Download Development of an Integrated Approach to Cancer Disparities: One

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Commentary
Development of an Integrated Approach to Cancer
Disparities: One Cancer Center’s Experience
Karen M. Emmons,2 Karen Burns White,1 and Edward J. Benz3
1
Dana-Farber/Harvard Cancer Center, 2Harvard School of Public Health,
and 3Harvard Medical School, Boston, Massachusetts
The National Cancer Institute’s (NCI) Cancer Centers
Program has provided a critical infrastructure for
discovery related to the causes, prevention, and treatment of cancer. This program spends more than $200
million annually to fund 39 comprehensive cancer
centers in 24 states. The substantial resources provided
to cancer centers throughout the country provides the
NCI with a significant opportunity to influence key
areas of need. For example, the cancer center guidelines
have been used to increase the emphasis on translational
research which has the potential to affect patient care, to
increase interdisciplinary research and inclusion of
population approaches to cancer prevention and early
detection, to standardize quality control and safety
protections for clinical trials, and to promote cooperation among centers. The guidelines also ensure that all
cancer centers continuously focus on accrual to clinical
trials and take steps to increase population representativeness among clinical trial participants. Although the
guidelines do not explicitly require cancer centers to
address disparities, the increasing recognition of persistent cancer disparities as an urgent problem requiring
extensive and systematic effort has led to increased
scrutiny of the way in which cancer centers use their
significant resources related to addressing disparities
(1). A recent Institute of Medicine (2) review of the
NIH’s role in identifying solutions to persistent disparities highlights the importance of leveraging existing
resources and structures that have a potential to make
an impact. An emphasis on the role of cancer centers in
addressing cancer disparities beyond minority accrual to
trials is much needed, given that cancer disparities
among low income groups and some racial/ethnic
minority groups are unrelenting and, to date, intractable. In responding to this challenge, cancer centers
must determine how to use limited resources in a time
of flat funding and shrinking budgets. The DanaFarber/Harvard Cancer Center (DF/HCC) has restructured flexible resources to provide an integrated
Cancer Epidemiol Biomarkers Prev 2007;16(11):2186 – 92
Received 3/7/07; revised 7/17/07; accepted 8/29/07.
Grant support: P30 CA06516 and U01 CA114644 from the National Cancer Institute,
and U48 DP000064 from the National Cancer Institute and the Centers for Disease
Control and Prevention.
Requests for reprints: Karen M. Emmons, Center for Community-Based Research,
Harvard School of Public Health and Dana-Farber Cancer Institute,
44 Binney Street, Boston, MA 02115. Phone: 617-632-2188; Fax: 617-632-5690.
E-mail: [email protected]
Copyright D 2007 American Association for Cancer Research.
doi:10.1158/1055-9965.EPI-07-0211
structure within the cancer center related to disparities,
and to create incentives for investigators to refocus on
disparities. We offer this commentary to describe this
approach, which may be useful to others. This is still a
work in progress—our success will only be measured
over time by our ultimate effect over time on cancer
disparities in the communities we serve.
An earlier NCI review of the cancer center had been
critical of the low rate of accrual of minority patients to
clinical trials and the Center’s limited emphasis on
cancer disparities. Although there were researchers in
the Harvard system who focused on disparities, they did
not necessarily focus their work on cancer, and were
largely uninvolved in the cancer center. Furthermore,
virtually all of the limited efforts in cancer disparities
resided in discipline-based programs (e.g., population
science). There was little likelihood that the situation
would improve without a deliberate and strategic
emphasis on disparities. The leadership recognized both
the challenge and opportunity of this situation, and set
about to create an emphasis on cancer disparities that
would permeate all aspects of the cancer center’s
functioning. This was particularly challenging given that
the DF/HCC includes seven separate institutions, all of
whom had their own strategies for addressing disparities. These forces led to the creation of the Initiative to
Eliminate Cancer Disparities (IECD), a comprehensive,
integrated, Center-wide initiative designed to lower the
existing barriers that were impeding the study of factors
contributing to, and solutions for, cancer disparities. A
primary goal of the IECD is to transform the way DF/
HCC member institutions work together on cancer
disparities, in part by creating an intentional focus on
cancer issues within communities of color. The Initiative
was designed by first examining the structural barriers
both within the cancer center and in the broader research
community related to addressing disparities. Such
barriers included disciplinary and funding silos that
have largely relegated research in disparities to population sciences, lack of mechanisms for ensuring the
faculty’s cultural competency, having a very limited
number of minority faculty, and a perception among
some basic and clinical scientists that cancer disparities
were not relevant to them. We identified strategies to
address each of these barriers, and have also identified
and tried to take advantage of factors at the federal level
that could facilitate our efforts (see Table 1).
