Community Outreach and Engagement at U.S. Cancer Centers: Notes from the Third Cancer Center Community Impact Forum.

Community outreach and engagement (COE) is a fundamental activity of cancer centers as they aim to reduce cancer disparities in their geographic catchment areas. As part of COE, NCI-Designated Cancer Centers must monitor the burden of cancer in their catchment area, implement and evaluate evidence-based strategies, stimulate catchment area relevant research, support clinical trial enrollment, and participate in policy and advocacy initiatives, in addition to other responsibilities. The Cancer Center Community Impact Forum (CCCIF) is a national annual meeting of COE professionals who work at or with cancer centers across the country. CCCIF grew out of earlier discussions at American Society of Preventive Oncology (ASPO) annual meetings, where COE was often discussed, but not exclusively. The third annual CCCIF meeting-hosted by the Sidney Kimmel Cancer Center at Thomas Jefferson University-was held in June 2022 in Philadelphia, PA, where more than 200 participants listened to dynamic presentations across 12 COE-related panel sessions. CCCIF leadership and ASPO AD/PL Workshop Planners worked together on the agenda. The 12 sessions used a COE lens to focus on: Diversity, Equity, and Inclusion; Policy; State Cancer Coalitions; Evaluation and Metrics; Implementation Science; In-reach; Outreach; Training and Education; Funding, Personnel and Resources; Clinical Trials; Innovative Methods; and Lessons from the COVID-19 pandemic. This article is a summary of main points and key lessons from each session, as well as a summary of overarching themes that were evident across the sessions.

Addressing Health Disparities Across the Cancer Continuum-a Los Angeles Approach to Achieving Equity.

Introduction: 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. Methods: 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. Results: 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. Discussion: 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. 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.

Preliminary Results of Lung Cancer Screening in a Socioeconomically Disadvantaged Population.

OBJECTIVE: The objective of our study was to describe the preliminary results of our clinical low-dose CT (LDCT) lung cancer screening program targeting a minority, socioeconomically disadvantaged, high-risk population different from that studied in the National Lung Screening Trial (NLST). MATERIALS AND METHODS: Community partner clinics in an underserved region of south Los Angeles County referred interested candidates to our program. All patients met National Comprehensive Cancer Network eligibility criteria for lung cancer screening. RESULTS: From July 21, 2015, through April 3, 2017, 889 individuals were referred to the program. Of the 329 eligible participants, 275 (mean age, 59 years; 52% men) underwent baseline screening LDCT: 84% of patients were black, and 66% had a high school education or less. The median pack-years was 40, and 81% of patients were current smokers. Thirty-one percent of participants reported occupational exposure to one or more known lung carcinogens. Lung CT Screening Reporting and Data System (Lung-RADS) categories were assigned using baseline LDCT examinations: Lung-RADS category 1 or 2 were assigned in 86% of patients, category 3 in 7%, category 4A in 4%, and category 4B or 4X in 3%. Lung cancer has been diagnosed in two of these patients (0.7%) to date: stage IIIB small cell lung carcinoma in one patient and stage IV lung cancer of unknown type in the other patient. Among the 275 patients, 29% had potentially clinically significant incidental findings. CONCLUSION: Lung cancer screening with LDCT in a minority, socioeconomically disadvantaged, high-risk population is feasible but may yield a different lung cancer profile than screening populations in more privileged communities. More follow-up time is required to determine whether the reduction in lung cancer mortality shown in the NLST applies to this underserved population.

Let's Move for Pacific Islander Communities: an Evidence-Based Intervention to Increase Physical Activity.

Pacific Islander (PI) populations of Southern California experience high obesity and low physical activity levels. Given PI's rich cultural ties, efforts to increase physical activity using a community-tailored strategy may motivate members in a more sustainable manner. In this paper, we (1) detail the program adaptation methodology that was utilized to develop the Weaving an Islander Network for Cancer Awareness, Research and Training (WINCART) Center's PI Let's Move Program, a culturally tailored program aimed to increase physical activity levels among members of PI organizations in Southern California, and (2) share the program's pilot evaluation results on individual and organizational changes. The WINCART Center applied the National Cancer Institute's program adaptation guidelines to tailor the evidence-based Instant Recess program to fit the needs of PIs. The end product, the PI Let's Move Program, was piloted in 2012 with eight PI organizations, reaching 106 PI adults. At baseline, 52 % of participants reported that they were not physically active, with the average number of days engaged in medium-intensity physical activity at 2.09 days/week. After the 2-month program, participants increased the number of days that they engaged in medium-intensity physical activity from 2.09 to 2.90 days/week. Post-pilot results found that 82 % of participants reported intentions to engage in physical activity for at least the next 6 months. At baseline, only one organization was currently implementing a physical activity program, and none had implemented an evidence-based physical activity program tailored for PIs. After the 2-month timeframe, despite varying levels of capacity, all eight organizations were able to successfully implement the program. In conclusion, results from our program provide evidence that disparity populations, such as PIs, can be successfully reached through programs that are culturally tailored to both individuals and their community organizations.

Rates and sociodemographic correlates of cancer screening among South Asians.

Although the third largest Asian subgroup in the U.S., South Asians have rarely been included in cancer research. The purpose of this study was to assess rates and correlates of cancer screening in a community sample of South Asians. This study was a collaboration between the UCLA School of Public Health and South Asian Network (SAN), a social service organization in Southern California. Data were collected from 344 adults including a substantial portion of immigrants and individuals with low income and education. Few participants received screening within guidelines for colorectal (25%), breast (34%), cervical (57%) and prostate cancer (10%). Health insurance, younger age and increased length of stay in the U.S. predicted a higher likelihood of cancer screening. Women were significantly less likely to have received colorectal cancer screening compared to men. These results will guide SAN's program planning efforts. Future interventions should focus on increasing cancer screening in this population.

Tobacco use among South Asians: results of a community-university collaborative study.

OBJECTIVE: Although South Asians (individuals from India, Pakistan, Sri Lanka, Bangladesh, Nepal, Bhutan, and the Maldives) are the third largest Asian group in the USA, relatively little data are available to document their use of tobacco. We collected data from a community sample of 344 South Asian adults to assess rates of smokeless tobacco product use and smoking and examine demographic predictors of use. DESIGN: Non-random sample; cross-sectional survey. RESULTS: Close to a third of the sample (28%) reported current use of smokeless tobacco products. In multivariate analyses, gender and ethnicity were significant predictors of use of smokeless tobacco products. Men and Bangladeshis were more likely to use smokeless tobacco. The overall rate of daily cigarette/bidi smoking observed in our sample (9%) was similar to that observed in the population of California (10%); however, the rates among men (19%) and some ethnic subgroups (16% for Pakistanis) were significantly higher. Gender, ethnicity and years in the USA emerged as significant predictors of daily smoking with men and Pakistanis being significantly more likely to smoke. Length of stay in the USA was inversely related to daily smoking. CONCLUSION: These findings emphasize the need to disaggregate data for South Asians and suggest that tobacco control interventions should target specific segments of the population (men, Bangladeshis, Pakistanis). Interventions to decrease use of smokeless tobacco products are especially warranted for South Asians.