Developing a city-wide, community-engaged cancer disparities research agenda

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Leader, Yawei Song, Evelyn T. González, Thierry Fortune, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4009521/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 28 Sep, 2024 Read the published version in Cancer Causes & Control → Version 1 posted 10 You are reading this latest preprint version Abstract Introduction: In response to high levels of cancer disparities in Philadelphia, PA, three NCI-designated clincal cancer centers formed Philadelphia Communities Conquering Cancer (PC3) to bring stakeholders together and establish infrastructure for future cancer reducing initiatives. The PC3 coalition aimed to develop a prioritized cancer disparities research agenda in order to align cancer center resources and research interests with the concerns of the community about cancer, and to ensure that initiatives were patient- and community-centered. Methods: Agenda development activities culminated in a city-wide cancer disparities conference. The conference, attended by 55 diverse stakeholders, was the venue for small group discussion sessions about cancer concerns related to prevention, early detection, treatment, survivorship and quality of life. Sessions were guided by a moderator guide and were audiorecorded, transcribed, and analyzed by the PC3 leadership team. Results were reviewed and consensus was achieved with the help of PC3’s Stakeholder Advisory Committee. Results: Stakeholders identified four thematic areas as top priorities for cancer disparities research and action in Philadelphia: communication between patients, providers, and caregivers; education that reaches patients and community members with tailored and targeted information; navigation that assists people in finding and accessing the right cancer screening or treatment option for them; and representation that diversifies the workforce in clinics, cancer centers, and research offices. Conclusion: A community-informed, prioritized research agenda provides a road map for the three cancer centers to collaborate on future initiatives that are important to patients and stakeholders, to ultimately reduce the burden of cancer for all Philadelphians. cancer disparities stakeholder coalition cancer research community-engaged research BACKGROUND The Burden of Cancer in Philadelphia Philadelphia is the sixth largest city in the United States, home to more than 1.5 million residents [ 1 ]. It is also one of the poorest large cities in the U.S., with 23% of the population living below the federal poverty line [ 2 ]. Philadelphia’s population is very diverse, with 40% of residents identifying as Black or African American, 16% identifying as Hispanic or Latino, and 8% identifying as Asian [ 1 ]. More than one quarter of Philadelphians are immigrants or have a foreign-born parent [ 3 ]. Seven percent of residents lack some form of health insurance [ 1 ]. Cancer is the second leading cause of death in Philadelphia [ 4 ]. Each year, more than 6,000 Philadelphians are diagnosed with cancer and roughly 3,000 die of the disease [ 5 ]. Incidence and mortality rates for cancer are some of the highest in the state of Pennsylvania [ 5 ]. Cancer burden is unequally distributed among communities in Philadelphia, with the highest burden seen in higher-poverty neighborhoods in North and West Philadelphia [ 6 ]. African American and Hispanic Philadelphians, which comprise more than half of residents, largely bear the burden of cancer disparities, with higher-than-expected rates of most cancers [ 7 ]. Cancer risk factors, including obesity, smoking, alcohol consumption, physical inactivity, poor diet, and environmental exposures, are disproportionately higher in Philadelphia as compared to national averages [ 4 ]. The Role of NCI Designated Cancer Centers in Philadelphia Philadelphia is home to three NCI-designated clinical cancer centers (Abramson Cancer Center at the University of Pennsylvania, Sidney Kimmel Cancer Center at Thomas Jefferson University, and Fox Chase Cancer Center - Temple Health), spread across the city in different neighborhoods, all focused on reducing the cancer burden, treating cancer patients, and improving quality of life for cancer survivors. As part of NCI requirements for community outreach and engagement (COE), each cancer center is required to maintain a bi-directional relationship with the communities that they serve, working to disseminate and implement evidence-based interventions and guidelines, public education, and public health policy recommendations [ 8 ]. This bidirectional relationship between communities and cancer centers creates an infrastructure and promotes an understanding of cancer that is holistic and transdisciplinary, encompassing of different views and experiences, culturally sensitive, and reflective of mutual goals. Launching a City-Wide Cancer Disparities Coalition Philadelphia is at the heart of each of the three clinical cancer centers’ communities, creating a natural synergy and starting point for a city-wide coalition and a prioritized research agenda to reduce cancer disparities. While city-wide cancer coalitions have existed in other cities [ 9 , 10 ], and a cancer site-specific collaboration exists in Philadelphia [ 11 ], the city has lacked an organizational infrastructure for key stakeholders, including community-based partners, to tackle the burden of cancer across all communities, cancer types, and populations in Philadelphia. In 2022, with extramural funding shared among the three cancer centers, Philadelphia Communities Conquering Cancer (PC3) was launched to engage Philadelphians to reduce cancer disparities through community engagement, resource alignment, information sharing, research, and prevention. The Need for a City-Wide Cancer Disparities Research Agenda The successful process of establishing PC3 has underscored the need for both agreed-upon priorities for disparities research and established structures to meaningfully engage Philadelphia stakeholders and community members. Early activities included convening a diverse Stakeholder Advisory Committee and conducting listening sessions with a variety of community groups across the city. We then convened a city-wide cancer disparities conference in June 2023 that had a primary objective of developing Philadelphia’s first ever community-engaged prioritized research agenda. The day-long conference, attended by community stakeholders, patient advocates, local government representatives, and COE leaders from the three cancer centers, allowed participants to reflect on and discuss key cancer concerns in their community, followed by interactive discussions to determine the prioritized research agenda. What follows below is a detailed explanation of the city-wide disparities conference, the results of the research agenda, and how PC3 plans to leverage the results going forward in future community-engaged cancer efforts. METHODS Stakeholder Engagement A Stakeholder Advisory Committee (SAC) meets monthly and helps to guide all of the initiatives of PC3, including the city-wide disparities conference and the prioritized research agenda. It is led by a Community Chair and Co-Chair, both with longstanding