Proceedings from

Enhancing Interactions

to Reduce Cancer

Health Disparities:

An NCI-wide Workshop

November 2005

Including a Proposed Action Plan

to Achieve the NCI Strategic Priority:

Overcome Cancer Health Disparities

National Cancer Institut

Submitted to the NCI Executive Committee

February 2006

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

National Institutes of Health
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

National Institutes of Health

Proceedings from

Enhancing Interactions 

to Reduce Cancer 

Health Disparities: 

An NCI-wide Workshop 

November 2005

Including a Proposed Action Plan 

to Achieve the NCI Strategic Priority: 

Overcome Cancer Health Disparities 

Submitted to the NCI Executive Committee

February 2006
i Letter from the Workshop Co-Chairs

1

National Cancer Institute: A Strategic Plan for Leading the Nation to Eliminate the Suffering and

Death Due to Cancer, Objective 8: Overcome Cancer Health Disparities. NCI/OSPA, Draft 10/20/05

Dear NCI Executive Committee:

Eliminating cancer health disparities is a critical step in achieving the National Cancer Institute’s goal of

eliminating suffering and death due to cancer for all people. It is with great enthusiasm that we submit these

proceedings from the NCI-wide Workshop on Enhancing Interactions to Reduce Cancer Health Disparities. The

proceedings evolved from a two-day workshop approved and endorsed by the NCI Executive Committee,

May 24, 2005, and convened on the NIH campus, November 17 and 18, 2005. More than 250 registrants

from virtually every NCI division, office and center contributed expertise in biomedical and social sciences to: 

• Build synergy around NCI efforts to reduce cancer health disparities by 

enhancing communications, stimulating interactions across the Institute, 

and leveraging strengths through information sharing; and 

• Propose strategies for strengthening collaborations across NCI to reduce 

cancer health disparities.

Working together both in plenary sessions and breakout groups, we developed a proposed path to guide NCI’s

strategic priority to overcome cancer health disparities. Overarching objectives emerged during the workshop’s

general sessions and action plans addressing seven specific topic areas were developed in the breakout groups. 

These objectives and action plans provide a call to action to NCI. The content in these proceeding provide 

a strong foundation upon which NCI can develop a business plan to address a major priority in NCI’s 2006

Strategic Plan: Overcoming Cancer Health Disparities1

. 

This historic workshop energized the NCI community, catalyzed NCI’s commitment, and raised awareness

about the need to collaborate across the Institute in programs and projects focused on cancer health disparities

research. As a group, we are committed to eliminating the disparities that affect too many Americans. 

Respectfully,

Lenora Johnson, MPH, CHES

Director, Office of Education and Special Initiatives

National Cancer Institute

L. Michelle Bennett, PhD

Associate Director for Science, Center for Cancer Research

National Cancer Institute

A letter from the Workshop Co-Chairs

“We are committed”
Message from Dr. Mark Clanton 

I was privileged to host and attend the NCI-wide Workshop on Enhancing Interactions 

to Reduce Cancer Health Disparities, November 17 and 18, 2005. It was a historic meeting 

for the expressed purpose of taking stock of just how well NCI is meeting the challenges

presented by cancer disparities. It is clearly documented that the poor and many ethnic

minorities experience the burden of cancer disproportionately. This is due to obvious, as

well as less obvious, barriers to accessing cancer care, resources, and knowledge.

It was the first time since NCI formed the Center to Reduce Cancer Health Disparities

(CRCHD) in 2001, that such an Institute-wide assessment was held. All of the division

directors were present, with their sleeves rolled up, looking for ways to connect and

collaborate across all of NCI.

I moderated the opening session on “Where We Are Today” and was honored to introduce

Dr. Harold P. Freeman, a true pioneer in this field, a great surgeon, and the first director of

CRCHD. Dr. Freeman reminded us that cancer is not only a disease, but also a lens through

which social realities are powerfully reflected.

We also heard about the recent Trans-HHS Cancer Health Disparities Progress Review

Group that was spurred into existence by NCI Director Dr. Andrew von Eschenbach. This

effort has already begun to pay off by crystallizing common as well as unique perspectives

among the many different HHS agencies, and leading to synergies that are welcome and

necessary—particularly in an era of tighter budgets.

It is a time of exciting change at NCI, as we begin to focus on the strategic priority areas

that will move us down the road toward the 2015 Challenge Goal. Reducing cancer health

disparities is one of the major areas of emphasis. Integration and Implementation (I2)

Teams have been established for some of the other initiatives with a clear mandate 

to produce quick and practical interventions. With the wealth of ideas and challenges 

that emerged from the workshop, an I2 Team to reduce cancer health disparities may 

also be established. 

NCI has a long way to go—as do the rest of the nation and the world—before we can say

that cancer disparities no longer contribute to disproportionate suffering and death due to

cancer. The workshop’s intense dialogue and cross-cutting actions have produced a report

and action plans with pledges from all of the major division directors to reenergize 

and recommit their staffs to this NCI goal. I have no doubt we can make this happen.

Mark Clanton, MD, MPH 

Deputy Director, National Cancer Institute and 

Deputy Director for Cancer Care Delivery Systems

“

“

A message from Dr. Mark Clanton

“We can make this happen”
iii
Table of Contents 

I. Letter from the Workshop Co-Chairs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i

II. Message from Dr. Mark Clanton. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ii

III. Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vi

IV. Workshop Planning Committee Members . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . viii

V. Executive Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

VI. NCI’s Commitment to Overcoming Cancer Health Disparities: 

Past, Present, and Future . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

VII. NCI Action Plans to Overcome Cancer Health Disparities

Genetic and Biological Differences. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Narrowing the Gap between Research and Practice. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Clinical Trials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Sociocultural and Behavioral Influences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Cancer Care Delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Education and Training for Cancer Care Professionals and Researchers . . . . . . . . . . . . . . . . . . 21

Communications Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

VIII. Next Steps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

IX. In Conclusion: Emerging Themes in Cancer Health Disparities Research . . . . . . . . . . . 27

X. Final Word: A Vision for Overcoming Cancer Health Disparities . . . . . . . . . . . . . . . . . 31

XI. Appendices

A. Workshop Agenda . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

B. Workshop Participant List . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

C. Strategic Objective 8 – Overcome Cancer Health Disparities, from The NCI Strategic 

Plan for Leading the Nation to Eliminate the Suffering and Death Due to Cancer . . . . . . . . . . . 43

D. Executive Summary from Analysis of the National Cancer Institute’s Minority Health 

and Health Disparities (MHHD) Research Portfolio . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51

E. Glossary of Acronyms and Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

Table of Contents
v
Acknowledgments 

The workshop co-chairs wish to formally acknowledge the tremendous contributions, effort, and commitment 

of the planning committee of the workshop itself and the subsequent development of these proceedings,

including the Action Plans to Overcome Cancer Health Disparities.

Breakout Group Co-Chairs 

In addition to members of the planning committee who served as breakout group co-chairs, we appreciate 

the participation and leadership of the following individuals:

■ H. Richard Alexander, Jr., MD, Center for Cancer Research, Narrowing the Gap between 

Research and Practice

■ Kenneth Chu, PhD, Center to Reduce Cancer Health Disparities, Sociocultural and 

Behavioral Influences

■ W. Douglas Figg, PharmD, Center for Cancer Research, Genetic and Biological Differences

■ Martin Gutierrez, MD, Center for Cancer Research, Clinical Trials

■ Jon Kerner, PhD, Division of Cancer Control and Population Sciences, Narrowing the Gap 

between Research and Practice 

■ Belinda Locke, MS, Office of Centers, Training and Resources, Education and Training for 

Cancer Care Professionals and Researchers 

■ Helen Meissner, ScM, PhD, Division of Cancer Control and Population Sciences, Sociocultural 

and Behavioral Influences

■ Arnie Potosky, PhD, Division of Cancer Control and Population Sciences, Cancer Care Delivery 

■ Linda Squiers, PhD, Office of Communications, Communications Research

■ Nadarajen A. Vydelingum, PhD, Center to Reduce Cancer Health Disparities, Genetic and 

Biological Differences

■ Sabra Woolley, PhD, Office of Communications, Communications Research

■ JoAnne Zujewski, MD, Cancer Therapy Evaluation Program, Clinical Trials

MHHD Portfolio Analysis 

The planning committee appreciates the contributions of Kevin Callahan, PhD, Office of Science Planning and

Assessment, and Karen Rulli, SAIC, Inc., in the development of the NCI MHHD Portfolio Analysis. We also

appreciate the significant assistance and support of the following individuals:

■ Mary Leveck, PhD, Office of Science Planning and Assessment

■ Terri Sanders, Center to Reduce Cancer Health Disparities

■ Dashboard Contractors: Padmaja Thallur and Dere Huether, Woodbourne Solutions

Acknowledgments
vii Acknowledgments

Workshop Support 

■ Publications Support Branch, Office of Communications: Donna Bonner, Del Harrod, and Paul LaMasters

■ MMG (Matthews Media Group): Laura Anthony, Mary Partlow, Karen Davison, and Nancy Siebert Murphy

Workshop Presenters

We gratefully acknowledge the time and commitment of the workshop presenters: 

■ Mary Anne Bright, RN, MN, Office of Communications

■ Kenneth Buetow, PhD, Center for Bioinformatics

■ Nelvis Castro, Office of Communications

■ Mark Clanton, MD, MPH, Office of the Director

■ John Cole, PhD, Division of Cancer Biology

■ Robert Croyle, PhD, Division of Cancer Control and Population Sciences

■ Leon Espinoza, Office of Workforce Development

■ M. Teresa Estrada, PhD, Office of Workforce Development

■ Pebbles Fagan, PhD, MPH, Division of Cancer Control and Population Sciences

■ Joseph Fraumeni, Jr., MD, Division of Cancer Epidemiology and Genetics

■ Harold Freeman, MD, Office of the Director (formerly, Center to Reduce Cancer Health Disparities)

■ Frank Govern, PhD, Division of Cancer Treatment and Diagnosis

■ Garth Graham, MD, MPH, Office of Minority Health, Department of Health and Human Services

■ Paulette Gray, PhD, Division of Extramural Activities

■ Peter Greenwald, MD, PhD, Division of Cancer Prevention

■ James Hadley, Office of Liaison Activities

■ Brooke Hamilton, Office of Liaison Activities

■ Ernest Hawk, MD, MPH, Office of Centers, Training and Resources

■ Jon Kerner, PhD, Division of Cancer Control and Population Sciences 

■ Cherie Nichols, MBA, Office of Science Planning and Assessment

■ John Niederhuber, MD, Office of the Director

■ Rochelle Rollins, PhD, MPH, Office of the Director 

■ Sanya Springfield, PhD, Center to Reduce Cancer Health Disparities, Office of Centers, Training and Resources

■ Nadarajen A. Vydelingum, PhD, Center to Reduce Cancer Health Disparities

■ Jeffrey White, MD, Office of Cancer Complementary and Alternative Medicine

■ Robert Wiltrout, PhD, Center for Cancer Research

■ Barbara Wingrove, MPH, Center to Reduce Cancer Health Disparities

Finally, the planning committee acknowledges the support of Dr. Mark Clanton and the NCI Executive Committee

and the participation of NCI staff members from across the Institute. 
Workshop Planning Committee Members 

Workshop Planning Committee Members

Co-Chairs:

Lenora Johnson, MPH, CHES L. Michelle Bennett, PhD

Office of Education and Special Initiatives Center for Cancer Research

Hector Nelson Aguila, PhD, Office of Centers, Training and Resources

Vi Black, Center for Cancer Research

Mary Anne Bright, RN, MN, Office of Communications

CAPT Linda Morris Brown, MPH, DrPH, Division of Cancer Epidemiology and Genetics

Gail Bryant, Division of Extramural Activities

Nelvis Castro, Office of Communications

John Cole, PhD, Division of Cancer Biology

Pebbles Fagan, PhD, MPH, Division of Cancer Control and Population Sciences

James Hadley, Office of Liaison Activities

Suzanne Heurtin-Roberts, PhD, MSW, Division of Cancer Control and Population Sciences

Kay Johnson, MS, NIH Office of the Director

Anna Levy, MS, Office of Science Planning and Assessment

Worta McCaskill-Stevens, MD, Division of Cancer Prevention

Tarsha McCrae, MPH, CHES, Center to Reduce Cancer Health Disparities

Kathie Reed, MS, Office of Science Planning and Assessment

Rochelle Rollins, PhD, MPH, Office of the Director

Sanya Springfield, PhD, Center to Reduce Cancer Health Disparities

Office of Centers, Training and Resources

Ted Trimble, MD, Division of Cancer Treatment and Diagnosis

Irma Velazquez, Office of Education and Special Initiatives

Barbara Wingrove, MPH, Center to Reduce Cancer Health Disparities
ix Executive Summary

Definition of Health Disparities

Cancer health disparities are differences in the incidence,

prevalence, mortality, and burden of cancer and related

adverse health conditions that exist among specific

population groups in the United States. These population

groups may be characterized by gender, age, ethnicity,

education, income, social class, disability, geographic

location, or sexual orientation.1

Despite steady improvement in the overall health of the 

U.S. population, racial and ethnic minorities, with few

exceptions, experience higher rates of cancer morbidity 

and mortality than non-minorities. The reasons for these

cancer health disparities are complex and poorly

understood, and may largely reflect socioeconomic

differences, differences in health-related risk factors,

environmental influences, and racial discrimination.

1

Division of Cancer Control and Population Sciences, NCI

There is a community out there that needs the work that

you do. Many of them don’t understand genomics or

nanotechnology. All they understand is life or death...They

know there is somebody out there who knows more than

they do who is going to help them. That somebody is you.