We believe it is critical in such an effort to engage the
cancer center membership fully, including researchers in
areas that typically do not consider disparities within
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Table 1. Structural barriers and strategies used to address them
Structural barriers
Factors facilitating
adoption at federal level
Disciplinary silos
NIH emphasis
on transdisciplinary
science
Funding silos
Perceived lack
of relevance
NIH and other federal
agencies emphasize
the importance of
research on disparities
National focus
on disparities
NCI attention
to minority
accrual to trials
Limited expertise
in cancer disparities
across DF/HCC
programs
Need cultural competency
training mechanism for
clinical research faculty
Limited numbers
of minority faculty
Minority
supplement
mechanism
Strategies used within DF/HCC
Cost considerations
DF/HCC nodal point structure requires
emphasis on interdisciplinary and
transdisciplinary research
None
DF/HCC leadership structure expanded
to integrate a focus on disparities in all
decision-making processes, via appointment
of an Associate Director of the IECD,
who reports to the Cancer Center Director
15% FTE of
senior faculty
Heavily publicize federal funding
opportunities focus on disparities,
and provide mentoring related
to application development
None; uses existing
communication
mechanisms
Use cancer center pilot research
mechanism to stimulate disparities
Nine pilot projects
funded focused on
disparities (out of
30 total awards)
Set disparities research as a priority
for fund-raising/development efforts
None
Prominent national speakers provide
keynote addresses on disparities
None; funded with
existing mechanisms
Thought-leaders within basic and
clinical science programs engaged
in considering ways their work
could address disparities
None
Identify potential added value of initiative
to disease programs (e.g., provide assistance
with increasing diversity of applicants
on training grants; expand faculty
recruitment opportunities with minority
faculty hiring supplement
None
Develop more relevant algorithms
for assessing progress
None
Conduct internal pilot projects to determine
opportunities for improving accrual
Some staffing costs
Identify disparities researchers and engage
them in cancer-related outcomes
None
Identify and engage basic and clinical
scientists targeting topics related to
disparities (e.g., genetic factors and
potential treatment targets related to
high breast cancer mortality in young
African-American women)
None
Established cultural competency training
initiative for clinical research faculty
Subcontract with local
cultural competency
expert to offer initial
didactic program and
to develop a cancerrelevant e-tool
Opportunities to use NIH minority
supplement mechanisms identified
None
Minority faculty recruitment supplements
$100,000 per faculty
position; one position
allocated per year from
development resources
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The DF/HCC Initiative to Eliminate Cancer Disparities
their domain (e.g., basic scientists). It is clear that the
causes of cancer disparities are multifactorial, and that
effective solutions will require involvement from a range
of disciplines. For example, there are well-documented
disparities in lung cancer morbidity and mortality
among African-Americans. It is clear that lung cancer
has specific behavioral risk factors that require the
development of effective behavioral interventions (e.g.,
smoking prevention and cessation). However, there may
be important genetic factors at play in determining both
smoking cessation and lung cancer treatment outcomes
(3-9). Health care services research also plays an
important role, with recent studies showing that hospital
factors are associated with disparate lung cancer outcomes for African-Americans (10, 11). There is increasing
information across a range of disease areas showing the
potential role of cell regulation and gene-environment
interactions across a range of cancers. We have sought to
use data such as this to emphasize to all cancer center
members the potential role they could play in our efforts
to reduce cancer disparities.
