Advancing equity in cancer care through community-academic partnerships: Results from the addressing Latinx cancer care equity—Program for long-term united skills building (ALCANCE-PLUS).
Authors: Kamran Rafaay , Wood Emily Hayes , Perez Cynthia , Medrano Hector S. , Villicana Gerardo , Lopez Guzman Lesly , Reynaga Jajaira , Trotter Chardria , Koontz Zachary M. , Patel Manali I. 
Published: October 2023

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Background: Addressing Latinx CANcer Care Equity - Program for Long-term United Skills Building (ALCANCE-PLUS) is an ongoing community-academic partnership between the Stanford University School of Medicine Partnerships to Advance Care and Pacific Cancer Care (PCC). The partnership began in 2019 and is comprised of several community-identified multi-level interventions to improve cancer health equity in an undeserved, rural migrant farm-working community. The intervention components are delivered by trained community health workers to low-income and racial and ethnic minoritized patients receiving active cancer treatment and include: 1) precision medicine education using literacy- and language-concordant educational tools; 2) food insecurity screening and intervention with plans to cross-train >150 CHW's across the county to expand cancer screening and care delivery in the county. Here, we describe the characteristics of participants and the program's impact to date on metrics identified by the community. Methods: ALCANCE-PLUS eligibility includes: all patients with cancer actively receiving cancer-directed treatment at PCC who are ≥ 18 years old and speak English or Spanish. Community identified metrics of success include: % treatment adherence (completion), no-show rate, days from diagnosis to treatment, and % who received clinical trials education as compared to baseline (prior to program start). We used descriptive statistics and chi-squared tests to compare metrics of participants in the program to baseline. Results: At baseline, 62% of low-income and racial and ethnic minoritized patients in the county completed treatment, 35% had no-shows to clinic or infusion appointments with an average of 82.7 days from diagnosis to treatment and only 15% received clinical trial education. As of program start in July 2022, a total of 143 patients participated in the program. Mean ages were 58.6 ± 14.53, 77 (57%) identified as male, 91 (63%) as Hispanic or Latino, 1 (0.7%) African American or Black, 11 (8%) Asian American, 1 (0.7%) Native Hawaiian or Other Pacific Islanders, and 48 (36%) White with 108 (75%) insured by Medicaid or Medicare or uninsured. As of June 26, 2023, there were statistically significant improvements in treatment completion (p<0.001) with 140 (98%) completed treatment; reductions in no show with only 3 (2%) participants with a no-show for their clinical or infusion appointments, average time from diagnosis to treatment was halved to 42.5 days (p<0.001) and all participants received clinical trial education (p<0.001) with 48 (34%) actively participating in a clinical trial. Conclusions: Community-academic partnerships to co-design and implement approaches to overcome community-identified needs for marginalized populations are essential to achieve cancer health equity.