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PURPOSE: Cancer disparities persist among medically underserved populations despite widespread efforts to address them. We describe the development of a framework for addressing cancer care disparities across the cancer care continuum (CCC), guided by the CCC domains established by the Institute of Medicine/National Academies of Sciences, Engineering, and Medicine (IOM/NAS). MATERIALS AND METHODS: An environmental scan was conducted to identify strategies and associated experts who are providing or have successfully provided community- and/or patient-centric IOM/NAS-defined domain standards to our target populations. A multistakeholder expert roundtable working group was convened for framework development. A premeeting survey informed agenda development, documented expert practices for target populations, and identified priority areas for meeting focus. RESULTS: The environmental scan identified 84 unique experts across 8 stakeholder groups and 44 patient organizations; 50 were invited to the roundtable and 33 participated. They broadly represented disease sites, geography, and experience with target populations and all CCC domains. The premeeting survey (16 responses) identified coordination of care or patient navigation (66.7%), community engagement (60.0%), and healthcare system changes (53.3%) as priority focus areas. The experts identified access and treatment barriers or gaps within and between CCC domains, specified key notable practices to address these, and developed an actionable framework and recommendations for each priority focus area. CONCLUSION: The framework and recommendations are intended to guide researchers, healthcare leaders, advocates, community- and patient-focused service organizations, and policy leaders to address and promote health equity in cancer care access and treatment outcomes.

While cancer mortality is declining in the United States, significant racial, ethnic, economic and geographic inequities persist. To help address inequities in cancer treatment, care, support and research, the National Cancer Institute (NCI) instituted the community outreach and engagement (COE) mandate for NCI-designated comprehensive cancer centers (CCCs). The Bristol Myers Squibb Foundation designed a convening and listening session on COE with NCI leaders and staff gathering representatives from CCCs and the broader cancer community. This paper captures recommendations from the listening session for the NCI and CCCs to further evolve the implementation and impact of the COE mandate on cancer control and outcomes.

In recent years, the cancer research and care community has been more attuned to health equity, increasingly pursuing coordinated and comprehensive action to achieve equitable health outcomes. In addition to its support of a joint research agenda for health disparities in 2017, the National Cancer Institute (NCI) has demonstrated its commitment to addressing health inequities with its 2012 requirement for cancer centers to define and address the needs of a local "catchment area" and the 2016 mandate for Community Outreach and Engagement (COE). With several years of experience with the COE requirements, there is an opportunity to reflect on the experience to-date and identify opportunities to bolster the impact of COE on equitable cancer outcomes for the future. To do so, the Bristol Myers Squibb Foundation (BMSF) hosted a special convening and listening session in April 2019. The session agenda was cocreated by BMSF and NCI leaders and staff. It brought together 41 individuals, including representatives from the NCI Cancer Centers Program, Division of Cancer Control and Population Health and Center to Reduce Cancer Health Disparities, 22 NCI-designated, emerging or affiliated comprehensive cancer centers, and the broader cancer community. This article captures key themes from that meeting, including an overview of current COE efforts, with a deeper look at how four cancer centers are embedding health equity and COE efforts into their institutions and work, and the successes and challenges they have encountered.

Cancer continues to be the leading cause of death in Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPIs), with over one-third of the AANHPI population residing in California and Hawai’i. Due to linguistic, cultural, and sociodemographic differences, cancer prevention, control, and treatment remains a challenge. These compounded factors hinder AANHPIs from seeking care or following through with provider’s recommendations as they experience high level of dissatisfaction in care, risk of misdiagnosis or ineffective treatment plans, resulting in low levels of engagement with the healthcare system. This has called for a need to create partnerships and improve coordination between community, primary care, and specialty care. The Bristol-Myers Squibb Foundation’s Specialty Care for Vulnerable Populations initiative addresses inequities in access to and utilization of specialty care services by medically underserved and vulnerable populations in the US. The goal of this national initiative is to catalyze sustainable improvement and expansion of specialty care and health service delivery by safety net providers for people at high risk of cancer and cardiovascular disease. In response to the cancer disparities and inequities faced by AANHPI populations, the Bristol-Myers Squibb Foundation’s Specialty Care for Vulnerable Populations awarded 4 organizations $750,000 each to support 3 year health service delivery demonstration projects to improve access to quality cancer care, patient engagement, and supportive services to AANHPIs. Objectives for this session will be: • Describe the cancer disparities in Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPIs) • Explain current research and new partnerships to improve cancer outcomes and access for AANHPIs • Disseminate different models of care bolstering community, primary care, and specialty care in AANHPI cancer patients This session will delve into the cancer disparities apparent in AANHPIs and highlight the 4 AANHPI-dedicated projects to create better coordination between community, primary care, and specialty care: 1. University of California Davis Cancer Center/Health & Life Organization 2. University of California San Francisco 3. University of California Irvine Chao Family Comprehensive Cancer Center 4. University of Hawai’i John A. Burns School of Family Medicine These projects include forming new partnerships between a NCI comprehensive cancer center + FQHC-lookalike; testing an in-person and virtual patient navigation portal; utilizing a hub-and-spoke model between primary care, FQHCs, and specialty care; and bolstering telehealth capabilities to train workers in USAPI territories and Hawai’i on cancer topics and services. Citation Format: Priscilla Ko, Patricia Doykos, Moon Chen, Scarlett Lin Gomez, Neal Palafox, Sora Park Tanjasiri. Developing community-primary care-specialty care partnerships to address cancer disparities in Asian Americans, Native Hawaiians, and Pacific Islanders [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B007.