— Dr. Harold Freeman 

“

“
Executive Summary 

EXECUTIVE SUMMARY

Proceedings from Enhancing Interactions to Reduce

Cancer Health Disparities evolved from an NCI-wide

workshop held November 17 and 18, 2005 on the NIH

campus involving more than 250 participants from

virtually every NCI division, office, and center. The

purpose of the workshop was to convene representatives

from the entire Institute to take stock of the health

disparities programs, studies, and initiatives that are

being implemented across NCI; encourage trans-institute

collaborations; and propose overarching objectives and

feasible action plans for reducing cancer health

disparities. These objectives and action plans provide 

a foundation for developing a business plan that: 

■ Aligns with NCI’s priority of overcoming cancer

health disparities in the 2006 Strategic Plan, and 

■ Contributes to achieving the NCI Challenge Goal

of eliminating suffering and death due to cancer

for all Americans. 

Ideally, the objectives that emerged from workshop

discussions and the action plans developed by workshop

participants will be considered by a newly formed Health

Disparities Integration and Implementation (I2) Team 

to develop a business plan outlining investment areas

that will contribute to achieving the Challenge Goal. 

Scope of Health Disparities

Activities at NCI

The workshop speakers provided an overview of the

major activities and initiatives that address health

disparities at NCI. Through a series of presentations by

NCI division, office, and center directors on activities

spearheaded by their areas, as well as a report from an

MHHD Portfolio Analysis, workshop participants

learned that:

■ NCI committed 5.6 percent of its total budget to

health disparities research in 2004, using current

coding criteria.

■ NCI funded 778 health disparities-related research

projects. Research training accounted for the majority

of the projects (418 projects, or 54 percent); however,

clinical research accounted for the majority of the

money spent ($146.6 million, or 55 percent).

NCI is better positioned than ever before to address,

understand, and reduce cancer health disparities. For

example, research into the effectiveness of interventions

to educate and motivate individuals to reduce risk

factors, obtain cancer screening, seek follow-up care, 

and other health enhancing actions has led to the

development of several highly focused, evidence-based

efforts that target culturally-sensitive resources to people

with the greatest need. Currently, nearly every NCI

division, office, and center operates or funds initiatives

or research on health disparities focused on a

subpopulation or specific geographic area. Some of these

initiatives include NCI’s Patient Navigator Program,

Community Networks Program, and the Community

Clinic at Upper Cardozo in Northwest Washington,

D.C. The trend, workshop presenters concluded, is

toward initiatives that are practical, focused on 

high-need populations, and tailored as closely as 

possible to individual behaviors. 

Emerging Challenges

The workshop revealed several challenges that NCI 

faces in overcoming cancer health disparities: 

■ The need to develop metrics to evaluate 

whether 5.6 percent of the NCI budget is

sufficient to overcome, reduce, and eliminate 

the disproportionate burden of cancer in

underserved and minority populations;

■ The need to determine a sufficient level of 

funding for health disparities research;

■ The need for additional research, strategies, and

collaborations within NCI to make substantial

progress in reducing cancer health disparities 

by 2015—thus the objective proposed in these

proceedings and in the action plans.
2 Executive Summary

Challenge to Participants

With a solid foundation on the state of research activities

to reduce cancer health disparities at NCI, participants

divided into groups to develop action plans in seven

topic areas. The groups developed plans that: address the

most pressing area of concern within their area of focus;

establish action steps that could be put in place now, one

year from now, and/or in subsequent years; and identify

NCI partners that could be involved in planning and

implementation. Participants were encouraged by NCI

leadership to think big, be innovative, not consider cost,

and include quick and practical actions in their plans. 

The seven topic areas were (1) genetic and biological

differences, (2) narrowing the gap between research and

practice, (3) clinical trials, (4) sociocultural and

behavioral influences, (5) cancer care delivery, (6)

education and training for cancer care professionals and

researchers, and (7) communications research. Full action

plans for the seven areas are contained in the main body

of this report. 

Our Plan to Overcome 

Cancer Health Disparities

The major elements proposed for each of the topic 

areas follow:

■ Conduct a pharmacogenomic study to address

treatment and survival disparities and an

epidemiologic study to address cancer

susceptibility disparities. 

■ Narrow the gap between research and practice 

by establishing a community clinic in our area,

improving our research portfolio analysis,

increasing training, forging new partnerships, and

expanding the dissemination and implementation

of what works to the community.

■ Elevate health disparities research to a discipline 

in clinical science.

■ Include sociocultural and behavioral influences

variables when conceptualizing research activities,

and mandate training in cultural awareness across

the Institute.

■ Develop strategies that integrate cost-effective

innovative public programs and models of care

into the health care delivery systems which provide

care to underserved, poor and near-poor

populations. 

■ Broaden education and training efforts in health

disparities beyond researchers to health care

practitioners and trainees pursuing a career in

cancer control. 

■ Develop a process for synthesizing results from

communications research, disseminating what

works, and enhancing NCI expertise in evidencebased communications approaches, especially for

populations affected by cancer health disparities.

About the Workshop 

■ Open to all NCI staff

■ Attendance: 250+ from every division,

office, and center

■ Purpose: Improve communication and

collaboration across NCI to enhance existing

programs and develop new initiatives to

overcome cancer health disparities.

■ Challenge: Identify, discuss and propose

steps to address issues that contribute 

to cancer health disparities

■ Outcome: A proposed action plan to 

use as a foundation for achieving the 

NCI Strategic Priority: Overcome Cancer

Health Disparities

■ Proposed Next Steps: 1. Create a Health

Disparities I2 Team, 2. Elevate health

disparities as a discipline, 3. Welcome

future proposals to overcome health

disparities through collaboration,

coordination, and communication.

EXECUTIVE SUMMARY
Executive Summary 

Next Steps

The workshop planning committee presents three major

recommendations to the NCI executive committee as

next steps toward overcoming cancer health disparities.

(The full presentation can be found on page 25.)

1. Create an I2 Team for Health Disparities. The

overarching vision generated from the workshop

(below) and the action plans (above) should be

considered in the assessment and business plan

development processes of an I2 Team. 

2. Elevate Health Disparities Research Across the Institute.

NCI should commit to integrating the elimination of

cancer health disparities into the NCI mission and

into all major NCI initiatives. 

3. Maintain Momentum. NCI should identify an

infrastructure to maintain the momentum gained 

by the workshop (e.g., a newly formed small or

existing working group) to: publish a bulletin to 

keep NCI staff informed of health disparities

programs and encourage trans-NCI collaboration;

assess needed staff, financial, and infrastructure

resources and continue coordination of NCI health

disparities efforts; and maintain an Intranet portal 

for posting health disparities initiatives and

communications. In addition, NCI should establish 

a mechanism for considering future proposed

initiatives to rapidly impact disparities, as well as

continue to strongly advocate for the implementation

of Trans-HHS Cancer Health Disparities Progress

Review Group recommendations. 

EXECUTIVE SUMMARY

Our Vision

The workshop planning committee and participants are committed to closing 

the gap in cancer health disparities. Based on themes that emerged at the

workshop, the following vision is proposed for NCI: to lead the nation’s effort 

to overcome cancer health disparities. To achieve this vision, NCI needs to 

commit to the following goals: actively incorporate the elimination of health

disparities into “what we do;” establish health disparities as a formal research

discipline; align community research problems with discovery research;

communicate advances, and support team science and multidisciplinary 

approaches to health disparities research; support a diverse workforce; 

and continuously strive for social justice and equality in all of our research

activities. (The full vision statement can be found on page 31.)
4 NCI’s Commitment to Overcoming Cancer Health Disparities: Past, Present, and Future

1973

A crucial report by Drs. Ulrich Henschke and

LaSalle Leffall from Howard University examining

25 years of data revealed the alarming increase

in cancer mortality in African Americans and

put health disparities on the map.

1985

The U.S. Department of Health and Human

Services created the Office of Minority Health

to address health disparities and other issues.

1986

The report, Cancer in the Economically

Disadvantaged, analyzed the interrelationships

between health, poverty, and race. (Freeman,

American Cancer Society)

1989

NCI founded the National Black Leadership

Initiative on Cancer; national hearings were

held on “Cancer and the Poor.” 

1990

The report, Excess Mortality in Harlem, (McCord,

Freeman, New England Journal of Medicine)

revealed that a Black man in Harlem had less 

of a chance of reaching age 65 than a Black

man in Bangladesh. 

1992

NCI established the National Hispanic

Leadership Initiative and Appalachian

Leadership Initiative on Cancer.

1995

NCI established the Office of Special

Populations Research to focus research funds 

on subgroups experiencing health disparities.

1999

Two reports, The Unequal Burden of Cancer,

published by the Institute of Medicine, and 

the President’s Cancer Panel’s Discovery 

Must Be Linked to Delivery, noted that the

disconnect between health care discovery 

and delivery contributes significantly to the

unequal burden of cancer when important

medical advances are not made available 

to those most in need. 

2000

NCI established 18 Special Populations 

Network cooperative agreements to build

relationships with underserved communities

across the U.S. and concentrate programs 

in areas of highest need.

2001

NCI established CRCHD to implement “bold

initiatives to reduce, and ultimately, to end

blatant injustices within the health care

system;” the President’s Cancer Panel issued

Voices of a Broken System: Real People, Real

Problems that made recommendations to 

close the gap between cancer research and

delivery to the underserved. 

2003

The Institute of Medicine issued 

Unequal Treatment: Confronting Racial and Ethnic

Disparities in Healthcare, which further defined

disparities issues. 

2004

The Trans-HHS Cancer Health Disparities

Progress Review Group issued its report,

Making Cancer Health Disparities History,

including a Call to Action of 14 priority

recommendations for eliminating cancer 

health disparities. 

2005

NCI creates Community Networks Program

cooperative agreements, an outgrowth of 

the Special Populations Network.

Milestones in Efforts to Reduce Cancer Health Disparities

Source: Workshop presentation by Dr. Harold Freeman
NCI’s Commitment to Overcoming Cancer Health Disparities: Past, Present, and Future 

Health Disparities: A Look Back

Prior to the 1980s, there was no tailoring of prevention,

screening, treatment, or research programs to the needs

of special populations. Since HHS created the Office of

Minority Health in 1985, the health community has asked,

“Why do certain minority populations have markedly

higher incidence and prevalence of cancer, heart disease,

diabetes, HIV/AIDS, and other diseases than the general

population?” In the late 1980s and early 1990s, NCI

established the Community Based Coalitions for Cancer

Prevention and Control, including the National Hispanic

Leadership Initiative on Cancer, the National Black

Leadership Initiative, and the Appalachian Leadership

Initiative on Cancer. Over the past two decades, both the

number of initiatives to reduce health disparities and the

volume of health disparities research have increased

significantly across the public and private sectors.

Although progress has been made, cancer health

disparities remains a major problem today and impedes

NCI’s ability to meet its Challenge Goal for all people. 

Health Disparities Initiatives Today

Workshop presenters stated that NCI is better positioned

than ever before to address, understand, and reduce

cancer health disparities. The trend, they stated, is

toward initiatives that are practical, focused on

populations with the greatest need, and tailored as

closely as possible to individual behaviors. For example,

research into the effectiveness of interventions to educate

and motivate individuals to reduce risk factors, obtain

cancer screening, seek follow-up care, and other healthenhancing actions has led to the development of several

highly focused, evidence-based efforts that target

culturally sensitive resources to people with the greatest

need. Currently, nearly every NCI division, office, and

center operates or funds programs, initiatives, or research

addressing health disparities focused on a subpopulation

or specific geographic area. 

NCI’s CRCHD, created in 2001, recently evolved its

successful Special Populations Network into the

Community Networks Program, which forms

partnerships with clinics in underserved areas and

delivers cancer care to people on an individual level.

NCI’s Patient Navigator Program provides one-on-one

assistance to individuals who receive an abnormal finding

and helps them stay within the health care system

through treatment or until the finding is resolved. There

is evidence that this level of assistance works—a recent

study shows that in Harlem, the 5-year breast cancer

survival rate increased from 39 percent to 70 percent in

women who took part in the program. This example of

delivery-based care is proof that, while not changing the

level of poverty or people’s circumstances, taking essential

services to the community can contribute to reducing

disparities. NCI is funding research on other Patient

Navigator Programs around the country to collect evidencebased information that can be used to evaluate the value

of these programs to underserved patient populations. 

In the area of cervical cancer—a disease from which no

one should die and yet too many impoverished women 

do each year—NCI can now look at county-level death

rates and has targeted cervical cancer education and

outreach programs to Appalachia, the Deep South, the

Texas-Mexico border, and the Plains states. NCI is currently

conducting phase III clinical trials in Costa Rica, where

cervical cancer rates are high, to test a NCI-developed

vaccine against the human papillomavirus, or HPV. 

The vaccine holds tremendous promise for reducing the

global burden of this very preventable cancer.

NCI is committed to understanding the basis of cancer health disparities and accelerating the

development and application of interventions for overcoming disparities across the cancer care

continuum and among all underserved populations. This commitment goes back 20 years when the study 

of health disparities first began to appear on the national agenda. 

NCI’s Commitment to Overcoming Cancer

Health Disparities: Past, Present, and Future
6 NCI’s Commitment to Overcoming Cancer Health Disparities: Past, Present, and Future

Distribution of Health 

Disparities Funding

To gain perspective on the scope of health disparities

initiatives at NCI for the use of the workshop

participants, NCI performed a Minority Health and

Health Disparities (MHHD) Portfolio Analysis. The

analysis includes NCI intramural and extramural grants

and projects, current in FY2004. Distribution of

MHHD research dollars was examined by NCI division,

National Center for Minority Health and Health

Disparities (NCMHD) reporting category, Common

Scientific Outline (CSO) categories, funding mechanism,

and race/ethnicity (for NCMHD clinical research only).

The portfolio analysis revealed that NCI committed 

5.6 percent of its total budget to health disparities research 

in 2004, using current coding criteria.

Other key findings include:

■ NCI funded 778 health disparities-related research

projects. Research training accounted for the

majority of the projects (418 projects, or 54

percent); however, clinical research accounted for

the majority of the money spent ($146.6 million,

or 55 percent).

