A cancer diagnosis can upend work and family life, leading patients to reallocate resources away from essentials such as food. Estimates of the percentage of people navigating a cancer diagnosis and food insecurity range between 17% and 55% of the cancer patient population. The complexity of addressing food insecurity among those diagnosed with cancer during different phases of treatment is multifactorial and often requires an extensive network of support throughout each phase. This commentary explores the issue of food insecurity in the context of cancer care, explores current mitigation efforts, and offers a call to action to create a path for food insecurity mitigation in the context of cancer. Three programs that address food insecurity among those with cancer at various stages of care are highlighted, drawing attention to current impact and actionable recommendations to make programs like these scalable and sustainable. Recommendations are grounded in the National Academies of Sciences, Engineering, and Medicine social care framework through 5 essential domain areas: awareness, adjustment, assistance, alignment, and advocacy. This commentary seeks to highlight opportunities for the optimization of cancer care and reframe food access as an essential part of treatment and long-term care plans.

Demographic factors such as race, socioeconomic status, gender identity, area of residence, native language, and cultural barriers have an effect on outcomes in cancer care. To identify unmet needs, challenges, and opportunities in achieving high-quality, patient-centered cancer care for all, NCCN conducted a yearlong environmental scan, which involved stakeholder meetings with patients and patient advocacy groups to discuss these topics. The findings from this scan informed the corresponding NCCN Patient Advocacy Summit: Advocating for Equity in Cancer Care, held in Washington, DC, on December 10, 2018. In addition to the many patient advocacy groups, the summit featured a number of other stakeholders that advocate for equity in cancer care. This article encapsulates the findings of the environmental scan and the discussion from the NCCN Patient Advocacy Summit.

Introduction: WVU Cancer Institute’s Cancer Prevention and Control (CPC) and the Patient Advocate Foundation (PAF) is working to address lung cancer disparities in West Virginia (WV). Their goal is to decrease lung cancer mortality, the leading cause of cancer deaths in WV, and improve early diagnosis of lung cancer in the state. Brief Description: In 2016 there was no infrastructure for lung cancer screening in WV. The rural state’s significant geographic barriers, low socioeconomic status, lack of lung cancer screening facilities, and limited provider knowledge regarding screening guidelines created substantial challenges. The major aim of the WV Lung Cancer Project (WVLCP) is to increase lung cancer screening among low-income and limited resourced individuals across WV. The project has three primary components: provider outreach and engagement; patient awareness and education; and case management support. Summary of Data: The WVLCP initially developed a case management (CM) protocol with one of the major Medicaid Managed Care Organizations (MCO) in the state in order to reach those eligible for screening and navigate them to primary care providers for care. The result of protocol implementation was the identification of lack of provider knowledge. The team then surveyed health care providers to further assess their knowledge, attitudes, beliefs, and practices regarding lung cancer screening. The results indicated a need for education on the screening guidelines, including recommended test, frequency, eligibility, and insurance coverage. As a result, project staff provided academic detailing to health care providers and created a continuing education webinar. Beyond the need to enhance health care provider understanding, there was a need to educate the public about lung cancer screening and the location of services. To enhance patient awareness and education, the project established and promoted the WV Lung Cancer CareLine and participated in community education events. Between 2016 and 2019, American College of Radiology (ACR) screening facilities increased from five to 24 sites. The WVLCP was able to facilitate the addition of 12 sites to the ACR Registry by working one-on-one with various health care entities during this time. Two of the MCOs fully implemented the CM protocol. Thousands of patients were assessed, hundreds referred to a primary care provider, tens were screened, and two cases of lung cancer were found. As a result, both companies incorporated the protocol into their operations and have case managers contacting patients to reduce barriers to screening. Conclusion: By partnering with care providers, the public, and health insurance payors, the project has expanded the lung cancer screening infrastructure in WV. As the project concludes in 2019, the state’s comprehensive cancer coalition, Mountains of Hope, will work to promote lung cancer screening in WV and continue the efforts of PAF and the WVUCI. Note: This abstract was not presented at the conference. Citation Format: Stephenie K Kennedy-Rea, Shonta Chambers, Lauren Hixenbaugh. West Virginia Lung Cancer Project [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C117.

151 Background: The inability to afford healthcare has a widespread effect on cancer patients, notably impacting treatment decisions and outcomes. Patients receiving financial assistance to offset medication costs still face challenges overcoming cost of care barriers. This study investigated sources of concern and financial stress among racial groups and identified solutions to address patients’ needs beyond medication-related costs. Methods: This cross-sectional study utilized secondary survey data collected from cancer patients who received co-payment and/or financial aid from PAF in 2018. Respondents answered questions describing their financial distress and the COmprehensive Score for financial Toxicity (COST) tool (0-44 with lower scores indicating worse toxicity). Descriptive statistics were calculated using means and standard deviations (SD) for continuous variables and frequencies for categorical variables. Two sample t-tests were used for bivariate comparisons between racial groups. Results: Of 494 cancer patients surveyed, 72% were Caucasian, 11% were African American (AA), and 71% indicated a household income of < $48,000. Although this population received financial assistance, cost of medications was still a major barrier to adhering to treatment (59% vs 69%). AA patients reported greater financial burden caused by cost of deductibles/copay/coinsurance (58% vs 50%) and treatment costs not covered by insurance (49% vs 21%). AA patients highly rated day-to-day living expenses as an unmet need (64% vs 40%). COST scores differed significantly between Caucasian (mean 17.7, SD 8.6) and AA cohorts (mean 12.1, SD 8.6; p < .001), driven by the inability to meet monthly expenses at all (35% vs 11%). Of AA, 80% felt they do not have enough money in savings/retirement to cover treatment costs. Overall, the AA cohort reported higher frustration with not being able to work or contribute as much as usual (45% vs 26%). Conclusions: Under-resourced AA cancer patients identify a need for a comprehensive approach to cost of care conversation, to drive better adherence and improved treatment outcomes.

The root causes of racial disparities in access to optimal cancer care and related cancer outcomes are complex, multifactorial, and not rooted in biology. Contributing factors to racial disparities in care delivery include implicit and explicit bias, lack of representation of people of color in the oncology care and research workforce, and homogenous research participants that are not representative of the larger community. Systemic and structural barriers include policies leading to lack of insurance and underinsurance, costs of cancer treatment and associated ancillary costs of care, disparate access to clinical trials, and social determinants of health, including exposure to environmental hazards, access to housing, childcare, and economic injustices. To address these issues, ACS CAN, NCCN, and NMQF convened the Elevating Cancer Equity (ECE) initiative. The ECE Working Group developed the Health Equity Report Card (HERC). In this manuscript, we describe the process taken by the ECE Working Group to develop the HERC recommendations, the strategies employed by NCCN to develop an implementation plan and scoring methodology for the HERC, and next steps to pilot the HERC tool in practice settings.