|
Discover the fundamental causes of health disparities in cancer, develop effective interventions to reduce these disparities, and facilitate their delivery. Collaborate through the discovery-development-delivery continuum to ensure continuous access to evidence-based and high quality cancer prevention, early detection, and treatment services for all Americans
Overcoming cancer health disparities is one of NCI's top priorities for reaching our challenge goal of eliminating suffering and death due to cancer. It is well known and documented that the burden of cancer is not borne equally by all population groups in the United States. One's gender, ethnicity, and socioeconomic status influence cancer incidence, morbidity, and mortality. For example:
- Men have about a 50 percent higher annual death rate from cancer than women.
- African Americans and Alaskan Natives experience a higher incidence of colorectal, lung, and bronchus cancers than any other ethnic group.
- The death rate from prostate cancer among African American men is approximately twice that of White men.
- Asian and Pacific Islanders, including Native Hawaiians, have a substantially higher incidence of stomach cancer than other populations.
- People living in areas of low socioeconomic status generally have higher cancer death rates than those in areas of higher socioeconomic status.
The scientific community has a critical and unique role in addressing the moral and ethical dilemmas posed by the unequal burden of cancer in our society. We must use our overall knowledge and understanding of cancer and our knowledge of the fundamental causes of health disparities to develop and deliver effective interventions to all Americans, particularly those who bear the brunt of the burden. This is an especially opportune time for NCI to commit additional resources to address cancer health disparities, in light of:
- The availability of new technologies, such as telemedicine, for bringing screening and diagnostic services to people where they live.
- The exciting potential for scientific advances in cancer prevention and treatment.
- New developments in addressing the cancer communications needs of specific communities.
top of page
From Discovery to Delivery
From Discovery to Delivery
Bridging the Gap between Discovery and Delivery to Address Disparities
Over the past several years, NCI has increased its support for research to address the gaps in the delivery of research advances to all populations regardless of their age, gender, race, ethnicity, or socioeconomic status.
NCI-supported Special Population Networks (SPNs) at 18 institutions across the country are building long-term relationships between large research institutions and community-based programs to learn more about the causes of cancer disparities in minority communities and to develop and test ways to address and eliminate these causes. The SPNs are located in institutions that serve American Indian populations in the Southwest, rural underserved populations of Appalachia, Asian and Pacific Islanders in the West, and underserved and immigrant minority groups in inner cities. The programs promote cancer awareness through culturally tailored education programs; encourage cancer screening and participation in clinical trials; and conduct community-based cancer research.
To bring new radiation-related treatments for cancer to underserved communities, NCI is providing support and resources for radiation oncology clinical research in institutions that traditionally have not been involved in NCI-sponsored research, but that care for a disproportionate number of medically underserved, low-income, and ethnic and minority populations. Supported through the Cooperative Planning Grant for Cancer Disparities Research, this initiative also has established partnerships between institutions that are new to radiation oncology clinical trials research and those experienced institutions that are actively involved in NCI-sponsored research. This support also provides for the use of telemedicine and teleconferencing systems between institutions and partners, including patient exam cameras and remote-controlled microscope capability to examine biopsy specimens, allowing for simultaneous examination and discussion. The use of telemedicine in communities such as Native American reservations can significantly improve access to care.
The Patient Navigator program, a new approach to providing individualized assistance to newly diagnosed cancer patients, is being piloted at two institutions supported through the Cooperative Planning Grant for Cancer Disparities Research. Patient navigators are trained, culturally sensitive individuals who help cancer patients manage the complexities of medical care by providing information and guidance on screening, diagnosis, and treatment options. Results of this pilot will provide NCI with a model for examining the effectiveness of promising interventions to address gaps in the delivery of cancer health services.
NCI, in collaboration with four institutes and offices within the National Institutes of Health, recently provided support to establish Centers for Population and Health Disparities. Interdisciplinary in focus, these centers provide environments conducive to collaborations among biomedical, social science, and environmental research investigators working with communities serving low-income and racially diverse populations. The centers will accelerate knowledge about social, cultural, biological, behavioral, and environmental factors that contribute to health disparities, and the development of effective interventions to reduce them.