■ Of the $264 million spent on minority and health

disparities research, $71.9 million was spent in the

Division of Cancer Control and Population

Sciences (DCCPS) (27.1 percent) and $67.8

million in the Office of the Deputy Director of

Extramural Science (DDES) (25.6 percent). 

■ By CSO category, the greatest amount, or onethird of health disparities funding, was in cancer

control and survivorship (37 percent), followed by

etiology (28.2 percent) and treatment (12.5 percent). 

■ Nearly one quarter (24.5 percent) of MHHD

research funding supported cooperative

agreements, demonstrating that NCI staff had

significant involvement in how MHHD research

dollars are spent.

■ By mechanism, one third (33 percent) of 

MHHD research projects were conducted 

by independent investigators.

■ Although half of all MHHD dollars were in 

clinical research, more than half (55 percent) 

were focused on Caucasians, with the remaining

45 percent devoted to other racial/ethnic groups.

■ Ten percent of funding focused on

Hispanic/Latino populations. 

While the portfolio analysis had limitations (specific data

were not available before 2004 because of a change in

definition of NCMHD categories, difficulty in reporting

data by race and ethnicity, rural or low socioeconomic

status, etc.) information gleaned from the analysis can

help determine strategies needed to increase the

proportion of the total NCI budget that focuses on or

applies to health disparities, as well as strategies

undertaken by individual divisions. 

As NCI plans for the future, the portfolio analysis

presents NCI with several challenges: 

■ The need to develop metrics to evaluate 

whether 5.6 percent of the NCI budget is

sufficient to overcome, reduce, and eliminate 

the disproportionate burden of cancer in

underserved and minority populations;

■ The need to determine a sufficient level of 

funding for health disparities research;

■ The need for additional research, strategies, and

collaborations within NCI to make substantial

progress in reducing cancer health disparities 

by 2015—thus the objective proposed in these

proceedings and in the action plans.

Health Disparities Initiatives: 

The Future

As technology and medicine advances, NCI initiatives to

eliminate cancer health disparities will require a rigorous

integration of biomedicine, civil and human rights, social

science, and social justice. Programs that target geographic

areas experiencing excess mortality with an intense approach

to providing culturally relevant education, appropriate

access to screening, diagnosis, treatment, and an improved

social support network are part of a trend that is 

catching on and could serve as models of what works. 

Several principles guide NCI’s health disparities going

forward. To be effective, NCI’s internal scientific

community must recognize that health disparities present

a moral and ethical dilemma to the cancer research

community. Perhaps most importantly, we must

continue to conduct a serious dialogue to elucidate how

human populations really differ and how to group

people for biological and clinical study. We must expand

our knowledge of population genetics and acknowledge

that scientific truth must be wedded to social justice.
NCI’s Commitment to Overcoming Cancer Health Disparities: Past, Present, and Future 

N=778 projects

Outreach

8% (n=66)

Basic Research

2% (n=15)

Infrastructure

4% (n=29) Clinical Research

32% (n=250)

Training

54% (n=418)

DISTRIBUTION OF MHHD PROJECTS 

BY NCMHD CATEGORY, 2004

N=$264M 

(5.6% of total 

NCI budget)

OD

n=$24.8M 

(9.4%)

CCR

n=$17.1M 

(6.5%)

CRCHD

n=$18.7M 

(7.1%)

MHHD FUNDING BY NCI DIVISION, 2004

DCB

n=$2.8M 

(1.1%)

DCCPS

n=$71.9M 

(27.1%)

DDES

n=$67.8M 

(25.6%)

DCTD

n=$13.0M 

(4.9%) DCP

n=$13.6M 

(5.1%)

DCEG

n=$35.0M 

(13.2%)

NCI Portfolio Review on Health Disparities Research (2006) based on 2004 data.

NCI Portfolio Review on Health Disparities Research (2006) based on 2004 data.
8 Action Plans to Overcome Cancer Health Disparities

Health disparities represents an issue 

about which many at NCI feel passionate 

and on which we are ready to act.

— Workshop Participant

“

“
Action Plans to Overcome Cancer Health Disparities 

Genetic and Biological Differences

Defining the Need

Understanding how genetic and biological differences

affect the incidence of cancers and response to

treatment is of paramount importance in eliminating

cancer health disparities. In the U.S., race and ethnic

background have long been used as a basis for prejudice

and discrimination. As a result, scientists have been

cautious in pursuing research focusing on these

differences. However, the sequencing of the human

genome, as well as new biological, pharmacological,

and socioeconomic research, has recently enhanced 

our understanding of biologic mechanisms and

pathways and improved our ability to distinguish

hereditary from environmental factors influencing

cancer susceptibility and response to treatment. 

Proposed Actions

1. Conduct a trans-disciplinary pharmacogenomic 

study to address disparities in cancer treatment and

survival by identifying genetic variance for differential

metabolism, transport, and absorption of anti-cancer

medications in ethnic groups worldwide. 

2. Conduct a trans-disciplinary epidemiologic study to

address disparities in cancer susceptibility by comparing

cancer risk factors across and within genetically

distinct populations under various environmental/

behavioral conditions. 

Impact of Proposed Actions

The pharmacogenomic study will provide variance 

rates for genes involved in drug metabolism, transport,

and absorption for various ethnic groups. Results could

reduce complications of chemotherapy by alerting

clinicians to potential adverse drug therapy outcomes 

A major product of the workshop was the development of highly focused action plans to reduce

cancer health disparities through intra-institute collaboration. Multidisciplinary teams of

workshop participants selected their break-out group in which the plans would be developed based 

on their area of interest: 

■ Genetic and Biological Differences

■ Narrowing the Gap between 

Research and Practice

■ Clinical Trials

■ Sociocultural and Behavioral Influences

Each resulting action plan identifies one or more high priority areas requiring immediate action in order 

to overcome cancer health disparities. Participants were tasked with identifying actions where NCI can 

be most effective; major steps that can be put in place now, one year from now, and in subsequent years;

and NCI partners in the plan’s implementation. 

Emphasis was placed on developing plans that are highly executable, practical, and hold promise for

making a considerable impact in a relatively short period. Taken together, the individual action plans

provide a foundation for the development of an overall NCI strategy for overcoming cancer health disparities.

■ Cancer Care Delivery

■ Education and Training of Cancer Care

Professionals and Researchers

■ Communications Research

NCI Action Plans to Overcome 

Cancer Health Disparities
10 Action Plans to Overcome Cancer Health Disparities

in genetically diverse populations and providing guidance 

in choice of medication and tailoring of drug dosage. 

The epidemiologic study would ascertain rates and

evaluate risk factors for selected cancers among

genetically distinct populations. For example, in the

U.S., twice as many African Americans develop multiple

myeloma as Caucasians. Comparing risk factor and

genetic profiles of “black” myeloma cases from various

diverse populations (e.g., Africa and parts of the

Americas) would shed light on the relative roles of

heredity and environment/lifestyle in this disease 

and lead to a better understanding of the complex

interrelationships between heredity and environment 

in predicting and causing cancer.

Barriers Proposed Actions Would Address

■ Duplicating efforts: Researchers need to investigate

current national and international initiatives in

this arena to avoid duplication and determine

whether additions to ongoing protocols could 

be value added.

■ Protecting data: Protection of human subjects

guidelines are especially important in genetic

research to avoid any misuse or abuse of the 

data that are collected.

■ Developing appropriate definitions and

categorizations: Difficulty in disaggregating genetic

from environmental factors is exacerbated by the

fact that OMB and Census classifications for

race/ethnicity fulfill social and policy needs, rather

than those of scientific research. Developing

definitions and categorizations appropriate for

scientific use will require an interdisciplinary

approach, including geneticists, anthropologists,

epidemiologists, and sociologists.

■ Creating innovative study instruments: Researchers

need a customized questionnaire and protocol

designed by an interdisciplinary team to capture

the demographic, ethnic, ancestral, and

environmental exposure data that are relevant 

to the proposed studies.

Action Steps–Short Term

■ Create interdisciplinary teams to assess feasibility

and potential of each initiative. Team members

will need to include both biological and social

scientists to identify populations and risk factors. 

■ Develop questionnaires to capture the genetic,

environmental, and behavioral information,

including accurate demographic and ancestral 

data from participants.

■ Create international consortia to facilitate the

coordinated collection of data from diverse racial

and ethnic populations both within and outside

the U.S. 

Action Steps–Long Term

■ Create or identify shared international databases

for data collection and analysis.

■ Share results publicly to facilitate dosing decisions. 

■ Apply the study results to other drugs that use

similar pathways.

Partnership Opportunities

Both initiatives call for interdisciplinary teams such as

pharmacists, epidemiologists, oncologists, geneticists,

anthropologists, and molecular biologists that would

draw on every NCI division, as well as transnational

consortia that would enhance access to genetically

distinct populations and leverage expertise worldwide. 

It might be possible to incorporate these initiatives into

ongoing pharmacogenetic collaborations and/or large

multi-ethnic epidemiologic NCI studies. 

We’re asking the smart people in this room 

to figure out how to be creative, how to use 

research across disciplines to bring information

and research together to provide solutions to 

the problems of cancer health disparities.

— Dr. Mark Clanton 

“

“
Action Plans to Overcome Cancer Health Disparities 

Background

The groundwork for the proposed pharmacogenomics

study was provided by Dr. Douglas Figg’s presentation

on the influence of pharmacogenomics in anti-cancer

drug development, which showed that the effects of 

the same medications could vary from 3- to 40-fold,

depending on alleles controlling metabolism, transport,

and absorption. While variant alleles exist in all

populations, the proportions differ along genetic markers

that correspond roughly to traditional classifications 

that link “races” or “subspecies” to historical patterns 

of continental distribution. Dr. Figg estimated that 

about 50 genes control the pharmacokinetics of

chemotherapies. 

This proposed initiative involves collecting 500 to 

1,000 samples from people in a number of countries

representing various ethnic groups (e.g., the U.S.,

Canada, Mexico, Argentina, China, India, Japan, 

African nations, etc.). Investigators in each country

would collect detailed information on hereditary,

environmental, and behavioral characteristics of 

subjects. An international, multidisciplinary consortium

of scientists would analyze results to determine ethnic

differences in drug metabolism. To date, research 

on drug metabolism and toxicity has included only 

very small samples of different racial/ethnic groups. 

The proposed study would yield data from much 

larger samples of selected racial/ethnic groups and 

would provide variance rates for each gene involved 

in drug metabolism and transport for each ethnic 

group. Participants believed this research could 

guide dosing for anti-cancer agents and reduce

complications of chemotherapy.

In the U.S., cancer health disparities exist between 

its majority population (i.e., Caucasians) and its

socioeconomically disadvantaged groups (e.g., African

Americans, Hispanics, and American Indians). However,

racial disparities in health cannot be explained solely 

on the basis of poverty, access to health care, or

environmental factors. They are also dependent on

interactions between these factors and genetics. The

sequencing of the human genome opened up the

possibility of identifying directly the genetic variations

associated with differences in disease incidence and

treatment response among individuals and populations.

Currently, the International Haplotype Map (Hap Map)

Project is working to describe the common patterns of

human DNA sequence variation. This tool will make 

it easier and less expensive to identify genetic factors

affecting cancer occurrence and treatment outcomes. 

For example, polymorphisms of the gene thiopurine

methyltransferase (TPMT), can have a marked impact

on response to mercaptopurine treatment for childhood

leukemia. Three of the 10 common TPMT alleles result

in severe adverse effects if full doses are given. These

alleles are distributed disproportionately among

genetically identifiable populations, and genotyping 

for the allele is now common practice in treatment.

Likewise, polymorphisms in drug targets also can affect

response to medications.

Narrowing the Gap between

Research and Practice: Plan 1*

Defining the Need

Despite major research advances of the 20th century in

understanding the basic biological origins of cancer and

the development and testing of interventions to prevent,

detect early, diagnose, and treat cancer and the related

sequelae, disparities remain in how different populations

ultimately benefit. Recent assessments of the unequal

burden of cancer in the U.S. point to gaps in understanding

the causes of and solutions to health disparities and the

need to improve translation of knowledge from basic

research and population studies into effective

interventions (Plan 1), in addition to improving the

translation of evidence-based interventions (EBIs) tested

in research into broad public health, primary care, and

oncology specialty care practice (Plan 2).

Proposed Actions

Improve translation of knowledge from basic research

and population studies into effective interventions

through 1) development of a pilot community clinical

program in an underserved area in Baltimore-Washington,

2) improved mapping and analysis of NCI’s health

disparities research portfolio, and 3) development of health

disparities training programs for NCI intramural researchers.

1) Pilot Community Clinical Program in 

Baltimore-Washington 

This proposed initiative will be modeled after the Center

for Cancer Research’s (CCR’s) current partnership with

the National Institute of Arthritis and Musculoskeletal

Diseases (NIAMS) at the Community Clinic at Upper

* This topic was covered by two breakout groups. Plans 1 and 2 identify different priority areas within the topic area.
12 Action Plans to Overcome Cancer Health Disparities

Cardozo, located in the multicultural Cardozo/Shaw

neighborhood of Northwest Washington, D.C. The new

proposed pilot program would establish a clinic in

another underserved area of Baltimore-Washington.

Under the pilot, NCI will partner with community

physicians and organizations to provide cancer screening,

evaluation, consultation, and enrollment into clinical

treatment protocols to area residents. These patients are

likely to present with multiple comorbid conditions,

complicating treatment options and potential participation

in clinical trials, and reimbursement issues may limit

options for providing standard care. 

Impact

■ Serve as a model health program for the community.

■ Provide access to the region’s rich array of biomedical

research institutions for cancer prevention and

screening, evaluation, consultation, and enrollment

into clinical trials for underserved residents. 

Barriers Addressed

■ The proposed clinical program will remove many

practical barriers to care, including lack of

transportation, inconvenient hours of service, and

competing life demands for individuals it serves. 

■ To establish trust, the clinic will be staffed by

members of the community in partnership with

experts from NCI and local grantee institutions.

■ Partners will develop new approaches to providing

residents with access to culturally sensitive care,

and methods to overcome such systems barriers as

lack of coverage of standard care for patients on

trials or those ineligible for participation. 

