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

Evolution of community outreach and engagement at National Cancer Institute-Designated Cancer Centers, an evolving journey

Cancer mortality rates have declined during the last 28 years, but that process is not equitably shared. Disparities in cancer outcomes by race, ethnicity, socioeconomic status, sexual orientation and gender identity, and geographic location persist across the cancer care continuum. Consequently, community outreach and engagement (COE) efforts within National Cancer Institute-Designated Cancer Center (NCI-DCC) catchment areas have intensified during the last 10 years as has the emphasis on COE and catchment areas in NCI's Cancer Center Support Grant applications. This review article attempts to provide a historic perspective of COE within NCI-DCCs. Improving COE has long been an important initiative for the NCI, but it was not until 2012 and 2016 that NCI-DCCs were required to define their catchment areas rigorously and to provide specific descriptions of COE interventions, respectively. NCI-DCCs had previously lacked adequate focus on the inclusion of historically marginalized patients in cancer innovation efforts. Integrating COE efforts throughout the research and operational aspects of the cancer centers, at both the patient and community levels, will expand the footprint of COE efforts within NCI-DCCs. Achieving this change requires sustained commitment by the centers to adjust their activities and improve access and outcomes for historically marginalized communities.

Association of Historical Redlining and Present-Day Social Vulnerability with Cancer Screening

BACKGROUND

The Healthy People 2030 initiative has set national cancer screening targets at 77.1%, 74.4%, and 84.3% for breast, colon, and cervical cancers, respectively. We sought to assess the association between historical redlining relative and present-day social vulnerability on screening targets for breast, colon, and cervical cancer.

STUDY DESIGN

Data on national census-tract level cancer screening prevalence and social vulnerability index in 2020 was extracted from the CDC PLACES and CDC social vulnerability index databases, respectively. Census tracts were then assigned Home-Owners Loan Corporation grades (A: "Best", B: "Still Desirable", C: "Definitely Declining," and D: "Hazardous/Redlined"). Mixed-effects logistic regression and mediation analyses were conducted to evaluate the association between Home-Owners Loan Corporation grades and achievement of cancer screening targets.

RESULT

Among 11,831 census tracts, 3,712 were classified as redlined (A: n = 842, 7.1% vs B: n = 2,314, 19.6% vs C: n = 4,963, 42.0% vs D: n = 3,712, 31.4%). Notably, 62.8% (n = 7,427), 21.2% (n = 2,511), and 27.3% (n = 3,235) of tracts met screening targets for breast, colon, and cervical cancer, respectively. After adjusting for present-day social vulnerability index and access to care metrics (population to primary care physician ratio and distance to nearest healthcare facility), redlined tracts were markedly less likely to meet breast (odds ratio [OR] 0.76, 95% CI 0.64 to 0.91), colon (OR 0.34, 95% CI 0.28 to 0.41), and cervical (OR 0.21, 95% CI 0.16 to 0.27) cancer screening targets compared with the "Best" tracts. Notably, poverty, lack of education, and limited English proficiency, among others, mediated the adverse effect of historical redlining on cancer screening.

CONCLUSIONS

Redlining as a surrogate for structural racism continues to adversely impact cancer screening. Policies that aim to make access to preventive cancer care more equitable for historically marginalized communities should be a public priority.

Current Approaches to Serving Catchment Areas in Cancer Centers: Insights from the Big Ten Cancer Research Consortium Population Science Working Group

In 2021, the NCI issued updated guidance clarifying the mission and organizational structure for Community Outreach and Engagement (COE) for Cancer Center Support Grants. These guidelines outlined how cancer centers should address the cancer burden of the catchment area (CA) and define how COE would partner with the community to inform cancer research and implement programs to reduce the cancer burden. In this paper, the Common Elements Committee of the Population Science Working Group in the Big Ten Cancer Research Consortium describes their respective approaches to implementing these guidelines. We discuss our definitions and rationales for each CA, data sources used, and our approach to assessing the impact of COE efforts on the burden of cancer in our respective CA. Importantly, we describe methods of translating unmet CA needs into our cancer-relevant outreach activities, and cancer research addressing the needs of respective CAs. Implementing these new guidelines is a challenge, and we hope that sharing approaches and experiences will foster cross-center collaborations that may more effectively reduce the burden of cancer in the US and meet the mission of the NCI's Cancer Center Program.

