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Health Equity Journal Highlights Pathways for More Effective Outreach and Engagement in Comprehensive Cancer Centers

Health Equity recently published two journal articles co-authored by the Center for Health Law and Policy Innovation’s Sarah Downer, highlighting key findings and recommendations on community outreach and engagement efforts of the National Cancer Institute’s Comprehensive Cancer Centers. The titles of each article and full abstracts are featured below. 

Special Convening and Listening Session on Health Equity and Community Outreach and Engagement at National Cancer Institute-Designated Comprehensive Cancer Centers
Patricia M. Doykos, Moon S. ChenJr., Karriem Watson, Vida Henderson, Monica L. Baskin, Sarah Downer, Lauren A. Smith, Neeraja Bhavaraju, Samantha Dina, and Christopher S. Lathan.Health Equity.Mar 2021.84-90.http://doi.org/10.1089/heq.2020.0155

Abstract
In recent years, the cancer research and care community has been more attuned to health equity, increasingly pursuing coordinated and comprehensive action to achieve equitable health outcomes. In addition to its support of a joint research agenda for health disparities in 2017, the National Cancer Institute (NCI) has demonstrated its commitment to addressing health inequities with its 2012 requirement for cancer centers to define and address the needs of a local ‘‘catchment area’’ and the 2016 mandate for Community Outreach and Engagement (COE). With several years of experience with the COE requirements, there is an opportunity to reflect on the experience to-date and identify opportunities to bolster the impact of COE on equitable cancer outcomes for the future. To do so, the Bristol Myers Squibb Foundation (BMSF) hosted a special convening and listening session in April 2019. The session agenda was cocreated by BMSF and NCI leaders and staff. It brought together 41 individuals, including representatives from the NCI Cancer Centers Program, Division of Cancer Control and Population Health and Center to Reduce Cancer Health Disparities, 22 NCI-designated, emerging or affiliated comprehensive cancer centers, and the broader cancer community. This article captures key themes from that meeting, including an overview of current COE efforts, with a deeper look at how four cancer centers are embedding health equity and COE efforts into their institutions and work, and the successes and challenges they have encountered.

 

Recommendations from a Dialogue on Evolving National Cancer Institute-Designated Comprehensive Cancer Center Community Outreach and Engagement Requirements: A Path Forward
Patricia M. Doykos, Moon S. ChenJr., Karriem Watson, Vida Henderson, Monica L. Baskin, Sarah Downer, Lauren A. Smith, Neeraja Bhavaraju, Samantha Dina, and Christopher S. Lathan.Health Equity.Mar 2021.76-83.http://doi.org/10.1089/heq.2020.0156

Abstract
While cancer mortality is declining in the United States, significant racial, ethnic, economic and geographic inequities persist. To help address inequities in cancer treatment, care, support and research, the National Cancer Institute (NCI) instituted the community outreach and engagement (COE) mandate for NCI-designated comprehensive cancer centers (CCCs). The Bristol Myers Squibb Foundation designed a convening and listening session on COE with NCI leaders and staff gathering representatives from CCCs and the broader cancer community. This paper captures recommendations from the listening session for the NCI and CCCs to further evolve the implementation and impact of the COE mandate on cancer control and outcomes.

While cancer mortality is declining in the United States, significant racial, ethnic, economic, and geographic inequities persist. A number of factors inside and outside of clinical care contribute to these disparities, including environmental, socioeconomic, and biologic factors, as well as historic distribution of the structural and social determinants of health (SDOH).1 The level of institutional commitment and capacity of cancer research and care organizations to effectively engage with and serve disproportionately affected and medically underserved populations have also contributed to these inequities. Yet today, with a confluence of factors, including scientific breakthroughs in cancer prevention, detection, and treatment, demographic trends toward growing racial and ethnic minority populations, growing cancer burden among these and rural populations, and reignited social justice and equity movements, mitigating these inequities has never been more critical.2,3

In recent years, the cancer research and care community has been more attuned to health equity and has pursued increasingly coordinated and comprehensive action. For example, the American Association for Cancer Research (AACR), the American Cancer Society (ACS), the American Society of Clinical Oncology (ASCO), and the National Cancer Institute (NCI) issued a joint position statement on the research agenda for health disparities in 2017.4 The Centers for Disease Control’s (CDC) National Comprehensive Cancer Control Program also cites health equity as a cross-cutting priority and highlights three areas for action: training a culturally competent workforce, promoting equitable access to resources, and using data measurement in research and surveillance to guide community-driven plans.5

The NCI has recently started to shift more fully in this direction with its 2012 Cancer Center Support Grants (CCSG) requirement for cancer centers to define and address the needs of a local “catchment area” (CA) and the 2016 mandate for Community Outreach and Engagement (COE).6 The COE mandate identifies seven areas of action for NCI-designated Comprehensive Cancer Centers (CCCs): (1) defining a CA and understanding the CA population; (2) performing research to address the needs of the CA population; (3) engaging the CA population; (4) taking action to address cancer disparities in the CA; (5) designing clinical trials to represent the diversity of the CA population; (6) translating research into policy recommendations; and (7) extending research and policy within and beyond the CA.7

While these mandates reference disparities and encourage CCC activity to address them, there remains significant opportunity to improve the effectiveness and impact of COE on cancer disparities. At a special convening in April 2019, the Bristol Myers Squibb Foundation (BMSF) hosted a dialogue between the NCI, 22 NCI-designated, emerging, and affiliated CCCs, and affiliated programs, and the broader cancer community to understand the current state of COE and identify opportunities to improve COE and cancer health equity efforts more broadly. NCI co-developed the agenda with BMSF. Presentations highlighted that early experience with COE points to several adjustments that could inform ongoing revisions to the CCSG guidelines, including a more explicit focus on developing and maintaining high quality, authentic engagement with the community, deeper understanding of the historic and current structural barriers that contribute to inequities and how to address them, and effective resourcing and evaluation of COE as a tool to improve equity. This article shares highlights of COE work across NCI CCCs and major recommendations that emerged from the meeting discussion for the NCI and for cancer centers to deepen their impact on cancer inequities.

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