaccinated.

MS. CASEY: Well, we do have a question from our audience that has come to us, to ask you, Dr. Frederick. This is Sue Densmore in Ohio. She wants to know what does the science around mRNA vaccines offer for future cancer treatment?

DR. FREDERICK: You know, I think there's a lot of opportunities and possibilities here. Messenger RNA vaccines have demonstrated that we can fine-tune the body's immune system very precisely to attack a particular antigen or infectious agent, or possibly even a cancer cell. And I think what you will start seeing in our laboratories is an increasing interest in developing vaccines against the detached cancer cells that could be effective. This opens up a whole new era of exploration that I think can really result in many treatments coming forward in the arena of cancer.

MS. CASEY: Well, that's a hopeful note to end on. Thank you so much for joining us, Dr. Wayne Frederick. We really appreciate your time today.

DR. FREDERICK: Thanks for having me.

MS. CASEY: And if you would like to check out what interviews we have coming up, please head to washingtonpostlive.com to register and to find out more information about all of our upcoming programs.

I'm Libby Casey. Thank you for watching.

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