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

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.