Initiative to Eliminate Cancer Disparities: Key
Components
There are five key strategies that we have used to
develop the IECD including (a) stimulating research in
cancer disparities; (b) developing new metrics for
evaluating minority accrual to trials; (c) development of
a cultural competency training program for cancer center
members; (d) identifying a coordinated set of outreach
activities; and (e) student training and recruitment/
retention of minority faculty. A summary of the activities
within each of these strategies, and benchmarks developed to judge our progress, is provided in Table 2.
Development of a Research Program in Cancer
Disparities. We have stimulated research in disparities
by creating a research program-in-development focused
on cancer disparities, bringing in a leader of that program
who is an expert in disparities but is relatively new to
cancer, and identifying a co-leader with cancer expertise.
Although it has been tempting to push this program to
fully deemed status quickly, it has been given time to
mature. Three years following its initiation, it is now in the
process of going to full status in a position of considerable
strength. Applications for NCI and Centers for Disease
Control and Prevention mechanisms designed to address
disparities have helped us to build an infrastructure
for this work (e.g., NCI-funded Community Network
Program grant and U56; Centers for Disease Control and
Prevention/NCI-funded Cancer Prevention and Control
Research Network). This program has 51 affiliated cancer
center members, a research portfolio of $16.7 million, and
active collaborations with four disease programs.
We have also extensively used our Developmental
Funds to seed pilot research projects in disparities.
Available mechanisms include annual competitive solicitations for large pilot projects ($75,000/y for 2 years) and
on-going availability of smaller developmental opportunities for new and innovative ideas ($10,000). Both types
of awards have been used for stimulating collaborations
in disparities. This has also been an important mechanism to help our junior minority investigators establish
their research programs, thus increasing their competi-
tiveness for federal funding. We have funded nine pilot
projects focused on disparities (total cost, $930,000). To
date, approximately half of these pilots have led to
extramural funding. We have also used pilot monies
available through other funding mechanisms (e.g., U56,
Community Network Program, Cancer Prevention and
Control Research Network) to stimulate disparities
research within the Center (12 additional pilots funded).
Effective engagement of the disease programs is
critical to the long-term success of our disparities
research efforts. As one example, we have collaborated
with leaders of the Gastrointestinal Cancer Specialized
Programs of Research Excellence to develop a research
program focused on vitamin D as a potential mechanism
in colorectal cancer disparities. This collaboration provided an opportunity for the Gastrointestinal Cancer
program investigators to access a population-based
cohort of 1,500 low income, racial and ethnic minority
adults that had been part of a community-based
colorectal cancer screening study. There was great value
added for the Gastrointestinal Cancer investigators in
this collaboration because it provided a significant
economy of scale by allowing work with an existing
cohort that had been recruited and characterized.
Through the process of developing the application, we
were able to increase the disease program leaders’
knowledge of and interest in disparities. Furthermore,
we recently added a prostate cancer component to the
vitamin D work, as proposed by one of our minority
junior faculty members and his fellow. This component
was funded by the DF/HCC developmental monies.
Development of New Metrics for Evaluating Clinical
Trials Accrual. The 2004 Cancer Center Support Grant
guidelines requires Centers to account for minority
patient accrual to therapeutic trials to determine whether
accrual figures are proportional to the cancer patient
population in the Cancer Center’s primary catchment
area. However, our Center, like most others, had historically compared our accrual against the overall minority
population, rather than against the subpopulation of
minority group members who had developed cancer.
