Finster Laurel J, Shirazipour Celina H, Escobedo Loraine A, Cockburn Myles, Surani Zul, Haile Robert W
Cancer Research Center for Health Equity, Division of Medical Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, United States.
Norris Comprehensive Cancer Center, University of Southern California, Keck School of Medicine, Los Angeles, CA, United States.
Front Oncol. 2022 Jul 5;12:912832. doi: 10.3389/fonc.2022.912832. eCollection 2022.
Different models have been developed to address inequities across the cancer care continuum. However, there remains a scarcity of best practices on understanding and responding to the burden of cancer in a defined catchment area.As such, the National Cancer Institute (NCI) recently provided a framework to maximize the impact on cancer burden, including a greater focus on community outreach and engagement. In this paper, we describe how Cedars Sinai Cancer (CSC), a health system that serves one of the most diverse counties in the US, implemented the framework to define its catchment area, characterize its population, identify high risk priority groups, and make decisions to address health disparities.
We provide a review of the methods used to assess socio-ecological levels of influence. Data were reviewed from numerous national, statewide, and county sources and supplemented by locally administered questionnaires, heat maps, and community profile summaries to gain more localized snapshots of cancer disparities in Los Angeles County. Lastly, feedback was solicited from external peer groups, community stakeholders, and key decision-makers, and the proposed catchment area was aligned with the State's Cancer Plan and the NCI Catchment Area and Community Outreach and Engagement Mandate.
The selected CSC catchment area meets NCI criteria and has potential to demonstrate impact both at the population level and within specialty populations. As a result, strategies are being developed to organize community outreach and engagement, as well as research across basic, clinical, and population sciences to guide cancer control and prevention efforts.
To maintain a high level of cultural inclusion and sensitivity, multiple layers of data are needed to understand localized pictures of cancer disparities and underlying causes. Community engagement remains essential to implementing policy, best practice, and translational science for broader impact.
The clinical and translation work conducted at any cancer center requires an understanding of the determinants of health that contribute to the differences in cancer incidence and mortality among different groups. The NCI-aligned approach that we highlight is critical to support the design of future cancer control strategies that address and possibly reduce local health inequities.
为解决癌症护理连续过程中的不平等问题，已开发出不同模式。然而，在明确的集水区内，关于理解和应对癌症负担的最佳实践仍然匮乏。因此，美国国立癌症研究所（NCI）最近提供了一个框架，以最大限度地提高对癌症负担的影响，包括更加关注社区外展和参与。在本文中，我们描述了西达赛奈癌症中心（CSC），一个服务于美国最多元化县之一的医疗系统，如何实施该框架来定义其集水区、描述其人口特征、识别高风险优先群体，并做出解决健康差距的决策。
我们回顾了用于评估社会生态影响水平的方法。数据来自众多国家、州和县级来源，并辅以当地管理的调查问卷、热图和社区概况摘要，以获取洛杉矶县癌症差异的更本地化快照。最后，征求了外部同行团体、社区利益相关者和关键决策者的反馈意见，并使拟议的集水区与该州的癌症计划以及NCI集水区和社区外展与参与任务保持一致。
选定的CSC集水区符合NCI标准，有潜力在人群层面和特定人群中展示影响。因此，正在制定战略，以组织社区外展和参与，以及开展基础、临床和人群科学研究，以指导癌症控制和预防工作。
为保持高度的文化包容性和敏感性，需要多层数据来了解癌症差异的本地化情况及其根本原因。社区参与对于实施政策、最佳实践和转化科学以产生更广泛影响仍然至关重要。
任何癌症中心开展的临床和转化工作都需要了解导致不同群体癌症发病率和死亡率差异的健康决定因素。我们强调的与NCI一致的方法对于支持未来癌症控制策略的设计至关重要，这些策略能够解决并可能减少当地的健康不平等问题。
