Under-served populations – strategy, structure and function of programmatic approaches

Under-served populations – strategy, structure and function of programmatic approaches

Under-served populations – strategy, structure and function of programmatic approaches (#12)

Derek Raghavan ¹

Levine Cancer Institute, Charlotte, NORTH CAROLINA, United States

Despite very high health care expenditures, the USA does not offer a uniform standard of medical care to its population, and egregious deficits in cancer care continue to exist in various segments of the community, leading to significant disparities in outcome (1-3). This may affect ethnic and racial minorities, the elderly, the indigent and some geographically isolated populations. Contributing factors, which should be the target of programmatic approaches, include socio-economic (poverty, education, language barriers), access (lack of health insurance, medical home, access to care), cultural issues (stigma of cancer, minority community suspicion, low community expectations of outcome), medical issues (co-morbidities, delays in diagnosis), and health provider/system factors (overload, funding, language and cultural barriers, social stereotyping, paucity of relevant research) (1-4). The problem is not unique to the USA (5), and is not resolved by a national health insurance system. To achieve parity of outcomes for under-served populations, compared to the majority community, each of the above indices must be targeted. In particular, specific staff training, recruitment of culturally competent staff, funding for integrated clinical care and relevant research, approaches to overcoming barriers in culture, communication and education, and decentralization of care and research are essential. Programmes developed by the American Society of Clinical Oncology Disparities Task Force, American Cancer Society and Levine Cancer Institute illustrate strategic approaches to the resolution of these issues.

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Authors contributing to this presentation.

Raghavan, D

Dr. Raghavan, President of the Levine Cancer Institute, Charlotte, North Carolina, has served at senior level in oncology for more than 25 years, including roles as Director & Frank Rudy Distinguished Chair, Taussig Cancer Institute, Cleveland Clinic, Chair of Medical Oncology & Associate Director (Clinical Research), University of Southern California Norris Comprehensive Cancer Center, and Professor & Chair of Solid Tumor Oncology/Investigational Therapeutics, Roswell Park Cancer Institute. Trained initially in Australia, Dr. Raghavan completed a PhD at the University of London, and undertook post-doctoral research at the University of Minnesota. Upon his return to Australia, he developed a new paradigm of neoadjuvant therapy for bladder cancer, accompanied by the development of a series of preclinical models of heterogeneity and stem cell function in bladder cancer and prostate cancer. In the United States, he has served as Chair of the National Cancer Institute Cancer (NCI) Clinical Investigations Review Committee, Chair of the Veterans Administration Merit Review Board in Oncology, and has been a member of the FDA Oncology Drug Advisory Committee and the NCI Clinical Oncology Review Section. Dr. Raghavan has been Chair of the Cancer Communications Committee and the Health Disparities Advisory Group of the American Society of Clinical Oncology, a member of the ASCO Value Task Force, was a member of the Scientific Audit Committee of the EORTC for 7 years, has advised Cancer Research UK and the Irish Cancer Society, and the Italian Agency for Cancer Research, has been a member of the Scientific Advisory Board and the Board of Governors of Southwest Oncology Group, and has sat on the International Advisory Board of Deutsche Krebshilfe for more than 5 years. He has previously been the Chairman of the Medical Oncology Group of Australia and Chair of the Specialist Advisory Committee in Oncology of the Royal Australasian College of Physicians. Dr. Raghavan has published more than 250 papers and 12 books, with areas of focus including heterogeneity of tumor function, biology and management of cancers of the bladder, testis and prostate, new drug development in lung cancer, and geriatric oncology. He has been a member of editorial boards of Journal of Clinical Oncology, Clinical Cancer Research, European Journal of Cancer, Annals of Oncology, and many others, and has served on the external scientific advisory boards of 10 comprehensive cancer centers. He is the Editor-in-Chief (Medical Oncology) of HemOnc Today. He received the Frank Moran Award for Leadership in Cancer Research from the University of Michigan in 2003, was elected a Fellow of the American Association for the Advancement of Science in 2009, and a Fellow of the American Society of Clinical Oncology in 2010, and received a Statesman Award from ASCO in 2010. He was awarded a research doctorate in medicine (MD) from the University of Sydney in 2012.

Under-served populations – strategy, structure and function of programmatic approaches (#12)

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