There had been no effort to determine the racial/ethnic
minority representation of the local cancer patient
population, and thus it was impossible to accurately
judge our success in this area. By using data from The
Massachusetts Community Health Information Profile
database, which is maintained by the state Department of
Public Health and Tumor Registry data, we could
determine the representation of different racial and ethnic
minority groups among all cancer patients diagnosed in
our catchment area. Furthermore, we could identify the
hospitals at which those patients received their treatment,
and therefore, we could characterize much more specifically the effectiveness of our participation in cancer care
delivery for patients of color. We further stratified these
analyses by cancer site. Thus, in addition to tracking the
rate of accrual to trials among minority and non – minority
patients, we could identify the percentage of minority
cancer patients in our catchment area that are on trial. This
is a much more relevant figure than overall accrual rates.
Our goal is to provide on-going feedback to disease
program leaders in order to engage them in efforts to
improve accrual rates and to increase their program’s
interest in disparities research.
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Table 2. IECD components and benchmarks used to assess progress
IECD Component
Establish robust
research program in
cancer disparities
Benchmark
Status
Articulate disparities
research agenda
Completed; 51 cancer center members
affiliated with program
Engage leaders of two
to three disease programs
Have actively engaged gastrointestinal,
gynecologic, lung, and breast
programs; other efforts under way
Assist investigators who are
developing grants in disparities
Program leadership has mentored
investigators submitting more than
20 grant applications
Use DF/HCC developmental
funds to seed disparities research
Nine pilot grants on disparities funded
to date through DF/HCC; 12 pilots
funded leveraging other resources
(two additional under review)
Establish junior faculty seminar series
focused on research in cancer disparities
Monthly seminars for 2 y; attract
15 to 20 participants regularly
Increase disparities-focused
extramural funding
Identifying opportunities to embed
cancer disparities into disease-based
programs. Create new research theme
in gene expression with explicit focus
on health disparities
Develop new metrics
for evaluating minority
accrual to trials
Metrics developed representing
accrual relative to the Boston
minority cancer patient population
Completed
Develop a cultural
competency training program
for cancer center members
Conduct a didactic cultural
competency program
Completed initial program; annual
activities in all care-giving institutions
Implement and evaluate a cancer-relevant
cultural competency e-learning tool
Initial pilot with faculty completed; pilot
and evaluation with fellows under way
Establish a Community Engagement
Committee across all seven
DF/HCC institutions
Has met monthly for 6 y; draws
on Community Benefits resources
of each institution
Develop strategic partnerships with key
community groups related to cancer and
clinical trials education
Faith-based initiative under way
Faith-based cancer education toolkit
developed and being implemented in
participating churches
Identify a coordinated
set of outreach activities
Annual emphasis on National Minority
Cancer Awareness Week
Student training
Recruitment/retention
of minority faculty
Develop a patient navigator network
to provide support and share resources
across navigators in the DF/HCC
care-giving institutions
Patient navigator network developed
and meeting quarterly for 3 y
Develop robust training mechanism
CURE program in place for 6 y
Develop tracking system
for present/past student progress
Completed
At least 70% of CURE students will
pursue further education/careers
in science and cancer
More than 90% of CURE
students are meeting this goal
Secure funding for minority
postdoctoral fellowships
Completed; funding in place for 3 y;
from shared institutional funds
Establish mechanism and funding for
minority faculty recruitment supplements
Completed; four awarded during the
first 5 y; anticipating five additional
positions in current funding cycle
Develop mechanism to collect
data and regularly report on race/ethnicity
of DF/HCC faculty
Completed
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Implementation and Evaluation of a Cultural Competency Training Program. The goal of the emerging
field of cultural competence in health care is to improve
the providers’ ability to understand, communicate with,
and care for patients from diverse backgrounds. Following a needs assessment, we determined that an explicit
effort in cultural competency was needed, and thus, contracted with a local expert to develop a cultural competency training curriculum consisting of group sessions in
the context of regular program meetings. We contracted
with Quality Interactions, an e-learning tool for crosscultural care, to add cancer cases to this tool, which
expanded its appropriateness for our membership. We
conducted a pilot of the tool with selected disease programs, and are now rolling it out on a broader basis. An
evaluation plan has been developed in order to determine
the effect of the program on patient-related outcomes.
Identify a Coordinated Set of Outreach Activities.