Background: Cervical cancer outcomes are influenced by race, socioeconomic status and region. African American women have the highest mortality rate from cervical cancer and Hispanic and American Indian/Alaska Native women have the highest cervical cancer incidence rates among racial/ethnic groups. Disparities in cervical cancer can be greatly improved by increasing access to and awareness of Pap screening and HPV vaccination among vulnerable populations. Safety net and community hospitals offer broader opportunities to reach at-risk individuals, however these hospitals face many challenges that mirror those of the patients they serve, including: decreased access to innovative research and treatment, decreased access to the full range of specialty care, and funding challenges. Public-Public partnerships between academic medical centers, cancer centers and private service organizations that extend to safety net and community hospitals can increase cervical cancer screening rates among individuals at greatest risk. Methods: The Loretto Hospital and Norwegian American Hospital serve communities that suffer the highest cervical cancer mortality rates in Chicago. Funded by the Bristol Myers Squibb Foundation, the University of Illinois Cancer Center partnered with these two community hospitals located on the west sides of Chicago to increase cervical cancer screening rates through clinical and community patient navigation. Evidence based methods such as small media interventions, client reminders, and one-on-one education will also be used to increase screening awareness and education. The evidence-based, implementation science program is guided by the RE-AIM framework. Reach, adoption and sustainability will be maximized through the integration of community hubs that comprise faith-, community-, school-based organizations and policy makers. Results: The project is a three year project. Now in its pre-implementation phase, the program is currently piloting data instrumentation and implementation processes. Preliminary results will be presented at the meeting. The Partnership development phase has been achieved and Full implementation will begin August 2019. Conclusion: It is expected that building partnerships between large academic medical centers, cancer centers and community hospitals will increase the capacity of community hospitals to offer quality screening and specialized care to community members and increase access to cervical cancer screening and education among at-risk populations ultimately decreasing cervical cancer disparities among underserved populations in the University of Illinois Cancer Center catchment. Citation Format: Vida Henderson, Jessica Madrigal, Jeanette Gonzalez, Erica Martinez, Katherine Tossas-Milligan, Patricia Doykos, Karriem Watson, Robert Winn. Building sustainable partnerships between cancer centers and safety net community hospitals to increase access to and quality of cancer care [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A128.

Rising income inequality and pessimism about the current and future status of race relations in the United States make this both a challenging time for the pursuit of health equity and also an important opportunity for action. We glean lessons from past and ongoing philanthropic investments in health equity and recommend approaches that can guide future work by foundations. Improving health equity is a complex process that must take into account a variety of factors that affect health, of which access to high-quality health care is just one element. Accordingly, improving health equity will require the combined forces of philanthropy, the public sector, and sectors that have not traditionally been identified with health.

In 2000, 1.4 million children were living with HIV/AIDS in sub-Saharan Africa, according to the Joint United Nations Programme on HIV/AIDS. Few of them were receiving lifesaving antiretroviral therapy because public health systems lacked the clinical infrastructure and trained health care workers to implement and disseminate high-quality care. Research has shown that without treatment, half of HIV-infected infants die by age two. From 2000 to 2011 the Bristol-Myers Squibb Foundation worked with the Baylor International Pediatric AIDS Initiative, governments in sub-Saharan Africa, and other funders to help ensure that children received needed treatment and care. The partnership led to the creation of seven Children's Clinical Centers for Excellence and the Pediatric AIDS Corps of physicians. The mortality rate for the 13,154 children receiving antiretroviral therapy at the centers was 3.35 deaths per 100 patient-years, which compares favorably with results of similar programs in Africa. The experience showed that strategic investments by foundations and others can have a positive impact on health service delivery and the training of health professionals to meet the specific needs of HIV-infected children for the short and long terms.

Research studies show that 30% of cancer patients experience significant disease-related psychosocial distress, which is often under-recognized and undertreated. To satisfy the need for increased capacity to deliver accessible, affordable, community-based psychosocial counseling for cancer patients and their families, the Bristol-Myers Squibb Foundation developed the Individual Cancer Assistance Network (ICAN) demonstration project. Results of a 3-phase evaluation in diverse community settings in Florida show that ICAN effectively provided "cancer sensitivity"; training for social workers preparing them to deliver short-term individualized psychosocial counseling, on a sliding fee scale, to cancer patients and their families, and to market it effectively to oncologists and the community.

Antiretroviral therapy (ART) for HIV/AIDS in developing countries has been rapidly scaled up through directed public and private resources. Data on the efficacy of ART in developing countries are limited, as are operational research studies to determine the effect of selected nonmedical supportive care services on health outcomes in patients receiving ART. We report here on an investigation of the delivery of medical care combined with community-based supportive services for patients with HIV/AIDS in four resource-limited settings in sub-Saharan Africa, carried out between 2005 and 2007. The clinical and health-related quality of life (HRQOL) efficacy of ART combined with community support services was studied in a cohort of 377 HIV-infected patients followed for 18 months, in community-based clinics through patient interviews, clinical evaluations, and questionnaires. Patients exposed to community-based supportive services experienced a more rapid and greater overall increase in CD4 cell counts than unexposed patients. They also had higher levels of adherence, attributed primarily to exposure to home-based care services. In addition, patients receiving home-based care and/or food support services showed greater improvements in selected health-related QOL indicators. This report discusses the feasibility of effective ART in a large number of patients in resource-limited settings and the added value of concomitant community-based supportive care services.