ties to Philadelphia and to the cancer centers, and is comprised of nine members. The members were purposefully selected to represent diverse communities across Philadelphia incuding those who are Hispanic, African American, Asian, LGBTQ+, older adults, cancer patients and survivors, members of faith-based groups, and immigrants and refugees. During the conference planning phase, the SAC provided input on the agenda, suggested invited speakers, and shared names of potential attendees; on the day of the conference, several SAC members led breakout sessions and helped with gathering attendees’ thoughts about the prioritized research agenda. Conference Attendees We invited 83 people who represented diverse communities, organizations, and institutions across Philadelphia who had an interest in reducing cancer disparities. Of those, 55 attended, including eight members of the SAC, eleven from cancer patient advocacy organizations, eight from non-profit or community-based organizations, three from faith-based organizations, two from a local government health department, five from a local biotechnology company, and 18, including the conference organizers, from the COE programs of the three cancer centers. Conference Agenda The agenda was designed to provide attendees with background information, as well as sufficient time for discussion, to ultimately be able to contribute their ideas for the prioritized research agenda. Morning sessions began with a review of cancer trends and disparities data for Philadelphia, followed by a presentation on local initiatives from the American Cancer Society. The SAC Chair and Co-Chair shared findings from 8 listening sessions that were held across the city to engage diverse groups of residents in understanding their concerns about cancer prevention, treatment, and survivorship. There was time in the agenda for people to share personal stories about cancer, as well as to provide thoughts about the presentations and ask questions to the panelists. Conference Breakout Sessions The focal point of developing the prioritized research agenda were small breakout sessions with scripted discussion questions to elicit attendees’ thoughts about cancer disparities research priorities. The leadership team, informed by the SAC, developed a moderator guide that asked attendees to think about the most important things for the three cancer centers to focus on related to: cancer prevention and screening, diagnosing cancer and connections to care, cancer treatment and caregiving, and survivorship and quality of life. After going through each of these topic areas, the moderator guide asked, “Of all of the priorities that we’ve discussed here, what do you think is the GREATEST research priority?” Breakout sessions occurred during one hour over lunch, were individually moderated by SAC members, were audiorecorded, and included a notetaker in each group. Each of the five groups included between 7 and 9 conference attendees. Presentation of Breakout Session Discussion Highlights At the conclusion of the breakout sessions, each group presented its findings to all attendees by summarizing their notetaker’s notes. Members of each group had a chance to add thoughts beyond the notetaker’s summary, and other attendees could comment on each group’s key findings. By the end of reporting across the six groups, a high-level prioritized research agenda was taking shape. Analysis of Breakout Session Discussions The research agenda was further informed by the audiorecordings of the breakout sessions and the notetakers’ notes. The audiorecordings of the breakout sessions were professionally transcribed. Upon receipt, members of the leadership team reviewed the transcripts to confirm the preliminary results from the consensus conference as well as ensure that no major themes or trends were identified during the breakout sessions that were not reported during the discussion highlights. Final consensus was achieved by sharing and discussing the results with the SAC members, who also provided insight into community priorities and perspectives. RESULTS City-wide, Community-engaged Cancer Disparities Research Agenda The discussions held at the city-wide cancer disparities conference led to the following four thematic areas being prioritized by stakeholders as the most important research foci to contribute to reducing cancer disparities (Table 1 ): Table 1 Community-Engaged, Prioritized Cancer Disparities Research Agenda Theme Description Potential Action/Intervention Communication Improving communication between healthcare providers, patients, and caregivers about cancer-related health decisions Shared decision making between patients and providers Provider education to ensure strong recommendations when appropriate Preparing (educating) patients to participate in high-quality discussions with providers Education Identifying novel ways to reach patients and community members with tailored and targeted cancer-related information Educational tools to assist patients in understanding complex information Campaigns to raise awareness about misinformation and disinformation in digital spaces Navigation Understanding the most effective ways to help patients identify and access appropriate screening and cancer care services Patient and peer navigation, including community health workers Linkages between cancer centers and community-based clinics to facilitate access to speciality care and clinical trials Representation Investing in workforce and training programs to increase the diversity of the workforce in clinics, cancer centers, and research offices Training programs for community members to engage in and understand cancer research Pipeline programs at cancer centers for trainees from underrepresented groups Investment in programs that retain and promote cancer researchers and clinicians from underrepresented populations Communication: Identifying and evaluating strategies to improve communication between healthcare providers, patients, and caregivers about cancer-related health decisions, especially for older adults Education: Identifying novel ways to reach patients and community members with tailored and targeted information about cancer prevention, screening, and treatment Navigation: Understanding the most effective ways to help patients identify and access appropriate screening and cancer care services Representation: Investing in workforce and training programs to increase the diversity of the workforce in clinics, cancer centers, and research offices, thereby improving the public and patients’ trust in cancer research and health care services DISCUSSION PC3, and the city-wide cancer disparities research agenda, are responses to the high burden of cancer disparities in Philadelphia blended with an effort to leverage the resources of three NCI-designated cancer centers and synergize research and intervention efforts in the future. This collective impact approach can serve as a model for other cancer centers in close proximity with overlapping cancer centers, to work together on common priorities. Indeed, a recent analysis of cancer center catchment areas found that roughly one-third of U.S. counties are in the primary catchment area of more than one cancer center [ 12 ]. The COE initiatives in each