Recognizing the importance and role of the community,
we have prioritized building linkages with the community
and creating a community voice within the cancer center.
Our initial aim was to bring together the cancer-related
resources and activities of the seven individual institutional
offices charged with addressing disparities and/or community relations. Our approach to engaging the community is 3-fold: (a) increase community access to research
through clinical trials education; (b) implement and
support innovative programs that will reduce the barriers
to care; and (c) develop a mechanism that will provide a
standing forum to solicit the viewpoints of the community.
Our clinical trials education efforts included producing
an educational video and brochure, which has received
numerous awards. The video is distributed to all patients
considering enrollment in a clinical trial. In addition, we
are actively partnering with two community coalitions to
provide clinical trials education across the city of Boston.
The Center must fill another central role in the
development of community-based initiatives to reduce
barriers to care, i.e., the implementation of support
programs. We conduct a number of activities to inform
the community about research and resources available
within the Center, including Public Health Grand Rounds
at community health centers, special events in recognition
of National Minority Cancer Awareness Week, and
community health fairs. We have a partnership with the
faith-based community, and regularly participate in
meetings of the ministerial leaders and in health events
sponsored by the various churches. With our faith-based
partners, we have developed a toolkit that includes a
number of ‘‘plug and play’’ resources (e.g., bulletin
inserts, informational materials, material to support
health-oriented sermons and health ministries, and
resource material). We are also connecting the health
ministries to cancer screening resources (e.g., our mobile
mammography van), and leveraging other resources
within the DF/HCC institutions. For each of our activities,
we develop a community-based advisory board to ensure
that community needs and perspectives are considered.
Train the Next Generation of Cancer Researchers,
and Recruit and Retain Minority Faculty
Our training efforts target postdoctoral fellows, as well as
high school juniors and seniors and undergraduate
students with demonstrated aptitude in the sciences.
The centerpiece of our training effort for the latter group is
a Continuing Umbrella of Research Experiences (CURE)
supplement to our cancer center grant. The program has
two tracks, (a) a 2-year program, and (b) a summer-only
internship. Both opportunities include an intensive
9-week summer experience. Two-year students continue
in a part-time capacity during the academic year. Based
on their areas of research interest, students are paired with
appropriate DF/HCC faculty mentors for a full-time,
hands-on research experience. Students attend scientific
research seminars, journal review sessions, and prepare
an article on their research. They are also encouraged and
supported to present at scientific meetings/science fairs
and to participate in opportunities for publications.
Although based on interest, most students are placed in
basic science research environments, some of the participants also gain experience in clinical and population
sciences. Several of our CURE students have gone on to
work in their mentors’ laboratories following graduation,
which has positioned them quite competitively for
graduate and medical school.
Many of our faculty have predoctoral and postdoctoral
training grants, and having access to a cadre of outstanding minority students who are receiving mentoring
in career development has been of great interest to them.
We are currently developing better linkages between our
student training programs and our postdoctoral training
programs. To date, 90% of our CURE students have
continued their education in science upon completion of
our program. Ninety percent of the high school students
have gone on to science-focused undergraduate majors,
and 84% of the college students are either working in
the science field or pursuing advanced degrees. As noted
in a recent National Academies report, there is little
national data available on the success of these programs
to benchmark our success against (12). Our internal
benchmarks are for 70% of students to continue their
work and/or education in science.
We also actively participate in local efforts to improve
science education and training for minority students.
Through a U56 cancer center/minority-serving institution
partnership grant, we work with our minority-serving
institution partner, the University of MassachusettsBoston, to develop their minority training programs.
Increasing the rigor of scientific training of their minority
students will have a direct effect on DF/HCC’s opportunities for training and hiring minority students
interested in cancer. This partnership has played an
instrumental role in the University of MassachusettsBoston’s applications for three major grant programs
targeting training of minority students that have recently
been funded (‘‘Bridges to Baccalaureate’’, ‘‘Graduate
Assistance in Areas of National Need’’, and ‘‘Urban
Massachusetts Louis Stokes Alliance for Minority Participation Project’’; total costs: $3,546,426).
