Community Outreach and Engagement at U.S. Cancer Centers: Notes from the Third Cancer Center Community Impact Forum

The Cancer Center Community Impact Forum (CCCIF) is held annually and allows cancer center faculty, staff, and administration associated with community outreach and engagement (COE) the opportunity to share best practices, develop common approaches, network, and learn from each other. In 2022, CCCIF featured 12 panel sessions, each chaired by a leader in COE who moderated the session (Table 1). Here, we describe the 12 panels as well as the key messages and takeaway points from each panel. This article can serve as a review of not only the 2022 CCCIF meeting but as a summary of current opportunities and challenges when executing COE at an NCI-Designated Cancer Center.

The COE and diversity, equity, and inclusion (DEI) panel allowed participants to learn about the Plan to Enhance Diversity (PED), the newest Cancer Center Support Grant (CCSG) requirement from NCI (1), and its potential connections to COE. The aim of the PED component is to enhance diversity in the membership and leadership of the cancer center. Promoting systemic change will require comprehensive, data-driven, and multilevel transformative strategies including: use of best practices in recruitment, hiring, advancement and retention of women, racial and ethnic minorities, individuals with disabilities, and those that meet the definition of being from a disadvantaged background according to the NIH (2); development of pipeline programs, requiring resources at all levels of the emerging cancer workforce; career and leadership development, including coaching, mentorship, and sponsorship to cancer center roles and positions of leadership; and workforce climate transformation that promotes core DEI values and is championed by cancer center leaders. Center leaders need to create a culture that values differences over similarities, belonging over marginalization, and intentionally eliminates microaggressions, discrimination, and harassment. In the words of Dr. Robert Winn, Director of the Massey Cancer Center at Virginia Commonwealth University: “True change will require courage to make the time and safe space for honest, difficult conversations and follow-up on those conversation with stakeholders to create the change envisioned by the cancer research workforce community.”

At the simplest level, policies are a set of guidelines or rules that determine a course of action. The goal of the CCCIF session was to provide real-world examples of how COE teams engage in policy initiatives to advance cancer control efforts in their respective catchment areas. The policy activities described varied from implementing tobacco control policies on college campuses, to leveraging community health needs assessment data to inform state cancer control planning, to increasing access to biomarker testing through insurance coverage for patients diagnosed with cancer. Although the topics differed, COE teams commonly used strategies such as engagement of community members and patients as well as developing partnerships with shared goals or objectives to educate decision makers. Cancer center COE teams prioritized issues that were informed by data and deemed important by the community. Notably, each COE team was diligent in documenting their efforts, assessing process measures, and considering the elements that would indicate success. Developing shared metrics of impact, ongoing assessment, and feedback were essential to driving policy changes. Taken together, COE teams can play an important role in policy initiatives that improve the health of the communities where people live, work, play, worship, and receive their health care.

This session provided examples of how cancer center COE teams are working with state coalitions to implement state cancer control plans supported by the Centers for Disease Control and Prevention (CDC; ref. 3); described how partnerships facilitate cancer center missions and reduces the cancer burden in catchment areas; and explained how context influences effective partnerships. First, a panelist from a state cancer consortium illustrated joint efforts with a cancer center to improve access to breast cancer screening in rural communities through a state-wide campaign. Second, a robust partnership with a state cancer coalition and a cancer center focused on encouraging residents to pursue cancer screenings, human papillomavirus vaccination, and tobacco cessation. Finally, a third state cancer coalition described efforts aimed at prevention, screening, and treatment in rural and underserved areas. Each presenter highlighted how strong ties between COE and state cancer coalitions helped to engage community members in prioritizing identified disparities and enhancing access by pooling resources and building infrastructure to disseminate evidence-based interventions through earned and social media public awareness campaigns. Although context influences the basis and direction of these multisector partnerships, cancer center COE teams can and should be leaders in the evolution of state cancer control plans by identifying opportunities to leverage organizational resources, providing data to inform plans, and articulating measurable goals that advance shared priorities.