cancer center are poised to lead this collaborative work. The ability of cancer centers to work together, with the partnership of stakeholders, to implement community-important research priorities is paramount to overcoming the disproportionate burden of cancer in the U.S. One of the four research priorities identified by stakeholders was communication , or improving the quality of discussions between the health care team and patients, families, and caregivers. Research has shown that provider recommendation, shared decision making, and high quality communication are important in a patient’s decision to screen for cancer and lead to higher screening uptake [ 13 ]. Communication may be even more important when navigating the complexities of cancer care, where decisions about treatment, clinical trials, and care management are of utmost importance. While many patients, especially those who are older, report difficulties with provider communication [ 14 ], patients who are immigrants or from racial and ethnic minority groups report some of the highest levels of communication difficulties [ 15 ]; reduced quality of communication between language discordant providers and patients has actually been shown to negatively impact cancer outcomes [ 16 ]. Because of this, many interventions, including those being proposed by PC3, aim to improve provider communication or patient engagement in health care decisions [ 17 ]. Additionally, national cancer organizations have proposed guidelines on how effectively communicate with patients [ 18 ]. A second research priority was education , or identifying novel ways to reach patients and community members with tailored and targeted information about cancer prevention, screening, and treatment. Undoubtedly, the intracacies of cancer care are difficult for many patients to understand [ 19 ]; the more recent integration of genetics, genomics, and precision medicine into cancer treatment decisions has made the information even more complex [ 20 ]. Separately, many patients and caregivers use the Internet to find health information [ 21 ], susepting themselves to misinformation and disinformation about cancer risk or outcomes [ 22 ]. Data from a nationally representative survey recently found that there is a subset of individuals, about 15% of the population, that do not believe that the health information on the Internet is misleading [ 23 ]. Interventions that increase the health and digital literacay of people, particulary those with lower educational levels, is needed. Additionally, interventions that have provided targeted or tailored patient information across the cancer continuum have shown promise [ 24 ]; ensuring that these types of interventions exist in Philadelphia, as well as developing new interventions to educate patients and communities, is important. A third cancer disparities research priority was navigation , or support for identifying the most effective ways to help patients find and access appropriate screening and cancer care services. Patient navigation has been shown to be effective in many contexts in cancer [ 25 ], from helping people access appropriate screening services [ 26 ], to helping patients receive an accurate diagnosis of cancer and begin treatment [ 27 ]. Navigation interventions may be particularly effective when pairing patients with navigators who have similar lived experiences, such as in minority or immigrant communities [ 28 ]. Research is still emerging about the best type of navigator for various situations, with some utilizing nurse-based navigation programs for newly diagnosed patients and others utilizing community health workers to navigate patients to cancer screening programs [ 29 ]. In any context, determining the best way to get people to the services that they need, in a way that is relatable, is important to reducing cancer disparities in Philadelphia. The final research priority identified by stakeholders was representation , or investing in workforce and training programs to increase the diversity of the workforce in clinics, cancer centers, and research offices, thereby improving the public and patients’ trust in cancer research and health care services. Lack of representation in the cancer workforce, due to structural and societal barriers [ 30 ], is a pressing issue that has very likely contributed to longstanding cancer disparities. The current oncology workforce, whether measured by physician demographics [ 31 ] or those who work in nursing and cancer research [ 32 ], rarely matches the demographics of the catchment area and patient population that is being served. This creates a division between the patients and the providers and can lead to mistrust. Interventions to diversify staff through programs meant to mentor students and trainees in the early stages of their careers shows substantial promise [ 33 ]. Understanding how PC3 can undertake or contribute to efforts to increase representation in local cancer center research staff could ultimately lead to increased participation of underrepresented communities in cancer clinical trials [ 34 ]. Interestingly, one of the next initiatives of PC3 is to train community members to be local cancer research advocates. The work described here is a culmination of establishing a city-wide cancer coalition, convening a diverse Stakeholder Advisory Committee, and hosting a cancer disparities conference to determine Philadelphia’s first-ever community engaged cancer disparities research agenda. Other cancer centers can and should take advantage of these processes to replicate similar initiatives in their catchment areas. Stakeholders identified broad themes for priority research areas, such as education and navigation, rather than focusing on a specific type of cancer or stage of cancer research. A similar approach involving professional experts identified themes of patient navigation, community engagement, and healthcare system changes as priorities for addressing cancer disparities in the U.S [ 35 ]. These broader, theme-based agendas allow for a certain amount of flexibility when implementing research to align with the agenda, as investigators can determine which cancer types or stage along the cancer continuum is best suited to the theme. To be sure, any research conducted as a result of this prioritized agenda should be conducted in partnership with patients, stakeholders and community members to ensure that the research is reflective of the needs and circumstances of those who would most benefit. It is the hope of all of those involved in PC3 that this community-engaged, prioritized research agenda contributes to a significant reduction of the burden of cancer in Philadelphia. Declarations Acknowledgements Funding: This project was funded through a Patient-Centered Outcomes Research Institute (PCORI) Eugene Washington PCORI Engagement Award (EACB 24847) Disclaimer: The statements presented in this publication are solely the responsibility of the author(s) and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute® (PCORI®), its Board of Governors or Methodology Committee. A special thank you to the members of the Stakeholder Advisory Committee, whose thoughtful ideas, consistent action, and important contributions to this work have ensured that patients and