Action Steps–Short Term

■ Convene a trans-NCI working group of current

community partners (Cardozo Community Clinic)

and NCI experts, including those from CCR,

CRCHD, and extramural divisions, to develop

program concept and implementation plans. 

■ Hire a dedicated, full-time research clinician 

to coordinate the program.

■ Establish partnerships with community leaders 

in the proposed neighborhood and larger

Baltimore-Washington area to devise novel

strategies to overcome barriers to providing

patients with state-of-the-science care.

■ Establish partnerships with biomedical

institutions, NCI grantees such as those in 

the Community Networks Program, and 

physician groups in the Baltimore-Washington

area for patient treatment and referral. 

■ Develop outcome measures to evaluate progress

and identify successful strategies and best practices

that can be adapted for similar programs in other

underserved communities. 

Action Steps–Long Term

■ Open clinic (approximately 2007)

■ Conduct ongoing community education 

programs at clinic

■ Evaluate clinical program for effectiveness

■ Disseminate program results 

Partnership Opportunities

■ Experts from disciplines across the intra- and

extramural programs to collaborate with

community leaders and health care providers to

refer patients for cancer screening, evaluation,

consultation, and enrollment into clinical

treatment protocols 

■ Federal and non-federal agency partners 

■ Biomedical research institution partners, including

Community Networks Program grantees, Cancer

Centers, and others 

■ Community physicians and other health care

providers reached through Baltimore-Washington

medical and health care provider associations

2) NCI Health Disparities Research 

Mapping and Analysis 

This proposed initiative will refine coding and assessment

of ongoing NCI research, including identification of key

data variables. The analysis of NCI’s health disparities

portfolio prepared for the workshop presents only a

partial picture of NCI-supported research in FY2004 

and current coding does not accurately portray the scope

of NCI’s research to reduce cancer health disparities.

Large, complex grants, such as Cancer Centers,

Specialized Programs of Research Excellence (SPOREs),

Program Project Grants (P01s), and cooperative

agreements include multiple sub-projects which may 

not be coded and included in current grants data and 

are difficult to identify. Other tools, such as geographic

information systems, provide resources to identify

populations and regions of need so that research can 

be directed to addressing specific gaps.
Action Plans to Overcome Cancer Health Disparities 

Impact

Improving mapping and analysis of the NCI research

portfolio will help to better characterize NCI research

and activities related to understanding and reducing

cancer health disparities. This will enhance strategic

planning and improve our ability to evaluate progress 

to maximize the impact of ongoing health disparitiesrelated programs. 

Barriers Addressed

Common coding of health disparities research grants,

cooperative agreements, and contracts will facilitate

NCI’s analysis of gaps in our health disparities portfolio

and increase the number of intramural and extramural

researchers who focus on disparities research.

Action Steps–Short Term

■ Establish an interdisciplinary working group 

to be led and coordinated by the CRCHD

■ Refine coding and assessment of ongoing research,

including identification of key data variables 

■ Work with NCI data projects to integrate health

disparities research information with other

resources so that it can be maintained and updated

regularly and considered in the full context of the

NCI research portfolio

■ Publish health disparities research portfolio

analysis within six months

Action Steps–Long Term

■ Update and release portfolio annually

Partnership Opportunities

■ Interdisciplinary working group will include

representatives from all NCI divisions

■ Mapping project will be coordinated 

through CRCHD

3) Health Disparities Training Modules 

This proposed initiative will help to educate NCI

researchers across disciplines about the importance and

opportunities in research on cancer health disparities.

Impact

Training modules will raise awareness of the relevance 

of all phases of the translational research continuum to

understanding and eliminating disparities, and provide

opportunities to recruit researchers into the cancer health

disparities research community.

Barriers Addressed

Training can be developed as model programs to reduce

health provider bias and/or lack of cultural awareness in

communities that experience health disparities. 

Action Steps–Short Term

■ Establish working group

■ Review existing training programs for researchers

funded by NCI (e.g., R25-funded programs) 

■ Develop and/or adapt training curriculum to 

be piloted with NCI intramural investigators

■ Schedule series of training programs

Action Steps–Long Term

■ Conduct training programs starting in late 2006

■ Evaluate and refine program based on 

participant feedback

■ Make available to the extramural research

community

Partnership Opportunities

Training will be available to all intramural research staff.

The training program will be developed and implemented

under CCR, DCEG, and CRCHD, with assistance from

experts in the Office of Communications (OC), Office

of Education and Special Initiatives (OESI), Cancer

Information Service (CIS), and DCCPS. 

Narrowing the Gap between

Research and Practice: Plan 2

Defining the Need

Communities affected by health disparities experience

multiple challenges. Factors such as a low level of 

cancer research conducted in these communities, lack 

of trust among individuals both of the science and the

source, and a corresponding low level of participation 

in research, are compounded by an inadequate

infrastructure for delivering EBIs—interventions that

have been proven through research to have a 

measurable effect—and limited knowledge of successful

EBIs by program planners. Narrowing the gap 

between what is known to work in improving cancer

outcomes from research and what is put into practice 

in high-risk communities requires a multiple-step

approach by partners at all levels committed to

reducing health disparities.
14 Action Plans to Overcome Cancer Health Disparities

Proposed Action

Expand the development and evaluation of innovative

approaches to integrate EBIs for populations experiencing

health disparities across all service delivery levels,

including community, public health practice, clinical

practice, patients, and individuals at risk.

Impact of Proposed Action

■ Increased understanding among scientists,

researchers, community health workers, and

program planners in high-risk communities 

where EBIs have been proven to decrease 

health disparities

■ Increased understanding throughout NCI 

of the information, tools, and resources that

communities would find most useful

■ Increased willingness and trust of populations

affected by health disparities to partner with 

NCI in research to reduce health disparities

■ Increased number of organizations that adopt 

EBIs into their programs

Barriers Proposed Action Would Address

■ Barriers of time, money, fear, mistrust, lack of

direction, leadership, competition within NCI for

funding, staff availability, and gaps in the evidence

base, all inhibit the use of EBIs by communities

affected by health disparities. 

■ Challenges in narrowing the gap between research

and practice include rethinking how research is

approached, reassessing how NCI chooses research

partners and priorities, and strategically

disseminating new tools and technologies to

reduce disparities. 

■ NCI faces further challenges including cataloging

existing research that has demonstrated impact in

addressing disparities; ensuring that interventions

are developed with these communities at the

forefront; making research more applicable and

closer to the ground; and identifying and building

effective delivery mechanisms, or adapting

interventions that have been proven to be

successful in one population for a different

community, without losing its effectiveness. The

latter challenge is derived not simply from a lack

of solutions, but a lack of research-tested models

of knowledge translation and evidence-based

service delivery in real-world settings. 

Action Steps–Short Term

■ Inventory existing evidence-based practices (EBPs)

that have demonstrated impact on health disparities

■ Conduct an evaluation of what key audiences

impacted by health disparities want from NCI 

and the intervention research that NCI supports

■ Work with non-traditional partners identified

through CHCRD and NCI’s Office of Cancer

Complementary and Alternative Medicine

(OCCAM) to increase NCI credibility about

addressing health disparities and trust of 

research findings

■ Work with OCCAM to develop partnerships 

with “traditional healers” who provide care in

communities impacted by health disparities

Action Steps–Long Term

■ Expand funding of dissemination and

implementation research grants to increase

knowledge on the adoption of EBPs

■ Require, or provide supplements to, NCIdesignated cancer centers to translate EBPs to

eliminate local cancer health disparities beyond 

the patients seen in their own institutions 

■ Apply what is known from policy research 

(e.g., tobacco control) to influence policy makers

Partnership Opportunities 

■ Insights garnered from the Research Dissemination

and Diffusion initiative involving DCCPS and

OESI to close the gap from discovery to delivery

in the general population will be adapted to

identify EBIs among communities affected by

health disparities. NCI will adapt this program to

at-risk populations and share information with

partnering organizations through meetings,

workshops, and conferences. 

■ Education on the use of Cancer Control

PLANET, another key resource from NCI’s

dissemination and diffusion activities, will be

conducted with cancer control planners, program

staff, and researchers to assist them in accessing

evidence-based programs and products. Emphasis

will be on using the Research-Tested Intervention

Programs (RTIPs) Web site, Step 4 within

PLANET, which provides an inventory of EBIs

searchable by topic, age, race, ethnicity, and

intervention setting. 

■ NCI will work with practitioners of traditional

medicine identified through OCCAM. 
Action Plans to Overcome Cancer Health Disparities 

■ NCI will adapt its practice of partnering with

other NIH Institutes and solicit grant applications

with the intent of supporting innovative approaches

to the adoption of EBIs. Adoption to date has

been limited or significantly delayed. 

■ NCI will evaluate programs such as Cancer 101

and Body and Soul to determine their effectiveness,

and based on these findings determine the level 

of expansion needed. 

Other High-Priority Areas

■ Identify and create EBIs that have demonstrated 

a positive effect in addressing health disparities.

■ NCI must not only understand the needs of the

community, it must adequately fund research that

will address how to adapt and implement EBIs

within community-based service settings. NCI

must be committed to making the outcomes of its

research available through expanded training grant

opportunities to public health, primary care, and

oncology specialty care practitioners within

communities affected by health disparities.

■ Overcoming societal/environmental barriers will

require an active collaboration with community

members, local health care providers, and researchers,

as well as the flexibility to engage consumers

through diverse and nontraditional outlets. 

Clinical Trials

Defining the Need 

Clinical trials represent a key approach to understanding

and reducing cancer care and outcome disparities among

racial/ethnic minorities and other special populations.

Recruiting and accruing adequate numbers of individuals

from minority racial and ethnic groups to NCI-funded

clinical trials presents a significant challenge to both

intramural and extramural researchers. It is important

that patients understand the role clinical trials play in

defining good evidence-based cancer care. Equally

important is their understanding of the impact that this

type of treatment can have on their prognosis. 

Proposed Action

Elevate health disparities research as an academic

discipline. Enhance individual, investigator, and

community participation in clinical trials—with health

disparity outcomes as the primary or secondary objective. 

Impact of Proposed Action

Health disparities research must be elevated to a

discipline in clinical science in the long term.

Implementation will provide high-quality cancer care 

to a greater portion of underserved populations. 

Future NCI grant awards must be contingent on

including this goal in grants.

Barriers Proposed Action Would Address

■ Elevate the status of health disparities research,

particularly among the cooperative groups

■ Make necessary data available on minority

participation and outcomes

■ Encourage new studies on biological/genetic

factors of health disparities

■ Increase the number of faculty and clinical

researchers in health disparities research

■ Improve reimbursement for participation

■ Increase recruitment of minority populations 

to clinical research

Action Steps–Short Term

■ Define and incorporate the discipline of health

disparities research within the academic community.

Raise the levels of disparities research within the

academic community and participating community

investigators. Where appropriate, increase activities

of health disparities subcommittees within the

clinical trials cooperative groups that would result

in protocols with primary or secondary health

disparities objectives. 

■ Identify scientific questions that affect minority 

and disadvantaged populations. Studies defining

biological and genetic differences within a

population that may relate to socioeconomic status,

comorbidity, and other factors would attract new

investigators, researchers from cooperative groups,

and more minorities to clinical trials. 

Action Steps–Long Term

■ Conduct trials to evaluate health disparities

interventions. Examples include the role of

navigator strategies; outreach coordinators;

advocacy involvement in planning, peer review,

and recruitment; and culturally competent

outreach and language interpretation.

■ Annotate population registries and biological

specimens with race, socioeconomic status, age, 

and other data. This would ultimately result in

possible biological explanations for racial/ethnic
16 Action Plans to Overcome Cancer Health Disparities

disparities in clinical outcomes and support 

the study of emerging issues in minority

populations, such as increasing incidence rates 

in certain cancer types that are not yet reflected 

in national databases.

■ Apply models to other health care delivery systems.

The Centers for Medicare & Medicaid Services

(CMS), for example, has agreed to work with NCI

to develop collaborative efforts to identify and

initiate high-priority clinical trials in specific areas. 

■ Increase health disparities clinical research training.

Recruit faculty and clinical investigators with an

emphasis on developing a diverse staff; provide

cultural competency training to physicians,

researchers, and outreach staff; improve minority

recruitment and support and enhance the progress

from clinical trials to research and delivery. 

■ Provide supplements to existing clinical trials

programs to address health disparity interventions.

Issue Requests for Applications (RFAs) or

Supplementals that recognize research in health

disparities and will attract researchers to the field.

■ Develop an overarching plan to disseminate a specific

type of research or recruitment model to other clinical

trials. Evaluate projects in terms of effectiveness

and outcomes, and share information on lessons

learned and barriers that need to be overcome;

determine if the same successful model can be

used in both prevention and treatment trials. 

■ Promote a National Clinical Trials Participation

Recognition Day. The event would address the

mistrust that minority groups hold about 

clinical research and recognize the significant 

role they play. 

■ Partner with organizations to support prevention,

treatment, and supportive care in clinical trial

participation. Develop interventions to address

lack of public trust, and attempt to apply

successful strategies from prevention trials to

treatment trials for minority groups. 

■ Create a Web site. Support a network to facilitate

communication among investigators about

minority-related issues

■ Track the activities that have been implemented 

and share and disseminate results.

Partnership Opportunities

■ Minority-Based Clinical Community Oncology

Programs (MCCOPs). Invite MCCOP principal

investigators to meet with cooperative group chairs

and the chairs of disease-specific and minority

research committees to identify a core group of

research questions for protocol development.

Provide financial support for MCCOP investigators

to design and conduct minority-focused 

clinical trials.

■ Clinical Community Oncology Programs (CCOP).

Facilitate the dissemination of minority-focused

EBIs across the entire CCOP network; focus on

clinical trials research and health disparities

interventions within a large efficient cooperative

group to go beyond lessons learned in health

service delivery and recommend strategies that

have worked in the field.

■ Cancer Therapy Evaluation Program (CTEP).

