In Brief
2002 Budget Request
Scientific Priorities for Cancer Research
Infrastructure Needed for Cancer Research
Planning Disease-Specific Research
How We Work
Other Ways to Get This Information
Cancer Information for Patients and Health Professionals
|
|
Infrastructure Needed for Cancer Research: NCI's Challenge
Reducing Cancer-Related Health Disparities
Goal
Challenge
Progress Toward Meeting the Challenge
2002 Plan and Budget Request
Links to Related Information
Goal
Understand the causes of cancer health disparities and develop effective interventions to reduce them.
Challenge
The unequal burden of disease in our society is a challenge to science and a
moral and ethical dilemma for our nation. Cancer is no exception.
Components of the Challenge:
The Disparate Burden of Cancer
Research Needed in Health Disparities
Research to Application for Reducing Health Disparities
The Disparate Burden of Cancer
Despite progress in biomedical science over the past several decades that has increased longevity
and improved quality of life for many Americans, the burden of disease is not borne
equally by all population groups in the United States. For example:
- The death rate from prostate cancer among African American men is almost twice that of white men.
- Stomach cancer mortality is substantially
higher among Asian-Pacific Islanders, including Native Hawaiians, than other populations.
- Cervical cancer incidence in Hispanic women has been consistently higher at all ages than
for other women, and African American women have the highest death rate from cervical cancer.
- Persons of low socioeconomic status have higher death rates for most cancers than
persons of higher socioeconomic status.
- Overall, men are about 50 percent more likely than women to die from cancer.
- Among all women, Alaskan Natives are about 30 percent more likely to die from cancer.
Disease always occurs within a context of human life circumstances.
- Social position, economic status, culture, and environment are critical determinants of
who is born healthy, who grows up healthy, who sustains health throughout his or her life span,
who survives disease, and who maintains a good quality of life after diagnosis and treatment.
- In particular, social injustice has to a large extent created the health disparities that
currently exist in the United States.
Research Needed in Health Disparities
The elements that influence health disparities are complex, and their interactions are largely unknown. While health disparities have been framed historically in the context of racial and ethnic disease differences, racial and ethnic classifications have always been socially and politically determined with no basis in biological science. The power of scientific discovery must be used to elucidate the meaning and effect of the human circumstances in which differential disease burdens occur.
The National Cancer Institute (NCI) is strongly committed to a research program that will address
cancer health disparities across the cancer control continuum from prevention to end of life care,
consistent with recommendations in the Institute of Medicine's report,
The Unequal Burden of Cancer and reflected in the Healthy People 2010 goal to eliminate racial and ethnic health disparities.
NCI has developed and will pursue a research framework that builds upon the growing evidence that socioeconomic, cultural, health care provider, institutional, and environmental factors contribute substantially to cancer-related health disparities.
- If we are to reduce these disparities, the relative importance of social causes to their development and their relation to factors that result in unequal access to high quality cancer diagnosis and treatment must be explained. To do this, we must increase fundamental research into:
- The social causes of health disparities
- The psychosocial factors that mediate them
- The biologic pathways that can explain their impact
- The relative importance of different determinants also can be expected to vary depending on where in the disease process a disparity occurs. The key questions are:
- How can we best measure and monitor cancer-related health disparities across the spectrum of cancer incidence, stage of disease at diagnosis, disease recurrence, quality of life, and cancer mortality?
- What is the extent to which prevention, early detection, treatment, and communication interventions can effectively reduce cancer-related health disparities?
Research to Application for Reducing Health Disparities
There is a critical disconnect between scientific discovery and cancer care delivery in our national effort against cancer.
This disconnect is itself a key determinant of the unequal burden
of cancer in our society. Barriers that prevent the benefits of research from reaching all populations, particularly those who bear the greatest disease burden, must be identified and removed. In response to this challenge, NCI will:
- Develop new intergovernmental and public/private partnerships to improve the dissemination and diffusion of evidence-based interventions.
- Encourage the development of health care policies for underserved communities.
Note: All of NCI's efforts to explain cancer-related health disparities are closely related to our initiatives to improve the quality of care for people with cancer and those at risk for the disease.
(For a discussion of our progress in quality of care research and interventions, see the
discussion of NCI's Challenge on the Quality of Cancer Care.)
Learn More About:
Progress Toward Meeting the Challenge
NCI has established a variety of infrastructures and initiatives to improve understanding of
disparities and develop strategies and interventions to overcome them. These activities
provide a firm foundation from which to expand and intensify our efforts.
Example areas of progress:
Center to Reduce Cancer Health Disparities
Research on Health Disparities
Office of Special Populations Research
Increasing the Number of Minority Scientists
Linking Minority Patients to Clinical Trials
Role of Special Populations in Health Disparities Research
Center to Reduce Cancer Health Disparities
To direct implementation of NCI's Strategic Plan to Reduce Health Disparities and provide an
organizational locus for critical tasks in translating discovery into delivery, NCI has created a
Center to Reduce Cancer Health Disparities.
For a copy of NCI's Strategic Plan to Reduce Health Disparities,
visit http://ospr.nci.nih.gov/healthdisprpt.pdf.
