Advisory Committee Members participating in the teleconference:
Andrew von Eschenbach, M.D., Director, National Cancer Institute (Chair)
Frederick R. Appelbaum, M.D., Fred Hutchinson Cancer Research Center (Board of Scientific Advisors)
LaSalle D. Leffall, Jr., M.D., Howard University School of Medicine (President's Cancer Panel)
Barbara LeStage, American Cancer Society (Chair, Director's Consumer Liaison Group)
Michael B. Kastan, M.D., Saint Jude Children's Hospital
Thomas J. Kelly, M.D., Ph.D., Sloan-Kettering Institute
John Niederhuber, M.D., University of Wisconsin (National Cancer Advisory Board)

Ex Officio Members present:
Paulette Gray, Ph.D., Acting Director, Division of Extramural Activities, National Cancer Institute

Executive Secretary:
Cherie Nichols, M.B.A., Director, Office of Science Planning and Assessment, National Cancer Institute

Trans-HHS Cancer Health Disparities Progress Review Group Leadership and Members:
Moon Chen, Ph.D., PRG Co-Chair, University of California, Davis
Diana Lopez, Ph.D., PRG Co-Chair, University of Miami
Yvonne Maddox, Ph.D., PRG Executive Director, National Institute of Child Health and Human Development, National Institutes of Health
Harold Freeman, M.D., Center to Reduce Cancer Health Disparities, National Cancer Institute
Nathan Stinson, Jr., Ph.D., M.D., M.P.H., Office of the Secretary/Office of Minority Health, (HHS)

Trans-HHS Cancer Health Disparities Progress Review Group Federal Steering Committee Member:
Walter W. Williams, M.D., Associate Director for Minority Health at the Centers for Disease Control and Prevention (CDC)

NCI Staff
Jon Kerner, Ph.D., Deputy Director for Research Dissemination and Diffusion, National Cancer Institute
Mary Leveck, Ph.D., Office of Science Planning and Assessment, National Cancer Institute
Anna Levy, M.S., Office of Science Planning and Assessment, National Cancer Institute
Kathie Reed, M.S., Office of Science Planning and Assessment, National Cancer Institute
Lisa Stevens, Ph.D., Office of Science Planning and Assessment, National Cancer Institute

Others on the call:
Dorie Hightower, NCI Press Office
James Alexander, NCI Press Office
Catherine Kappel Hall, Ph. D., and Sabina Robinson, Ph. D., Science Applications International Corporation
Kerri McGowan Lowrey, J.D., M.P.H., NOVA Research Company (science writer)

The purpose of this teleconference was to present to the Advisory Committee to the Director (ACD), for its discussion and acceptance, the draft report of the Trans-HHS Cancer Health Disparities Progress Review Group (PRG). The ACD must formally accept the report to enable NCI to present it to the Secretary of HHS for subsequent implementation.

Dr. Andrew von Eschenbach thanked members of the ACD for their time and attention to the report and thanked members of the PRG for their significant effort in preparing the report. This is one of the most significant initiatives that the group will have the opportunity to present to HHS for implementation. Although this initiative has been supported by the National Cancer Institute (NCI), it is intended to be global and expansive in its impact.

Ms. Cherie Nichols reminded the group of the purpose of the teleconference and noted that members of the ACD were provided with a read ahead presentation package with notes to explain the features of the report.

Dr. Maddox presented a brief overview of the purpose and contents of the PRG report. The significance of the report is apparent because of the compelling evidence of disparities in the nation's cancer burden. Closing the gap in health disparities is a top priority of the President and the Department of Health and Human Services (HHS). The report was an effort to provide solutions for suspected causes of health disparities that have been supported by research in recent years. The report is unique in that it was initiated by-and developed in partnership with-the entity to which its recommendations are being directed: HHS. In addition, this examination of cancer health disparities can serve as a model for all health disparities. The PRG was able to obtain the assistance of leaders in the field in developing the report and solicited comments through PRG and progress mapping mechanisms. The PRG received 465 suggestions, which were consolidated into 114 areas in which to eliminate cancer health disparities. Through a roundtable workshop, these 114 areas were further consolidated to 29 recommendations and then to 14 final recommendations that fit within the purview of HHS agency missions. An HHS-wide Federal Steering Committee was also involved in the process, providing a valuable resource to the PRG. Therefore, the 14 priority recommendations contained in the report are the result of a consensus process.

The PRG felt that it was important to develop these recommendations under a "call to action"-having a defined timeframe and system for organization. The recommendations were organized using the discovery-to-delivery continuum. Due to the need for coordination, three recommendations were packaged under the Planning and Coordination category. Four recommendations are in the Discovery category; two are in Development; and five are in Delivery. The PRG also associated reasonable timeframes for initiation of the recommendations-to encourage implementation.

Drs. Diana Lopez and Maddox delivered a brief overview of and reasons for the 14 priority recommendations.