The goals of this session were to explore key activities that could be included in a COE evaluation plan and logic model, and to illustrate how two cancer centers developed their evaluation plans and defined evaluation metrics. First, preliminary findings were shared from a national study of COE leaders and staff in which participants named, sorted, and rated key COE activities. The findings and discussion highlighted that while COE programs are faced with a long list of expectations, they have varying levels of resources. As such COE programs would benefit from generating consensus in the COE community around prioritizing the most essential activities to focus on and evaluate. Next, the two evaluation case studies shared useful strategies for building a COE evaluation plan, such as using the CDC Evaluation Framework (4) to guide the process; creating a logic model that outlines resources, activities, process metrics (outputs), outcomes, and outcome metrics; and establishing baseline values and targets for outcome measures. Finally, the case studies illustrated useful methods for tracking and reporting process metrics (e.g., using a REDCap database for real-time data entry of activities by COE staff; tracking activities by cancer type and by year) and outcome metrics (e.g., breaking down short-term, medium-term, and long-term outcomes; tracking improvements over time).

The goals of this session were to understand the determinants, context, and conditions that influence implementation of evidence-based interventions (EBI) in real-world settings and to share best practices for conducting implementation science research. The session highlighted projects that demonstrated collaboration with cancer center investigators across research programs and in partnership with community members, particularly those that addressed social determinants of health through structural changes at the health system level. The EBIs incorporated components of universal social risk factor screenings, engagement with community health workers, bidirectional linkages with community partners, and antiracism training. These EBIs can lead to short-term and long-term outcomes to reduce structural racism and improve cancer health equity. In addition, community-academic partnerships require considerable and intentional effort, but can lead to critical insights in intervention adaptation. Finally, many EBIs never reach real-world usage. Cancer centers should leverage community advisory boards to help adapt or tailor “home-grown” EBIs, identify implementation strategies, and assess acceptability, appropriateness, and feasibility to collectively meet community needs within the catchment area.

The purpose of this session was to share approaches that three COE teams have taken to communicate and engage with internal partners, including scientists, providers, administrators, staff, and patients. Having a thoughtful and intentional approach to in-reach is critical, as the COE component of the CCSG encompasses efforts across the entire cancer center; building relationships across the cancer center and engaging scientists from all research programs is paramount. During this session, presenters stressed the importance of identifying and articulating benefits for scientists—especially basic scientists—to dedicate their time to community-based work, as this work has not been traditionally rewarded in academia. They also shared communication tactics and recommended that COE teams identify scientists who can serve as liaisons to share information with their research programs and the broader scientific community, as messages delivered by scientists may resonate more with fellow scientists. And, finally, they discussed the importance of working with cancer center scientists, administrators, and staff to consider and address barriers—including financial, logistical, social, and otherwise—to community members looking to engage in or participate in research studies, as the success of cancer centers’ research is dependent on it.

The goal of this session was to share successful outreach programs and initiatives that have resulted in sustainable partnerships and community-level impact in cancer prevention and control. The panelists shared examples of successful partnerships with federally qualified health centers (FQHC), the impact of mobile cancer screening programs, and other innovative collaborations. Mobile screening vans in urban areas may require a significant investment but they have successfully addressed structural barriers for populations with disparities and resulted in higher screening rates and a reduction in mortality for breast and other cancers. These programs and initiatives can only be effective by cultivating and sustaining strong, mutually beneficial partnerships with FQHCs, community-based organizations, and hospitals through capacity building and resource sharing. Cancer centers are uniquely positioned to convene multilevel partnerships to cultivate innovative ecosystems in which a collective vision of creating lasting impact through community-driven action planning can result in equity.

This session showcased three cancer center efforts that emphasized cultural responsiveness, inclusion, health equity, policy, and advocacy, as well as institutional level catchment area priorities, community-academic partnerships, and increasing diversity in research, clinical trials, and the biomedical workforce. The first presentation highlighted two distinct navigation efforts: one leveraging community partners to address health disparities via a telephonic health navigation and the other connecting community health workers, community colleges, and university research faculty to support the emerging care workforce. The second presentation showcased education and training through the lens of the COVID-19 pandemic and the concerted effort of community and academia to pivot education and outreach to virtual platforms and using community inputs to grow programming and resource development. The final presentation provided an extensive look into a COE integration pilot project's recruitment, training, and real-world integration efforts of scientist from a cancer center research program. Each presentation illustrated the fusing of community and academic knowledge to strengthen COE education and training efforts. One key takeaway was that community-academic collaborations are necessary, effective, and as diverse as the communities they serve. A second takeaway was the strong need for community education and training efforts to be adaptive, bidirectional, and integrate social determinants of health, lived experiences, and incorporate quantifiable efforts to disseminate and sustain research findings. Finally, both community and academic navigation is integral to the success of COE education and training.