Research on Health Disparities
NCI's Surveillance, Epidemiology, and End Results cancer registry program has been expanded to cover more of the racial, ethnic, and socioeconomic diversity of the United States, allowing for better
description and tracking of trends in health disparities.
Visit http://www-seer.cancer.gov.
Methodologic studies are seeking better ways to:
- Measure socioeconomic factors and determine their relationship to cancer incidence, survival, and mortality.
- Examine the environmental, sociocultural, behavioral, and genetic causes of cancer in different populations and apply these discoveries through interventions in clinical and community settings. These interventions cover topics such as tobacco control, dietary modification, and adherence to screening practices.
Recognizing the broad relevance of this research to other disease outcomes, NCI
collaborates with other Federal agencies in supporting important research initiatives, including
co-funded research with the Agency for Healthcare Research and Quality under its initiative,
"Understanding and Eliminating Minority Health Disparities."
Office of Special Populations Research
NCI's Office of Special Populations Research (OSPR) has been a focal point for leadership
and coordination on research addressing the cancer-related concerns of underserved and other
vulnerable populations. OSPR administers a variety of outreach and other programs targeting specific
special populations.
Its newest initiative is the Special Populations Networks for Cancer Awareness
Research and Training, a network of 17 institutions that will create and implement cancer
control, prevention, research, and training programs in minority and underserved communities.
Increasing the Number of Minority Scientists
The Comprehensive Minority Biomedical Program (CMBP) aims to increase the number of minority scientists in biomedical research, and enhance the careers of those already in the field.
CMBP programs include:
- The Continuing Umbrella of Research Experiences, NCI's newest training initiative for underserved minorities
- A host of other training opportunities targeting high school students through established
researchers
Increasing the representation of ethnic and minority individuals in research and clinical care is crucial to ensure that important research questions about disparities are investigated and that discoveries are
translated into community practice. (See Training, Education, and Career
Development for a more detailed description of NCI training initiatives targeting special populations.)
Linking Minority Patients to Clinical Trials
Greater participation of minority health professionals in clinical trials is
essential to our efforts to explore research questions about cancer-related health disparities.
The Minority-based Community Clinical Oncology Programs have for many years sought to address clinical research questions relevant to the disproportionate cancer burden experienced by specific populations. NCI has also established collaborations with key minority professional organizations to increase participation of physicians from
underserved populations in cancer treatment and prevention trials.
Enhancing the Role of Special Populations in Health Disparities Research
NCI's Office of Liaison Activities was established to provide a consistent point of contact with diverse consumer constituencies, to ensure that the Institute is aware of and responsive to cancer-related issues affecting specific population groups.
In addition, NCI has convened a Special Populations Working Group to bring to bear the expertise of individuals in the community on the evolving health disparities research agenda.
2002 Plan and Budget Request
Goal
Understand the causes of health disparities in cancer and develop effective interventions
aimed at reducing these disparities.
Objectives, Milestones, and Budget Request
| Objective 1 |
2002 Budget Request |
| Create a new and comprehensive plan to organize, coordinate, and monitor NCI activities in health disparities research,
education, training, and health services support. |
$2.0M |
| 2002 Milestones |
| Maintain support for the NCI Center to Reduce Cancer Health Disparities. ($1.50M) |
| Refine and implement an agenda for reducing health disparities. Identify and support
successful research activities, facilitate
dissemination, and monitor success. ($.50M) |
| Develop an integrated low literacy education program. |
| Objective 2 |
2002 Budget Request |
| Improve capacity and accelerate knowledge through fundamental cancer control and population research. |
$12.0M |
| 2002 Milestones |
| Create 4 Centers for Population Health to: (1) expand understanding of the social and
environmental causes of cancer-related health disparities and the psychosocial, behavioral, and
biological factors that mediate them, (2) develop hypotheses for cancer control research at individual,
social, institutional, and policy levels, and (3) develop, apply, evaluate, and disseminate interventions to
improve cancer outcomes and reduce outcome disparities. ($8.00M) |
| Expand ongoing epidemiologic investigations to explore racial/ethnic cancer disparities with a focus on cancers for which these disparities are greatest (e.g., breast, cervix, kidney, prostate). Conduct new methodologic studies to evaluate factors influencing recruitment and participation of
underserved populations in cancer epidemiology studies. ($4.00M) |
| Objective 3 |
2002 Budget Request |
| Expand our ability to define and monitor cancer-related health disparities. |
$9.0M |
| 2002 Milestones |
| Support 2 to 5 new Surveillance, Epidemiology, and End Results registries to improve coverage of key populations: non-Mexican Hispanics, residents of Appalachia and other rural areas (especially those of lower socioeconomic classes), rural African Americans, American Indians, and populations with high cancer mortality rates.
(See Studying Emerging Trends in Cancer Plan, Objective 1.) |
| Enhance national and regional data systems to measure disparities in cancer-related health behaviors and screening practices. Expand support for supplements to national and regional surveys to enhance data on socioeconomic and other demographic factors associated with disparate cancer outcomes.
