Developing a Virtual Equity Hub: Adapting the Tumor Board Model for Equity in Cancer Care

Abstract

We define cancer equity as all people having as the same opportunity for cancer prevention, treatment, and survivorship care. However, marginalized populations continue to experience avoidable and unjust disparities in cancer care, access to clinical trials, and cancer survival. Racial and ethnic minorities, and individuals with low socioeconomic status, Medicaid insurance, limited health literacy, disabilities, and mental health disorders are more likely to experience delays to cancer diagnosis and less likely to receive guideline-concordant cancer care. These disparities are impacted by the social determinants of health including structural discrimination, racism, poverty, and inequities in access to healthcare and clinical trials. There is an urgent need to develop and adapt evidence-based interventions in collaboration with community partners that have potential to address the social determinants of health and build capacity for cancer care for underserved populations. We established the Virtual Equity Hub by developing a collaborative network connecting a comprehensive cancer center, academic safety net hospital, and community health centers and affiliates. The Virtual Equity Hub utilizes a virtual tumor board, an evidence-based approach that increases access to multi-specialty cancer care and oncology subspecialty expertise. We adapted the tumor board model by engaging person-centered teams of multi-disciplinary specialists across health systems, addressing the social determinants of health, and applying community-based research principles with a focus on populations with poor cancer survival. The virtual tumor board included monthly videoconferences, case discussion, sharing of expertise, and a focus on addressing barriers to care and trial participation. Specifically, we piloted virtual tumor boards for breast oncology, neuro-oncology, and individuals with cancer and serious mental illness. The Virtual Equity Hub demonstrated promise at building capacity for clinicians to care for patients with complex needs and addressing barriers to care. Research is needed to measure the impact, reach, and sustainability of virtual equity models for patients with cancer.

Breast Cancer Care Pathways for Women with Preexisting Severe Mental Disorders: Evidence of Disparities in France?

“…Similarly, the data do not provide any information on SMI symptom levels and functioning, nor on adherence to pharmacological medications—that can be particularly complicated for psychotropic drugs [ 71 ], while there may be specific challenges associated with the care of patients with unstable or untreated psychiatric disorders compared to patients with stabilized SMI [ 33 ]. In addition, while we tried to provide a comprehensive picture of cancer care pathways, our research lacks some possible elements of these trajectories including access to clinical trials [ 72 ], breaks/disruptions in planned cancer treatment [ 33 ], pain management during cancer care [ 73 ], and the occurrence of multidisciplinary team meetings, which are not currently available at the national scale. Regarding our statistical analysis, despite a small number of cases for whom three controls could not be found, unmatched cases were more socioeconomically deprived than matched cases, and our findings may therefore not be fully generalizable to the most vulnerable women with SMI.…”

Cloud platform to improve efficiency and coverage of asynchronous multidisciplinary team meetings for patients with digestive tract cancer

“…The integration of AI in radiotherapy not only autocontours the gross target volume and normal tissue but also plays a role in online adaptive radiotherapy, which saves considerable time for radiation oncologists and physicists and holds the potential for more personalized and efficient cancer care (40)(41)(42)(43). Virtual tumor boards were piloted for breast oncology and neurooncology, with an optimistic capacity for helping clinicians care for patients with complex needs and address barriers (44). Digital technology could help individuals better connect among the members of multidisciplinary teams.…”

Scoping review on the state of racial disparities literature in the treatment of neurosurgical disease: a call for action

“…Irwin et al described a virtual equity hub tumor board model encompassing a multidisciplinary team from both an academic safety net hospital and a comprehensive cancer center. 41 By combining these two teams, providers were able to provide more robust care for their patients through the comprehensive care center while understanding their complex social needs through established relationships and trust at the safety net level. 41 Although it is imperative to address how systems negatively impact the care of minority patients, we must also look inward at how our actions as surgeons contribute.…”

“…41 By combining these two teams, providers were able to provide more robust care for their patients through the comprehensive care center while understanding their complex social needs through established relationships and trust at the safety net level. 41 Although it is imperative to address how systems negatively impact the care of minority patients, we must also look inward at how our actions as surgeons contribute. Racial bias has been associated with lower satisfaction, worse communication, and undertreatment of pain for Black patients, who are often labeled as less medically adherent than their White counterparts.…”