Disseminate the findings of the current

“Overcoming Barriers to Clinical Trials Project”

once the studies are completed and encourage

investigators to apply for additional research

projects that would further this research, especially

to address those with advanced cancer, which is

disproportionately found in minority populations. 

■ Cancer Disparities Research Partnership (CDRP) 

of the Radiation Research Program.

■ Patient Navigator Program. Issue an RFA to study

the issue of language barriers and the role of

interpreters, test ideas within specific settings, 

and share findings. 

Background

Certain populations are underrepresented in cancer

clinical trials, including the elderly, those of low socioeconomic status, and those living in rural areas, as well 

as Latino/Hispanic, Asian/Pacific Islander and American

Indian/Alaska Native men and women, and AfricanAmerican men. Slow overall accrual means that the

answers to important clinical trials questions are delayed.

The low number of minority patients admitted to any

one trial means that potentially important biological

differences and genetic differences within a population

may be obscured. However, the very small minority

sample sizes in many trials make such observations

difficult, if not impossible, to detect.

Recent expert recommendations to address low minority

participation in clinical trials include:
Action Plans to Overcome Cancer Health Disparities 

* This topic was covered by two breakout groups. Plans 1 and 2 identify different priority areas within the topic area.

■ Developing well-designed, controlled studies of

strategies to improve accrual to cancer prevention

and treatment trials 

■ Creating success measures for recruitment of

underrepresented populations as well as evaluation

and reporting of recruitment results in a more

consistent manner 

■ Designing relevant and pragmatic trials to address

problems in underserved communities 

■ Ensuring community-based participatory research

and community involvement through all phases 

of the research 

■ Including actual recruitment of underrepresented

populations as a major outcome of cancer clinical

trials and linking studies regarding barriers to

accrual to the trial implementation 

■ Improving strategies to recruit African-American

males and Hispanic men and women 

■ Investigating effective communication strategies

on information delivery on clinical trials 

■ Building relationships with community members,

including providers, before accrual 

■ Linking data collection about barriers and

promoters of trial participation to concrete plans

for intervention design to address barriers 

■ Developing cost-effective strategy to address

barriers to care by comparing the efficacy of a

recruitment intervention specialist to that of usual,

opportunistic recruitment practices 

■ Linking efforts to improve enrollment of

minority populations in cancer clinical trials 

with other initiatives designed to address cancer

health disparities 

■ Developing effective mentoring programs 

to develop minority academic faculty and

recruitment initiatives to hire minority faculty

(Ford, et al., 2005; Christian & Trimble, 2003)

Sociocultural and Behavioral

Influences: Plan 1*

Defining the Need

Sociocultural and behavioral (SCB) research contributes

to the understanding of factors associated with

disparities in cancer incidence and outcomes and the

pathways that mediate these factors, and informs the

development and testing of interventions to reduce

cancer-related health disparities. To determine how

SCB factors influence health disparities, it is essential to

examine socioeconomic, psychosocial, and lifestyle

variables that affect behaviors, susceptibility to cancer,

and cancer outcomes. By more fully and systematically

integrating the study and consideration of SCB

influences into NCI basic and clinical research,

program planning, and development, NCI can

dramatically increase the likelihood that scientific

advances will be adopted in practice. Addressing health

disparities in a comprehensive manner is a huge and

overwhelming undertaking—there are countless U.S.

populations varying in culture, age, and other factors.

This issue needs to be addressed broadly and

systematically to reach all groups and will need to be

done in “bite-size pieces” with the ultimate goal of

including SCB issues in NCI’s everyday work.

Proposed Action

Institutionalize a comprehensive and integrated process

to include SCB variables when conceptualizing and

developing research activities. 

Impact of Proposed Action

The proposed action would enable NCI to improve and

enhance the likelihood that scientific findings will be

translated into interventions that are appropriate for

Your work is meaningful to folks in churches, 

in community health centers, in the general U.S.

population where this is really important. They are

relying on us to be passionate about what 

we are doing and to make a difference.

— Dr. Garth Graham 

“

“
18 Action Plans to Overcome Cancer Health Disparities

groups that historically have poor cancer outcomes 

and are accepted and adopted for use in public health

and medical practice. 

Barriers Proposed Action Would Address

■ New scientific advances would be disseminated for

public health application by taking into account

such issues as cultural sensitivity, economic

feasibility, and other acceptance factors. 

■ Scientists would gain an in-depth understanding

of the communities and thereby more effectively

disseminate recommendations that are culturally

sensitive and appropriate. 

■ Understanding SCB factors that influence

screening uptake would increase the likelihood

that effective tests will be used. 

■ Awareness would be raised about the impact 

that understanding SCB influences has on 

health disparities, reinforcing and recognizing

NCI collaborations that address SCB factors. 

■ Surveys often measure health behaviors and

utilization but do not probe into the “whys” of 

the responses. This approach limits the cultural

meaning and understanding of the findings. 

■ Including SCB factors in cancer research could

influence the political climate in which health

messages are promoted and how.

Action Steps–Short Term

■ Commission a systematic review of models and

interventions from other disease areas that address

SCB variables/barriers/successes.

■ Create new methodologies to incorporate 

SCB issues into research and practice.

■ Develop a model for NCI-wide integration, 

e.g., HPV vaccine/testing, clinical trial

recruitment, tobacco control. 

■ Raise awareness of the impact SCB influences 

have in reducing health disparities.

■ Demonstrate to NCI stakeholders how inclusion 

of SCB issues in research will increase the impact 

the research has on reducing health disparities. 

Action Steps–Long Term

■ Promote and/or establish early partnerships 

with underserved communities to inform research

and disseminate effective interventions—

”anticipatory collaboration.”

■ Initiate SCB research that can and does inform

policy to reduce health disparities.

■ Recognize and reward NCI-wide collaborations

that address SCB issues.

■ Monitor and evaluate the impact of including

SCB considerations/factors/expertise in the full

spectrum of NCI activities/research.

Partnership Opportunities

■ The Centers for Disease Control and Prevention

(CDC) and other HHS agencies – Adapt strategies

or best practices that address health disparities to

enhance the information available to NCI and

address health disparities in a more holistic manner.

■ NCI’s CRCHD – Disseminate CRCHD qualitative

research results from public and community

gatekeepers that stress the benefit of and desire 

for social support, and distrust of “the system.” 

■ Community representatives – Continue to engage

target communities to inform the development of

cancer interventions and promote public ownership

of, trust in, and adoption of new behaviors. 

■ NCI research directors – Incorporate SCB issues

into current NCI research in trial recruitment,

tobacco control, and HPV research, as well as

intramural studies, e.g., inform strategies

promoting the use of HPV vaccine or self-tests,

when ready for dissemination.

■ Across NCI – Provide comprehensive funding

mechanisms to plan interventions on a structural

level, enabling intra-NCI partnerships to further

disparities research and intervention development;

continue to host meetings similar to this workshop

to inform NCI scientists across disciplines of

projects with collaboration potential; and

continually update programs in this area on

progress to help build and maintain relationships

across the Institute. 

Sociocultural and Behavioral

Influences: Plan 2 

Defining the Need

Studies in the area of SCB influences on cancer health

disparities focus on socioeconomic status, psychosocial

factors, and lifestyle variables that are significant for

healthy behaviors, susceptibility to cancer, and cancer

outcomes. Topics in this area include the influence of

social capital on the functioning of communities and

individuals; the physical effects of inferior material

conditions and their social meanings; the effects of social
Action Plans to Overcome Cancer Health Disparities 

injustice on risk factor behaviors, disease incidence, 

and stage of disease at diagnosis; and individual risk

behaviors such as poor diet, lack of exercise, smoking,

and alcohol abuse. While acknowledging a commitment

to reducing cancer disparities, NCI scientists and

researchers, for the most part, do not experience health

disparities in this context and therefore require exposure

and education on the SCB factors that influence cancer

outcomes in at-risk populations. 

Proposed Action

Develop a comprehensive, sustained, mandatory

education program to address a perceived lack of SCB

awareness among internal and extramural research

personnel affiliated with NCI, including researchers,

advocates, providers, community representatives, and 

lay health workers.

Impact of Proposed Action

This training and education program would improve

understanding of how social and cultural factors 

affect health disparities across the entire cancer

continuum and would address ways to remove barriers

to health care. The proposed approach would make

cross-NCI training mandatory (in the same way 

that ethics training is mandatory) to make cultural

considerations and disparities part of the vocabulary 

of researchers as they identify areas of study and 

seek grants for application.

Barriers Proposed Action Would Address

■ The lack of understanding across NCI on SCB

issues that lead to cancer health disparities

■ Fragmentation within NCI: not everyone at 

NCI realizes that sociocultural issues are central 

to addressing disparities

Action Steps–Short Term

■ Convene working group to lead training initiative,

including representatives from education, 

research, and social and cultural issues, as well 

as consumers, patients, providers, and targeted

community members 

■ Develop training curriculum based on working

group input

Action Steps–Long Term

■ Hold first in series of training programs 

at NCI in second year

■ Evaluate effectiveness of training (ongoing)

Partnership Opportunities

Potential partners in implementing the proposed education

program include the Office of Liaison Activities (OLA)

and OESI. The working group would: 

■ Consult with the Consumer Advocates in Research

and Related Activities (CARRA) as a model for

identifying and training individuals from diverse

communities who could both perform health

education in specific communities for NCI, and

educate NCI about communicating appropriately

and effectively with specific populations.

■ Work with the Patient Navigator Program, or

Culture Brokers, a framework from the mental

health rehabilitation field that helps patients find

their way in the medical system, to offer training

in the context of culture that is meaningful to

patients and families.

■ Participate in, sponsor, or offer NCI speakers to

the Intercultural Cancer Council’s symposium on

health disparities in April 2006. The symposium 

is expected to attract 2,000 people nationwide

including legislators, NIH directors, grassroots

advocates, and students. 

Other High-Priority Area

■ Develop programs to influence the current system

of healthcare (from health promotion to treatment

and follow-up) to allow for differences in perceptions

and reactions by various groups to standard efforts

of care. This is a health policy issue in that the system

needs to change in order to incorporate awareness,

understanding, and regard for sociocultural differences

that affect use and compliance with programs.

Cancer Care Delivery 

Defining the Need

Fragmentation in the organization, financing, and delivery

of health care services in the U.S.––disproportionately

high among low-income and minority communities––is 

a characteristic of the current health care system which

underlies cancer-related disparities in prevention,

diagnosis, treatment, and survivorship care. There is a

need to identify and eliminate fragmentation of care

delivery to underinsured and uninsured patients,

including care surrounding abnormal test result followup, referral, use of proven and emerging therapies and

technologies, and survivorship follow-up care planning. 
20 Action Plans to Overcome Cancer Health Disparities

Proposed Action

Establish initiatives across Public Health Service (PHS)

agencies to promote the development of strategies that

integrate cost-effective care to underserved communities

and populations.

■ Establish a research agenda focused on exploring

the root causes of poor care coordination and

follow-up along the entire cancer care continuum

in underserved populations. 

■ Create innovative policies, programs, and models

of care to improve cancer care coordination and

follow-up. 

■ Identify key areas of fragmentation of cancer 

care delivery to underinsured and uninsured

patients––focusing on those covered by Medicaid

and those “near poor” who do not qualify for

Medicaid but lack adequate insurance coverage.

■ Partner with other federal agencies to develop 

and implement programs. 

Impact of Proposed Action

■ The proposed action would help to increase 

use of preventive screening and treatment 

services; improve cancer care coordination;

increase the potential to inform policy changes

through the collection of cost-benefit data; 

and improve outcomes in mortality, quality 

of life, and satisfaction. 

■ Specific examples of outcome measures include

delivery of cancer prevention services to “well”

populations at high risk; ensuring follow-up of

abnormal screening test results, appropriate and

timely referral to cancer specialists at the time 

of initial diagnosis, the use of proven and 

newly emerging therapies and technologies, 

and the coordination of survivorship follow-up

care planning. 

Barriers Proposed Action Would Address

■ A lack of resources at the community level would

be addressed by directing resources toward the

community itself and assessing local needs.

■ A lack of access to primary care, difficulty

navigating complicated care systems and

inefficient and inconvenient health care systems

would be studied. 

■ Programs will be implemented to ensure that

abnormal test results during screening are followed

up with treatment and strategies are put in place

to ensure that once an individual starts treatment,

he or she finishes it. 

Action Steps–Short Term

■ Establish a cross-agency working group

■ Evaluate existing programs and research aimed 

at care coordination

■ Coordinate efforts to improve integration of

cancer care delivery via the existing trans-NCI

Cancer Care Delivery and Outcomes Group

(CCDOG)

■ Plan development of cost-effective strategies that

integrate care delivery (e.g., telemedicine). 

Action Steps–Long Term

■ Develop new large cohort studies with other PHS

agencies to examine best practices to ensure access

to prevention and treatment care for all and, using

the Geographic Information System (GIS), target

the availability of provider resources to those areas

experiencing the highest excess mortality rates.

Partnership Opportunities 

■ The Health Resources and Services Administration

(HRSA), CDC, and CMS – Develop a model care

system, using cervical or colorectal cancer as a

model for a successful care delivery continuum,

integrating federal agencies through existing programs

that address health care fragmentation issues. 

There is a disconnect between discovery and

delivery. There are people who don’t get the

benefits of the research that we do. That is 

a critical determinant in health disparities.

— Dr. Harold Freeman 

“

“
Action Plans to Overcome Cancer Health Disparities 

■ HRSA’s Office for the Advancement of Telehealth

and Office of Rural Health Policy, or the Alaska

Federal Health Care Access Network – Partner

with these groups to examine the role of

telemedicine in the development of integrated

cancer care systems. 

■ NCI’s Body & Soul Program – Expand beyond

government partners to the community and 

family levels. 

■ The Surveillance, Epidemiology, and End

Results (SEER) Program – Collect data on

underinsured and uninsured populations that 

do not quality for Medicaid or Medicare, and

analyze state cancer registry, including SEER, 

data over extended periods to better understand

under- and over-testing. 

