New recommendations for addressing disparities in cancer care

New recommendations co-developed by Dana-Farber Cancer Institute call for a significant expansion of the National Cancer Institute (NCI) and NCI-designated Comprehensive Cancer Centers to understand the causes of inequities in cancer care and a commitment to building sustained community partnerships to reduce them.

The recommendations, published in the March issue of the journal Health Equity, are based on a 2019 "listening session" in which representatives from the NCI, comprehensive cancer centers, and the broader cancer community discussed current efforts to address disparities in cancer care and how they can be strengthened. A separate paper on that meeting appears in the March Health Equity.

Events of the past year have brought renewed attention to issues of health equity – how we think about the ways that structural racism, income disparities, and geographic location, affect the care that people receive. In recent years the NCI has moved to strengthen the requirements for comprehensive cancer centers around community outreach and engagement. The 2019 meeting was organized as a conversation between the comprehensive cancer centers and the NCI about what measures have worked in the past and how they can be made more effective in the future."

Christopher Lathan, MD, MS, MPH, faculty director for cancer care equity at Dana-Farber Cancer Institute, the senior author of the two papers

The nation's 51 Comprehensive Cancer Centers are certified by the NCI for their expertise in laboratory, clinical, and population-based research. In addition to initiating clinical trials of novel therapies, they're also required to conduct outreach and education programs and inform the public and healthcare professionals about research and treatment advances. Institutions designated as Comprehensive Cancer Centers receive grants from the NCI to support these efforts.

The 2019 meeting identified five major opportunities for the NCI and Comprehensive Cancer Centers to improve the impact of their community outreach programs:

• Adopt an explicit focus on health equality, prioritizing efforts with the greatest potential impact
• Understand and address the structural barriers to equitable cancer outcomes
• Improve access to quality care by creating lasting collaborations with community partners
• Advance legislation and government policies that support cancer control
• Evaluate the effectiveness of community outreach programs and implement improvements as needed

Within each of these categories, the meeting's participants developed specific recommendations for the NCI as well as individual Comprehensive Cancer Centers. Examples include:

• Support research into the drivers of cancer disparities and encourage investment in community-scale outreach efforts
• Increase funding for community outreach efforts in NCI "core" grants to cancer centers
• Shift from a narrow focus on clinical trial recruitment to a longer-term focus on addressing the challenges that interfere with trial participation
• Establish long-term partnerships with trusted community organizations to build understanding of local communities and connect patients with resources.
• Educate policymakers on gaps in care that result from lack of coverage or enrollment in health plans that do not comply with the Affordable Care Act benefit requirements
• Include community members in the development of community outreach studies to ensure accurate representation and analysis

One of the major concerns voiced at the 2019 meeting was that while comprehensive cancer center investigators "do excellent research into the social determinations of health, the traditional scope of research grants hasn't supported the kind of long-term engagement in the community that makes a lasting difference," Lathan remarked. "We need to find ways to better align our research with the community's needs – to build relationships that have durable results for people in the community."

The recommendations set forth in the new paper will provide an agenda for those efforts going forward, he continued. "Health equity research needs to be more than descriptive – more than identifying problems – but has to involve the people who will benefit from it and engage them in building programs that work."