Health Equity and Health Disparities in Cancer Survivorship

Advancing health equity in cancer survivorship is central to the Office of Cancer Survivorship (OCS) mission to enhance the quality and length of survival of all persons diagnosed with cancer.

All cancer survivors should have the opportunity to achieve their highest level of health possible, also known as health equity. Unfortunately, there are obstacles to health that can affect where cancer survivors live, grow, learn, work, play, worship, access care, and age. These barriers can create differences in healthcare utilization, quality of care, and health outcomes, also known as health disparities.

Some cancer survivors may experience obstacles to health based on their racial or ethnic group; religion; socioeconomic status; age; mental health; cognitive, sensory, or physical disability; sexual orientation; gender identity; geographic location (place/context); or other characteristics historically linked to discrimination or exclusion.

The causes of health disparities are therefore multiple, multilevel, complex, and intertwined. However, researchers, advocacy groups, community organizations, health systems, clinicians, cancer survivors, caregivers, and other collaborators can work together to advance health equity in survivorship by identifying and intervening upon the modifiable obstacles, pathways, and mechanisms that create and amplify health disparities.

Selected examples of health equity research in cancer survivorship include the following:

Areas of Research Emphasis

OCS, along with other divisions, programs, and offices of NCI and NIH, supports innovative health equity and health disparities research. A recent analysis of the NIH Cancer Survivorship Portfolio from Fiscal Years 2017 to 2022 identified 147 grants focused on NIH-designated populations that experience health disparities.

Read the complete report.

Diversity and Inclusion

Seventy-four percent of those identified NIH grants were focused on cancer survivors from racial and ethnic minority groups. However, there was a lack of grants focused on cancer survivors from American Indian and Alaska Native populations, Native Hawaiian and other Pacific Islander populations, and sexual and gender minority populations.

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Note: Grants may focus on more than one of these populations. Therefore, the sum of the percentages is more than 100.

Data source: Doose M, Mollica MA, Acevedo AM, Tesauro G, Gallicchio L, Reed C, Guida J, Maher ME, Srinivasan S, Tonorezos E. Advancing health equity in cancer survivorship research: National Institutes of Health 2017-2022 portfolio review. J Natl Cancer Inst. 2024 Mar 27:djae073. doi: 10.1093/jnci/djae073. Epub ahead of print. PMID: 38544292.

Drivers of Health Disparities

Eighty-two percent of those identified NIH grants measured or intervened upon health disparities at the individual level, such as cancer survivors’ behaviors and healthcare use. The societal level and physical and built environment were least addressed (see figure below).

Drivers of health disparities beyond the individual were also measured or intervened upon in 65% of the grants, including

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Note: This graph shows the distribution of grants that measured or intervened upon health disparities at each domain and level of influence. Each grant could measure at multiple domains and levels, and therefore the total exceeds 147 grants.

Data source: Doose M, Mollica MA, Acevedo AM, Tesauro G, Gallicchio L, Reed C, Guida J, Maher ME, Srinivasan S, Tonorezos E. Advancing health equity in cancer survivorship research: National Institutes of Health 2017-2022 portfolio review. J Natl Cancer Inst. 2024 Mar 27:djae073. doi: 10.1093/jnci/djae073. Epub ahead of print. PMID: 38544292.

The figure below highlights selected grant topics from the NIH Cancer Survivorship Portfolio from Fiscal Years 2017 to 2022. Italicized text represents areas of research currently not in the portfolio. Opportunities to understand and address health disparities beyond the individual level of influence include policies and laws that affect behaviors at the societal level (e.g., alcohol or tobacco policies) and the physical and built environment within communities (e.g., housing, green space).

    LEVELS OF INFLUENCE
    Individual Interpersonal Institutional/community Societal

DOMAINS OF INFLUENCE

Biological

  • Biologic/genetic/epigenetic pathways—allostatic load
  • Biological responses—Disease symptoms, inflammation
  • Caregiver-survivor interaction
  • Family microbiome
  • Community illness exposure
  • Herd immunity
  • Immunization
  • Pathogen exposure

Behavioral

  • Health behaviors – patient activation, self-management
  • Coping strategies
  • Quality of life—physical, mental, psychosocial well-being
  • Caregiver-survivor dyads or families—support, interactions, functioning, attachment, communication
  • School and work functioning
  • Community functioning
  • Policies and laws

Physical/built environment

  • Personal environment
  • Living conditions
  • Residential history
  • Employment environment
  • Neighborhood environment—walkability, food access, green spaces, orderliness, population density, street connectivity
  • Climage events
  • Federal housing program

Sociocultural environment

  • Sociodemographics
  • Social and cultural identity, attitudes, language
  • Social isolation
  • Perceived stress and resilience
  • Culturally responsive social support
  • Family/peer norms and influences
  • Social networks
  • Social engagement/integration
  • Community resilience
  • Residential segregation/Ethnic enclaves
  • Neighborhood social stressors, resources, and opportunities
  • Structural racism
  • Societal norms

Healthcare system

  • Insurance coverage
  • Receipt of survivorship care plans
  • Utilization/adherence to care
  • Treatment preferences
  • Patient-clinician relationship/communication
  • Share decision-making
  • Healthcare team functioning
  • Provider preferences or bias
  • Availability and accessibility of health services
  • Infrastructure needs and workflow within and across clinics and health systems
  • Coordination and navigation services
  • Health policies—Affordable Care Act, Medicaid expansion, high-volume facilities, medical homes
  • Consolidation/integration of oncology practices
  • Hospital closures

Doose M, Mollica MA, Acevedo AM, Tesauro G, Gallicchio L, Reed C, Guida J, Maher ME, Srinivasan S, Tonorezos E. Advancing health equity in cancer survivorship research: National Institutes of Health 2017-2022 portfolio review. J Natl Cancer Inst. 2024 Mar 27:djae073. doi: 10.1093/jnci/djae073. Epub ahead of print. PMID: 38544292.

Selected OCS Staff Publications

Included below is a selection of recent OCS staff publications related to health disparities and health equity research in cancer survivorship.

Selected Funding Opportunities

A list of funding opportunities related to health disparities and health equity in cancer survivorship research at NIH can be found on this Apply for Cancer Control Grants page.

Contacts

Michelle Doose

Michelle Doose, PhD, MPH

Program Director
OFFICE OF CANCER SURVIVORSHIP
SECONDARY APPOINTMENT:
HEALTH COMMUNICATION AND INFORMATICS RESEARCH BRANCH
BEHAVIORAL RESEARCH PROGRAM

michelle.doose@nih.gov

Crystal Reed

Crystal Reed, MHA

HEALTH SCIENTIST ADMINISTRATOR
OFFICE OF CANCER SURVIVORSHIP

crystal.reed@nih.gov

Last Updated
June 03, 2024