TY - JOUR
T1 - Measuring and addressing health equity
T2 - an assessment of cancer center designation requirements
AU - Semprini, Jason T.
AU - Biddell, Caitlin B.
AU - Eberth, Jan M.
AU - Charlton, Mary E.
AU - Nash, Sarah H.
AU - Yeager, Katherine A.
AU - Evans, Donoria
AU - Madhivanan, Purnima
AU - Brandt, Heather M.
AU - Askelson, Natoshia M.
AU - Seaman, Aaron T.
AU - Zahnd, Whitney E.
N1 - Funding Information:
The study was supported by National Institute of Dental and Craniofacial Research (Grant No. 1F31DE032250-01 to Jason T. Semprini); National Cancer Institute (Grant Nos. T32-CA-116339 to Caitlin B. Biddell; R01CA254628 to Mary E. Charlton); Centers for Disease Control and Prevention (Grant Nos. U48 DP006399; U48 DP006377; U48 DP006396; U48 DP006413; U48 DP006389; U48 DP006400; U48 DP006401; U48 DP006398 to Jan M. Eberth, Katherine A. Yeager, Purnima Madhivanan, Natoshia M. Askelson); National Cancer Institute, United States (Grant No. P30CA086862 to Mary E. Charlton); U.S. Department of Health and Human Services (Grant No. HHSN261201800012I to Sarah H. Nash); and Heather M. Brandt was supported by American Lebanese and Syrian Associated Charities (ALSAC) of St. Jude Children’s Research Hospital.
Funding Information:
This paper was published as part of a supplement sponsored by the Cancer Prevention and Control Research Network (CPCRN), a thematic network of the Prevention Research Center Program and supported by the Centers for Disease Control and Prevention (CDC). Work on this paper was funded in part by the Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion of the Centers for Disease Control and Prevention, U.S. Department of Health and Human Services (HHS) under Cooperative Agreement Numbers [U48 DP006399; U48 DP006377; U48 DP006396; U48 DP006413; U48 DP006389; U48 DP006400; U48 DP006401; U48 DP006398]. The findings and conclusions in this article are those of the authors and do not necessarily represent the official views of, nor an endorsement, by CDC/HHS, or the U.S. Government.
Publisher Copyright:
© 2023, The Author(s).
PY - 2023
Y1 - 2023
N2 - Purpose: By requiring specific measures, cancer endorsements (e.g., accreditations, designations, certifications) promote high-quality cancer care. While 'quality' is the defining feature, less is known about how these endorsements consider equity. Given the inequities in access to high-quality cancer care, we assessed the extent to which equity structures, processes, and outcomes were required for cancer center endorsements. Methods: We performed a content analysis of medical oncology, radiation oncology, surgical oncology, and research hospital endorsements from the American Society of Clinical Oncology (ASCO), American Society of Radiation Oncology (ASTRO), American College of Surgeons Commission on Cancer (CoC), and the National Cancer Institute (NCI), respectively. We analyzed requirements for equity-focused content and compared how each endorsing body included equity as a requirement along three axes: structures, processes, and outcomes. Results: ASCO guidelines centered on processes assessing financial, health literacy, and psychosocial barriers to care. ASTRO guidelines related to language needs and processes to address financial barriers. CoC equity-related guidelines focused on processes addressing financial and psychosocial concerns of survivors, and hospital-identified barriers to care. NCI guidelines considered equity related to cancer disparities research, inclusion of diverse groups in outreach and clinical trials, and diversification of investigators. None of the guidelines explicitly required measures of equitable care delivery or outcomes beyond clinical trial enrollment. Conclusion: Overall, equity requirements were limited. Leveraging the influence and infrastructure of cancer quality endorsements could enhance progress toward achieving cancer care equity. We recommend that endorsing organizations 1) require cancer centers to implement processes for measuring and tracking health equity outcomes and 2) engage diverse community stakeholders to develop strategies for addressing discrimination.
AB - Purpose: By requiring specific measures, cancer endorsements (e.g., accreditations, designations, certifications) promote high-quality cancer care. While 'quality' is the defining feature, less is known about how these endorsements consider equity. Given the inequities in access to high-quality cancer care, we assessed the extent to which equity structures, processes, and outcomes were required for cancer center endorsements. Methods: We performed a content analysis of medical oncology, radiation oncology, surgical oncology, and research hospital endorsements from the American Society of Clinical Oncology (ASCO), American Society of Radiation Oncology (ASTRO), American College of Surgeons Commission on Cancer (CoC), and the National Cancer Institute (NCI), respectively. We analyzed requirements for equity-focused content and compared how each endorsing body included equity as a requirement along three axes: structures, processes, and outcomes. Results: ASCO guidelines centered on processes assessing financial, health literacy, and psychosocial barriers to care. ASTRO guidelines related to language needs and processes to address financial barriers. CoC equity-related guidelines focused on processes addressing financial and psychosocial concerns of survivors, and hospital-identified barriers to care. NCI guidelines considered equity related to cancer disparities research, inclusion of diverse groups in outreach and clinical trials, and diversification of investigators. None of the guidelines explicitly required measures of equitable care delivery or outcomes beyond clinical trial enrollment. Conclusion: Overall, equity requirements were limited. Leveraging the influence and infrastructure of cancer quality endorsements could enhance progress toward achieving cancer care equity. We recommend that endorsing organizations 1) require cancer centers to implement processes for measuring and tracking health equity outcomes and 2) engage diverse community stakeholders to develop strategies for addressing discrimination.
KW - Cancer centers
KW - Diversity
KW - Equity
KW - Quality
KW - Treatment
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U2 - 10.1007/s10552-023-01680-4
DO - 10.1007/s10552-023-01680-4
M3 - Article
AN - SCOPUS:85150388451
SN - 0957-5243
JO - Cancer Causes and Control
JF - Cancer Causes and Control
ER -