Tackling Cancer Care Disparities in the Community
The theme of this issue of the NCI Cancer Bulletin is cancer health disparities, in conjunction with NCI's Cancer Health Disparities Summit 2007 held last week.
The summit convened a transdisciplinary cadre of more than 700 cancer health disparities investigators, health care providers, community partners, program managers, project staff, and civic leaders from across the country. NCI grantees from such programs as the Community Networks Program and the Patient Navigation Research Program were at the forefront of the 3-day event, discussing collaborations and partnerships, communications and bioinformatics, community engagement, managing and sustaining programs, and training and education.
Cancer health disparities continue to be a tremendous public health challenge. A recent study, led by the American Cancer Society, found that people who are without health insurance or on Medicaid are far more likely to be diagnosed with advanced cancer than those with private insurance. Another study, which documented the underuse of surgery to treat early-stage pancreatic cancer, found that African American patients were far less likely to be offered surgery and more likely to refuse surgery.
Both studies highlight the complex economic, social, educational, and cultural factors that contribute to cancer care disparities - and reinforce the importance of identifying the most effective ways to address this unacceptable deficit in cancer care and outcomes.
A key part of the mission of the recently launched NCI Community Cancer Centers Program (NCCCP) is to research new and enhanced ways to assist, educate, and better treat the needs of underserved populations. The 16 participating sites - community hospital-based cancer centers that already offer a combination of medical, surgical, and radiation oncology care - must use 40 percent of the NCCCP funds they receive from NCI for disparities-related activities.
The cornerstones of these activities are expanded outreach and patient navigation, with the aim of allowing us to better study how to improve access to care and bring the latest scientific advances to all patients.
Expanded outreach will focus on improving primary and secondary prevention, including programs for smoking cessation, mammography, and colorectal cancer screening. Partnerships between NCCCP sites and community-based health and civic organizations will ensure the widest possible reach to at-risk populations.
Expanded prevention and screening programs can only be effective if there is a process in place to get care to those who need it. That is why NCCCP sites must ensure that people who are screened through their programs will receive necessary treatment. This reinforces the need for strong patient navigator systems, so that those who have abnormal findings during a screening and are diagnosed with cancer have the tools available to ensure they gain timely access to quality oncology care. This pilot program will improve our ability to identify barriers to treatment and follow-up and lead to the best models for effectively moving patients from diagnosis to treatment to posttreatment care.
One of the NCCCP pilot's most important goals is to seek broad-based and sustainable models that include public/private partnerships to address the unmet health care needs of their communities. If we are going to make significant progress toward reducing cancer care disparities, public institutions, private industry, and community-based organizations must work together to bring state-of-the-art cancer care to all patients, not just a privileged few.
Dr. John E. Niederhuber