community members’ concerns and priorities are at the forefront of our efforts to reduce cancer disparities in Philadelphia. Author Contribution A.L. and K.G. made substantial contributions to the conception or design of the workAll authors were involved in the collection and analysis of dataA.L. and K.G. drafted the manuscript All authors reviewed and edited the manuscript All authors approved the version to be published References Census Bureau US, QuickFacts (2023) Accessed February 2, 2024. https://www.census.gov/quickfacts/fact/table/philadelphiacitypennsylvania/PST045223 Pew Charitable Trusts (2023) : The state of the city. Accessed February 2, 2024. https://www.pewtrusts.org/-/media/assets/2023/05/philadelphia-2023-the-state-of-the-city.pdf Pew Charitable Trusts. The State of immigrants in Philadelphia (2019) Accessed February 2, 2024. https://www.pewtrusts.org/-/media/assets/2019/04/philadelphia_state_of_immigrants.pdf City of Philadelphia Department of Public Health. Health of the city report (2021) Accessed February 2, 2024. https://www.phila.gov/media/20220718132807/HealthOfTheCity-2021.pdf Pennsylvania Department of Health. EDDIE: Enterprise Data Dissemination Informatics Exchange. Accessed February 2 (2024) https://www.phaim1.health.pa.gov/EDD/WebForms/CancerCntySt.aspx Drexel University Urban Health Collaborative. Cancer in Philadelphia neighborhoods. Accessed February 2 (2024) https://drexel.edu/uhc/research/projects/community-impact-reducing-cancer/Cancer%20in%20Philadelphia%20Neighborhoods/ Drexel University Urban Health Collaborative. The state of cancer in Philadelphia. Accessed February 2 (2024) https://drexel.edu/~/media/Files/uhc/Cancer%20Philadelphia/Cancer%20Report.ashx?la=en Paskett ED, Hiatt RA (2018) Catchment Areas and Community Outreach and Engagement: The New Mandate for NCI-Designated Cancer Centers. Cancer Epidemiol Biomarkers Prev 27(5):517–519 Hiatt RA, Sibley A, Fejerman L, Glantz S, Nguyen T, Pasick R et al (2018) The San Francisco Cancer Initiative: A Community effort to reduce the population burden of cancer. Health Aff (Millwood) 37(1):54–61 Simon MA, Fitzgibbon M, Ciecierski C, Cooper JM, Martinez E, Tom L et al (2019) Building cross-institutional collaborative infrastructure and processes: Early lessons from the Chicago Cancer Health Equity Collaborative. Prog Community Health Partnersh 13(5):5–13 Barta JA, Erkmen CP, Shusted CS, Myers RE, Saia C, Cohen S (2023) The Philadelphia Lung Cancer Learning Community: a multi-health-system, citywide approach to lung cancer screening. JNCI Cancer Spectr 7(5):pkad071 Leader AE, McNair C, Yurick C, Huesser M, Schade E, Stimmel EE et al (2022) Assessing the coverage of US cancer center primary catchment areas. Cancer Epidemiol Biomarkers Prev 31(5):955–964 Peterson EB, Ostroff JS, DuHamel KN, DAgostino T, Hernandez M, Canzona M et al (2016) Impact of provider-patient communication on cancer screening adherence: A systematic review. Prev Med 93:96–105 Hult A, Lundgren E, Fröjd C, Lindam A, Jangland E (2023) Patient complaints about communication in cancer care settings: Hidden between the lines. Patient Educ Couns 114:107838 Palmer Kelly E, McGee J, Obeng-Gyasi S, Herbert C, Azap R, Abbas A et al (2021) Marginalized patient identities and the patient-physician relationship in the cancer care context: a systematic scoping review. Support Care Cancer 29(12):7195–7207 Diamond L, Izquierdo K, Canfield D, Matsoukas K, Gany F (2019) A systematic review of the impact of patient-physician non-English language concordance on quality of care and outcomes. J Gen Intern Med 34(8):1591–1606 Haverfield MC, Tierney A, Schwartz R et al (2020) Can patient-provider interpersonal interventions achieve the quadruple aim of healthcare? A Systematic Review. J Gen Intern Med 35(7):2107–2117 Gilligan T, Coyle N, Frankel RM et al (2017) Patient-Clinician Communication: American Society of Clinical Oncology Consensus Guideline. J Clin Oncol 35(31):3618–3632 Wang T, Molassiotis A, Chung BPM, Tan JY (2018) Unmet care needs of advanced cancer patients and their informal caregivers: a systematic review. BMC Palliat Care 17(1):96 Wolyniec K, Sharp J, Lazarakis S, Mileshkin L, Schofield P (2020) Understanding and information needs of cancer patients regarding treatment-focused genomic testing: A systematic review. Psychooncology 29(4):632–638 Ferraris G, Monzani D, Coppini V, Conti L, Pizzoli S, Grasso R et al (2023) Barriers to and facilitators of online health information-seeking behaviours among cancer patients: A systematic review. Digit Health 9:20552076231210663 Grimes DR (2022) The struggle against cancer misinformation. Cancer Discov 12(1):26–30 National Cancer Institute. Health Information National Trends Survey 6 (2022) Accessed February 2, 2024. https://hints.cancer.gov/view-questions/all-hints-questions.aspx Housten AJ, Gunn CM, Paasche-Orlow MK, Basen-Engquist KM (2021) Health literacy interventions in cancer: a systematic review. J Cancer Educ 36(2):240–252 Chan RJ, Milch VE, Crawford-Williams F et al (2023) Patient navigation across the cancer care continuum: An overview of systematic reviews and emerging literature. CA Cancer J Clin 73(6):565–589 Mosquera I, Todd A, Balaj M et al (2023) Components and effectiveness of patient navigation programmes to increase participation to breast, cervical and colorectal cancer screening: A systematic review. Cancer Med 12(13):14584–14611 Okoli GN, Lam OLT, Reddy VK et al (2021) Interventions to improve early cancer diagnosis of symptomatic individuals: a scoping review. BMJ Open 11(11):e055488 Liu D, Schuchard H, Burston B, Yamashita T, Albert S (2021) Interventions to Reduce Healthcare Disparities in Cancer Screening Among Minority Adults: a Systematic Review. J Racial Ethn Health Disparities 8(1):107–126 Roland KB, Milliken EL, Rohan EA et al (2017) Use of community health workers and patient navigators to improve cancer outcomes among patients served by Federally Qualified Health Centers: A Systematic literature review. Health Equity 1(1):61–76 Owoyemi O, Aakhus E (2021) Underrepresentation in oncology: Identifying and addressing structural barriers. Oncologist 26(8):630–634 Deville C Jr, Charles-Obi K, Santos PMG, Mattes MD, Hussaini SMQ (2023) Oncology physician workforce diversity: Rationale, trends, barriers, and solutions. Cancer J 29(6):301–309 Estape ES, Quarshie A, Segarra B et al (2018) Promoting diversity in the clinical and translational research workforce. J Natl Med Assoc 110(6):598–605 Locklear T, Lewis R, Calhoun F et al (2022) Advancing workforce diversity by leveraging the Clinical and Translational Science Awards (CTSA) program. J Clin Transl Sci 7(1):e30 Oyer RA, Hurley P, Boehmer L et al (2022) Increasing racial and ethnic diversity in cancer clinical trials: An American Society of Clinical Oncology and Association of Community Cancer Centers Joint Research Statement. J Clin Oncol 40(19):2163–2171 Winkfield KM, Regnante JM, Miller-Sonet E, González ET, Freund KM, Doykos PM (2021) Development of an actionable framework to address cancer care disparities in medically underserved populations in the United States: Expert roundtable recommendations. JCO Oncol Pract 17(3):e278–e293 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 28 Sep, 2024 Read the published version