Georgetown University Lombardi Comprehensive Cancer Center Support Grant

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Cancer Center Organizational Assessment to Eliminate Outcome Disparities Among CCS Continuity of care for childhood cancer survivors (CCS) is essential to promote lifelong health and well-being, as many survivors will confront prolonged late-effects of their disease and treatment. However, there are barriers to CCS equitably accessing follow-up care. Underserved racial/ethnic minorities, especially those who are already facing multiple social determinants of health (SDOH) barriers, are among the most adversely impacted by this inequity. The majority of prior research has focused on the organization and delivery of CCS care in well- resourced and majority groups: gaps remain in studies designed to identify and reduce disparities among vulnerable CCS. The complex and multiply-determined nature of CCS care delivery, along with recognizing the importance of SDOH, inform our research. The goal of this P30 supplement application, submitted on behalf of Georgetown University's Lombardi Comprehensive Cancer Center (Washington, DC) and its NCI-designated research consortium partner John Theurer Cancer Center (Hackensack, NJ), is to better understand and help eradicate disparities and barriers to the receipt of recommended CCS care. This care includes risk-based cancer surveillance, screening, and management, the prevention of cancer late effects, and care coordination. We plan to do this by assessing our cancer centers' internal organizational attributes and behaviors (including both practices and policies) that may inadvertently curtail access to such care among adolescent and young adult (AYA; ages 15-39 years) CCS in our geographic areas. This is important because these AYAs could (and could continue to) be served by our health systems in addressing the needs of this special population. Among the issues we seek to study are: 1) how prevalent underserved AYA CCS are across our systems; 2) what happens if/when they transition from pediatric to adult care (or become lost to follow-up); 3) if they are universally identified and recognized by our systems as CCS in need of CCS services, and; 4) if differences in care outcomes exist and may be attributable to organizational and SDOH factors, among others. We will thoroughly analyze our AYA CCS care systems, determine how to improve their quality, and formulate institutional action plans that will close gaps and remove obstacles to underserved CCS receiving the services they need across the lifespan. These action plans will then be tested and followed-up in subsequent interventional pilot initiatives promoting adherence to cancer treatment or guideline-concordant care. And they will be sustained by resources and a strengthening of our organizational capacity to better serve our catchment's diverse populations of AYA CCS.