Background Vast differences in barriers to care exist among Asian American, Native Hawaiian, and Pacific Islander (AANHPI) groups and may manifest as disparities in stage at presentation and access to treatment. Thus, we characterized AANHPI patients with stage 0–IV colon cancer and examined differences in (1) stage at presentation and (2) time to surgery relative to white patients. Patients and Methods We assessed all patients in the National Cancer Database (NCDB) with stage 0–IV colon cancer from 2004 to 2016 who identified as white, Chinese, Japanese, Filipino, Native Hawaiian, Korean, Vietnamese, Laotian, Hmong, Kampuchean, Thai, Asian Indian or Pakistani, and Pacific Islander. Multivariable ordinal logistic regression defined adjusted odds ratios (AORs), with 95% confidence intervals (CI), of (1) patients presenting with advanced stage colon cancer and (2) patients with stage 0–III colon cancer receiving surgery at ≥ 60 days versus 30–59 days versus < 30 days postdiagnosis, adjusting for sociodemographic/clinical factors. Results Among 694,876 patients, Japanese [AOR 1.08 (95% CI 1.01–1.15), p < 0.05], Filipino [AOR 1.17 (95% CI 1.09–1.25), p < 0.001], Korean [AOR 1.09 (95% CI 1.01–1.18), p < 0.05], Laotian [AOR 1.51 (95% CI 1.17–1.95), p < 0.01], Kampuchean [AOR 1.33 (95% CI 1.04–1.70), p < 0.01], Thai [AOR 1.60 (95% CI 1.22–2.10), p = 0.001], and Pacific Islander [AOR 1.41 (95% CI 1.20–1.67), p < 0.001] patients were more likely to present with more advanced colon cancer compared with white patients. Chinese [AOR 1.27 (95% CI 1.17–1.38), p < 0.001], Japanese [AOR 1.23 (95% CI 1.10–1.37], p < 0.001], Filipino [AOR 1.36 (95% CI 1.22–1.52), p < 0.001], Korean [AOR 1.16 (95% CI 1.02–1.32), p < 0.05], and Vietnamese [AOR 1.55 (95% CI 1.36–1.77), p < 0.001] patients were more likely to experience greater time to surgery than white patients. Disparities persisted when comparing among AANHPI subgroups. Conclusions Our findings reveal key disparities in stage at presentation and time to surgery by race/ethnicity among AANHPI subgroups. Heterogeneity upon disaggregation underscores the importance of examining and addressing access barriers and clinical disparities. Supplementary Information The online version contains supplementary material available at 10.1245/s10434-023-13339-0.

The Oncology Care Model (OCM), launched in 2016 by the Centers for Medicare and Medicaid Services (CMS), was the first demonstration of value-based payment in oncology. While the OCM delivered mixed results in terms of quality of care and total episode costs, the model had no significant impact on remediating racial, ethnic, and socioeconomic disparities among beneficiaries. These deficits have been prominent in other aspects of US healthcare, and as a result, the Institute for Healthcare Improvement (IHI) has advocated for stakeholders to leverage improvement science, an applied science that focuses on implementing rapid cycles for change, to identify and overcome barriers to health equity. With the announcement of the new Enhancing Oncology Model (EOM), a continuation of the OCM’s efforts in introducing value to cancer care for episodes surrounding chemotherapy administration, both policymakers and providers must apply tenets of improvement science and make eliminating disparities in alternative payment models (APMs) a forefront objective. In this commentary, we discuss previous inequities in APMs, the role that improvement science plays in addressing healthcare disparities, and steps that stakeholders can take to maximize equitable outcomes in the EOM.

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P rimary care has been at the forefront of health care transformation over the past several decades. In traditional primary care models, primary care physicians (PCPs) provide basic preventive, curative, and rehabilitative health services to their patients in offices, nursing homes, and hospitals. 1 In a bid to contain the cost of health care, the role of PCPs is increasingly being shared with physician assistants, nurse practitioners, and other health care professionals who collectively work to deliver holistic care. 2 However, these primary care teams typically operate in clinics inaccessible to underprivileged individuals due to distance and financial barriers, thereby compounding disparities in the uptake of health services and outcomes. 3 More recently, nontraditional direct-to-consumer primary care models are emerging to make primary care accessible within communities via digital health, home health, outpatient specialty clinics, retail clinics, pharmacies, patientcentered medical homes, and ambulatory intensive care units. 4 Despite early evidence from these communitycentric health care pilots, they struggle to scale due to a paucity of health care resources. 5 Given that paramedics and emergency medical technicians (EMTs) possess medical knowledge to shoulder a wide scope of emergencies and safety and disaster crises, they can be integrated in these pilots to improve primary care access for patients. 6 Paramedics and EMTs can enable these new health care models

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In addition to the ethical imperative to combat epistemic injustice in cancer research, work from differently resourced settings may shed light on questions of implementation and access. This piece discusses several recent randomized controlled trials whose findings advance not only clinical science but also the implementation of care. One trial demonstrates the efficacy of dose‐reduced immunotherapy and another demonstrates the utility of oral chemotherapy, respectively tackling issues of cost and ease of access. This commentary explores the implications of these and similar studies in light of financial, geographic, and social barriers to access experienced by many people with cancer in low‐ and middle‐income countries, proposes actionable next steps to improve epistemic equity in cancer research, and calls for patient‐centric implementation in clinical trial design.