1. Conduct program and budget reviews of all relevant HHS programs for the purpose of shifting and realigning support, where possible, to culturally competent evidence-based programs that are effective in addressing cancer health disparities. (Planning and Coordination: for initiation within one year)
2. Assemble a Federal Leadership Council on Cancer Health Disparities led by the HHS Secretary in partnership with the Secretaries of other appropriate Federal departments to mobilize available resources in a comprehensive national effort to eliminate cancer health disparities. (Planning and Coordination: for initiation within one year)
3. Implement, in all HHS health service and reimbursement agencies, the recommendations from the Institute of Medicine report entitled Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare. (Planning and Coordination: for initiation within three years)
4. Evaluate specific grant and contract processes to determine what additional steps are needed to enhance the cultural competence, representative composition, and methodological expertise of peer review panels for cancer health disparities research. (Discovery: for initiation within one year)
5. Establish new approaches for data collection and sharing to aid in the study of the effects of cancer and their relationship to variables such as race, ethnicity, and socioeconomic status. (Discovery: for initiation within two years)
6. Increase the proportion of HHS agency support targeted specifically to disease prevention, health promotion, evaluation, and translational research on cancer health disparities. (Discovery: for initiation within two years)
7. Establish partnerships for and support the development of sustainable community-based networks for participatory research in areas of high cancer disparities. (Discovery: for initiation within three years)
8. Develop and implement a new trans-HHS initiative to qualify high disparity geographic areas for special program designation as Communities Empowered to Eliminate Disparities. Communities would qualify for the program by submitting strategic plans to reduce specific cancer disparities for identifiable populations. (Development: for initiation within two years)
9. Develop, implement, and evaluate education and training programs designed to create a diverse and culturally competent cancer care workforce. Apply standards to certify the cultural competence of health professionals who receive Federal support. (Development: for initiation within two years)
10. Implement evidence-based tobacco control strategies, including those that create financial disincentives for tobacco consumption and those that provide social reinforcement for not smoking. (Delivery: for initiation within one year)
11. Ensure that populations at highest risk have access to age- and gender appropriate screening and follow-up services for breast, cervical, and colorectal cancer. Expand to include these services for other cancers (e.g., prostate and lung) when there is evidence that they are effective at improving survival. (Delivery: for initiation within two years)
12. Support culturally, linguistically, and literacy specific approaches for eliminating cancer health disparities. These should include evidence based "best practices," proven interventions, and outreach strategies. (Delivery: for initiation within two years)
13. Ensure that every cancer patient has access to "state of the science" care. (Delivery: for initiation within three years)
14. Collaborate with the private and voluntary health sectors to ensure that all Americans receive the full range of lifesaving information, services, and quality care from cancer prevention to screening to diagnosis to treatment. (Delivery: for initiation within three years)

By pursuing a comprehensive approach in which all HHS agencies work together and are held accountable, and in which incentives are aligned to optimize appropriateness, efficiency, and effectiveness, HHS will make cancer health disparities history. These advances should be easily translated to other diseases in which there are health disparities (e.g., cardiovascular disease).

Questions and Discussion

Dr. Michael Kastan expressed concern that this report might affect other budget priorities. For example, the recommendation that asks HHS to conduct a budget review and shift and realign support to evidence-based programs is disconcerting in the absence of some oversight. Dr. Kastan asked Dr. von Eschenbach whether this report would impact how other budget decisions are made. Dr. von Eschenbach replied that he cannot give an absolute answer because HHS would ultimately govern implementation of these recommendations; however, the spirit of the recommendations is to eliminate unnecessary duplication and foster alignment and collaboration of health disparities work across HHS agencies. Different agencies are involved in different mechanisms of funding-e.g., research versus provision of services. Dr. Maddox added that the PRG sought to identify critical areas for elimination of health disparities, not to dictate how money should be spent. The National Institutes of Health (NIH) is not the only entity that would be affected by the recommendations, and, in fact, many of the recommendations would not fall under NIH's mission at all. It is the responsibility of HHS to work with agency heads as budget processes occur to decide where to allocate money. The recommendations should not affect programs already underway. Dr. Kastan said that he was still uncomfortable with making a blanket recommendation that HHS should increase the proportion of HHS agency support; perhaps this could be worded differently such that the PRG recommends assessing the proportion of support. Dr. Maddox said that this was a reasonable request. Dr. Moon Chen noted that the proportion of support for reducing health disparities across HHS is small. In order to address higher goals, such as Healthy People 2010 and the NCI's 2015 challenge, increasing the overall proportion of support allocated to reducing health disparities will be necessary. Dr. Maddox added that the PRG report does not recommend redistribution of funding, but rather it advocates increasing the amount of money allocated to health disparities across the entire department.

Dr. von Eschenbach said that, over a year ago at a trans-HHS planning meeting, the senior leadership identified its five highest priorities. Elimination of healthcare disparities was one of these top five priorities. There are significant healthcare disparities in cancer and there are mechanisms and processes that already exist in the cancer community that facilitate the ability to develop a strategic plan and implementation plan. The HHS decided to use cancer as a model to create a process and plan that could then be used as a template to address health disparities across a variety of diseases. This report is a department initiative that will bring about systemic change. It will not be an NCI initiative, nor will the burden of its implementation be placed solely on NCI.

Ms. Nichols put the report to a vote.

The report was accepted unanimously.

Ms. Nichols thanked members of the ACD for their time and consideration. The report is available on the Cancer Health Disparities Web site (http://www.chdprg.omhrc.gov/pdf/chdprg.pdf).

The teleconference adjourned at 11:25 a.m.