Early findings from a national quality improvement (QI) program to address disparities in bladder cancer (BLCA) care.
Authors: Khaki Ali Raza , Sun Fionna , Hensley Patrick J. , Dunn Mary , Peebles Rebecca , Chisolm Stephanie , Johnson Karen , Vira Manish A. , Carthon Bradley Curtis , Harvey Allison , Mangir Christina , Offit Caroline , Kisiel Molly , Plotkin Elana , Washington Samuel L , Goltz Heather Honoré 
Published: February 2025

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Background:
Rates of guideline-concordant treatment for BLCA remain <50%, driven by access and care delivery barriers. The Association of Cancer Care Centers (ACCC) designed a 6-month QI program to identify and implement site-specific strategies to support equitable care delivery at cancer programs. We aim to characterize findings from participating sites’ pre-implementation assessments as well as initial directions for QI.
Methods:
The ACCC QI program was conducted with cancer programs between November 2023 – November 2024, guided by an advisory committee, patient advocacy partners, and multidisciplinary faculty. Each program completed a pre-assessment to characterize organizational resources, catchment population demographics, patient volume, sentiment regarding organizational culture, practice patterns and identified barriers. Open-ended questions and those regarding sentiment used a 5-point Likert scale. During each in-person workshop, participants discussed barriers and prioritized interventions using an impact-feasibility matrix. Descriptive summary data are presented.
Results:
Three programs (one in California, North Carolina and Kentucky) were selected; one in an urban setting and two suburban; two NCI-designated and one Comprehensive Community Cancer program. Annual case volumes ranged from 103-1439, with 167-220 new diagnoses; >50% of cases were non-muscle invasive at each site and male-predominant (up to 30% female), with variable patient diversity (up to 50% Asian and 15% Black). Insurance coverage varied across programs: 52-80% Medicare, 17-29% Private, 0-3% uninsured. All programs agreed/strongly agreed leadership, staff and multidisciplinary team members were committed to improving equitable care, but only 1 program had processes to regularly assess disparities and 1 felt they had adequate training or culturally appropriate educational materials. Program-specific barriers to care included limitations around transportation support, limited care coordination, few community practitioners providing specialized care, and limited awareness of available resources. Based on impact and feasibility ratings, intervention targets included assessing and aligning care coordination preferences, mapping supportive care resources and addressing gaps, and tailoring educational materials to patient populations.
Conclusions:
Our study demonstrates a strong recognition by health systems of disparities affecting BLCA care, shows the feasibility of developing a QI program focused on addressing disparities in diverse practice settings and highlights the importance of systems-level support. Implementing mitigation strategies require program-specific understanding of barriers to provide equitable care. Health systems level strategies require a community-based approach to address barriers and deliver equitable care tailored to the needs of communities served.