Personal Impact and Growth Reflection - Professional Guilt and the Moonshot

Sarah Scarpace Peters
PharmD MPH BCOP
Associate Professor of Pharmacy Practice
Albany College of Pharmacy and Health Sciences
Albany, NY

I was honored to attend then–Vice President Joe Biden’s Cancer Moonshot Summit at Howard University in Washington, DC, on June 29, 2016. It is not every day that you receive an e-mail from the office of the Vice President. I truly was so proud that HOPA had made it onto the Vice President’s radar. As an organization that was founded only 12 years ago and served initially as a forum for education, I was struck by how far we have come. HOPA has a robust advocacy and health policy agenda and has made many connections with pharmacy, patient, oncology, nursing, and industry organizations, and now, the Moonshot Summit.

Only 300 guests were invited to the Summit, representing stakeholders in cancer care even more diverse than the partnerships that HOPA now has established. When Jeremy Scott (one of HOPA’s government relations representatives from Drinker-Biddle who was instrumental in securing HOPA’s invitation to the event) and I arrived in the main conference room, tables in rounds of eight awaited us. There were no assigned seats, but placards with “#canserve” were prominently displayed as centerpieces on the “White House blue” tablecloths. The Vice President asked us to tweet our ideas about how we personally, or as the organization we represent, “#canserve” toward the goal of making 10 years of progress toward a cure in 5 years. I tweeted about how pharmacists #canserve by employing adherence strategies and managing side effects of treatment to keep patients on therapy longer, with better quality of life, until the next new breakthrough in treatment is available.

Jeremy and I were assigned to separate small-group sessions, each with approximately 20 participants. Both of my sessions involved passionate discussions and even some animosity between cancer prevention group representatives (Tobacco-Free Kids, American Cancer Society, and others) and those of us on the treatment side. I was personally and professionally conflicted as a HOPA representative and as someone who holds a master’s in public health with an epidemiology concentration (specifically focused in chronic disease and cancer epidemiology) and is aware that public health and preventative medicine initiatives are routinely underfunded when compared to investments in research and development for treatments (whether for cancer or any other disease state). The cancer prevention group representatives made the argument that more funding for primary prevention was the only pathway to “cure” cancer. We framed our efforts on secondary prevention and treating cancer as a chronic disease. Primary prevention through behavior change and policies focused on limiting environmental exposures are generally less expensive and can have many additional health benefits beyond cancer prevention than focusing on turning cancer into a chronic disease. 

The Vice President raised his voice only twice during the Summit: once to proclaim, “if there are angels in heaven, they are all nurses” in response to the excellent nursing care his son Bo had received during his cancer journey; and second to protest the high cost of cancer drugs, deepening my professional and even moral conflict. 

At the end of the day, I was walking down the stairs and heard someone call my name. Standing to the side was a woman whom I had met at an advisory board meeting almost a year earlier. The pharmaceutical company that ran that advisory board had the wisdom to invite patients to hear their perspectives on being treated. This patient was in one of my breakout sessions at the meeting, and I had gotten to spend time with her in a very small group. She had been diagnosed with stage IV lung cancer 3 years earlier, and she tearfully shared with us what it was like to live with a terminal illness and what treatment meant to her. She remembered me because she had no idea that hematology/oncology pharmacists were available to meet directly with patients to address their medication-related problems. That was the most profound advisory board meeting I had ever attended. And now here this patient was, with me again at this profound Moonshot Summit.

We talked for a bit about how she was doing and our impressions from the day. We shared the same sentiment about the broad scope of the Moonshot Summit and its unclear direction. In the end, though, she wanted to make sure that it was known that treatment matters—tolerable treatment, that is.

After speaking with her, I put my professional “guilt” about being on the treatment side of cancer aside and felt new hope and commitment that what I do—what all HOPA members do—matters to patients. In the August 20, 2016 issue of the Journal of Clinical Oncology, Bower and colleagues reported the results of a Swedish registry study that indicate that in the post-imatinib era, patients newly diagnosed with chronic myelogenous leukemia live almost as long as their age-matched peers (minus 3 years). It is my hope to read a similar paper for stage IV lung cancer in the next 20 years. It may be a Moonshot, but perhaps with the assistance of hematology/oncology pharmacists, patients like my new friend will stay on therapy longer with minimal adverse events as each new breakthrough descends from the research stars.