A conversation about health equity with Dr. Brian Rivers

We sat down with Atlanta’s Dr. Brian Rivers, Professor at Morehouse School of Medicine (MSM) in the Department of Community Health and Preventive Medicine, Director of MSM Cancer Health Equity Institute, and member of Movember’s Global Cancer Advisory Committee to discuss health equity and what it would take to truly close the cancer care gap.

Can you tell us about your work in the cancer space and health equity?

A lot of my work has focused on trying to better understand the drivers of prostate cancer disparities and how we might advance prostate cancer health equity.

My program of research has spanned the entire prostate cancer continuum, from evaluating models of patient and caregiver education, to multilevel community-based interventions to enhance decision making for prostate cancer screening. Our research team has also examined the psychosocial sequalae from diagnosis through treatment to survivorship. Our charge at MSM Cancer Health Equity Institute is to lead in the creation and advancement of health equity to achieve health justice. For the past two decades, we’ve been able to characterize health disparities pretty well. We understand that the drivers of cancer disparities are multifactorial, meaning it’s not just one factor associated with disparate outcomes, but there are multiple factors to consider such as biological/genetic factors, social/environmental factors, psychological factors, clinical factors, behavioral factors, and cultural factors. Our research lab has led in understanding the unique interplay of these factors and how they disproportionately impact men health outcomes. Now we must apply what we know, what we have learned, by putting forth meaningful intervention strategies to mitigate and/or eliminate the deleterious impact of these factors or drivers of adverse health outcomes. My program of research has and will continue to lead in the creation and advancement of these solutions.

What has the focus been in your equity research?

Equity is giving people what they need, in the amount that they need, at the exact time that they need it. Based on this philosophy, our approach to medicine is different where it's not just a practice of medicine or a model of one-size-fits-all, but it really places the patient at the center. For example, we realize that limitations in advancing prostate cancer health equity is that we don’t have good or representative data to make informed decisions as it relates to cancer prevention and control and treatment.

We need better representation in our research studies, especially of those populations that are disproportionately impacted by this disease, those that identify as African American or Black, and those with a family history of prostate cancer. Those are the individuals we want to study, from a molecular level to their behavior to the environment in which they live, work and play. Through such an approach, we can identify new biomarkers or understand certain genetic mutations that are germane to certain populations or study gene-environment interactions.

We are currently implementing a study entitled Clinical Trails and Cancer Genomic Education Program, a theory-informed, multilevel intervention addressing the factors associated with participation in clinical trials and genomic research studies.The overarching goal of this intervention study is to increase the representation of Blacks and Hispanics in clinical and biomedical research.As we advance models of precision medicine, it will be important to ensure study representation reflects the demographics of society and in cases where a disease is being studied and particularly population is disproportionately impacted by the disease, then you would expect an overrepresentation of this populations.Ensuring that we have the right data for the right individuals to help us make the right clinical decisions is paramount.

The theme of World Cancer Day earlier this month was “close the care gap”. If we’re looking to take action in closing the cancer care gap from a health equity point of view, what do we need to be talking about?

If we reflect on the lessons learned from the recent COVID pandemic, we saw significant gaps emerge in our research infrastructure, society’s understanding and trust of research, and the capacity of our health systems and their ability to address the issues of medically underserved populations. We dealt with issues around vaccine hesitancy, and skepticism around science, trustworthiness of scientists and of the research enterprises in this country. But one of the things that I thought was done very well and highlighted the power of collective action was how the world came together to develop the vaccine at an incredible pace and how the science of community outreach and engagement emerged as a critical component of the research continuum, with quite a bit of focus on implementation and dissemination science.

I reflect on the pandemic to demonstrate what is possible!How collectivism in research could accelerate our scientific advances and ultimately prevent deaths.We need to see this same level of collectivism with prostate cancer disparities. And I think that’s where Movember is getting it right and could be a demonstration to other agencies grappling with this disease and other diseases, of how you have multiple countries working on different facets of prostate cancer. We need robust studies. As an example, my modestly powered research studies have a sample size of on average 250-500 African American men. How generalizable is that data? It lacks sufficient power to really generalize the findings to all individuals to make something a standard of care. We need studies with tens of thousands of men, and the only way we can achieve that is a global approach.

Additionally, over the past 5 years, we have advanced our understanding of the impact of social determinants of health or social drivers on health outcomes among cancer patients.Integrating the ability to account and intervene on patients’ social risk factors and health-related social needs during the administration of care will be integral to ensuring we are ‘closing the care gap’ and administering quality cancer care.

What does disruption look like in this space?

In the space of prostate cancer health equity, disruption is doing something that hasn’t been done before. We need to look beyond what has been done over the last 40 years, because if we continue to do the same things, we’re going to continue to get the same results.

Disruption is turning our research enterprise upside down and doing things from a different perspective – looking at things from a different angle. We need to increase the voice of the advocate or those with lived experiences, ensuring they’re part of the research review process and making them central to helping us as scientists understand: what is the right research question or questions we should be asking?We must consider who and how we fund research and the scope of the research studies, such as funding periods, composition of research teams, and where the research is being administrated, by academic institutions or in collaboration with communities and corporations, such as Walmart.

If we look ahead 20 years from now, what’s your hope for the future state of equitable cancer care for all men?

The language is starting to change as with other cancer conversations over the last 10 years. Take cervical cancer for example. The HPV vaccine was developed to decrease the prevalence of cervical cancer. Now, we’re hearing language toward “the elimination of cervical cancer”. I would love to hear that word “elimination” in the same sentence with prostate cancer disparities. We’re well on our way and the possibility is not too far off. We’re making tremendous progress, but a significant amount of work remains!

What drives you in your work in cancer care equity?

In grad school, one of my assignments were to create a genogram, basically detailing my family history and detailing health-related causes of death. While completing the genogram and I kept seeing “prostate cancer”.After further examination of this disease, I soon learned about the risk factors and realized I am at increased risk!Of course, I was shocked and even more so, confounded by the many unanswered scientific questions that remained. This is where my journey truly began!I was determined to not be a statistic but contribute meaningful to addressing these gaps in the science.I began my research in grad school and completed my Master’s thesis on understanding the barriers to prostate cancer screening.I continued his work through my doctoral program and further expanded my study on prostate cancer screening and incorporated the role of technology and health systems in our study approach.

The need I saw then still remains, so that’s what keeps me going. That’s what keeps me excited to come into the office every day, to work regionally, nationally, and globally on this disease in the hopes that we’re advancing prostate cancer health equity in a meaningful way.