Five Questions With: Sanjay Mishra

SANJAY MISHRA, research program manager at the Lifespan Cancer Institute, received the Eric and Wendy Schmidt Award for Excellence in Science Communications from the National Academies of Science, Engineering and Medicine in partnership with Schmidt Futures for his research. / COURTESY LIFESPAN CORP.

Sanjay Mishra, research program manager at the Lifespan Cancer Institute, recently received the Eric and Wendy Schmidt Award for Excellence in Science Communications from the National Academies of Science, Engineering and Medicine in partnership with Schmidt Futures.

The National Academies gave out 24 Eric and Wendy Schmidt Awards this year, including nine for science communication by research scientists, nine for science journalists and six for science communicators. Mishra was honored in the Research Scientist: Early Career category.

PBN: Your research has focused on understanding the effect of COVID-19 on those with cancer, what have your discoveries shown so far?

MISHRA: When the COVID-19 pandemic began, oncologists suspected that various effects of the pandemic – not just the infection but also COVID-19 treatments and the disruption to health care – could disproportionately affect patients with ongoing or previous cancers. But there was very little data or experience at that time.

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In March 2020, I began working with national clinical informatics leaders such as Dr. Jeremy Warner and researchers from more than 120 participating institutions to establish a global COVID-19 and Cancer Consortium, or CCC19. Our first study in the prestigious British journal The Lancet, published in June 2020, showed that hydroxychloroquine treatment for COVID-19 was actually very dangerous to patients with cancer.

Our subsequent research has shown that patients with cancer and COVID-19 need to be monitored for thromboembolism, especially if they were recently treated with systemic anticancer drugs. We found that convalescent plasma as treatment against COVID-19 can potentially save lives of patients with hematologic cancers. Our research has also shown that three or more doses of COVID-19 vaccines are needed for patients with cancer for protection.

Isaac Newton said that we see further afar by standing on the shoulders of giants. It is the work of over 600 collaborators that has advanced our collective understanding about the effect of COVID-19 on patients with cancer. We have accomplished much but still have work to do. Our preliminary studies show that continuing research to understand the factors that drive long COVID in patients with cancer are needed. In particular, we need to understand whether longer-term cancer-specific outcomes could be affected following COVID.

PBN: What racial inequalities in health care access and outcomes have you found through your research?

MISHRA: The CCC19 research has shown that having cancer and COVID-19 is worse for Black patients than for white patients, at least in the earlier phases of the pandemic. Not only do Black patients have higher preexisting comorbidities, such as obesity, diabetes and kidney disease; they also suffer with more moderate to severe COVID-19.

We have shown that COVID-19 outcomes differ significantly between racial and ethnic groups of women with breast cancer. But we discovered that despite presenting with worse disease, Black patients had less access to novel treatments, for example the antiviral medicine remdesivir, which was later approved by [the Food and Drug Administration] for treatment of COVID-19.

During the first six months of the pandemic, Black patients were given remdesivir about half as often as white patients, and this trend continued further into the pandemic. On the other hand, Black patients were treated more often with hydroxychloroquine than their white counterparts – a drug that, as mentioned previously, not only didn’t help but likely harmed patients with cancer.

PBN: What challenges do you perceive in addressing these inequalities?

MISHRA: The disparities in health care access and outcomes among Black and white patients are well known. Our CCC19 studies have merely highlighted some of the existing inequalities that have continued and, in some ways, worsened during COVID-19.

While our research was not designed to measure the causes, we can safely assume that already well-established challenges, such as barriers to accessing primary health care, timely screenings, insurance and affordability, and gaps in knowledge, all have been magnified during the pandemic.

PBN: How might these challenges be overcome? 

MISHRA: Our CCC19 research looking at regional variability on outcomes of COVID-19 on patients with cancer shows that patients treated in centers located in less-densely populated areas had significantly improved outcomes compared with patients treated in centers in more-densely populated areas. So, a uniform distribution of health care based on population, and health care that is accessible to everyone regardless of their economic and social status, is the first requirement of equitable health care outcomes.

Although Rhode Island is a small state, we have a lot of socioeconomic diversity, and people from all walks of life deserve to have the best outcomes possible. I spend a lot of time distilling scientific research for lay readers through my popular science writings because scientifically valid and easily understandable knowledge is a great tool against misinformation, which can kill just like diseases can.

PBN: What are some topics you hope to research further?

MISHRA: The COVID-19 and Cancer Consortium members are also interested in studying how the treatment trajectories changed over the course of the pandemic, and if the inequalities also changed, for good or worse.

As scientists, we rely on public funding. … So, whether we can continue to study the intersection of COVID-19 and cancer will depend on the availability of those funds.

Katie Castellani is a PBN staff writer. You may contact her at Castellani@PBN.com.

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