■ U.S. Department of Veterans Affairs (VA) –

Collect data on the differences in care among

systems administered by the VA and CMS

■ The cancer Biomedical Informatics Grid 

(caBIG) – Build upon its infrastructure by

capturing treatment information to aid in 

better understanding racial/ethnic differences 

in cancer risk via patient-level genetic or 

molecular information.

Education and Training for 

Cancer Care Professionals 

and Researchers

Defining the Need

Significant gaps exist in educating and training 

cancer care professionals and researchers about health

disparities. Contributing to the gaps are an absence of

systems within NCI to clearly define, track, and assess

health disparities research and training projects and a

dearth of mechanisms and approaches to educate and

train clinicians on the front lines of cancer care delivery. 

Proposed Action

Broaden NCI's education and training efforts in health

disparities to audiences beyond researchers to include

health care practitioners. Dedicate more resources to

enhance knowledge and skill of cancer care professionals

in general, with emphasis on improving cultural

competence among physicians, nurses, pharmacists, 

and other health care professionals, as well as trainees in

pursuit of a health care career focused on cancer control. 

Impact of Proposed Action

■ Training would define specific and relevant issues

contributing to cancer health disparities

■ Effectively communicate and build trust with

minority and economically disadvantaged patients

■ Understand the differences in cancer epidemiology

and treatment efficacy among various racial and

ethnic groups

■ Appreciate patients’ cultural backgrounds and

behaviors—acknowledging that professionals’ own

backgrounds might conflict—and work toward

cultural competence in their cancer care practice 

Barriers Proposed Action Would Address

Training would alleviate:

■ A lack of information available to health care

providers about specific problems contributing 

to disparities in cancer care and methods for

eliminating these disparities

■ A lack of a clear definition of health disparities

research and a coordinated tracking system; this

may be attributable, at least in part, to privacy

concerns associated with identifying the investigators

conducting health disparities-related research 

Because NCI's education and training focus has traditionally

been on researchers, the proposal to significantly focus

training toward health care deliverers is a major challenge,

particularly in resource-limited times. Nevertheless, the

current culture, with its emphasis on health care delivery

of therapies to complement the discovery and

development processes, provides a prime opportunity to

strive for a balance in focus. Such attention could serve

to increase providers’ efforts to address issues and modify

systems and environments to better serve the needs of

groups of patients most vulnerable to cancer. 

Action Steps–Short Term

■ Assess opportunities to forge fruitful partnerships

within and beyond NCI

■ Evaluate existing education/training funding

mechanisms and their capacities to address 

health disparities

■ Develop a research agenda to define the role of

education and training in reducing cancer disparities

Action Steps–Long Term

■ Build cancer care education/training models for

disseminating information and evidence, building

skills, and changing delivery practices in ways that

contribute to the reduction of disparities 
22 Action Plans to Overcome Cancer Health Disparities

Partnership Opportunities

■ Successful government and private-sector

interventions already in place, including NCI’s

Cancer Collaborative to reduce breast, cervical,

and colon cancer mortality by helping clinicians 

to close the gap between levels of cancer screening

and follow-up in underserved people and the

general U.S. population 

■ NCI-supported EPEC-O project, an expansion 

of the Education for Physicians on End-of-Life

Care project targeted to oncology professionals 

■ The Cancer Care Outcomes Research and

Surveillance (CanCORS) Consortium initiative 

of NCI's DCCPS 

■ NCI’s Patient Navigator Program 

■ An enhancement of NCI's continuing medical

education offerings, “Physician Data Query”

(PDQ) database; and the NIH-wide Quality

Cancer Care Committee task force 

Other High-Priority Area

A subordinate issue identified by the breakout group is

the lack of data to determine what is actually occurring

in the area of cancer health disparities research. The

breakout group broke this issue down into sub-issues

including NCI's lack of a useful method to track existing

health disparities research projects and an inability to

elucidate what constitutes cancer health disparities

research. The group's proposed solution involved

fashioning a Request for Application-type mechanism to

increase education/training funds designated specifically

for health disparities research. This approach would

provide distinct funding for researching education and

training approaches that have the greatest potential for

impacting health disparities, while clarifying what

qualifies as disparities research so that individuals

impacted can be trained accordingly. Also, this would

provide a simple method to follow projects to their

conclusions and beyond.

Communications Research

Defining the Need

What are the most effective ways to communicate health

information with at-risk populations? How does NCI

ensure that effective communications initiatives, proven

to be effective, are implemented in the community? Who

at NCI is conducting research into these issues? The

bridge between research and application needs to be

supported so that the many interventions supported by

NCI are informed by research on the most effective ways

to communicate with at-risk populations, taking into

account cultural competencies and health literacy.

Within NCI, there is a need to know more about what

others are doing in the area of communications on

cancer health disparities in order to better collaborate

and integrate resources. 

Proposed Action

Synthesize results from communications research into

effective strategies for reaching populations experiencing

health disparities.

Impact of Proposed Action

This action would use knowledge gained from

communications research to develop, implement, and

disseminate effective interventions and appropriate

health and scientific information to eliminate health

disparities. NCI and practitioners will develop better

communications activities targeting populations 

suffering from cancer health disparities.

Barriers Proposed Action Would Address

■ Dissemination of best practices would help

researchers and planners understand the language,

images, and messages that will resonate with a

particular group; ensure that materials are

presented in a manner that can be understood by

people with low literacy in English and/or another

language; and use the appropriate channels to

reach people, including “low tech” methods of

communication.

■ Knowledge of the full universe of NCI-sponsored

communications research activities would allow for

greater coordination and would lessen confusion

among the public over cancer news and information.
Action Plans to Overcome Cancer Health Disparities 

Action Steps–Short Term

■ Enhance internal communications about

communications research and activities to more

effectively collaborate and integrate resources. 

■ Develop a process for synthesizing communications

research and research that focuses on communicating

with populations suffering from cancer health

disparities. Such a process would identify the

scope of such a synthesis project including

research questions of interest and inclusion/

exclusion criteria. In addition, efficient and

effective methods for conducting this synthesis

project should be explored. For example, should

NCI contract with a group such as the Chochrane

Collaborative, which specializes in reviewing

research, or should NCI attempt to nurture this

expertise internally?

■ Disseminate findings from the research synthesis

both internally and externally, particularly among

staff who are not health communicators.

Action Steps–Long Term

■ Develop NCI experts who are knowledgeable

about evidence-based communication approaches

and can assist in the development of NCI

initiatives related to health disparities.

Partnership Opportunities

While OC and OESI have leading roles to play in

communicating about cancer health disparities, many

NCI divisions, offices, and centers are involved with

communicating with the public, or with those who

interact with the public (media, health care providers,

community organizations, and others).

■ Work with the Trans-NCI Health

Communication Research Activities Group and

Trans-NCI Health Disparities Interest Group 

to enhance internal communications about

communications research and activities to more

effectively collaborate and integrate resources.

■ Partner with OC to use its new Intranet 

as a method of information exchange about 

heath disparities communications efforts; list 

brief annotations and contact information for 

each activity. 

■ Work with Cancer Control PLANET to identify

peer-reviewed research articles on communications

interventions that have been considered effective.

■ Collaborate with DCCPS to foster information

exchange through a publication similar to 

“Recent Staff Publications and Contacts on 

Health Disparities.” 

■ Partner with regional organizations through CIS. 

■ Tap expertise of communication researchers in

areas of health communications beyond cancer, 

as well as communications research beyond health,

including audience analysis by the drug, alcohol,

and tobacco companies. 

■ Review preliminary results from ongoing studies.

Use a formative research compendium compiled

by OESI (soon available online). 

NCI leadership attended the workshop and 

voiced the need for us to communicate

better across all divisions in health disparities.

— Workshop Participant

“

“
24
Next Steps 

Based on input from workshop participants, a high level

of enthusiasm exists around continuing to work together

as an Institute to reduce cancer health disparities. Three

major “next steps” evolved from the workshop.

1. Create an I2 Team for Health Disparities. The

overarching vision generated from the workshop and

the action plans should be considered in the

assessment and business plan development processes

of an I2 Team. The I2 Team should look for synergies

and duplication of efforts among the various plans

and emerge with one multidisciplinary approach 

to reducing cancer health disparities in the U.S. 

2. Elevate Health Disparities Research Across the

Institute. NCI should commit to integrating the

elimination of cancer health disparities into the 

NCI mission and into all major NCI initiatives. 

3. Maintain Momentum

A. The workshop planning committee recommends

that the executive committee or senior

management team identify an infrastructure 

to maintain the momentum gained by the

workshop. This structure could be a newly

formed small or existing working group of

committed staff members from across the

Institute charged with:

■ Publishing a periodic update on NCI health

disparities initiatives for internal and external

distribution. Using the list of initiatives

compiled for the workshop as a platform, the

newsletter or bulletin would keep NCI staff

informed of programs and encourage transNCI collaboration. 

■ Assessing needed staff, financial, and

infrastructure resources and continuing existing

and new activities to coordinate health

disparities efforts within NCI. 

■ Maintaining an Intranet portal to post all

materials gathered for and supporting the

workshop (underway) and to capture

forthcoming NCI-wide efforts to reduce 

cancer health disparities. 

B. NCI should establish a mechanism for

streamlining future proposed approaches and

technologies that serve to rapidly impact cancer

health disparities. These initiatives should be

practical, short term, and easily accomplished;

identified through Institute-wide electronic

brainstorming sessions; and filtered by the

executive committee. In addition, NCI should

continue its efforts to strongly advocate for

continued actions related to the implementation

of recommendations from the Trans-HHS Cancer

Health Disparities Progress Review Group. 

Next Steps

This was a great start. 

We need to keep the momentum going.

— Workshop Participant

“

“
26
In Conclusion: Emerging Themes in Cancer Health Disparities Research 

Major Themes Emerging 

from the Workshop

Several critical themes emerged from careful

consideration and analysis of the questions, comments,

and discussion during the plenary and breakout sessions.

These themes are essential for NCI to consider in

evolving its strategic objective for overcoming cancer

health disparities 

Incorporate the elimination of cancer 

health disparities into “what we do”

Participants and presenters expressed the need for a

paradigm shift at NCI to examine the fundamental 

issues of access, fairness, and education as they relate 

to research, cancer care, and training, as evidenced in 

the following statements: 

■ The time has come for health disparities to be

elevated to a formal research discipline.

■ Because overcoming health disparities is one of

eight objectives in NCI’s strategic plan, we must

integrate components of health disparities research

in all major NCI-funded programs. 

■ NCI must look beyond its gates to make what we

do available to more people in our own backyard.

We could do a better job of sharing our expertise

and resources with at-risk populations in the

Baltimore-Washington area through partnerships

and programs, including establishment of a

community clinic to serve at-risk neighbors. 

Gain a better understanding of 

what we fund in health disparities

The review of the MHHD Portfolio Analysis was eye

opening. Many comments centered on the need to

continue to analyze and refine the portfolio on a regular

basis. Discourse on this topic included: 

■ Better systems for data capture and management

are needed to move us forward in understanding

our own contributions to reducing health

disparities. 

■ We know that 5.6 percent of the NCI budget was

spent on health disparities in 2004. The questions

are: How much should we be investing in health

disparities research, and what will it take to make

a significant impact toward reducing disparities?

We need to consider the quality and quantity of

research and whether we are generating the most

appropriate innovations for addressing disparities. 

Become more socially just 

in our research and practice

A theme introduced by Dr. Harold Freeman and

threaded throughout workshop discussions was the

commitment of social justice in our strides to reduce

cancer health disparities. Sentiments reflected in the

following statements are examples of a strong voice

supporting a socially just approach to guide NCI efforts

and initiatives on health disparities.

■ Are the audiences we wish to affect involved in

setting the research agenda?

■ While investments in cancer control abroad are

notable, such investments might detract from

resources needed to meet the critical needs for

vulnerable U.S. populations, such as those in the

Mississippi Delta and remote areas with limited

access to basic cancer control services.

■ We must remove barriers that prevent the benefits

of research from reaching all populations—if

innovations are not applicable to the most

vulnerable, they are socially unjust.

Align community issues with what we do

Participants stressed the need for constant interaction

with the communities we wish to affect, both to learn

what is needed and how best to deliver services.

■ Is our science aligned with what the community

wants, needs, and desires? Are our macro strategies

aligned with what society needs? For example, if

we invest heavily in expensive drugs that only 10

percent of the population can afford, shouldn’t we

consider ways to match complex problems with

effective interventions that can be delivered more

cost effectively? 

In Conclusion: Emerging Themes 

in Cancer Health Disparities Research 
28 In Conclusion: Emerging Themes in Cancer Health Disparities Research 

Increase attentiveness to evaluation 

of our work in health disparities

The need for greater focus on evaluation was a consistent

theme. Comments were directed toward increasing NCI’s

evaluation efforts in the area of health disparities research

and reinforcing systems supporting our ability to

evaluate progress. 

■ We need to know what works in overcoming

health disparities and divert investment in

initiatives that have not been proven to work. 

By investing in the science of evaluation we can

avoid reinventing the same approaches without 

an understanding of their impact.

■ With the investments made in NCI’s

Comprehensive Cancer Centers, NCI should be

able to systematically collect information that, 

in its aggregate, can reveal more than it could in 

any one center. Systematically collecting center

data on accrual and participation of specific

populations to studies would be beneficial in

understanding our impact and reach in clinical

research into health disparities.

■ Policy decisions must be data driven. We need 

to be able to present policymakers with accurate,

thorough data that reveal successes and promises

in cancer control and treatment. More

importantly, this information must be presented 

in clear and simple language that policymakers 

can use to develop fair and effective policies. 

A diverse workforce and evaluation 

of training initiatives are needed

Training and development cut across several topics.