in Cancer Causes & Control → Version 1 posted Editorial decision: Revision requested 23 Aug, 2024 Reviews received at journal 15 Aug, 2024 Reviewers agreed at journal 05 Aug, 2024 Reviews received at journal 15 Jul, 2024 Reviewers agreed at journal 11 May, 2024 Reviewers agreed at journal 14 Apr, 2024 Reviewers invited by journal 11 Mar, 2024 Editor assigned by journal 04 Mar, 2024 Submission checks completed at journal 04 Mar, 2024 First submitted to journal 03 Mar, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4009521","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":276350778,"identity":"8620659c-a1d6-49c0-b86e-bc386086cc3a","order_by":0,"name":"Amy E. Leader","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABB0lEQVRIie3PMUvDQBTA8VcOokNK1gNN+hVeONCh4md5R+GyVOhYsNBMnYrZ5PwW8RMYCMTlPoCQ5SbnjB1KMQ3W7UQ3wftPj8f7DQ/A5/urWYBRDqxCuElOO/Y9oYEEhKDEr0iI8CMSPRoEWt7GxYXpFh1hcl3UjYXlVOYOwtt5T8xMPD3clakmFJdvKkMwmZPAkcgNk6UZl2K820vNwys+2tROMhnIYS1fTGjFnnCtI9OTg5vgQPJalmEIAgiJw7wnuZukrVpU1LwKbQJMt4Sp5kpxajLhIkk7e7bd6j4utuwdd4QTHtUN71bT2Pk+nGP1OQX4tSTn+bEze5qYdd34fD7f/+4D6mVZzvdAcw8AAAAASUVORK5CYII=","orcid":"","institution":"Thomas Jefferson University","correspondingAuthor":true,"prefix":"","firstName":"Amy","middleName":"E.","lastName":"Leader","suffix":""},{"id":276350780,"identity":"6e56b61a-4f0b-4474-ab1b-3b6550d210f2","order_by":1,"name":"Yawei Song","email":"","orcid":"","institution":"Sidney Kimmel Cancer Center - Jefferson Health","correspondingAuthor":false,"prefix":"","firstName":"Yawei","middleName":"","lastName":"Song","suffix":""},{"id":276350783,"identity":"b750d211-3a9a-43a1-a2d4-812ddb182865","order_by":2,"name":"Evelyn T. González","email":"","orcid":"","institution":"Fox Chase Cancer Center","correspondingAuthor":false,"prefix":"","firstName":"Evelyn","middleName":"T.","lastName":"González","suffix":""},{"id":276350784,"identity":"0388fae4-a153-4985-a9f4-2690f7ec35d4","order_by":3,"name":"Thierry Fortune","email":"","orcid":"","institution":"Philadelphia Department of Public Health","correspondingAuthor":false,"prefix":"","firstName":"Thierry","middleName":"","lastName":"Fortune","suffix":""},{"id":276350785,"identity":"f39f451c-b3d0-433c-bd54-e46d147eeb73","order_by":4,"name":"Nilsa Graciani","email":"","orcid":"","institution":"Esperanza College at Eastern University","correspondingAuthor":false,"prefix":"","firstName":"Nilsa","middleName":"","lastName":"Graciani","suffix":""},{"id":276350786,"identity":"7bb3cda8-bc4b-4b31-a75a-3a0ff1c87a35","order_by":5,"name":"Charnita Zeigler-Johnson","email":"","orcid":"","institution":"Fox Chase Cancer Center","correspondingAuthor":false,"prefix":"","firstName":"Charnita","middleName":"","lastName":"Zeigler-Johnson","suffix":""},{"id":276350787,"identity":"470390cc-a2aa-4732-9d48-fb34d7ee5e52","order_by":6,"name":"Karen Glanz","email":"","orcid":"","institution":"University of Pennsylvania","correspondingAuthor":false,"prefix":"","firstName":"Karen","middleName":"","lastName":"Glanz","suffix":""}],"badges":[],"createdAt":"2024-03-03 19:18:04","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4009521/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4009521/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s10552-024-01919-8","type":"published","date":"2024-09-28T15:57:57+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":65627345,"identity":"d5f5ea99-70f9-4027-8294-29b4f15e768d","added_by":"auto","created_at":"2024-09-30 16:15:09","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":294967,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4009521/v1/6e7d5c0d-1663-4fce-956b-cbeadaff7804.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Developing a city-wide, community-engaged cancer disparities research agenda","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003e \u003cem\u003eThe Burden of Cancer in Philadelphia\u003c/em\u003e \u003c/p\u003e \u003cp\u003ePhiladelphia is the sixth largest city in the United States, home to more than 1.5\u0026nbsp;million residents [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. It is also one of the poorest large cities in the U.S., with 23% of the population living below the federal poverty line [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Philadelphia\u0026rsquo;s population is very diverse, with 40% of residents identifying as Black or African American, 16% identifying as Hispanic or Latino, and 8% identifying as Asian [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. More than one quarter of Philadelphians are immigrants or have a foreign-born parent [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Seven percent of residents lack some form of health insurance [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCancer is the second leading cause of death in Philadelphia [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Each year, more than 6,000 Philadelphians are diagnosed with cancer and roughly 3,000 die of the disease [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Incidence and mortality rates for cancer are some of the highest in the state of Pennsylvania [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Cancer burden is unequally distributed among communities in Philadelphia, with the highest burden seen in higher-poverty neighborhoods in North and West Philadelphia [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. African American and Hispanic Philadelphians, which comprise more than half of residents, largely bear the burden of cancer disparities, with higher-than-expected rates of most cancers [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Cancer risk factors, including obesity, smoking, alcohol consumption, physical inactivity, poor diet, and environmental exposures, are disproportionately higher in Philadelphia as compared to national averages [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cem\u003eThe Role of NCI Designated Cancer Centers in Philadelphia\u003c/em\u003e \u003c/p\u003e \u003cp\u003ePhiladelphia is home to three NCI-designated clinical cancer centers (Abramson Cancer Center at the University of Pennsylvania, Sidney Kimmel Cancer Center at Thomas Jefferson University, and Fox Chase Cancer Center - Temple Health), spread across the city in different neighborhoods, all focused on reducing the cancer burden, treating cancer patients, and improving quality of life for cancer survivors. As part of NCI requirements for community outreach and engagement (COE), each cancer center is required to maintain a bi-directional relationship with the communities that they serve, working to disseminate and implement evidence-based interventions and guidelines, public education, and public health policy recommendations [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. This bidirectional relationship between communities and cancer centers creates an infrastructure and promotes an understanding of cancer that is holistic and transdisciplinary, encompassing of different views and experiences, culturally sensitive, and reflective of mutual goals.