A Future Without Cancer Disparities

Editor’s Note: This story originally appeared in the summer 2023 issue of NEXT magazine. Our online version includes more stories about innovative research happening on the MCV Campus.

By Paul Brockwell Jr.

Cancer’s burden falls unequally. It’s a reality that compounds the pain and fear that comes with a diagnosis, and it is a problem tangled inextricably with long-term, systemic gaps in education and access to screenings and care that vary wildly depending on a person’s ZIP code.

Disparities in cancer care transcend the rural and urban divide and have grown and spread over generations. But they are also the very issues that VCU Massey Comprehensive Cancer Center seeks to understand. The center is looking to develop ways to reduce the inequities by designing education and outreach efforts that overcome barriers and connect people with often lifesaving knowledge and care.

Massey has always thought critically about health disparities and how to mitigate the barriers to education and care for underserved populations, and that’s in part because of the people Massey has served since its founding. The center’s first director, Walter Lawrence, M.D., was a tireless advocate for equitable care and increasing diversity in clinical trials research.

A National Leader

A year after it was founded in 1974, Massey became one of the 71 cancer centers across the U.S. now designated by the National Cancer Institute (NCI) to help lead and shape the country’s cancer research efforts. Of those, Massey is both among the oldest designated cancer centers and has the largest number of indigent patients in its catchment area. This area includes 66 counties and cities spanning the eastern, central and southern portions of Virginia. That territory includes 72% of Virginia’s Black population, and cancer rates are higher and life expectancy is lower than average in some communities. That persistent and pernicious problem has animated Massey to become a community-engaged cancer center to understand the causes of and develop solutions to the disparities.

“Massey’s commitment to ensuring equal access to health care and information is deeply important to me,” said Robert A. Winn, M.D., director of Massey Comprehensive Cancer Center and Lipman Chair in Oncology. “Whether it is working to relieve suffering and death from cancer or helping to address long-standing health disparities that are exacerbated by the pandemic, Massey’s mission is perfectly aligned with my own values and priorities.”

Since his tenure as director began in December 2019, Dr. Winn has focused on taking Massey’s mission into its wider service area. Dr. Winn’s outreach includes educating health care partners, patients and donors, many in traditionally underserved communities, about how engagement with the community is a critical part of Massey’s research and care mission.

“The engagement piece is truly bidirectional,” Dr. Winn explained. “We’re giving and we’re getting information that allows us to tweak our strategies for providing care and health education that encourages residents to keep their preventive and wellness visits, to be tested at community sites if needed and to find the treatment they need to stay healthy.”

Community Outreach, Education and Research

Massey’s outreach and engagement efforts promote disparities-related research, provide access to cancer prevention and education, enable access to cancer screening, treatment and clinical trials, and advocate for public policy to reduce the cancer burden.

In 2023, Massey is rolling out the second phase of its Community Grant Initiative — known as cultivate grants — that invests in community-led efforts to promote health, health equity and person-centered care. The grants support local projects and connect community leaders to researchers at Massey in ways that will increase the impact and bridge the gap between resources and healthier outcomes.

“Cultivate grants allow us to focus on research that is truly important to our community partners,” said Vanessa Sheppard, Ph.D., Massey’s associate director for community outreach and engagement and founding interim dean of the VCU School of Population Health. “Communities can lead research and drive the agenda.”

In addition to supporting community organizations working to increase cancer education and screenings, Massey will deploy two mobile health education units this summer to serve parts of Central and Southside Virginia. Once operational, the vans are expected to reach hundreds of community members in these areas monthly and will provide cancer education, prevention, screening and care coordination services to underresourced communities in Massey Cancer Center’s service area, including Petersburg, Colonial Heights, Hopewell, Portsmouth, Martinsville and Brunswick County, as well as other priority areas of Virginia with the highest mortality rates for screenable cancers.

These mobile health education units are a vital part of Massey’s mission to combat cancer health disparities and improve outcomes for those diagnosed with cancer.

“Every person, no matter who they are or where they live, should have equal access to critical information and tools to help prevent and detect cancer, and to the most innovative treatments and care available,” Dr. Winn said. “Reducing cancer disparities and improving outcomes for everyone in our community is our driving force. We will not rest until we achieve cancer health equity for all.”

Collaborative, Community-Engaged Research

The community-based research that Massey supports is a driving force behind its health equity work. The cancer center’s Health Equity & Disparities Research team is a developing shared resource. The team will offer assistance and guidance to researchers and community partners to facilitate, develop and promote community-engaged research in cancer health equity and cancer disparities with the goal of improving research participation among minority, rural and underserved communities, enhancing bidirectional data management and guiding future researchers and community-initiated research on best practices for conducting community-engaged research.

Early projects have been aimed at known areas where interventions can make a big difference. One effort is examining how to design and test educational programs that successfully increase screenings for colorectal cancer among Black men. Colorectal cancer can be successfully treated in early stages when diagnosed through recommended screenings. Despite this, it remains the third leading cause of cancer-related death among men in the U.S. The American Association for Cancer Research’s 2022 Cancer Disparities Progress Report found Black individuals have the highest colorectal cancer incidence and mortality rates of all racial and ethnic groups in the U.S.: They have a 20% higher likelihood of getting colorectal cancer and a 40% greater chance of dying from it. Colorectal cancer is the second most common cancer and is the second leading cause of cancer death among Native Americans.