At the postdoctoral level, we have partnered with the
Harvard School of Public Health to support candidates
interested in cancer research through the Yerby Postdoctoral Fellowship Program. The Yerby Program is a bridge
between academic training in health-related disciplines
and entry-level faculty positions in public health,
particularly for trainees from under-represented backgrounds. The Program engages fellows in extensive
professional development opportunities, with a strong
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emphasis on the development of research and teaching
skills. We support up to two Yerby fellows per year in
the cancer center. To date, we have funded three students
on this mechanism, and the two that have completed
their training are now junior faculty at strong institutions. Current efforts are focused on increasing the rate at
which these fellows are retained within the Harvard
system. We also support the recruitment efforts of DF/
HCC training grants by providing resources to develop
and implement minority recruitment plans through the
monitoring of DF/HCC-wide success, and development
of center-wide strategies when needed.
To diversify our faculty, we have actively used cancer
center resources for the recruitment of minority faculty.
Developmental funds are used to provide supplements
of $100,000 on a competitive basis to institutional
recruitment packages for searches in which minority
faculty are identified as leading candidates. In our
previous funding cycle, four very strong researchers
from under-represented minority backgrounds were
recruited on this mechanism. We are currently evaluating the effect of this strategy, but anticipate extending the
use of developmental resources for minority faculty
recruitment in the current funding period.
We have also conducted a number of activities related
to the career development of our minority faculty, trainees, and those interested in cancer disparities. We initiated
a seminar series for junior researchers interested in
disparities to come together to meet senior faculty, learn
about research resources, obtain feedback on research in
progress, and forge new collaborations. The series is organized by one of our minority post-docs, which provides an
excellent leadership opportunity. In partnership with the
Office for Diversity and Community Partnership at
Harvard Medical School, we sponsor an Annual Junior
Investigators’ Health Disparities Research Poster Session,
which provides an opportunity to showcase our trainees’
and junior faculty’s research in disparities. This event
typically includes a talk by a very high-profile national
leader, which draws significant numbers of faculty and
encourages active interactions with poster presenters.
Finally, across all levels, we engage in significant
mentoring activities. All minority faculty hired under the
DF/HCC supplemental mechanism have an identified
mentor and twice-yearly evaluations of progress and the
quality of the mentoring relationship. We particularly
focus on providing junior faculty and postdoctoral
fellows from under-represented backgrounds opportunities to become involved in article preparation and grantwriting. This is a highly effective strategy, which,
although involving significant time from the IECD
leadership, has great potential for long-term pay-off.
Some of our senior faculty have obtained K05 grants,
which has provided important support to enable high
levels of engagement in mentoring. In the past year, the
leadership has provided active mentoring related to more
than 20 grant applications, including K-awards, R03s,
R01s, and U56 pilot projects. A large percentage of these
have been funded or have received competitive scores.
Organizational Structure
The IECD operates through a subcommittee structure,
which is supported by Senior Leadership and Adminis-
tration. It is led by the Associate Director of the IECD, a
full Professor who serves as a voting member on the
senior leadership group for the DF/HCC. Having a seat
on the leadership team insures that key issues related to
cancer disparities are addressed in all DF/HCC activities
and budgetary decisions. Furthermore, it provides an
opportunity to consider each program’s efforts related to
disparities during program review, and to consider the
potential effects on disparities when new requests for
funding with DF/HCC resources are made. The IECD is
co-led by a Deputy Associate Director, a senior administrator with substantial community-based experience.
Together, the IECD leadership staffs subcommittees,
engages in substantial outreach across the cancer center
membership and to the local communities, and oversees
collaborative endeavors and student training. Each of the
key components of the IECD is led by a senior leader
within the cancer center, representing basic, clinical, and
population sciences. These leaders have significant
institutional knowledge, as well as influence within the
cancer center and their own institutions. This has been a
very effective strategy for securing high-level support of
the Initiative.
