1. Rosenthal, Eric T.

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The American Association for Cancer Research, American Cancer Society, American Society of Clinical Oncology, and the National Cancer Institute have had various ventures with one or more of each other in the past, but never before have the four leading cancer organizations come together formally for a specific initiative.

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So it was significant when the four organizations met last month over three days in Alexandria, Va., where ASCO convened a think tank to discuss the current state of cancer health disparities research.


Experts in clinical cancer research, epidemiology, public health, and health care policy joined with patient advocates and others to discuss the state of the science and the needs and priorities in cancer disparities research to reach a consensus on recommendations that will be incorporated into a statement by all four organizations.


A joint news release noted that in the United States some racial and ethnic minorities are more likely to develop cancer, less likely to access high-quality cancer care, and more likely to die from cancer when compared with others and with whites. In addition, the information noted that African-American males have a death rate one-third higher than white males, while the death rate for African-American females is 16 percent higher than for white females.


In addition, the poor are affected by disparities, particularly those who are uninsured, and that even with the expansion of health insurance coverage from the Affordable Care Act, the Congressional Budget Office estimates that in 2019, some 30 million individuals will still be uninsured, continuing to make access to quality cancer care difficult for many people.


The think tank was the first step in identifying and determining what could be done to address health disparities.


In a telephone interview, ACS Chief Medical Officer Otis W. Brawley, MD, said he would like to see the resulting paper published in the official journals of all the partner organizations. He also noted that before the term "health disparities" was first used in the 1990s by former Surgeon General David Satcher, MD, PhD, the field had been referred to as "special populations" and "minority health."


The idea for a white paper on the subject by ASCO first arose several years ago, he said, when he and Derek Raghavan, MD, PhD, were Co-chairs of the society's Health Disparities Advisory Group (which eventually became the Health Disparities Committee). The idea was not developed any further, but eventually others revised the idea and brought in other groups, Brawley said.


Worta McCaskill-Stevens, MD, MS, Chief of NCI's Community Oncology and Prevention Trials Research Group, and a former ASCO Health Disparities Co-chair, noted that NCI had hosted two conferences with ASCO in 2011 and 2012, "A Collaborative Approach to Reduce Cancer Disparities: Research Priorities," which also included participants from ACS and AACR.


"This collaboration emanated from these two meetings and morphed from there," she said, adding that during the 2012 conference the idea of ASCO's white paper reemerged, with the organizations agreeing that what was needed was research across a spectrum of disciplines.


This is a new area in cancer disparities research, she said. She added that she would like to see the group publish one or two papers in a prominent journal that would also reach researchers outside of cancer, since helping to reduce health disparities requires multidisciplinary expertise, and collaborative funding is especially important during the current fiscally challenged times.


"We want to move fast and have something submitted within a couple of month-perhaps later this spring or summer," she said.


Blase Polite, MD, MPP, Director of the Center for Interdisciplinary Health Disparities at the University of Chicago School of Medicine, said that McCaskill-Stevens had contacted him last spring when he was still ASCO Health Disparities Chair about a possible NCI-ASCO collaboration on a paper about comorbidities related to health disparities.


That also helped resurrect the idea of ASCO's white paper, which along the way lost the somewhat ironic designation as a "white" paper and became a "statement." ACS then eventually came aboard, with Polite's colleague and mentor at Chicago, Olufunmilayo (Funmi) Olopade, MD, helping to get AACR formally involved.


AACR CEO Margaret Foti, PhD, said that all four groups were sharing the funding of the project and would be providing their respective expertise, and that overall coordination would be handled through ASCO.


Later this year, AACR will host its seventh conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved (the most recent one was held in December in Atlanta).


Polite, a medical oncologist specializing in gastrointestinal malignancies, said that health disparities research is "mature but not very well coordinated," and that the new initiative was an effort to help standardize the field.


The main areas that were discussed for possible inclusion in the future paper, he said, were the following:


* Integrating basic science with social determinations of health;


* Maturing community-based research;


* Recruiting the next generation of researchers; and


* Deciding how research should be conducted-e.g., should clinical trials be set up with racial and ethnic targets?



"The next step will be for us to look at these major recommendations and decide which should go into a document," Polite said, adding that his preference would be that the initial paper be an executive summary-type overview published simultaneously in several of the groups' journals followed by a series of more focused reports that could appear in various specialized journals.