Massey’s team is eager to learn more about individual behaviors in underscreened demographics in order to design, test and implement ways to encourage greater screening and treatment. It is even set to explore how it might deliver more successful interventions by meeting community members where they are in settings like local barbershops, which can be an important social center for Black men.

Cervical cancers are another target that, with colorectal cancers, formed into Project COALESCE, a pilot program that made strong headway in understanding racial disparities in screening rates for both cancer types, thanks to funding from a $400,000 award from Pfizer Global Medical Grants and with oversight from the American Cancer Society.

“The systemic, race-related barriers that our community partners have already identified are critical to our mutual efforts to increase access to colorectal and cervical cancer screenings,” said Katherine Tossas, Ph.D., M.S., director for catchment area data access and alignment and member of the Cancer Prevention and Control Program at Massey. “Together, we can chip away at the figurative walls standing between patients and the routine tests that can save lives.”

Specialized Research with National Impact

Recent prestigious grants have also elevated the level of nationally prominent research at Massey. In 2021, the National Cancer Institute announced that Massey won a highly competitive SPORE grant of around $3 million — the first ever awarded in the state of Virginia — intended to move research findings quickly from the laboratory to patients to address the disproportionate effects of lung cancer on the Black community.

Lung cancer continues to be one of the leading causes of morbidity and mortality among racial and ethnic minorities and individuals from other medically underserved groups. This is due to several determinants, including molecular and genetic factors, exposure to psychosocial stress and structural stressors in neighborhoods and communities.

The Translational Research Center in Lung Cancer Disparities (TRACER) grant established a multiregional consortium among three NCI-designated cancer centers — Massey Comprehensive Cancer Center, USC Norris Comprehensive Cancer Center at the University of Southern California and the City of Hope Comprehensive Cancer Center — to address racial disparities in lung cancer morbidity and mortality by developing more precise strategies for lung cancer prevention and early detection.

Massey’s SPORE project is composed of two initial research projects and a Developmental Research Program, providing the mechanism to solicit, develop, fund and evaluate new research concepts. These projects will be supported by a Biospecimen/Pathology Core, a Community Engagement Core and a Biostatistics and Bioinformatics Core, coordinated by an Administrative Core. TRACER will also engage a host of community groups across Virginia, California and South Carolina, including local health departments, community health centers, marginalized populations, civic activists, educational institutions, faith-based groups and cancer survivors.

“It’s important that the community has a seat at the table,” said Dr. Winn, who is a nationally-recognized expert on lung cancer disparities and TRACER’s principal investigator. “We’re optimistic that this dream team of researchers and community stakeholders will translate our basic science into clinical impact in reducing lung cancer disparities.”

Making the Grade: A Report Card for Health Equity

Massey leadership has been steering a national effort to create the Health Equity Report Card (HERC), an initiative that aims to improve the quality and equity of cancer care nationwide. A working group on elevating cancer equity has offered actionable recommendations to reduce racial disparities in access to cancer care.

“Your ZIP code and the neighborhood where you live impact many aspects of health, including cancer onset and outcome; beyond that, we know there is also implicit and explicit bias in care delivery,” Dr. Winn said. “These factors leave minority patients with an undue burden of cancer and impact incidence and survival rates. We’re excited about the potential of the Health Equity Report Card to help ensure the same standards of guideline-driven care are provided to every cancer patient, no matter their background or geographic location.”

The Health Equity Report Card was developed in early 2021 to recommend practice changes that, if implemented, would help providers and health care organizations identify and avoid 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 health care providers. It is now being piloted at five leading academic cancer centers to assess the feasibility of implementing the HERC as a tool that can both meaningfully and feasibly measure and report on equitable care practices. The Merck Foundation, through its Alliance for Equity in Cancer Care, is providing grant funding to partially support implementation of the HERC.

“We expect quality and safety reports from our health care institutions. Health equity reports should become the norm as well,” Dr. Winn said. “When we commit ourselves to that level of accountability, we can better earn and deserve the trust of our communities.”

What’s Next?

Health equity efforts are infused throughout Massey’s care and research mission, and the center’s leaders know that the fight against cancer health disparities will take patience, tenacity and a strong network of community organizations and resources dedicated to eliminating the barriers and gaps that result in disparate outcomes.

In June, Massey received official news that will help take that effort to the next level. The National Cancer Institute has designed Massey a “Comprehensive Cancer Center,” which is the highest federal rating a cancer center can achieve. This designation is the gold standard for cancer programs and is achieved only by the nation’s top cancer centers in recognition of their scientific leadership, depth and breadth of research, effective community outreach, and cancer research training and education. 

“We can reimagine what cancer centers can do for the next 50 years in extending new drugs and new approaches while also thinking about population health and science,” Dr. Winn said. “The reality is, where people live matters. With comprehensive status, Massey will show our peers in oncology and our patients in Virginia that we are driving the science-community conversation. We are taking it to the national level and finding answers to the question: What can we do to improve places and spaces to impact overall health?”

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If you would like to support the work of VCU Massey Comprehensive Cancer Center, please contact Jasmine Davis, Massey’s interim senior director of development, at 804-484-4903 or jjdavis3@vcu.edu.