Special Convening and Listening Session on Health Equity and Community Outreach and Engagement at National Cancer Institute-Designated Comprehensive Cancer Centers

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.

Improving Equity in Cancer Care in the Face of a Public Health Emergency

“…The impact some 70+ years later is still being felt by many of those impacted communities. The Urban Renewal programs contributed greatly • Avoid fragmentation of health plans along socioeconomic lines; ensure Medicaid enrollees have access to the same health plan products as privately insured patients • Develop and support multidisciplinary treatment and preventive care teams • Enhance patient-provider communication and trust by providing incentives to practices that reduce barriers and encourage evidence-based practice • Implement patient education programs to increase patients' knowledge of how best to access care and participate in treatment decision • Support the use of community health workers 2004 Sullivan 49 • Increase diversity at all levels of the health care workforce 10 • Improving access to high-quality education improves health • Changes in nutrition, physical activity, and safety within communities can be achieved through urban planning and community development, policy interventions that focus on employment, housing quality, and housing safety affect health 2020 Alcaraz et al 13 • Efforts to eliminate discrimination and stigmatization based on race/ethnicity must be supported • More research focused on implementation of programs to reduce long-standing structural barriers is needed • Care must be taken to address the structural, economic, and social environmental factors that contribute to social injustice 2020 Chapman et al 52 • Implementation of the ATIP principles (Acknowledgement, Transparency, Intentionality, rePresentation) will assist organization, systems, and medical societies to mitigate Black marginalization and promote equity • The LEADS (Learn, Engage, Advocate, Defend, Support) approach is recommended for individuals seeking to address anti-Black racism 2021 Winkfield et al 9 • Seven core themes were outlined to reduce cancer care disparities the include community engagement, patient navigation, data collection, health equity, education and training, and access to clinical trials • Establishing community-academic partnerships will be required to develop sustainable programs 2021 Doykos et al 53 • Cancer centers need to establish formal mechanisms to regularly gather community input and share research findings with the community • To counteract historical structural inequities that increase cancer risk, more focus on primary and secondary prevention and early detection are required • Expansion of screening programs and supportive service can mitigate disparities in the quality and timeliness of cancer screening and diagnosis • Partnerships with community-based health care organizations to streamline care pathways and provide more holistic care can reduce treatment disparities to the inequity of housing of Black versus Whites, but has played a significant role in health disparities. For example, there is longstanding acknowledgement of the increased toxic exposures associated with living next to these interstates.…”

PEARL: A Guide for Developing Community-Engaging and Culturally-Sensitive Education Materials

“…In 2016, the cancer center funding renewal was updated to include community outreach and education section. The goal of this section was to align catchment area needs with scientific research being conducted in the cancer center [12]. NCI cancer centers that apply for a catchment area supplement are completing a health assessment that documents community engagement activities in their catchment, which will be used to identify and address disparities in cancer outcomes [13].…”

“…Community engagement is the process of collaborating with groups of people-affiliated by geography, special interests, or shared experiences-in the information and decision-making processes. Community engagement gives rise to more effective, appropriate, and equitable health programs and improves institutional accountability and trust [12,[14][15][16]]. Yet currently, awareness and education interventions do not represent the majority of research projects within cancer centers.…”