Initiated in 1990, the Minority-Based Community Clinical Oncology Program (CCOP), continues to provide minority cancer patients with access to state-of-the-art cancer treatment, prevention, and control technology in their own communities. The current program includes 11 minority-based CCOPs and involves more than 40 hospitals and over 100 minority investigators. Greater involvement in clinical trials research by African American, Hispanic, Asian American, American Indian, and other racial and ethnic minority patients is needed to ensure that:
- Advances in clinical research are extended to all groups.
- Subsequent results can be generalized to the entire population.
NCI issued an announcement in spring 2003 to continue support for this program.
Broadening Our Understanding of the Causes of Cancer Disparities
Despite a three-fold reduction in cervical cancer mortality nationwide in the past 50 years, counties stretching from Maine southwest through Appalachia to the Texas/Mexico border, in many Southeastern states, and in the Central Valley of California have experienced persistently higher cervical cancer mortality rates. NCI assembled a think tank to synthesize research knowledge and identify core findings to provide Federal, state, and local policymakers with evidence-based recommendations to reduce these higher relative rates.
To address these high mortality rates, NCI has implemented a partnership demonstration project in eight states to increase cervical and breast cancer screening among women who have never or rarely been screened, in collaboration with the Centers for Disease Control and Prevention (CDC), the United States Department of Agriculture (USDA), and the American Cancer Society (ACS). Using NCI analyses of county mortality rates to identify high-rate counties, the partners are working together to train the following groups to use evidence-based cancer screening promotion programs to increase screening among high-risk women:
Published studies in leading medical journals show that Black patients tend not to receive the same level of treatment quality as White patients of similar socioeconomic status, insurance coverage, health status, and diagnosis. Other studies show that other race and ethnic minorities experience similar treatment disparities. The unsettling nature of these conclusions led NCI to more thoroughly explore the mounting evidence of racial bias, prejudice, and intolerance in the Nation's health care system. NCI conducted think tank meetings composed of experts from a variety of disciplines who could help shed light on a complex set of issues.
- The purpose of the first think tank was to plan an approach to understanding why patients of similar financial resources, health status, access, and other factors but of differing racial and ethnic backgrounds do not receive the same level of health care.
- A subsequent think tank addressed participants' concerns regarding the depth and complexity of the problem in science and society. This think tank examined how evolution, migration, genetics, and social history have contributed to the problems associated with race in science.
NCI supports numerous studies to identify risk factors for disease and describe racial and ethnic differences in cancer rates. For example:
The Southern Community Cohort Study (SCCS) is a landmark study that will further determine why African Americans are more likely to develop and die from cancer. A collaborative effort with public and private research-related organizations, the SCCS will examine disparities in lung, breast, colorectal, and prostate cancers by recruiting 70,000 African American and 35,000 non-African American residents in the southern United States. The association of diet and other factors contributing to gastric cancer is being studied in a 5-year, population-based case-control trial. Ethnic groups receiving special emphasis include Caucasians, Chinese, Filipinos, Hawaiians/part Hawaiians, and Japanese. A study of the causes of illness in Black women will examine multiple risk factors for cancer, cardiovascular disease, and other major illnesses. Possible risk factors to be examined include obesity, cigarette smoking, physical activity, alcohol use, diet, estrogen use, and reproductive factors. Through the NCI-supported Center for Psycho-Oncology, investigators are looking at the interrelationships among biological processes, cognition, emotion, and physical health in ethnically and culturally diverse survivors of breast cancer, prostate cancer, and AIDS-related cervical cancer.
In spring 2003, NCI and HHS announced a national campaign to reduce the risk of chronic diseases among African American men, encouraging the consumption of nine servings of fruits and vegetables a day. African American men are among the most seriously affected by diet-related chronic diseases such as cancer and have the lowest overall consumption of fruits and vegetables. The campaign includes national radio advertisements, brochures, and a new Web page for African American men (9aday.cancer.gov).