This session was organized to shed light on how cancer centers allocate resources to COE and to understand how COE efforts are funded, staffed, and sustained. Innovative strategies are needed to fund COE activities to reach all the populations in a catchment area, sufficiently address goals, achieve metrics, and meet needs of community members. Funding sources were diversified, including CCSG and institutional funding, NCI administrative supplements, grants from other federal agencies, state contracts and appropriations, pharmaceutical or industry support, and foundation and other philanthropic support. In terms of personnel, COE can serve as the link between other cancer center initiatives, such as DEI, clinical trials, data science, and government relations. Resources should support both internal and external initiatives and have an eye on return on investment for future COE initiatives and sustainability.

The purpose of this session was to highlight how cancer centers across the U.S. developed and continue to foster strategies within their institutions to enhance their ability to increase accrual to clinical trials from underrepresented populations. Strategies were categorized as internal strategies, those that cancer centers do within their institution, or external strategies, those that cancer centers do with partners in their catchment area. Internal strategies include: providing cultural sensitivity training; presenting data on the cancer burden within the catchment area to investigators; requiring new study applications to include the data on the cancer burden and the population to be impacted; hiring and utilizing bilingual/bicultural staff and navigators; developing targeted multicultural-multilingual clinical trial campaigns with community input that provide factual messages through trusted messengers; and establishing a community advisory committee or community research advisory board. External strategies include: building trust with community members and providers; sharing information with partners about the cancer burden and disparities in the catchment area; investigating barriers and facilitators to trial enrollment in community settings; educating communities about clinical trials in appropriate languages; establishing partnerships with FQHCs and other entities providing services to target population(s); and using social media platforms to disseminate information. A strategy that integrates both the internal and external context is one where community members and investigators partner in a research advocacy program, an initiative that exists at numerous cancer centers. Ultimately, a combination of internal and external strategies will be most successful in increasing diversity in cancer clinical trials.

The goal of this session was to share examples of innovative COE work at three different cancer centers. The first cancer center implemented a comprehensive multilingual needs assessment by applying a social determinants of health and systems-level approach. This needs assessment helped identity key cancer- and health-related needs and opportunities for their catchment area. The second panelist discussed a collaboration between COE programs at three different NCI-designated cancer centers that established a partnership to develop community relationships and shared research priorities to understand and address cancer-related needs of Indigenous people. The third panelist, a cancer survivor and lead patient advocate, described how a cancer center engaged and embedded patient advocates in their research from bench-to-curbside and from study design through dissemination. This patient-driven initiative has allowed patients and investigators to design and redefine innovative research collaboratively. Session takeaways included the importance of identifying local and regional partners, including patients with cancer, to build community-engaged consensus with and the value of developing authentic and bidirectional academic-community partnerships to understand and address cancer-related needs of specific communities.

The goal of this session was to understand how lessons learned during the COVID pandemic related to networks, strategies, and projects conducted by COE could be used to address cancer relevant areas in the future. Three panelists presented different lessons learned as their cancer center adapted their COE efforts during the pandemic. Three take-home messages were evident. First, community interactions were still possible even during the pandemic because of principles of trust and community ownership. Second, unprecedented opportunities during the pandemic can be leveraged to further new ways to assess and enroll minority patients to clinical trials. Third, understanding community context can lead to interventions to address hesitancy in vaccination for COVID-19 and other preventable diseases.

The word that comes to mind about this meeting was “passion”—everyone displayed incredible passion for what they are doing and the communities they serve. The key takeaway message is that all COE programs are doing a GREAT job! Because COE was first envisioned by the former director of the NCI Division of Cancer Control and Population Sciences, Dr. Robert Croyle, and implemented in the NCI Office of Cancer Centers Program by Dr. Henry Ciolino, it has grown to enormous heights—they are proud of these accomplishments. In many cancer centers, the importance of COE and catchment areas are being woven throughout the center, including among basic science investigators. There is a common phrase, “if you have seen one cancer center, you have seen one cancer center.” That is true for COE—“if you have seen one COE program, you have only seen one COE program.” Although COE programs might use common frameworks, programming is unique to each catchment area, and even within catchment areas, to each community. Because the populations are unique, successfully “doing” COE depends on knowing, understanding, and addressing the needs of each community in the catchment area—all while being innovative.