Several concepts were put forward:

■ Due to insufficient data systems, NCI is unable 

to fully understand the impact of its training 

and development activities. Office of Management

and Budget (OMB) rules limit our ability to

systematically follow up with those we train and

restrict our progress toward increasing workforce

diversity. Increased diversity may contribute to

increased research projects that focus on disparities

or minority communities. 

■ Because reports capture only those trained in

programs that target minorities, we are unable to

ascertain the number of individuals from diverse

backgrounds that benefit from NCI-sponsored

training initiatives. 

■ While there is broad support for training, we 

lack a clear understanding of how training for

disparities research differs from training for general

research. Are there specific training needs for those

who intend to devote their careers to the study of

health disparities? If so, we need to assure that

NCI training endeavors strive to fulfill them.

Likewise, there is support for complementing all

training with elements of increasing cultural

competency in research and practice.

■ Tying back to the theme of social justice, there is a

need for introspection, starting with advancement

opportunities for NCI’s own staff. NCI’s internal

actions with regard to garnering security in the future

of individuals (A76 issues) and workforce development

(restoring a career ladder) were cited as putting

our commitment to social justice into action. 

Seize the power of collaboration 

through support of team science

In alignment with the workshop theme, considerable

emphasis was placed on working smarter, defined as

consideration for how NCI might better coordinate

efforts and take advantage of information already

available to us. Concepts addressed opportunities for

greater collaboration: 

■ Recognize that a substantial investment of NCI

resources is in the cancer centers and SPORE

programs. We should be able to expect more in

return with regard to understanding the

contributions they make toward reducing cancer

disparities, and to capturing data on the number

of diverse populations participating in both

general and health disparities research. 

■ To better plan health disparities activities, a

comprehensive inventory of current efforts, 

roles, skills, and structures throughout NCI, 

as presented through this workshop, should 

be developed and updated on a regular basis.

■ Given that health disparities occur across disease

states, we should collaborate with other NIH

Institutes. Because people are whole and complex

beings, we should consider who we are trying to

reach, what other Institutes are striving to reach

the same audiences, and how we can partner in 

our combined quest to improve health status.

■ Periodically, the Institute needs to pause and

examine what positive contributions are 

being made and structure awards and rewards

accordingly.
In Conclusion: Emerging Themes in Cancer Health Disparities Research 

The unequal burden of disease in society 

is a scientific challenge, but it is also a 

moral and ethical dilemma. Scientific truth 

must always be wed to social justice. 

— Dr. Harold Freeman 

“

“
30 Final Word: A Vision for Overcoming Cancer Health Disparities

This was a long overdue event. Please do not 

let this be the first and last workshop.

— Workshop Participant

“

“
Final Word: A Vision for Overcoming Cancer Health Disparities 

As evidenced throughout the workshop, NCI is passionate about working together to reduce cancer 

health disparities. This is not only a moral and ethical dilemma but part of NCI’s core mission as 

articulated in its 2006 Strategic Plan.

The following vision statement is presented by the planning committee as a committed group of scientists,

researchers, communicators, and administrators working together to close the gap in health disparities.

Vision: 

NCI Will Lead the Nation’s Effort 

to Overcome Cancer Health Disparities

Final Word: A Vision for 

Overcoming Cancer Health Disparities

Goals to Achieve the Vision:

■ Actively incorporate the elimination of health disparities into “what we do.”

■ Define and establish health disparities as a formal research discipline and as a cross-cutting

need across all research areas, making it a requirement for many NCI funding mechanisms.

■ Consistently align community research problems with discovery research expertise.

■ Seize the power of collaboration by effectively communicating advances in health disparities

research and encouraging bold new initiatives across disciplines by supporting and rewarding 

team science and multidisciplinary approaches to health disparities research.

■ Strive for social justice and equality: Define, implement, and integrate successful programs 

to reduce or eliminate health disparities into everyday practice to reach all populations.

■ Fully support a diverse workforce internally and externally as evidenced by training for career

advancement and cultural competence. 
32
Appendix A 

Appendix A: Workshop Agenda

7:00–8:00 a.m. Registration

8:00–8:15 a.m. Call to Order

Lenora Johnson 

Welcome 

Mark Clanton

Deputy Director, Cancer Care Delivery Systems, NCI

8:15–8:25 a.m. Purpose and Charge to Participants

L. Michelle Bennett 

8:25–9:40 a.m. SESSION 1: Background and Where We Are Today 

Moderator: Mark Clanton

Health Disparities Today

Robert Croyle

Recommendations to Reduce Cancer Health Disparities: Past, Present, Future

Harold Freeman

Garth Graham 

Portfolio Analysis

Pebbles Fagan and Barbara Wingrove

9:40–10:10 a.m. Q&A with Panel

Moderator: Mark Clanton

10:10–10:25 a.m. Break

10:25–11:45 a.m. SESSION 2 – PART A: State of the Science in Health Disparities across NCI – 

Most Promising, Effective, Innovative Practices and Initiatives

Presentations from NCI Centers, Offices and Divisions

Moderator: Joseph Fraumeni

DCEG – Joseph Fraumeni

CCR – Robert Wiltrout

DCB – John Cole

DCP – Peter Greenwald

DCTD – Frank Govern

11:45 a.m.–12:15 p.m. Panel Discussion with Session 2 Part A Presenters

Moderator: Joseph Fraumeni

Panelists: Robert Wiltrout, Joseph Fraumeni, John Cole, 

Peter Greenwald, Frank Govern

12:15–1:45 p.m. Lunch and Poster Session

Thursday, November 17

All activities will occur in the Main Auditorium except the Poster Session, which will be held in the Atrium.
34 Appendix A

1:45–3:00 p.m. SESSION 2 – PART B: State of the Science in Health Disparities across NCI – 

Most Promising, Effective, Innovative Practices and Initiatives

Presentations from NCI Centers, Offices and Divisions

Moderator: Robert Croyle

DCCPS – Robert Croyle

CRCHD – Nada Vydelingum

OCCAM – Jeffrey White 

OLA – Brooke Hamilton and James Hadley

OESI – Lenora Johnson

3:00–3:30 p.m. Panel Discussion with Session 2 Part B Presenters

Moderator: Robert Croyle

Panelists: Robert Croyle, Nada Vydelingum, Jeffrey White, Brooke Hamilton, 

James Hadley, Lenora Johnson, Paulette Gray (DEA)

3:30–3:45 p.m. Break

3:45–5:00 p.m. SESSION 2 – PART C: State of the Science in Health Disparities across NCI – 

Most Promising, Effective, Innovative Practices and Initiatives

Presentations from NCI Centers, Offices and Divisions

Moderator: Nelvis Castro

OC – Mary Anne Bright

OSPA – Cherie Nichols

OWD – Teresa Estrada

OCTR – Ernie Hawk

NCICB – Ken Buetow 

5:00–5:30 p.m. Panel Discussion with Session 2 Part C Presenters

Moderator: Nelvis Castro

Panelists: Nelvis Castro, Mary Anne Bright, Cherie Nichols, Leon Espinoza, 

Teresa Estrada, Sanya Springfield, Ken Buetow

5:30 p.m. Concluding Remarks for Day 1

Dr. John E. Niederhuber

Deputy Director, NCI 

Deputy Director, Translational and Clinical Sciences, NCI

Thursday, November 17 (cont.)
Appendix A 

8:00–8:10 a.m. Reconvene/Announcements Main Auditorium

Lenora Johnson

8:10–9:00 a.m. SESSION 3: Sharing the Promises for Discovery, Main Auditorium

Development and Delivery through Partnerships

Moderator: Sanya Springfield

Comprehensive Cancer Control

Jon Kerner

Trans-HHS Quality Cancer Care Committee

Rochelle Rollins 

Minority-Serving Institutions/Cancer Center Partnership

Sanya Springfield

9:00–9:15 a.m. Workgroup Charge Main Auditorium

L. Michelle Bennett 

9:15–9:30 a.m. Break

9:30 a.m.–12:00 p.m. SESSION 4: Breakout Sessions

Communications research – A Natcher – Room B

Co-Chairs: Mary Anne Bright

Linda Squiers

Communications research – B Natcher – Room A

Co-Chairs: Nelvis Castro

Sabra Woolley

Genetic and biological differences – A Building 10, 

Co-Chairs: Linda Brown Room 2C118

Douglas Figg

Genetic and biological differences – B Building 10, 

Co-Chairs: John Cole Room 2C116

Nada Vydelingum 

Sociocultural and behavioral influences – A Natcher –

Co-Chairs: Kathie Reed Rooms G1 & G2

Helen Meissner

Sociocultural and behavioral influences – B Natcher – Room F

Co-Chairs: Suzanne Heurtin-Roberts

Ken Chu

Education and training for cancer care professionals and researchers Building 10, 

Co-Chairs: Lenora Johnson Room 2S235

Vi Black

Belinda Locke

Friday, November 18
36 Appendix A

Friday, November 18 (cont.)

Narrowing the gap between research and practice – A Natcher – 

Co-Chairs: Anna Levy Rooms C1 & C2

Richard Alexander

Narrowing the gap between research and practice – B Natcher – Room D

Co-Chairs: Pebbles Fagan

Jon Kerner

Clinical trials Building 50, 

Co-Chairs: Worta McCaskill-Stevens Room 1328

JoAnne Zujewski

Martin Gutierrez

Care systems research Building 10, CRC, 

Co-Chairs: Barbara Wingrove Room 3-2550

Rochelle Rollins

Arnie Potosky

12:00–1:00 p.m. Lunch

1:00–4:00 p.m. SESSION 5: Report Back to the Full Meeting Main Auditorium

(a 15-minute break Moderators: L. Michelle Bennett and Lenora Johnson

around 3:00 p.m.)

Communications research

Genetic and biological differences

Sociocultural and behavioral influences

Education and training for cancer care professionals and researchers

Narrowing the gap between research and practice

Clinical trials

Care systems research

4:00–4:20 p.m. SESSION 6: NCI’s Commitment to Reducing Health Disparities Main Auditorium

Joseph Fraumeni 

Robert Croyle

Sanya Springfield

4:20 p.m. Concluding Remarks and Adjournment Main Auditorium

L. Michelle Bennett and Lenora Johnson
Appendix B 

José Acosta Office of Communications

Tanya Agurs-Collins Division of Cancer Control 

and Population Sciences

Demetrius Albanes Division of Cancer Epidemiology 

and Genetics

H. Richard Alexander Center for Cancer Research

James Alexander Office of Communications

Mark Alexander Division of Cancer Control 

and Population Sciences

Lynn Amende Division of Extramural Activities

William Anderson Division of Cancer Epidemiology 

and Genetics

J. Fernando Arena Division of Cancer Control 

and Population Sciences

Cheryl Arenella Office of Education and 

Special Initiatives

Michael Arluk Office of Communications

Janet Ayres Office of Women’s Health, OSPA

Cathy Backinger Division of Cancer Control 

and Population Sciences

Charles Baffi Health Promotion Research Branch

Tai Baker Office of Cancer Complementary 

and Alternative Medicine

Rachel Ballard-Barbash Division of Cancer Control 

and Population Sciences

Marc Ballas Center for Cancer Research

Jamelle Banks Office of Science Planning 

and Assessment

Dalsu Baris Division of Cancer Epidemiology 

and Genetics

Jill Bartholomew Office of Education and 

Special Initiatives

Lisa Beauvois Neuro Oncology Branch

Shannon Bell Office of Workforce Development

Tammie Bell Office of Management Analysis

L. Michelle Bennett Center for Cancer Research

David Berrigan Division of Cancer Control 

and Population Sciences

Ken Bielat Division of Extramural Activities

Vi Black Center for Cancer Research

Gail Blaufarb Division of Extramural Activities

Mary Blehar Office of Centers, Training 

and Resources

Michele Bloch Division of Cancer Control 

and Population Sciences

Bonny Bloodgood Center to Reduce Cancer 

Health Disparities

Donna Bonner Office of Communications

Laura Boyle Office of Education and 

Special Initiatives

Nancy Breen Division of Cancer Control 

and Population Sciences

Erica S. Breslau Division of Cancer Control 

and Population Sciences

Mary Anne Bright Office of Communications

Melissa Bronez Center for Cancer Research

Diane Bronzert Division of Extramural Activities

Linda Brown Division of Cancer Epidemiology 

and Genetics

Martin Brown Division of Cancer Control 

and Population Sciences

Teri Brown Office of Centers, Training 

and Resources

Gail Bryant Division of Extramural Activities

Kenneth H. Buetow Center for Bioinformatics

Ilene Holly Burstyn Office of Communications

Dionne Burt Center to Reduce Cancer 

Health Disparities

Beth Buschling Division of Extramural Activities

Victoria Butz Center to Reduce Cancer 

Health Disparities (contractor)

Tyane Calhoun Center for Cancer Research

Appendix B: Workshop Participant List

NCI Health Disparities Workshop Registrant List
38 Appendix B

Philip Castle Division of Cancer Epidemiology 

and Genetics

Nelvis Castro Office of Communications

Kenneth Chu Center to Reduce Cancer 

Health Disparities

Mark Clanton Cancer Care Delivery Systems

Lin Clegg Division of Cancer Control 

and Population Sciences

John Cole III Division of Cancer Biology

Leslie Cooper Center to Reduce Cancer 

Health Disparities

Luis Cordeiro Division of Cancer Treatment 

and Diagnosis

Robert Croyle Division of Cancer Control 

and Population Sciences

Louise Cunningham Office of Education and 

Special Initiatives

Jane Daye Center to Reduce Cancer 

Health Disparities

Candace Deaton Office of Communications

Jean Decker Center for Cancer Research

Rhonda DeJoice Office of Education and 

Special Initiatives

Andrea Denicoff Cancer Therapy Evaluation Program

Susan Devesa Division of Cancer Epidemiology 

and Genetics

Jim Dickens Office of Budget & 

Financial Management

Mary DiGaudio Division of Cancer Control 

and Population Sciences

Ivan Ding Office of Centers, Training 

and Resources

Clarissa Douglas Research Analysis and Evaluation

Taira Duncan Office of Education and 

Special Initiatives

David Eckstein Cancer Training Branch

Regina el Arculli Officer of the Director

Nancy Emenaker Division of Cancer Control 

and Population Sciences

Jennifer Eng-Wong Medical Oncology Branch

Leon Espinoza Office of Workforce Development

Teresa Estrada Office of Workforce Development

Pebbles Fagan Division of Cancer Control 

and Population Sciences

William Figg Center for Cancer Research

Melizza Ford Cancer Therapy Evaluation 

Program (contractor)