Evaluation of Impact
We have two primary strategies for evaluating the effects
of the IECD over the long-term. First, the DF/HCC
leadership supports an External Advisory Board (EAB)
for this effort, separate from the overall DF/HCC EAB.
We felt that having an EAB specific to the IECD was
critical in order to have the initiatives guided by investigators with more extensive expertise in disparities, and
to have a more extensive review of each IECD component.
The primary responsibility of the IECD’s EAB is to
provide recommendations to the leadership for establishing priorities and identifying new areas of opportunity for
the initiative. The report from the IECD EAB is provided
to the DF/HCC’s overall leadership, and is included as
part of the annual report to the overall cancer center EAB.
Second, within each of the key components of the
initiative, we have identified benchmarks that serve
as metrics for evaluating progress within that area (see
Table 2). These are reviewed on a regular basis, and
corrective action is taken when needed. We are making
significant progress towards meeting our benchmarks.
Our research program is small but thriving, and is in the
process of going to full program status. It will be critical
that in the next phase of its development, we continue to
seek out ways to keep our members fully engaged, and to
extend our interactions with additional disease programs
that represent areas of persistent disparities. We have
successfully developed a new metric for evaluating our
clinical trials accrual. It is somewhat complex to evaluate
these data on an annual basis because we are dependent
on sources outside of the cancer center for the benchmarking data. The ultimate test of this strategy will be
whether we can use this data to address changes in
accrual patterns on an on-going basis. Our cultural
competency training program has been moving more
slowly than we would like, in part because of the
difficulties with developing a meaningful evaluation plan
that will affect not only changes in our knowledge, but
also on changes in our practice. We have recently engaged
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a cultural competency and quality of care expert as a
member of our team, which should greatly facilitate our
movement in this area. Our Community Engagement
Committee has developed a strong relationship with a
large faith-based network and, with their significant
input, has developed resources to support this effort.
The challenge for this committee is to fully engage the
community in a lasting, meaningful way with very
limited staffing resources. We believe that provision of
materials that can be used by well-established community
channels and providing technical assistance on an ongoing basis will be an effective strategy. Our student
training program is robust and thriving. We are not far
enough out yet to fully know the effects, but early
indicators suggest that we will meet or exceed our longterm goals. Although minority faculty recruitment is a top
priority, our progress here has been slower than hoped.
Our mechanism for providing supplements does not
always synch well with the timing of recruitments, and
the cancer center is not an appointment-granting body—
this is a function of the seven individual institutions.
Although substantial resources have been allocated to
this strategy ($400,000 in the previous funding cycle;
$500,000 in the current cycle), it is clear that hiring one
minority faculty member per year will not make an
impact in the context of a 900-member cancer center. We
are committed to this approach as one step towards
stimulating progress and emphasizing the commitment
of cancer center leadership, but are currently developing
other strategies to stimulate more progress in this area.
Summary
Recognizing the need to address the complex problems
associated with cancer disparities, the DF/HCC leadership has made a commitment of considerable faculty,
staff, and financial resources to tackling this issue. Senior
faculty participation in this effort has been generous,
with long-term commitments of time and effort. The
IECD was developed as a comprehensive, integrated,
Center-wide initiative to bring the intellectual and
organizational resources of the Center to bear on the
persistent problem of cancer disparities, and to heighten
the awareness of these problems throughout the leadership structure. In this regard, the IECD is emerging as
both a centralized research activity and a major resource
of the Center. The ultimate goal is to contribute
significantly to the elimination of racial, ethnic, and
socioeconomic disparities in both prevention and treatment of cancer. This is still a work in progress—its
success will only be measured in time by its effect on
cancer disparities in the communities we serve.
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Cancer Epidemiol Biomarkers Prev 2007;16(11). November 2007
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Development of an Integrated Approach to Cancer
Disparities: One Cancer Center's Experience
Karen M. Emmons, Karen Burns White and Edward J. Benz
Cancer Epidemiol Biomarkers Prev 2007;16:2186-2192.
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