Abstract B009: Advancing health equity in cancer survivorship research: A review of the National Institutes of Health (NIH) 2017-2021 portfolio
Authors: Doose Michelle , Mollica Michelle A. , Acevedo Amanda , Reed Crystal , Tesauro Gina , Gallicchio Lisa , Guida Jennifer , Maher Molly E. , Srinivasan Shobha , Tonorezos Emily 
Published: December 2023

Abstract
Background: Over the past decade there has been a call for a research paradigm shift from describing health disparities to a health equity research agenda that links and addresses the social, environmental, economic, health system, and policy contextual factors that drive health disparities. However, it is unknown if cancer survivorship research has made this transition. Methods: Research project grants funded during Fiscal Year (FY) 2017 to 2021 focused on cancer survivorship were identified using a text mining algorithm of words from the NIH Research, Condition, and Disease Categorization thesaurus with survivorship-relevant terms. A total of 586 grants were identified, of which the title and abstract were reviewed to identify grants focused on health disparities. Characteristics for each grant focused on health disparities were abstracted. We then coded the determinants of heath disparities by levels of influence (individual, interpersonal, organizational/community, societal) and domains of influence (biological, behavioral, physical/built environment, sociocultural environment, healthcare system).Results: A total of 134 grants were identified that focused on health disparities. These grants were funded by 5 NIH institutes with NCI funding 85%. The majority of grants (63%) used the R01 mechanism. The populations of focus included racial and ethnic minority survivors (75%), survivors living in rural areas (25%), socioeconomically disadvantaged cancer survivors (22%), and SGM survivors (2%). Half of the studies were of observational design, and half were interventional. Study topics included: late effects (44%), patient activation (28%), adherence to care guidelines (25%), health communication (18%), physical activity (13%), nutrition (8%), and policy research (4%). Nearly all grants included at least one individual-level of influence (95%), as compared to higher levels of influence (26% interpersonal, 33% organizational/community, 15% societal). Behavioral and healthcare system domains of influence were commonly represented, especially at the individual-level (76% and 43%). Determinants from the physical/built environment and sociocultural environment were less frequent. Conclusions: Our findings highlight that NIH-funded survivorship research on health disparities is still focused on the individual-level and behavioral domains of influence. However, the portfolio analysis also suggests that survivorship research is transitioning to a health equity research agenda by incorporating structural/institutional level factors. Gaps in funded research on understudied populations were identified, including SGM, American Indian and Alaska Native, and Native Hawaiian and other Pacific Islander. Future research is needed to identify mechanisms to address the upstream social drivers/determinants or contextual factors of where cancer survivors live, work, learn, play, age, and access care. Such work would inform the development or implementation of evidence-based interventions to prevent inequitable care and achieve the goal of health equity.
Citation Format: Michelle Doose, Michelle A. Mollica, Amanda Acevedo, Crystal Reed, Gina Tesauro, Lisa Gallicchio, Jennifer Guida, Molly E. Maher, Shobha Srinivasan, Emily Tonorezos. Advancing health equity in cancer survivorship research: A review of the National Institutes of Health (NIH) 2017-2021 portfolio [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B009.