Measuring and addressing health equity: an assessment of cancer center designation requirements

• Type of Material: Article
• Authors: Jason T. Semprini, University of Iowa, Iowa City; Caitlin B. Biddell, University of North Carolina, Chapel Hill; Jan M. Eberth, Drexel University; Mary E. Charlton, University of Iowa, Iowa City; Sarah H. Nash, University of Iowa, Iowa City; Katherine A. Yeager, Emory University; Donoria Evans, American Cancer Society; Prunima Madhivanan, University of Arizona, Tuscon; Heather M. Brandt, St. Jude Children's Research Hospital; Natoshia M. Askelson, University of Iowa, Iowa City; Aaron T. Seaman, University of Iowa, Iowa City; Whitney E. Zahnd, University of Iowa, Iowa City
• Language: English
• Date: 2023-03-20
• Publisher: Springer
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2023
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): https://doi.org/10.1007/s10552-023-01680-4
• Title of Journal or Parent Work: Cancer Causes and Control
• Volume: 34
• Start Page: 23
• End Page: 33
• Grant/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.
• Keywords: Equity; Cancer centers; Treatment; Diversity; Quality
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Oncology; Health Sciences, Public Health

Abstract

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.