\u003c/p\u003e \u003cp\u003e \u003cem\u003eLaunching a City-Wide Cancer Disparities Coalition\u003c/em\u003e \u003c/p\u003e \u003cp\u003ePhiladelphia is at the heart of each of the three clinical cancer centers\u0026rsquo; communities, creating a natural synergy and starting point for a city-wide coalition and a prioritized research agenda to reduce cancer disparities. While city-wide cancer coalitions have existed in other cities [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], and a cancer site-specific collaboration exists in Philadelphia [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], the city has lacked an organizational infrastructure for key stakeholders, including community-based partners, to tackle the burden of cancer across all communities, cancer types, and populations in Philadelphia. In 2022, with extramural funding shared among the three cancer centers, Philadelphia Communities Conquering Cancer (PC3) was launched to engage Philadelphians to reduce cancer disparities through community engagement, resource alignment, information sharing, research, and prevention.\u003c/p\u003e \u003cp\u003e \u003cem\u003eThe Need for a City-Wide Cancer Disparities Research Agenda\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThe successful process of establishing PC3 has underscored the need for both agreed-upon priorities for disparities research and established structures to meaningfully engage Philadelphia stakeholders and community members. Early activities included convening a diverse Stakeholder Advisory Committee and conducting listening sessions with a variety of community groups across the city. We then convened a city-wide cancer disparities conference in June 2023 that had a primary objective of developing Philadelphia\u0026rsquo;s first ever community-engaged prioritized research agenda. The day-long conference, attended by community stakeholders, patient advocates, local government representatives, and COE leaders from the three cancer centers, allowed participants to reflect on and discuss key cancer concerns in their community, followed by interactive discussions to determine the prioritized research agenda. What follows below is a detailed explanation of the city-wide disparities conference, the results of the research agenda, and how PC3 plans to leverage the results going forward in future community-engaged cancer efforts.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003e \u003cem\u003eStakeholder Engagement\u003c/em\u003e \u003c/p\u003e \u003cp\u003e A Stakeholder Advisory Committee (SAC) meets monthly and helps to guide all of the initiatives of PC3, including the city-wide disparities conference and the prioritized research agenda. It is led by a Community Chair and Co-Chair, both with longstanding ties to Philadelphia and to the cancer centers, and is comprised of nine members. The members were purposefully selected to represent diverse communities across Philadelphia incuding those who are Hispanic, African American, Asian, LGBTQ+, older adults, cancer patients and survivors, members of faith-based groups, and immigrants and refugees. During the conference planning phase, the SAC provided input on the agenda, suggested invited speakers, and shared names of potential attendees; on the day of the conference, several SAC members led breakout sessions and helped with gathering attendees\u0026rsquo; thoughts about the prioritized research agenda.\u003c/p\u003e \u003cp\u003e \u003cem\u003eConference Attendees\u003c/em\u003e \u003c/p\u003e \u003cp\u003eWe invited 83 people who represented diverse communities, organizations, and institutions across Philadelphia who had an interest in reducing cancer disparities. Of those, 55 attended, including eight members of the SAC, eleven from cancer patient advocacy organizations, eight from non-profit or community-based organizations, three from faith-based organizations, two from a local government health department, five from a local biotechnology company, and 18, including the conference organizers, from the COE programs of the three cancer centers.\u003c/p\u003e \u003cp\u003e \u003cem\u003eConference Agenda\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThe agenda was designed to provide attendees with background information, as well as sufficient time for discussion, to ultimately be able to contribute their ideas for the prioritized research agenda. Morning sessions began with a review of cancer trends and disparities data for Philadelphia, followed by a presentation on local initiatives from the American Cancer Society. The SAC Chair and Co-Chair shared findings from 8 listening sessions that were held across the city to engage diverse groups of residents in understanding their concerns about cancer prevention, treatment, and survivorship. There was time in the agenda for people to share personal stories about cancer, as well as to provide thoughts about the presentations and ask questions to the panelists.\u003c/p\u003e \u003cp\u003e \u003cem\u003eConference Breakout Sessions\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThe focal point of developing the prioritized research agenda were small breakout sessions with scripted discussion questions to elicit attendees\u0026rsquo; thoughts about cancer disparities research priorities. The leadership team, informed by the SAC, developed a moderator guide that asked attendees to think about the most important things for the three cancer centers to focus on related to: cancer prevention and screening, diagnosing cancer and connections to care, cancer treatment and caregiving, and survivorship and quality of life. After going through each of these topic areas, the moderator guide asked, \u0026ldquo;Of all of the priorities that we\u0026rsquo;ve discussed here, what do you think is the GREATEST research priority?\u0026rdquo; Breakout sessions occurred during one hour over lunch, were individually moderated by SAC members, were audiorecorded, and included a notetaker in each group. Each of the five groups included between 7 and 9 conference attendees.\u003c/p\u003e \u003cp\u003e \u003cem\u003ePresentation of Breakout Session Discussion Highlights\u003c/em\u003e \u003c/p\u003e \u003cp\u003eAt the conclusion of the breakout sessions, each group presented its findings to all attendees by summarizing their notetaker\u0026rsquo;s notes. Members of each group had a chance to add thoughts beyond the notetaker\u0026rsquo;s summary, and other attendees could comment on each group\u0026rsquo;s key findings. By the end of reporting across the six groups, a high-level prioritized research agenda was taking shape.\u003c/p\u003e \u003cp\u003e \u003cem\u003eAnalysis of Breakout Session Discussions\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThe research agenda was further informed by the audiorecordings of the breakout sessions and the notetakers\u0026rsquo; notes. The audiorecordings of the breakout sessions were professionally transcribed. Upon receipt, members of the leadership team reviewed the transcripts to confirm the preliminary results from the consensus conference as well as ensure that no major themes or trends were identified during the breakout sessions that were not reported during the discussion highlights. Final consensus was achieved by sharing and discussing the results with the SAC members, who also provided insight into community priorities and perspectives.