Attendees were asked to state one word that they heard the most during the conference (Fig. 1). The most common word was “equity,” followed by “disparities” and “engagement”—all fitting views of COE. On the basis of all the presentations and comments, several themes emerged across the sessions.

Several speakers gave attendees a call to action illustrated in the following quotes: “Use your privilege to create equity.” “COE [team]s need to be at the policy table and drive the car.” “Solving Rubik's Cube [COE] is complex and requires juggling priorities.” “It is not our {Cancer Center's} show.” Have “cultural humility” and be “bigger not bolder.” “Engagement is about building relationships.”

Across sessions, several common barriers were voiced:

• (i) Lack of appropriate data systems to fully understand race, ethnicity, and sexual orientation and gender identity data.

• (ii) The need for appropriate funding and competitive salaries to avoid losing competent and committed staff.

• (iii) Lack of insurance reimbursement for patient navigation and community health workers, which hinders employing an adequate number of staff.

• (iv) Little or no funding for evaluation of COE significantly limits conducting a comprehensive evaluation of COE impact.

• (v) Lack of guidance on how to address policy issues as part of the mandated activities for COE.

• (vi) Insufficient language translation and services negatively affects who comes to facilities and who can go on clinical trials.

• (vii) More attention needed to address the social determinants of health, such as housing, transportation, and food.

• (viii) Lack of health care coverage for all care, including cancer screening.

• (ix) More resources needed to execute of all areas of the COE mandate.

In conclusion, COE staff should not be discouraged and lose the passion and zeal for their work. There is a lot each person alone does not know, BUT collectively, a lot is known. The driving force of the work, activities, and thoughts is and must always be THE COMMUNITY. Meetings like CCCIF and ASPO serve to recharge and recommit all COE staff. Much that is discussed at CCCIF is further explored at ASPO, where COE research and conversations continue. As Dr. Gilbert Friedell, Director Emeritus of the University of Kentucky Markey Cancer Center and health champion for Appalachia, always said, “If the problem is in the community, the solution is in the community.”

No disclosures were reported.

The opinions expressed by the authors are their own and this material should not be interpreted as representing the official viewpoint of the U.S. Department of Health and Human Services, the NIH, or the NCI.

A sincere thank you and a job well done to Leslie Dietz and her team for organizing and executing the CCCIF meeting in Philadelphia, PA. Funding Sources: A.E. Leader: NIH/NCI Cancer Center Support Grant 5P30 CA056036 (PI: Chapman), H.M. Brandt: NIH/NCI Cancer Center Support Grant 5P30 CA021765 (PI: Roberts), K.J. Briant: NIH/NCI Cancer Center Support Grant 3P30 CA015704 (PI: Lynch), G. Curry: NIH/NCI Cancer Center Support Grant 3P30 CA014599 (PI: Odunsi), K. Ellis: NIH/NCI Cancer Center Support Grant 5P30 CA077598 (PI: Yee), E.T. Gonzalez: NIH/NCI Cancer Center Support Grant P30 CA006927 (PI: Chernoff), C.E. Guerra: NIH/NCI Cancer Center Support Grant 5P30 CA016520 (PI: Vonderheide), G. Harding: NIH/NCI Cancer Center Support Grant 5P30 CA042014 (PI: Ulrich), P.C. Hull: NIH/NCI Cancer Center Support Grant 5P30 CA177558 (PI: Evers), A. Israel: NIH/NCI Cancer Center Support Grant 5P30CA142543 (PI: Arteaga), R. Mellilo: NIH/NCI Cancer Center Support Grant 5P30 CA056036 (PI: Chapman), R.J. Mesia: NIH/NCI Cancer Center Support Grant 2P30 CA124435 (PI: Artandi), J.E. Schiffelbein: NIH/NCI Cancer Center Support Grant 5P30 CA023108 (PI: Leach), Y. Song: NIH/NCI Cancer Center Support Grant 5P30 CA056036 (PI: Chapman), J.A. Tiro: NIH/NCI Cancer Center Support Grant 3P30 CA014599 (PI: Odunsi), S.T. Vadaparampil: NIH/NCI Cancer Center Support Grant 2P30 CA076292 (PI: Cleveland), R.C. Vanderpool: No funding to disclose, E.D. Paskett: NIH/NCI Cancer Center Support Grant 5P30 CA016058 (PI: Pollock).