(See Studying Emerging Trends in Cancer Plan, Objective 2.) |
| Support statistical and methodological studies to improve accuracy and reliability of
data on socioeconomic determinants of cancer rates and risk, health behaviors, and screening in
national and regional populations. Expand use of modeling and
geographic analyses to examine the unequal burden of cancer. ($9.0M) |
| Conduct national tobacco control surveys on activities that impact tobacco control, including diverse populations.
(See Tobacco and Tobacco-Related Cancers Plan, Objective 1.) |
| Objective 4 |
2002 Budget Request |
| Expand cancer control intervention research in prevention, early detection, treatment, and communications. |
$17.50M |
| 2002 Milestones |
| Fund an additional 4 to 6 Special Population Network (SPN) sites to enhance research infrastructure and training in
underserved communities. Partner with academic cancer centers to continue developing and testing
community-based, participatory cancer control interventions addressing disparities. Provide additional
funds for pilot cancer control research projects within SPNs. ($6.00M) |
| Provide supplemental funding to Transdisciplinary Tobacco Use Research Centers to study differential tobacco use and quitting patterns among underserved populations and support development of more effective interventions to
reduce the burdens associated with tobacco use. ($1.00M) |
| Expand colorectal cancer screening use and follow-up studies. Conduct new intervention research to identify and overcome sociocultural and health care system barriers to the continuing under-use of fecal occult blood testing and flexible sigmoidoscopy, and to address co-morbid illness and other barriers to
appropriate clinical follow-up of abnormal findings. ($3.0M) |
| Expand research on breast and cervical cancer screening for women who have never been screened and those who are not screened regularly. Support new intervention research to identify barriers to screening for women who underuse or never use breast and cervical screening and address sociocultural determinants in
planning, implementing, and evaluating these interventions. ($3.50M) |
| Strengthen the methodologic and empirical foundation of quality of care assessment, to improve understanding of unequal access and treatment differences compared to other broader social determinants of these cancer outcomes.
(See Quality of Cancer Care Plan, Objective 2.) |
| Provide supplements to investigators and cancer centers to expand research on disparities
in survivorship, including ethnic, cultural, socioeconomic, and institutional factors affecting the
quality and length of cancer survivorship in underserved communities and strategies to help cancer patients and their
families make the transition to extended and long-term survivorship. ($2.0M) |
| Establish formal affiliations between NCI Cancer Centers and minority-serving institutions.
(See Centers, Networks, and Consortia Plan, Objective 1.) |
| Provide up to 3 years of supplemental funding to cancer centers to stimulate disparity research, particularly those located in or near underserved communities that experience the heaviest burden of cancer. High priority areas will include
disparities in risk factor exposures and access to prevention interventions (e.g., smoking cessation, dietary change, physical activity), quality cancer care, and clinical trials. ($2.00M) |
| Objective 5 |
2002 Budget Request |
| Expand the channels for research dissemination and diffusion. |
$7.0M |
| 2002 Milestones |
| Work with the Centers for Disease Control and Prevention (CDC) and the American Cancer Society (ACS) to model and monitor the impact of research dissemination and diffusion efforts on the Department of Health and Human Services Year 2010 health promotion
objectives generally and on cancer-related health disparities in particular. ($1.80M) |
| Facilitate adoption of evidence-based cancer control interventions through: collaborative (NCI, CDC, ACS) review of cancer health disparities objectives; consensus on indices of dissemination and diffusion program impact; identification of the most useful formats for presenting intervention research evidence; annual reviews of published evidence on best practices to reduce disparities; and publishing/posting intervention evidence reviews and best practices on NCI's
Dynamic Evidence in Cancer Control Web site. ($2.20M) |
| Fund Pilot Projects to Overcome the Digital Divide.
(See Cancer Communications Plan, Objective 1.) |
| Build special education/dissemination and diffusion partnership programs to reach underserved communities, test these programs' value in reducing health disparities in underserved communities, and make successful pilot programs available for use by local, regional, and national organizations
concerned with cancer and public health. ($1.0M) |
| Provide one-year competitive supplements to investigator-initiated intervention research grants. Create a supplemental funding mechanism to develop and implement a dissemination and diffusion plan for interventions proven by the original intervention research to be
effective in reducing health disparities. ($2.0M) |
| Objective 6 |
2002 Budget Request |
| Strengthen training and education in health disparities research. |
$1.6M |
| 2002 Milestones |
| Develop a new track in the Cancer Prevention Fellowship Program to increase the number of scientists studying health disparities. Recruit 2 fellows per year to focus on health disparities research within
the Office of Special Populations Research and the Division of Cancer Control and Population Sciences. ($.50M) |
| Expand community-based, cancer control research training within underserved communities. Encourage cancer centers to partner with community organizations and health care institutions in underserved areas to apply for training grant support for community-based clinical and
cancer control research training in health disparities research. ($1.10M) |
| Expand programs to recruit, train, and sustain underserved racial and ethnic minority individuals in cancer research and provide partnership opportunities for Minority-Serving Institutions with NCI Cancer Centers.
(See Providing Training, Education, and Career Development, Objective 4.) |
Links to Related Information
|
|