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003e \u003cem\u003eCity-wide, Community-engaged Cancer Disparities Research Agenda\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThe discussions held at the city-wide cancer disparities conference led to the following four thematic areas being prioritized by stakeholders as the most important research foci to contribute to reducing cancer disparities (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e):\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCommunity-Engaged, Prioritized Cancer Disparities Research Agenda\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTheme\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDescription\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePotential Action/Intervention\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCommunication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eImproving communication between healthcare providers, patients, and caregivers about cancer-related health decisions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eShared decision making between patients and providers\u003c/p\u003e \u003cp\u003eProvider education to ensure strong recommendations when appropriate\u003c/p\u003e \u003cp\u003ePreparing (educating) patients to participate in high-quality discussions with providers\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIdentifying novel ways to reach patients and community members with tailored and targeted cancer-related information\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEducational tools to assist patients in understanding complex information\u003c/p\u003e \u003cp\u003eCampaigns to raise awareness about misinformation and disinformation in digital spaces\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNavigation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnderstanding the most effective ways to help patients identify and access appropriate screening and cancer care services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePatient and peer navigation, including community health workers\u003c/p\u003e \u003cp\u003eLinkages between cancer centers and community-based clinics to facilitate access to speciality care and clinical trials\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRepresentation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInvesting in workforce and training programs to increase the diversity of the workforce in clinics, cancer centers, and research offices\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTraining programs for community members to engage in and understand cancer research\u003c/p\u003e \u003cp\u003ePipeline programs at cancer centers for trainees from underrepresented groups\u003c/p\u003e \u003cp\u003eInvestment in programs that retain and promote cancer researchers and clinicians from underrepresented populations\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eCommunication: Identifying and evaluating strategies to improve communication between healthcare providers, patients, and caregivers about cancer-related health decisions, especially for older adults\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eEducation: Identifying novel ways to reach patients and community members with tailored and targeted information about cancer prevention, screening, and treatment\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eNavigation: Understanding the most effective ways to help patients identify and access appropriate screening and cancer care services\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eRepresentation: Investing in workforce and training programs to increase the diversity of the workforce in clinics, cancer centers, and research offices, thereby improving the public and patients\u0026rsquo; trust in cancer research and health care services\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003ePC3, and the city-wide cancer disparities research agenda, are responses to the high burden of cancer disparities in Philadelphia blended with an effort to leverage the resources of three NCI-designated cancer centers and synergize research and intervention efforts in the future. This collective impact approach can serve as a model for other cancer centers in close proximity with overlapping cancer centers, to work together on common priorities. Indeed, a recent analysis of cancer center catchment areas found that roughly one-third of U.S. counties are in the primary catchment area of more than one cancer center [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The COE initiatives in each cancer center are poised to lead this collaborative work. The ability of cancer centers to work together, with the partnership of stakeholders, to implement community-important research priorities is paramount to overcoming the disproportionate burden of cancer in the U.S.\u003c/p\u003e \u003cp\u003eOne of the four research priorities identified by stakeholders was \u003cem\u003ecommunication\u003c/em\u003e, or improving the quality of discussions between the health care team and patients, families, and caregivers. Research has shown that provider recommendation, shared decision making, and high quality communication are important in a patient\u0026rsquo;s decision to screen for cancer and lead to higher screening uptake [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Communication may be even more important when navigating the complexities of cancer care, where decisions about treatment, clinical trials, and care management are of utmost importance. While many patients, especially those who are older, report difficulties with provider communication [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], patients who are immigrants or from racial and ethnic minority groups report some of the highest levels of communication difficulties [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]; reduced quality of communication between language discordant providers and patients has actually been shown to negatively impact cancer outcomes [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Because of this, many interventions, including those being proposed by PC3, aim to improve provider communication or patient engagement in health care decisions [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Additionally, national cancer organizations have proposed guidelines on how effectively communicate with patients [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA second research priority was \u003cem\u003eeducation\u003c/em\u003e, or identifying novel ways to reach patients and community members with tailored and targeted information about cancer prevention, screening, and treatment. Undoubtedly, the intracacies of cancer care are difficult for many patients to understand [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]; the more recent integration of genetics, genomics, and precision medicine into cancer treatment decisions has made the information even more complex [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Separately, many patients and caregivers use the Internet to find health information [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], susepting themselves to misinformation and disinformation about cancer risk or outcomes [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Data from a nationally representative survey recently found that there is a subset of individuals, about 15% of the population, that do not believe that the health information on the Internet is misleading [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Interventions that increase the health and digital literacay of people, particulary those with lower educational levels, is needed. Additionally, interventions that have provided targeted or tailored patient information across the cancer continuum have shown promise [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]; ensuring that these types of interventions exist in Philadelphia, as well as developing new interventions to educate patients and communities, is important.