The impact of structural and interpersonal racism is one of the major causes of disparities in cancer outcomes in the United States. According to the American Cancer Society’s Cancer Facts and Figures 2023, racial and ethnic disparities in the cancer burden largely reflect long-standing inequities in socioeconomic status and access to high-quality health care, which can be attributed to historical and persistent structural racism in the U.S. experienced by all people of color.
To help address these issues, NCCN, ACS CAN, and NMQF launched the Elevating Cancer Equity initiative in 2020, featuring a working group chaired by Robert A. Winn, MD, Director of the Virginia Commonwealth University Massey Cancer Center, and Shonta Chambers, MSW, Executive Vice President of Health Equity and Community Engagement at the Patient Advocate Foundation. In early 2021, that group developed the HERC to recommend actionable practice changes which, if implemented, would help providers and healthcare organizations identify and address discriminatory behaviors and bias in care delivery, address social determinants of health, and overcome systemic barriers to optimal care.
The 17 actionable practice changes from the HERC have been refined into an implementation plan including concrete metrics, sources of evidence, and a scoring methodology, all of which were vetted by oncology administrators and healthcare providers. In the first phase of a multi-phase pilot, five leading academic cancer centers are assessing the feasibility of implementing the HERC as a tool that can both meaningfully and feasibly measure and report on equitable care practices. Feedback through the pilot stages of implementation will be incorporated to ensure applicability across care settings and geographies.
“Our hope is that the Health Equity Report Card will be able to serve as a roadmap for health care organizations working to improve their practice, a transparency tool for patients, and an assessment tool for payers and accreditation entities,” said Robert W. Carlson, MD, Chief Executive Officer, NCCN. “Inequities in cancer outcomes across race and ethnicity have numerous contributing factors, including different levels of access to comprehensive insurance coverage, bias and discrimination in care delivery, and social determinants of health such as neighborhood and built environment, access to economic and educational opportunity, and food insecurity due to historic and ongoing structural discrimination. This accountability tool will be more than just a checklist exercise; we hope it will result in interventions that lead to meaningful, sustainable systems changes.”
“All people diagnosed with cancer deserve to get the best care possible – regardless of income, race, ethnicity, gender identity, disability status, sexual orientation, age or geography,” said Lisa Lacasse, President, ACS CAN. “Ensuring equity in cancer care is critical to reducing cancer disparities and ending cancer as we know it, for everyone. The Health Equity Report Card provides a tangible approach that can help achieve that goal.”
“Despite significant advancements in the detection and treatment of cancer in recent decades, minoritized communities continue to bear the high cancer burden,” said Dr. Gary Puckrein, President and CEO of the National Minority Quality Forum. “Inequities in cancer care are the result of failure to consider the lives of black, brown, yellow, red, and poor people. If we’re going to close systemic gaps in cancer care, we must re-imagine how we are approaching care delivery and realign systems to reduce patient risk. This tool is a step in the right direction to identify what system changes are needed to affect change.”
The HERC pilot program at academic cancer centers is supported by contributions from AbbVie Inc.; 2seventy bio; Genentech, Inc.; Lilly; and Sanofi Genzyme. A second pilot program in the community hospital setting is also in early stages, with support from GlaxoSmithKline LLC; Lilly; Merck Foundation; and Pfizer Inc. A peer-reviewed article with more information on the program will be publishing soon in JNCCN—Journal of the National Comprehensive Cancer Network.
Looking beyond race and ethnicity in the United States, research shows income, education, geographical location, and discrimination based on gender, sexual orientation, age, disability, and lifestyle are all factors that can negatively affect cancer care and outcomes. The burden of cancer in low- and middle-resource countries is particularly significant, currently accounting for approximately 75% percent of all cancer deaths worldwide, and is expected to continue to grow.
NCCN is involved in several global endeavors to address these disparities, including the adoption of inclusive language in clinical and patient guidelines, plus ongoing collaborations in:
- Sub-Saharan Africa
- Latin America and The Caribbean
- Eastern Europe
- Middle East and North Africa (MENA)
- And Worldwide
Learn more about free resources to help close the care gap worldwide at NCCN.org/global, and view the 17 actions from the Health Equity Report Card at NCCN.org/wcd.
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About the National Comprehensive Cancer Network
The National Comprehensive Cancer Network® (NCCN®) is a not-for-profit alliance of leading cancer centers devoted to patient care, research, and education. NCCN is dedicated to improving and facilitating quality, effective, equitable, and accessible cancer care so all patients can live better lives. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) provide transparent, evidence-based, expert consensus recommendations for cancer treatment, prevention, and supportive services; they are the recognized standard for clinical direction and policy in cancer management and the most thorough and frequently-updated clinical practice guidelines available in any area of medicine. The NCCN Guidelines for Patients® provide expert cancer treatment information to inform and empower patients and caregivers, through support from the NCCN Foundation®. NCCN also advances continuing education, global initiatives, policy, and research collaboration and publication in oncology. For more information visit NCCN.org.
About ACS CAN
The American Cancer Society Cancer Action Network (ACS CAN) makes cancer a top priority for policymakers at every level of government. ACS CAN engages volunteers across the country to make their voices heard to ensure that our cities, our states and our nation adopt evidence-based public policies that improve the lives of people with cancer and their families. We believe everyone should have a fair and just opportunity to prevent, detect, treat, and survive cancer. Since 2001, as the American Cancer Society’s nonprofit, nonpartisan advocacy affiliate, ACS CAN has successfully advocated for billions of dollars in cancer research funding, expanded access to quality affordable health care, and advanced proven tobacco control measures. We stand with our volunteers, working to change public policy to end cancer as we know it, for everyone. Join the fight by visiting www.fightcancer.org.
About National Minority Quality Forum
The National Minority Quality Forum (NMQF) is a 501(c)(3) not-for-profit research and advocacy organization based in Washington, DC. The mission of NMQF is to reduce patient risk by assuring optimal care for all. NMQF’s vision is an American health services research, delivery and financing system whose operating principle is to reduce patient risk for amenable morbidity and mortality while improving quality of life. NMQF leads the Cancer Stage Shifting Initiative which is aligned with the White House Cancer Moonshot program to move us from late-stage to early-stage diagnosis and treatment of cancer, improving cancer care and reducing cancer deaths for all, with a particular focus on equity and underrepresented populations. For more information, please visit https://www.nmqf.org/.
 Prager GW, Braga S, Bystricky B, et al. Global cancer control: responding to the growing burden, rising costs and inequalities in access. 2018;3(2):e000285.