Health Equity and Health Disparities in Cancer Survivorship

  1. Office of Cancer Survivorship
  2. Special Focus Areas
  3. Health Equity and Health Disparities in Cancer Survivorship

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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 related to 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.

How is NCI Addressing Issues Related to Health Disparities?

The causes the these health differences are multiple, multilevel, complex, and intertwined. However, researchers, advocacy groups, community organizations, health systems, clinicians, cancer survivors, caregivers, and other collaborators can work together to identify and intervene 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:

  • evaluating the available resources, opportunities, and built environment to help cancer survivors engage in and sustain healthy behaviors
  • advancing access to survivorship care by testing new models of care, implementing the newly developed National Standards for Cancer Survivorship Care, and examining the roles of expanded health coverage and access to specialized cancer centers and survivorship services
  • exposing how poverty contributes to conditions that lead to financial hardship

Areas of Research Emphasis

OCS, along with other divisions, programs, and offices of NCI and NIH, supports innovative research to enhance the quality and length of survival of all persons diagnosed with cancer. 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.

Inclusion

Seventy-four percent of those identified NIH grants were focused on cancer survivors from underrepresented populations. 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.

Cancer Survivors by percentage of grants. African American or Black 30.6%. Rural 25.9%. Socioeconomically disadvantaged 24.5%. Hispanic or Latino 22.5%. Asian 10.2%. Native Hawaiian and Other Pasific Islander 2.7%. Sexually or gender minority groups 2.7%. American Indian and Alaskan Native 1.4%.
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Cancer Survivors by percentage of grants. African American or Black 30.6%. Rural 25.9%. Socioeconomically disadvantaged 24.5%. Hispanic or Latino 22.5%. Asian 10.2%. Native Hawaiian and Other Pasific Islander 2.7%. Sexually or gender minority groups 2.7%. American Indian and Alaskan Native 1.4%.

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.

Measures

The majority of identified NIH grants measured or intervened at the individual level (82%), such as cancer survivors’ behaviors and healthcare use. The societal level and physical and built environment were least addressed (see figure below).

Other levels included:

  • interpersonal level (e.g., relationships between cancer survivor and caregiver, or social networks); 33%
  • community level (e.g., hospitals or neighborhoods); 42%
  • societal level (e.g., states or countries); 12%
Graph of 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.
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Graph of 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.

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.

  • Doose M, Kennedy AE, Williams SD, Srinivasan S. The Context of Poverty and Cancer: Denying Human Potential. Cancer Epidemiol Biomarkers Prev. 2024 Nov 1;33(11):1402-1404. doi: 10.1158/1055-9965.EPI-24-0953. PMID: 39482971
  • Brick R, Tonorezos ES. Addressing Disability in Cancer Survivors. J Clin Oncol. 2024 May 9:JCO2400479. doi: 10.1200/JCO.24.00479. PMID: 38723210
  • 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.
  • Verhoeven D, Doose M, Chollette V, Weaver SJ. Team complexity and care coordination for cancer survivors with multiple chronic conditions: a mixed methods study. J Cancer Surviv. 2024 Feb 14. doi: 10.1007/s11764-023-01488-w. Epub ahead of print. PMID: 38353854.
  • Mollica MA, Zaleta AK, Gallicchio L, Brick R, Jacobsen PB, Tonorezos E, Castro KM, Miller MF. Financial toxicity among people with metastatic cancer: findings from the Cancer Experience Registry. Support Care Cancer. 2024 Jan 30;32(2):137. doi: 10.1007/s00520-024-08328-2. PMID: 38286846.
  • Tonorezos E (editor). Journal of Cancer Survivorship Special Section: Hearing Loss in Cancer Survivorship. https://link.springer.com/collections/acfafeaiai

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.

Featured Webinars

The NCI OCS events webpage has archived webinars related to health equity and health disparities research in cancer survivorship. Here is a selected list of webinars.

Health Equity Research in Cancer Survivorship

Focus on American Indians and Alaska Natives

Focus on People with Disabilities

Focus on Sexual and Gender Minority Groups

Focus on Socioeconomic Status

Additional Resources

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
January 16, 2025