When Vice President Joe Biden came to Fred Hutchinson Cancer Research Center on March 21 as part of his National Cancer Moonshot initiative’s “listening tour,” he met with a panel of experts to ask for advice on the path to cures. One of the panelists was Dr. Angelique Richard, chief nurse executive and vice president of clinical operations at Seattle Cancer Care Alliance, the treatment arm of Fred Hutch.
During the panel, Biden praised the role of nurses in the medical profession and, specifically, those who cared for his oldest son, Beau Biden, before his death from brain cancer last year at age 46. “If there are any angels in heaven, they are all nurses,” he said.
During the panel, Richard, who holds multiple degrees including a doctorate in nursing science, told Biden that one of her biggest concerns is that patients may not have access to the care they need due to geographic or economic reasons. “I have truly had too many patients and had to talk to too many families who don’t have access to this extraordinary care,” she said.
Richard took time to answer questions from Fred Hutch News Service about the moonshot and more:
Q: In your experience as an oncology nurse, what do you think the moonshot could eventually mean for patients?
A: Getting a cancer diagnosis can be devastating for a patient and the entire family. The physical, emotional and, often, financial toll is palpable. [There can be] acute suffering associated with experiencing the disease progression and in too many cases, the loss of life. Additionally, the treatments for cancer can rival the effects of the disease, sometimes rendering a patient unable to work or enjoy normal daily activities due to the treatment side effects or the time required to undergo treatment.
Families often make great sacrifices to ensure that their loved one gets the care and support that he or she needs. For many, cancer is a lifelong disease, and they face these challenges daily. I believe the moonshot has the ability to alleviate these challenges for cancer patients and families, whether through more effective treatments, better supportive care or a greater number of cures. I also feel that the social and economic burdens have the potential of being significantly reduced or eliminated by the moonshot initiative.
Q: What are some of the biggest issues you see facing cancer patients today?
A: I see significant challenges with coverage and access to specialized cancer care, treatments and clinical trials. The healthcare system can be complex and overwhelming, and often a person diagnosed with cancer requires an advocate to navigate the system in order to obtain the best care possible.
The barriers are many. One is knowledge and information – patients may not know where to get the best care for their particular diagnosis. Another is coverage of their care/insurance – determining if their care is fully covered and if it is not, determining how to pay for the treatment/medications. The financial burden can be devastating to a patient/family.
We need to establish a system that supports cancer patients and families getting clear information about their best treatment options and full access to these options regardless of coverage. Cancer patients and families should be able to focus on getting better, not on getting access or figuring out how to pay for their care.
Q: I’m sure you have seen patients struggle from the effects of chemo, radiation and recovering from surgery. If immunotherapy becomes a widely available treatment for many cancers, what would that mean for patients in terms of fewer side effects?
A: Nursing is the No. 1 trusted profession in the country, and as an oncology nurse I understand the trust and faith that patients and families place in us and all members of the healthcare team to help them survive the extremely challenging effects of cancer treatment.
Often we focus on curing cancer, without asking ourselves, at what cost? Patients need to make a personal assessment of their values and priorities before choosing their treatment plan, given the arduousness of many treatment regimes. However, there are strong indications that with immunotherapy, we will be able to more effectively treat and even possibly cure some previously intractable cancers, with significantly fewer side effects than conventional treatments. This could potentially help rebalance the calculus for some patients, who might otherwise forego potentially life-extending treatments due to serious and significant side effects.
Q: Is there a particular cancer patient you’ve met who stands out to you or who has impacted your work?
A: I started my career at 21 years old as an oncology nurse working in the bone marrow transplant unit. All of the patients/families I've had the privilege of caring for have impacted my personal and professional life: the 30-year-old mother who underwent a bone marrow transplant, even though her odds were not good, so that her children would know that she did everything she could to stay with them; and Tommy, a 16-year-old bone marrow transplant patient who set what he labeled as “small milestones” to live to— for example, getting his class ring like the rest of his classmates.
But the patient who stands out the most was my younger sister Apryl, a breast cancer survivor. She was diagnosed in August 2012 after detecting a lump in her breast, which she asked me to palpate. Apryl was in between jobs and was without healthcare insurance when she was diagnosed. I have never been more frightened, as I not only understood the physical and emotional journey that lay ahead of her and my family, but the potential financial toll. Fortunately, we were able to not only take advantage of a Susan G. Komen grant for Apryl's mammogram but also the legislation that had been passed in Illinois that covered uninsured breast cancer patients' treatment.
I often wonder about the other Apryls in the world who don't have a family member who understands the options available within the healthcare system and can navigate the healthcare system for their loved ones.
Q: What is your biggest hope for the future of cancer care?
A: The elimination of cancer and its burden on humanity is steep but I think is a reachable goal. I consider myself lucky to be able to work toward that goal every day. My hope is simple, that there will be a cure for cancer and that all patients/families who get this diagnosis will be able to benefit from it. I also hope that all cancer patients and families have someone they trust to help them understand and navigate through this journey.
Q: What do you hope that Vice President Biden took away from his visit to Fred Hutch?
A: The federal government is indispensable in the fight against cancer. One major way is through the significant funding that it provides to research. However, even if we drastically increase funding, we will still fall short of our goals if those with cancer can't access the breakthroughs this funding enables. Passage of the Affordable Care Act expanded health coverage for millions of Americans, but there are troubling signs that access to high-quality, cutting-edge cancer care is increasingly being impeded by a drive to control costs through narrow or exclusionary insurance networks.
At the same time the federal government is working to make new treatments and cures available for Americans, it needs to simultaneously ensure that all Americans have access to these treatments if needed, regardless of insurance coverage.
Linda Dahlstrom is a former Fred Hutchinson Cancer Research Center editor. Previously, she was the health editor for NBC News Digital and msnbc.com. She also worked at several newspapers during her 25-year career as a journalist covering AIDS, cancer, end-of-life issues and global health.