Encouraging Minority Investigator Involvement in Cancer and Cancer-Related Disparities Research
NCI continues to support opportunities to improve recruitment and retention of minority researchers in cancer and cancer-related health disparities research through a variety of programs.
top of page
Discovery
Development
Delivery
Discovery
| 2. | Expand research on the magnitude and causes of health disparities in cancer. | $19.00 M |
- Support international collaborative studies on social determinants of cancer and cancer-related disparities through supplements to NCI-supported Centers for Population Health and Health Disparities. $2.00 M
- Expand epidemiologic studies exploring racial/ethnic cancer disparities. $2.00 M
- Conduct methodological research to ensure cross-cultural equivalence in survey, epidemiological, and clinical research involving cancer risk factors. $1.00 M
- Collect risk factor and screening data for small populations defined by geographic, racial/ethnic, socioeconomic, and other characteristics. $4.00 M
- Examine the genetics of race, and develop policies that define the role of race in science, through a trans-NIH study in partnership with the National Human Genome Research Institute. $5.00 M
- Examine the national costs associated with cancer health disparities, and the cost of not treating all patients equally, by conducting a multidisciplinary study on the economics of cancer with the NIH Office of Behavioral and Social Sciences Research. $5.00 M
|
Development
| 3. | Develop effective interventions to reduce cancer health disparities. | $41.00 M |
- Establish new and strengthen current collaborative research partnerships among the Special Populations Networks (SPNs), NCI Divisions, and other federally funded research networks. $2.00 M
- Test community-based interventions leading to the reduction of disparities in cervical cancer mortality through collaborations with NCI's SPNs in Appalachia, the South, and the Texas border. $5.00 M
- Reduce cancer health disparities through community partnerships, outreach, and training by continuing support for SPNs. Recompetition of the SPNs will emphasize bridging the gap between the discovery and development continuum of research and the delivery system of medical care in minority and underserved communities. $20.00 M
- Support research on planning, development, implementation, and evaluation interventions that provide access to timely and accurate cancer information, screening, early detection, and treatment in a variety of health care service delivery sites (e.g., examine the Patient Navigation Model as an effective intervention in populations experiencing serious cancer-related health disparities). $4.00 M
- Establish a Dissemination/Diffusion Research Grants Program to:
- Study social, environmental, and behavioral barriers to the adoption of evidence-based cancer prevention and control interventions by public health officials and community clinicians.
- Test new hypotheses for reaching underserved populations in under- resourced community health settings.
- Develop, apply, and evaluate dissemination and diffusion interventions to reduce cancer health disparities. $4.00 M
- Increase the number of scientists with a focus on health disparities research by recruiting four additional minority scientists and/or physicians through the Cancer Prevention Fellowship Program. $1.00 M
- Encourage high school to graduate-level minority students to enter careers in health disparities research by expanding the Continuing Umbrella of Research Experiences Program and the Science Enrichment Program. $3.00 M
- Support efforts to improve recruitment and retention of minorities in NCI-supported clinical trial programs. $1.00.M
- Increase minority participation in clinical trials through an NCI fellowship training program for healthcare providers and through other forums. $1.00 M
|
Delivery
| 4. | Facilitate implementation of new policy, community, and clinical interventions, and evaluate their impact on health disparities. | $ 5.50 M |
- Customize cancer information materials for targeted audiences by expanding NCI's integrated low-literacy program. $1.50 M
- To address health disparities among medically underserved populations, support local and regional science/practice partnership demonstration projects, and disseminate models of success to communities with similar infrastructure barriers. $2.50 M
- To help move science into practice, expand Cancer Information Service Partnership Program resources to build new collaborations with staff from the American Cancer Society's Division of Cancer Control and the Centers for Disease Control and Prevention-funded State Health Department Comprehensive Cancer Control Program. $1.50 M
|
| Management and Support | $0.80 M |
| Total | $71.30 M |
top of page
NCI's Progress Review Group process is serving as a model for a Trans-Department of Health and Human Services (HHS) effort to address health disparities. The purpose of the Trans-HHS Cancer Health Disparities Progress Review Group (CHD PRG) is to identify new opportunities for HHS agencies to address cancer health disparities, implement new initiatives toward that end, and evaluate their progress. This effort will serve as a demonstration project for possible replication in addressing health disparities in other diseases as well.
The process is designed to:
Comprehensively define and describe issues related to cancer health disparities. Identify areas of strength, gaps, opportunities, and priorities to address cancer health disparities in research and intervention development. Facilitate the adoption and implementation of evidence-based research, policy, community programs, and clinical interventions, and evaluate their impact on specific cancer health disparities. Ensure unbiased access to standard and continuous preventive care, early detection, and treatment of cancer for every American.
A report and recommendations from the CHD PRG will be issued in early 2004 and will form the basis for HHS's future planning to reduce cancer health disparities. Go to www.chdprg.omhrc.gov for more information on this trans-HHS initiative.
top of page
|