Joseph F. Fraumeni, Jr. Division of Cancer Epidemiology 

and Genetics

Neal Freedman Division of Cancer Epidemiology 

and Genetics

Dan Gallahan Division of Cancer Biology

Roland Garcia Center to Reduce Cancer 

Health Disparities

LaShell Gaskins Comprehensive Minority 

Biomedical Branch

Nina Ghanem Office of Communications

Jacquelyn Goldberg Cancer Therapy Evaluation Program

Jorge Gomez Office of Centers, Training 

and Resources

Nina Goodman Office of Education and 

Special Initiatives

Rashmi Gopal-Srivastava Office of Centers, Training 

and Resources

Lester Gorelic Office of the Deputy Director 

for Extramural Science

Frank Govern Division of Cancer Treatment 

and Diagnosis

Paulette Gray Division of Extramural Activities

Amanda Greene Center to Reduce Cancer 

Health Disparities

Peter Greenwald Division of Cancer Prevention

Addison Greenwood Office of Communications

Lynette Grouse Office of Communications

Barbara H Guest Division of Cancer Control 

and Population Sciences

Anjan Guhathakurta Center for Cancer Research

Martin Gutierrez Center for Cancer Research

James Hadley Office of Liaison Activities

David Haggstrom Applied Research Program

Brooke Hamilton Office of Liaison Activities

Camille Hammond Office of Cancer Survivorship

Bethany Hanna Office of Education and 

Special Initiatives

Brooke Hardison Office of Workforce Development

Virginia Hartmuller Division of Cancer Control 

and Population Sciences
Appendix B 

Ernest Hawk Office of Centers, Training 

and Resources

Kimberly Henderson Center to Reduce Cancer 

Health Disparities

Marianne Henderson Division of Cancer Epidemiology 

and Genetics

Suzanne Heurtin-Roberts Division of Cancer Control 

and Population Sciences

Dorie Hightower Office of Communications

Christine Holmberg Division of Cancer Prevention

Gibran Holmes Center for Cancer Research

Ami Hurd Division of Cancer Control 

and Population Sciences

Jane Jacobs Office of Liaison Activities, OD

Diana Jeffery Division of Cancer Control 

and Population Sciences

Jose Jeronimo Division of Cancer Epidemiology 

and Genetics

Lenora Johnson Office of Education and 

Special Initiatives

Maureen Johnson Office of the Director

Kay Johnson-Graham Office of Equal Employment 

Opportunity

Rachel Johnston Office of Strategic Management 

Planning

Jacquin Jones Center for Cancer Research

Abigail Joyce Office of Communications

Carol Kasten Division of Cancer Control 

and Population Sciences

Mary Kelley Office of Communications

Jon Kerner Division of Cancer Control 

and Population Sciences

Aimee King Office of Communications

Julaine King Center to Reduce Cancer

Health Disparities

Kristin Kiser Division of Cancer Epidemiology 

and Genetics

LaTonya Kittles Office of Communications

Marianne Kost Office of Science Planning 

and Assessment/OD

Susan Krebs-Smith Division of Cancer Control 

and Population Sciences

Lisa Krueger Division of Extramural Activities

Jennifer Kwok Center for Cancer Research

Edward Kyle Division of Extramural Activities

Madeline LaPorta Office of Communications

Kelli Langley Division of Cancer Epidemiology 

and Genetics

Colleen Lee Office of Cancer Complementary 

and Alternative Medicine

Simon Craddock Lee Division of Cancer Control 

and Population Sciences

Mary Leveck Office of Science Planning 

and Assessment

Anna Levy Office of Science Planning 

and Assessment

Belinda Locke Comprehensive Minority 

Biomedical Branch

Douglas Lowy Center for Cancer Research

Anne Lubenow Office of Communications

Francis X. Mahaney, Jr. Center to Reduce Cancer 

Health Disparities

Richard Manrow Office of Communications

Patricia G. Marek Division of Extramural Activities

Padma Maruvada Division of Cancer Prevention

David Maslow Division of Extramural Activities

Holly Massett Office of Education and 

Special Initiatives

Christine McCann Center to Reduce Cancer 

Health Disparities

Worta McCaskill-Stevens Division of Cancer Prevention

Lois McCourt Office of Liaison Activities

Lisa McCoy Office of Education and 

Special Initiatives

Paige McDonald Division of Cancer Control 

and Population Sciences

Devon McGoldrick Office of Liaison Activities

Moira McGuire Center for Cancer Research

Ilda McKenna Division of Extramural Activities

Susan McMullen Center for Cancer Research

Nicole McNeil Center for Cancer Research

Kathryn McNeill Division of Cancer Control 

and Population Sciences

Stephen Meersman Division of Cancer Control 

and Population Sciences

Genevieve Medley Office of Science Planning 

and Assessment
40 Appendix B

Helen Meissner Division of Cancer Control 

and Population Sciences

Isis Mikhail Epidemiology and Genetics 

Research Program

Melissa Miller Office of Cancer Survivorship

Michael Miller Office of Communications

Erin Milliken President's Cancer Panel

Rita Mincemoyer Center for Cancer Research

Lori Minasian Division of Cancer Prevention

Alyssa Minutillo Division of Cancer Epidemiology 

and Genetics

Terry Moody Center for Cancer Research

Lee Moore Division of Cancer Epidemiology 

and Genetics

Glen Morgan Division of Cancer Control 

and Population Sciences

Thuy Morzenti Office of Communications/

Public Affairs

Traci Mouw Nutrition Epidemiology Branch

Christy Mylks Office of Education and 

Special Initiatives

Wendy Nelson Division of Cancer Control 

and Population Sciences

Elizabeth Ness Center for Cancer Research

Meghan Newcomer Division of Cancer Control 

and Population Sciences

Sheila Nguyen Antibodies and Proteins 

Purification Unit

Cherie Nichols Office of Science Planning 

and Assessment

Peter Ogunbiyi Office of Centers, Training 

and Resources

Oluwadamilola Olaku Office of Cancer Complementary 

and Alternative Med

Ofelia Olivero Center for Cancer Research

Anita Ousley Office of Education and 

Special Initiatives

Rose Mary Padberg Office of Education and 

Special Initiatives

Karen Parker President's Cancer Panel

Linda Parreco Office of Communications

Appasaheb Patel Division of Cancer Control 

and Population Sciences

Lorna Patrick Office of Education and 

Special Initiatives

Judy Patt Office of Communications

Deb Pearson Office of Communications

June Peters Division of Cancer Epidemiology 

and Genetics

Brandy Peterson Office of Communications

Raymond Petryshyn Division of Extramural Activities

James Pingpank Center for Cancer Research

Laura Planas Office of Education and 

Special Initiatives

Paris Ponder Division of Cancer Control 

and Population Sciences

Arnold Potosky Division of Cancer Control 

and Population Sciences

Beverly Powell-St. James OD/Cancer Care Delivery Systems

Douglas Price Center for Cancer Research

Robyn Prueitt Laboratory of Human Carcinogenesis

Miranda Raggio Center for Cancer Research

Kathie Reed Office of Science Planning 

and Assessment

Sabrina Reed Mid-Atlantic Cancer 

Information Service

Kimberly Reyes Office of Communications

Margaret Rhoades Office of Communications

Weston Ricks Financial Management Branch

John Risinger Center for Cancer Research

Sonya Roberson Division of Extramural Activities

JaMuir Robinson Office of Education and 

Special Initiatives

Rochelle Rollins Cancer Care Delivery Systems

Julia Rowland Division of Cancer Control 

and Population Sciences

Anne Ryan Division of Cancer Prevention

Nicole Saiontz Office of Communications

Silvia Salazar Office of Education and 

Special Initiatives

Catherine Schairer Division of Cancer Epidemiology 

and Genetics

Sheri Schully Division of Cancer Epidemiology 

and Genetics

Hasnaa Shafik Division of Extramural Activities

Vickie Shavers Division of Cancer Control 

and Population Sciences
Appendix B 

Carol Sienche Office of Education and 

Special Initiatives

Susan Silk Office of Education and 

Special Initiatives

Felicia Solomon Office of Education and 

Special Initiatives

Perry Soriano Surgery Branch

Cherie Spencer Cancer Information Service

Sanya Springfield Office of Centers, Training 

and Resources

Linda Squiers Office of Communications

Shobha Srinivasan Division of Cancer Control 

and Population Sciences

Vaurice Starks Division of Cancer Control 

and Population Sciences

Caryn Steakley Center for Cancer Research

Michael Stefanek Division of Cancer Control 

and Population Sciences

Hillary Stevenson Office of Workforce Development

Laveta Stewart Division of Cancer Epidemiology 

and Genetics

Angela Stowe Center for Cancer Research

Carolyn Strete Cancer Training Branch

Meryl Sufian Division of Cancer Control 

and Population Sciences

Stephen Taplin Division of Cancer Control 

and Population Sciences

Emmanuel Taylor Center to Reduce Cancer 

Health Disparities

Sona Thakkar Office of Education and 

Special Initiatives

Tracy Thompson Center for Cancer Research

Jasmin Tiro Division of Cancer Control 

and Population Sciences

Tanyifor Tohnya Clinical Pharmacology Research Core

Phil Tonkins Cancer Complementary and 

Alternative Medicine

Jorge Toro Division of Cancer Epidemiology 

and Genetics

Lois Travis Division of Cancer Epidemiology 

and Genetics

Carmina Valle Division of Cancer Control 

and Population Sciences

Mary Ann Van Duyn Center to Reduce Cancer 

Health Disparities

Stacey Vandor Division of Cancer Control 

and Population Sciences

Yvonne Vargas Division of Cancer Control 

and Population Sciences

Jaye Viner Office of Centers, Training 

and Resources

Cynthia Vinson Division of Cancer Control 

and Population Sciences

Tom Vollberg Division of Extramural Activities

Bob Vollinger Division of Cancer Control 

and Population Sciences

Andrew von Eschenbach Office of the Director

Nadarajen Vydelingum Center to Reduce Cancer 

Health Disparities

Danell Watkins Division of Cancer Control 

and Population Sciences

Linda Weiss Cancer Centers Branch

Jeffrey White Office of Cancer Complementary 

and Alternative Medicine

Bernard Whitfield Division of Extramural Activities

Jonathan Wiest Center for Cancer Research

Sheila Wilcox Office of Education and 

Special Initiatives

Tyrone Wilson Division of Extramural Activities

Robert Wiltrout Center for Cancer Research

Barbara Wingrove Center to Reduce Cancer 

Health Disparities

Kim Witherspoon Cancer Therapy Evaluation Program

Rosemary Wong Division of Cancer Treatment 

and Diagnosis

David Woods Center for Cancer Research

Sabra Woolley Health Communication 

Research Branch

Roy Wu Cancer Therapy Evaluation Program

Dan Xi Office of Cancer Complementary 

and Alternative Medicine

Shen Yang Division of Cancer Biology

Grace Yeh Center for Cancer Research

Sandy Young Office of Communications

Shelia Zahm Division of Cancer Epidemiology 

and Genetics

Yueying Zhen Center for Cancer Research

JoAnne Zujewski Cancer Therapy Evaluation Program
42
Appendix C 

From The NCI Strategic Plan for Leading the Nation to Eliminate 

the Suffering and Death Due to Cancer

Appendix C: Strategic Objective 8 –

Overcome Cancer Health Disparities
44 Appendix C
Appendix C 
46 Appendix C
Appendix C 
48 Appendix C
Appendix C 
50
Appendix D 

From Analysis of the National Cancer Institute’s Minority Health 

and Health Disparities (MHHD) Research Portfolio

Appendix D: Executive Summary
52 Appendix D
Appendix E 

caBIG – Cancer Biomedical Informatics Grid 

CanCORS – Cancer Care Outcomes Research and Surveillance 

CARRA – Consumer Advocates in Research and Related Activities

CCDOG – Cancer Care Delivery and Outcomes Group 

CCOP – Clinical Community Oncology Programs

CCR – Center for Cancer Research 

CDC – Centers for Disease Control and Prevention

CDRP – Cancer Disparities Research Partnership 

CIS – Cancer Information Service 

CMS – Centers for Medicare and Medicaid Services 

CRCHD – Center to Reduce Cancer Health Disparities 

CSO – Common Scientific Outline

CTEP – Cancer Therapy Evaluation Program 

DCCPS – Division of Cancer Control and Population Sciences

DDES – Office of the Deputy Director of Extramural Sciences 

EBIs – Evidence-based interventions 

EBPs – Evidence-based practices 

GIS – Geographic Information System 

HRSA – Health Resources and Services Administration

I2 – Integration and Implementation Team

MCCOPs – Minority-based Clinical Community Oncology Programs

MHHD – Minority Health and Health Disparities 

NCMHD – National Center for Minority Health and Health Disparities 

NIAMS – National Institute of Arthritis and Musculoskeletal Diseases 

OC – Office of Communications

OCCAM – Office of Cancer Complementary and Alternative Medicine 

OESI – Office of Education and Special Initiatives 

OLA – Office of Liaison Activities 

OMB – Office of Management and Budget 

P01s – Program Project Grants

PDQ – Physician Data Query 

PHS – Public Health Service 

RFAs – Requests for Application 

RTIPs – Research-Tested Intervention Programs 

SCB – Sociocultural and Behavioral 

SEER – Surveillance, Epidemiology, and End Results Program

SPOREs – Specialized Programs of Research Excellence

VA – U.S. Department of Veterans Affairs

Appendix E: 

Glossary of Acronyms and Abbreviations
NIH Publication No. 07-6095

Printed October 2006