Q&A: Mandi Pratt-Chapman, MA Discusses Health Equity at the GW Cancer Center

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Mandi Pratt-Chapman, MA, Associate Center Director for Patient-Centered Initiatives and Health Equity at the GW Cancer Center

Pratt-Chapman, a longtime veteran of GW, has been with the University since 1998 and has been in her current role since early 2016. Check out our Q&A to learn more about her work and vision for health equity at the GW Cancer Center:

What brought you to GW?

I have always been told I think too much, so naturally, an academic environment suits me well. I like to think and I like to solve problems. I was initially hired to build a cancer survivorship presence for GW in 2008, which attracted me because at the time I was spending a good deal of time advocating for children going back to school after cancer treatment who needed Individual Education Plans (IEPs). I went to a lot of meetings to talk with teachers, principals and school social workers about alternative ways of teaching childhood cancer survivors - like letting kids record lessons and listen to them while doing their homework since oral/aural pathways of learning are less affected than reading and writing for some cancer survivors.

How did you decide on a career in the cancer field?

My stepbrother had osteosarcoma when I was growing up. I remember him traveling from rural Maine to get surgery after surgery in Boston and eventually having his leg amputated. I also lost my grandmother to metastatic breast cancer when I was just out of college. I am convinced that not talking about cancer was part of the problem. I remember her having one breast removed and then another. But we never talked about it. I lost her just as I was old enough to get to know her as a real person - as an adult. So both of those experiences were really formative.

Ultimately, I ended up as a cancer researcher because my family needed me to work. In 2003, I was getting a PhD in English Literature. A family member was diagnosed with a brain tumor and did not survive surgery. This required some financial adjustments to take care of my family which prevented me from completing my PhD. I sought a job helping children with serious illness at the National Institutes of Health, and then I did community outreach work for the Leukemia & Lymphoma Society. I’m a very non-traditional researcher since I really learned what I know experientially. I now have the benefit of nearing completion of my PhD in Translational Health Sciences. It would have been great to be trained before becoming a researcher, but I have done a lot of things in my life backward. That’s just how life works sometimes. And I am happy about what I do and extremely lucky to work with a phenomenally talented staff.

What inspires you most about your work?

I am truly driven by a commitment to saving lives. I strongly believe that people unnecessarily die each day, because we do not apply what we discover in science to benefit more people. My personal mission is to make evidence-based cancer control strategies available to as many people as possible as quickly as possible. I have a specific passion for improving the health of lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI) communities, since we have been targeted by alcohol and tobacco companies and face ongoing discrimination by just living our lives. But that really means that I’m committed to improving the health of everyone since LGBTQI people come from every race, ethnicity, religion, geography and nationality.

You are currently pursuing a PhD in translational health sciences. How has that experience informed your research and/or professional priorities?

​​Translational research historically meant moving basic science findings into clinical practice. Translational research today also encompasses implementation of system changes, dissemination of research via adult-learning methods and implementation of population science to public health practice. A translational health science perspective acknowledges the complexity of health systems as well as the internal and external factors that influence how, when and if evidence is implemented into practice. ​This perspective does not assume linearity and challenges the randomized controlled trial as a gold standard. My specific focus is on expanding training to reduce implicit bias on both sides of the patient-provider dyad as well as expansion of cervical screening coverage to clinic non-attenders through HPV self-testing.

You talk a lot about health equity, and it's even in your job title - can you explain what health equity is and why it's so important to cancer care?

I do not believe that quality in health care can truly exist without a core commitment to equity. Cancer does not discriminate. No one deserves to get cancer. But the systems we create as human beings do discriminate. Everyday, people choose risky behaviors to try to cope with social stigma, family rejection, and poverty. People who worry about how they will be received in the health care system - like many LGBTQI people - avoid health care until they are facing a serious threat to their lives. This is also true of racial and ethnic minorities and immigrants who may worry about the intentions of doctors and researchers given a history of abuse in research.

A really influential book for me was The Immortal Life of Henrietta Lacks. I met Henrietta’s grandchildren at an event at GW several years ago. They gave away the biography of their grandmother, and I read it. Henrietta Lacks was an impoverished black woman diagnosed with extremely aggressive cervical cancer. Her cancer cells were collected without her knowledge or consent. Her cells, named HeLa cells, were the first human cells successfully cloned. These cells were the foundation of the field of virology and were used to develop the first polio vaccine, to develop treatments for AIDS and to identify human papilloma virus as a cause for cancer. The irony is that Henrietta’s cells were used to develop treatments for people who could afford them which did not include her or her family. And her family did not receive any remuneration for her contribution to science while researchers created careers from her cells. We do not live and work in an ethical system when those who have contributed most to generalizable knowledge are provided with the least. This is why I do the work that I do and why I will continue to do the work that I do.

Health care should not be a commodity - it should be a right. And what is discovered by science-in my view-should not be patented, but made available to the public. It makes no sense to me why we ask people to participate in research and then-through our restrictions on health insurance coverage--withhold health care advances made possible by science from the very communities that made scientific progress possible.

What is a current project or work you are excited about and why?

A project I'm extremely excited about is our new TEAM education intervention. This hybrid training brings together multi-disciplinary teams to implement patient-centered system changes across the country. Some of the changes that these teams plan to implement include training to oncology providers on the needs of sexual and gender minority cancer patients, improving cancer screening for immigrants and refugees and improving data sharing to identify outcome disparities in breast cancer care. These are projects that can make a real difference in 24 settings across the U.S.

Last year you co-authored a commentary on international cancer control in conjunction with World Cancer Day. Do you think we've made progress on increasing access to care and health equity in the year since that piece was written? Where do you think there are still gaps?

​The challenges in access to care and health equity are daunting, and change is slow. Telemedicine co-learning opportunities, like Project Echo, offer immediate ways to expand workforce capacity to address health equity challenges. However, a sincere and long-term commitment to collaboration, stewardship, transparency and the infusion of health equity into all research and quality of care goals will be needed to make health equity a reality someday.

What can the average person do to reduce the burden of cancer in their community?

First, I will say that cancer is not entirely avoidable. No one who is diagnosed with cancer should feel any sort of blame. There is never a guarantee of avoiding cancer for anyone no matter what they do. But if all of us refused to consume tobacco, exercised more and ate more vegetables, fruit and lean protein, we would have less cancer as a population. We also have huge opportunities to avoid cancer by rejecting the idea that tanning is beautiful. Sun exposure and tanning beds cause serious forms of cancer that can be avoided through reduced exposure to ultraviolet light. We also have a huge opportunity to reduce cervical and anal cancer by making sure very boy and girl is vaccinated against high-risk strains for human papilloma virus (HPV). HPV causes the vast majority of cervical and anal cancer as well as some cancers of the vagina, vulva, penis, rectum and oropharynx (head and neck). Changes to population health happen through individual choices - we all have the power to make healthier choices and encourage those we love to do the same.

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