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

Community outreach and engagement has been a regular activity of the National Cancer Institute at its designated Cancer Centers. However, in 2016, community outreach and engagement became a required activity for all cancer centers. Yet there is a gap in the literature that provides guidelines for developing materials that resonate with communities. We developed the PEARL rubric to fulfill that gap from our work developing culturally sensitive breast cancer education materials for African American and Immigrant African women. We conducted a targeted literature review to understand the approaches that have been used for developing education materials for communities. We reviewed the literature and distilled key elements into our PEARL guide for creating culturally appropriate education materials. PEARL consists of five elements: Plain language and understandability, Explicit data, statistics, and graphs, Affirmative framing, Representative content, and Local connection. PEARL is a modern comprehensive guide that researchers can use for creating culturally sensitive materials. It is designed to guide researchers develop educational materials who have little to no experience in community engagement.

A National Map of NCI-Designated Cancer Center Catchment Areas on the 50th Anniversary of the Cancer Centers Program

BACKGROUND

In 1971, the National Cancer Act created a process to recognize the leadership, facilities, and research efforts at cancer centers throughout the United States. Toward this goal, each NCI-designated cancer center defines and describes a catchment area to which they tailor specific scientific and community engagement activities.

METHODS

The geographically defined catchment areas of 63 NCI-designated comprehensive and clinical cancer centers are collated and presented visually. In addition, the NCI-designated cancer center catchment areas are geographically linked with publicly available data sources to aggregate sociodemographic and epidemiologic characteristics across the NCI Cancer Centers Program.

RESULTS

The national map portrays the size, shape, and locations for 63 catchment areas of the 71 NCI-designated cancer centers. The findings illustrate the geographic extent of the NCI Cancer Centers Program during the 50th anniversary of the National Cancer Act.

CONCLUSIONS

NCI-designated cancer centers occupy a prominent role in the cancer control ecosystem and continue to perform research to address the burden of cancer among their local communities. The strength of the NCI Cancer Centers Program is partly defined by the scope, quality, and impact of community outreach and engagement activities in the catchment areas.

IMPACT

The collation and geographic presentation of the distinct, but complementary, NCI-designated cancer center catchment areas are intended to support future research and community outreach activities among NCI-designated cancer centers. See related commentary by Vadaparampil and Tiro, p. 952.

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

ABSTRACT

Cancer health disparities have been well documented among different populations in the United States for decades. While the cause of these disparities is multifactorial, the COVID-19 pandemic has highlighted the structural barriers to health and health care and the gaps in public health infrastructure within the United States. The most long-standing inequities are rooted in discriminatory practices, current and historical, which have excluded and disenfranchised many of the most vulnerable populations in the nation. These systemic barriers are themselves a public health crisis, resulting in increased mortality rates in communities of color from both COVID-19 and cancer. While implementing programs to temporarily improve cancer equity locally or regionally is laudable, it is imperative to develop a public health strategy focused on alleviating the root causes of health inequities to improve the health and well-being of every citizen and ensure readiness for the next public health emergency.

The Prevalence of Dissemination and Implementation Research and Training Grants at National Cancer Institute-Designated Cancer Centers

Background

Dissemination and implementation (D&I) research is a key factor in the uptake and use of evidence-based cancer control interventions. National Cancer Institute (NCI)–designated cancer centers are ideal settings in which to further D&I knowledge. The purpose of this study was to summarize the characteristics of NCI-funded D&I science grants in the nation’s cancer centers to understand the nature, extent, and opportunity for this key type of translational work.

Methods

We used the National Institutes of Health Research Portfolio Online Reporting Tool to identify active NCI-funded grants in D&I science at NCI clinical cancer centers (n = 13) and comprehensive cancer centers (n = 51) as well as their academic affiliates. Active projects were eligible for inclusion if they 1) were awarded directly to an NCI cancer center or an academic or research affiliate, and 2) identified D&I content in the abstract. Portfolio data were collected in February 2021.

Results

We identified 104 active NCI-funded D&I research or training grants across the 64 cancer centers; 57.8% of cancer centers had at least 1 NCI-funded D&I grant. Most awards (71.1%) were for research grants. Training grants constituted 29.1% of D&I-focused grants. Overall, 50.0% of grants (n = 52) concentrated on specific cancers. Almost two-thirds of grants (n = 68, 65.4%) had a stated health equity focus.

Conclusions

More than one-half of NCI-designated cancer centers have active funding in D&I science, reflecting a substantial investment by NCI. There remains considerable room for further development, which would further support NCI’s translational mission.