NCCN Launches Pilot Project Aiming to Measure, Implement Health Equity in Cancer Care Practices

The National Comprehensive Cancer Network (NCCN) today announced the launch of its Health Equity Report Card (HERC) that aims to evaluate the feasibility of implementing the pilot project as a tool for improving the quality and equity of cancer care.

Developed in early 2021, the HERC includes a total of 17 actionable practice changes, which, if implemented, would help providers and health care organizations identify and address discriminatory behaviors and bias in care delivery, address social determinants of health (SDOH), and overcome systemic barriers to optimal care.

These actionable changes were vetted by oncology administrators and health care providers and refined into an implementation plan, including concrete metrics, sources of evidence, and a scoring methodology.

“Our hope is that the HERC will be able to serve as a roadmap for health care organizations working to improve their practice, a transparency tool for patients, and an assessment tool for payers and accreditation entities,” said Robert W. Carlson, MD, CEO of NCCN, in an accompanying press release.

“Inequities in cancer outcomes across race and ethnicity have numerous contributing factors, including different levels of access to comprehensive insurance coverage, bias and discrimination in care delivery, and [SDOH] such as neighborhood and built environment, access to economic and educational opportunity, and food insecurity due to historic and ongoing structural discrimination. This accountability tool will be more than just a checklist exercise; we hope it will result in interventions that lead to meaningful, sustainable systems changes.”

Disparities in cancer outcomes by race have shown stark differences in screening, morbidity, and mortality. Compared with White men and women, respectively, Black men and women are associated with 19% and 12% higher cancer mortality rates, and the impact of structural and interpersonal racism is one of the major causes of these disparities.

Findings of the American Cancer Society’s Cancer Facts and Figures 2023 indicate that racial and ethnic disparities in the cancer burden largely reflect long-standing inequities in socioeconomic status and access to high-quality health care, which can be attributed to historical and persistent structural racism in the United States experienced by all people of color.

In joining the call to Close the Care Gap on World Cancer Day, the pilot program continues the Elevating Cancer Equity collaboration between the NCCN and the American Cancer Society Cancer Action Network (ACS CAN) and National Minority Quality Forum (NMQF).

Gary Puckrein, PhD, president and CEO of the NMQF, noted that the tool is a step in the right direction to identify what system changes are needed to affect change.

“Despite significant advancements in the detection and treatment of cancer in recent decades, minoritized communities continue to bear the high cancer burden,” Puckrein said in the press release. “Inequities in cancer care are the result of failure to consider the lives of black, brown, yellow, red, and poor people. If we're going to close systemic gaps in cancer care, we must reimagine how we are approaching care delivery and realign systems to reduce patient risk.”

“All people diagnosed with cancer deserve to get the best care possible—regardless of income, race, ethnicity, gender identity, disability status, sexual orientation, age, or geography,” added Lisa Lacasse, president of the ACS CAN. “Ensuring equity in cancer care is critical to reducing cancer disparities and ending cancer as we know it, for everyone. The HERC provides a tangible approach that can help achieve that goal.”

In the first phase of a multiphase pilot, 5 leading academic cancer centers are assessing the feasibility of implementing the HERC. Feedback through the pilot stages of implementation will then be incorporated to ensure applicability across care settings and geographies. An additional second pilot program in the community hospital setting is also in early stages.