Cancer

During the past decade, the National Cancer Institute has made significant progress in bringing to and addressing the health and other issues related to poor and medically underserved populations, racial and ethnic minorities, and residents of rural areas. A key to the institute's achievements was the development of the Special Populations Networks (SPN) program which from 2000–2005, established a deeper involvement in reducing cancer disparities than had been previously undertaken by increasing cancer awareness and creating opportunities for conducting community-based research.

The Special Populations Networks introduced the concept of combining cancer awareness, research and training into a single program for minority and underserved populations. By engaging research leaders of these populations to aid their own, train their own and develop research to help their own, the SPN program activated the power of their commitment to their own, producing significant and important results for their own.

This overview highlights major project themes, provides examples of differing grantee approaches to similar issues, and describes key lessons learned that may guide future programmatic and research efforts to eliminate cancer health disparities.

A community-based cancer control program emphasizing community involvement and minority scientist training resulted in population-focused grant awards, and enhanced the infrastructure needed to combat cancer health disparities among African-Americans.

The Increasing Access to Clinical and Education (ACES) Project was an initial step to address cancer health disparities in the African American community in Philadelphia. This effort involved establishing an operational infrastructure for the program, recruiting and mentoring special populations investigators, conducting pilot research studies, and leveraging support for ongoing activities. Lessons learned from the ACES Project can guide the adaptation and dissemination of cancer prevention interventions in community-based settings.

The Deep South Network partnered with underserved communities and organizations to build a substantial infrastructure in pursuit of its goal to eliminate cancer disparities between African-Americans and whites in Mississippi and Alabama.

Historically, participatory research processes in Indian communities seem to have involved a single researcher establishing a relationship with a single community member or developing a linkage to a particular community program. This strategy frequently created research that was isolated from other community-based research activities, disconnected from various segments of the community, and separated from the health services delivery system. In this paper, the authors discuss how one program expanded the participatory process to facilitate collaboration-building among partner institutions, programs, providers, as well as local communities. This process is a key to create an infrastructure and network for reducing cancer health disparities.

The Spirit of Eagles Special Populations Network has involved 38 communities in a broad range of cancer control activities tailored to the needs and cultures of American Indians and Alaska Natives.

Cancer is a leading cause of death, especially among underinsured and underserved Asian Americans. The Asian Tobacco Education and Cancer Awareness Research Special Population Network at Temple University, Philadelphia, Pennsylvania, addressed Asian cancer health disparities through an innovative, comprehensive, culturally and linguistically appropriate and community-based logic model that facilitated community capacity building that enhanced awareness, research, training, and program sustainability.

Asian American Network for Cancer Awareness, Research, and Training (AANCART) met its aims to 1) build an infrastructure to promote cancer awareness, research, and training among Asian Americans in 4 targeted regions; 2) establish partnerships to promote accrual of Asian Americans in trials, increase training opportunities, and develop pilot projects; and 3) formulate and implement grant-funded research. The success of these accomplishments can be attributed to AANCART colleagues' dedication and to a consensus-driven infrastructure, with delegation of responsibilities.

The Latin American Cancer Research Coalition (LACRC) was formed with the goal of reducing cancer disparities in the understudied Latino population in the Washington, DC, metropolitan area. The LACRC chose to develop a model for cancer control focused on community-based safety net clinics as the focal point for in-reach and community outreach targeted to Latinos.

By 2005, Redes En Acción supported 131 training positions for junior scientists, garnered 16 NCI-reviewed pilot awards totaling $800,000, and leveraged about $32 million in nonproject funding. It mounted a national, award-winning mass media public service announcement campaign on Hispanic clinical trial participation and conducted more than 1400 community and professional awareness events.

The principal investigators successfully built a Latino cancer prevention and research network with 5 funded pilot projects. Outreach activities such as the bilingual play The Cancer Monologues and the annual health fair Dia de la Mujer Latina positively impacted the Latino community.

A partnership of urban health care providers developed and implemented need-based cancer education, awareness, and screening programs in East Harlem, New York, to improve population understanding of cancer and increase cancer screening levels.

Physician awareness of cancer risk factors and screening recommendations significantly increased after a quasi-experimental intervention was employed. Utilizing the physician as the central change agent, the Arkansas special populations access network (ASPAN) successfully enhanced cancer screening awareness of minority physicians and their patients.

The Maryland Special Populations Cancer Research Network (MSPN) infrastructure was used to implement successful and innovative community-based cancer education interventions and technological solutions; conduct education and promotion of clinical trials, cancer health disparities research, and minority faculty cancer research career development; and leverage additional resources for sustainability to expand the MSPN infrastructure and programs.

The Cancer Awareness Network for Immigrant Minority Populations (CANIMP) has developed successful outreach, education, screening, survivorship, training, and research programs to decrease cancer disparities. These initiatives serve as models to address community, systems, physician, and research cancer gaps in immigrant communities.

The experience of 'Imi Hale—Native Hawaiian Cancer Network demonstrates that a community-based organization can successfully build capacity in cancer research and programming. Success stemmed from engaging Native Hawaiian individuals and communities from across Hawai'i and by adhering to principles of empowerment theory and community-based participatory research.

The legacy of the Pacific Islander cancer control network (PICCN) lies in its advancement of improving cancer control among Pacific Islanders and setting the stage for interventions that will help to eliminate cancer-related health disparities in this population.