The AACR Call to Action
Research is driving tremendous progress against cancer, but the grim reality is that the progress has not benefited everyone equally. The adverse differences in the burden of cancer that exist among certain population groups, referred to as cancer health disparities, are among the most pressing public health challenges that we face in the United States.
In recent years, some strides have been made in combating cancer health disparities, as illustrated by narrowing of racial and ethnic disparities in the overall cancer death rate. However, progress has come too slowly, and the cost of all disparities including COVID-19 and cancer health disparities—in terms of premature deaths, lost productivity, and the impact on communities of color—remains monumental and must be addressed.
Therefore, the AACR urges policymakers and all other stakeholders committed to eliminating cancer health disparities to:
- Provide robust, sustained, and predictable funding increases for the federal agencies and programs that are tasked with reducing cancer health disparities. Increased funding for the NIH, NCI, CDC, and numerous other federal agencies is necessary to support research and federal initiatives that will allow us to close cancer health disparity gaps in the United States. This funding would stimulate research opportunities as follows:
- Further explore the role of biology and genetics in cancer health disparities. Recent scientific and technological innovations have provided a tremendous opportunity for us to better understand the biological and genetic factors that contribute to health disparities. This information has much potential for directly and indirectly reducing cancer health disparities.
- Fund additional clinical and translational longitudinal molecular profiling studies in large diverse cohorts of cancer patients, which will help us understand the natural history of cancers in racial and ethnic minority patients from both the clinical and biological standpoint.
- Build model systems, such as cell lines, organoids, and patient-derived xenograft models, from racial and ethnically diverse patients that can be shared and distributed to the scientific community. This will provide a better and more broad understanding of cancer biology, which will give us new insight to develop new anticancer therapeutics for all cancer patients.
- Fund comprehensive studies that examine how the complex interplay of genetic, environmental, and social factors contributes to the differences observed in cancer incidence and mortality between various population groups. This knowledge will provide helpful insight into some of the policy levers to use to eliminate cancer health disparities.
- Implement steps to ensure that clinical trials include a diverse population of participants. It is important to recognize that while many types of cancer disproportionately affect racial and ethnic minorities, the related clinical trials are often not representative of the populations most affected by the diseases. To ensure racially and ethnically diverse clinical trial participation, the AACR recommends:
- Requiring clinical trial sponsors and clinical investigators to:
- complete a specific, prospective “study plan” that outlines how an appropriately diverse population will be included in the trial and set concrete targets for trial enrollment based on disease epidemiology/incidence;
- describe, with detailed strategies, how such targets will be met including approaches that will be employed to overcome cultural barriers;
- set prospective plans for how to meet targets in the postmarket setting if accrual goals are not achieved pre-FDA approval.
- Appointing a “diversity officer” to each phase II and phase III clinical trial to help design the trial and recruitment strategies for achieving the prespecified goals of representativeness and inclusion set forth in the study plan. The diversity officer role should be defined, and training offered to sponsors and investigators on what would constitute a qualified diversity officer.
- Educating clinical investigators and physicians who refer patients to clinical trials on the importance of representativeness and inclusion in trials and provide training on cultural competence toward that end.
- Encouraging federally funded trials to create a site infrastructure that includes certified navigation, community health workers/promoters, and patient advocate networks, to ensure diverse enrollment.
- Urging journal editors and peer reviewers to inquire about the diversity of the patient population that participated in the clinical trial when a clinical study is submitted for publication.
- Requiring clinical trial sponsors and clinical investigators to:
- Support programs to make sure that our health care workforce reflects and appreciates the diverse communities it serves. According to the NIH, the groups that are now underrepresented in academic medicine include women, African Americans, Latinos, and American Indians/Alaska Natives. Diversity in the workforce helps to form an environment of tolerance and teamwork, and allows people from all different backgrounds to come together to share new innovative ideas. Therefore, the AACR recommends:
- Increasing the diversity of the health care and public health workforce to ensure that the clinical research team members reflect the populations that they are intending to study.
- Creating mechanisms to support networks of skilled patient advocates from underrepresented communities and populations.
- Educating a new generation of health care professionals and researchers to ensure that they have a comprehensive understanding for underserved populations.
- Ensuring that investigators and referring physicians are educated on cultural competence, and the importance of community engagement.
- Improving cultural and linguistic competency and diversity of the health-related workforce.
- Prioritize cancer control initiatives. Cancer control aims to reduce the incidence, morbidity, and mortality of cancer and to improve quality of life for cancer patients and survivors through the implementation of evidence-based interventions for prevention, early detection, diagnosis, treatment, and palliative care. Therefore, the AACR recommends:
- Policy makers passing H.R. 2339, the “Protecting American Lungs and Reversing the Youth Tobacco Epidemic Act of 2020”. Among the provisions in the Act is the establishment of a demonstration grant program to develop strategies for smoking cessation among underserved communities.
- establishment of a demonstration grant program to develop strategies for smoking cessation among underserved communities. Closing the disparity gaps that exist in cervical cancer screening rates among different segments of the U.S. populations.
- Ensuring that the USPSTF screening guidance account for race-related differences in risk.
- Encouraging the USPSTF to lower the age and smoking history criteria required to deem African Americans smokers eligible for lung cancer screening.
- Work with members of the Congressional Tri-Caucus – comprised of the Congressional Asian Pacific American Caucus, Congressional Black Caucus, and Congressional Hispanic Caucus – to pass the provisions included in the Health Equity and Accountability Act (HEAA). The Act builds on more than 10 years of congressional action to combat health disparities, and it leverages the expertise and research of a 300-plus member community working group and endorsing organizations. Some of the recommendations included as part of the Act are:
- Expand Medicaid under the ACA to the remaining states that have still not implemented the initiative.
- Encourage federal agencies to award grants that expand existing opportunities for scientists and researchers and promote the inclusion of underrepresented minorities in the health professions.
- Establish a student loan reimbursement program to provide student loan reimbursement assistance to researchers who focus on racial and ethnic disparities in health.
The AACR has been a longtime leader in advancing the science of cancer health disparities and working toward the elimination of cancer health disparities, and we are proud to share this latest effort, the AACR Cancer Disparities Progress Report 2020. This inaugural annual report has brought to the forefront many of the key actions that are required to overcome the enormous public health challenge posed by cancer health disparities in racial and ethnic minorities. These actions include enhancing minority participation in clinical trials, prioritizing cancer control efforts, increasing minority researchers in the cancer workforce, and ensuring robust and sustained funding for federal agencies that conduct research which drives progress against cancer health disparities. Fulfilling the recommendations included in our Call to Action demands ongoing, active participation from a broad spectrum of stakeholders. These efforts must be coupled with action to eradicate the social injustices that are barriers to health equity, which is one of our most basic human rights. This is why the AACR stands in solidarity in the fight against racism, privilege, and discrimination in all aspects of life and actively supports policies that guarantee equitable access to quality health care to eradicate all barriers to achieving the bold vision of health equity.