\u003c/p\u003e \u003cp\u003eA third cancer disparities research priority was \u003cem\u003enavigation\u003c/em\u003e, or support for identifying the most effective ways to help patients find and access appropriate screening and cancer care services. Patient navigation has been shown to be effective in many contexts in cancer [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], from helping people access appropriate screening services [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], to helping patients receive an accurate diagnosis of cancer and begin treatment [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Navigation interventions may be particularly effective when pairing patients with navigators who have similar lived experiences, such as in minority or immigrant communities [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Research is still emerging about the best type of navigator for various situations, with some utilizing nurse-based navigation programs for newly diagnosed patients and others utilizing community health workers to navigate patients to cancer screening programs [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. In any context, determining the best way to get people to the services that they need, in a way that is relatable, is important to reducing cancer disparities in Philadelphia.\u003c/p\u003e \u003cp\u003eThe final research priority identified by stakeholders was \u003cem\u003erepresentation\u003c/em\u003e, or investing in workforce and training programs to increase the diversity of the workforce in clinics, cancer centers, and research offices, thereby improving the public and patients\u0026rsquo; trust in cancer research and health care services. Lack of representation in the cancer workforce, due to structural and societal barriers [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], is a pressing issue that has very likely contributed to longstanding cancer disparities. The current oncology workforce, whether measured by physician demographics [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e] or those who work in nursing and cancer research [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e], rarely matches the demographics of the catchment area and patient population that is being served. This creates a division between the patients and the providers and can lead to mistrust. Interventions to diversify staff through programs meant to mentor students and trainees in the early stages of their careers shows substantial promise [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Understanding how PC3 can undertake or contribute to efforts to increase representation in local cancer center research staff could ultimately lead to increased participation of underrepresented communities in cancer clinical trials [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Interestingly, one of the next initiatives of PC3 is to train community members to be local cancer research advocates.\u003c/p\u003e \u003cp\u003e The work described here is a culmination of establishing a city-wide cancer coalition, convening a diverse Stakeholder Advisory Committee, and hosting a cancer disparities conference to determine Philadelphia\u0026rsquo;s first-ever community engaged cancer disparities research agenda. Other cancer centers can and should take advantage of these processes to replicate similar initiatives in their catchment areas. Stakeholders identified broad themes for priority research areas, such as education and navigation, rather than focusing on a specific type of cancer or stage of cancer research. A similar approach involving professional experts identified themes of patient navigation, community engagement, and healthcare system changes as priorities for addressing cancer disparities in the U.S [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. These broader, theme-based agendas allow for a certain amount of flexibility when implementing research to align with the agenda, as investigators can determine which cancer types or stage along the cancer continuum is best suited to the theme. To be sure, any research conducted as a result of this prioritized agenda should be conducted in partnership with patients, stakeholders and community members to ensure that the research is reflective of the needs and circumstances of those who would most benefit. It is the hope of all of those involved in PC3 that this community-engaged, prioritized research agenda contributes to a significant reduction of the burden of cancer in Philadelphia.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFunding: \u0026nbsp;This project was funded through a Patient-Centered Outcomes Research Institute (PCORI) Eugene Washington PCORI Engagement Award (EACB 24847)\u003c/p\u003e\n\u003cp\u003eDisclaimer: The statements presented in this publication are solely the responsibility of the author(s) and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute\u0026reg; (PCORI\u0026reg;), its Board of Governors or Methodology Committee.\u003c/p\u003e\n\u003cp\u003eA special thank you to the members of the Stakeholder Advisory Committee, whose thoughtful ideas, consistent action, and important contributions to this work have ensured that patients and community members\u0026rsquo; concerns and priorities are at the forefront of our efforts to reduce cancer disparities in Philadelphia.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eA.L. and K.G. made substantial contributions to the conception or design of the workAll authors were involved in the collection and analysis of dataA.L. and K.G. drafted the manuscript All authors reviewed and edited the manuscript All authors approved the version to be published\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCensus Bureau US, QuickFacts (2023) Accessed February 2, 2024. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.census.gov/quickfacts/fact/table/philadelphiacitypennsylvania/PST045223\u003c/span\u003e\u003cspan address=\"https://www.census.gov/quickfacts/fact/table/philadelphiacitypennsylvania/PST045223\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePew Charitable Trusts (2023) : The state of the city. Accessed February 2, 2024. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.pewtrusts.org/-/media/assets/2023/05/philadelphia-2023-the-state-of-the-city.pdf\u003c/span\u003e\u003cspan address=\"https://www.pewtrusts.org/-/media/assets/2023/05/philadelphia-2023-the-state-of-the-city.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePew Charitable Trusts. The State of immigrants in Philadelphia (2019) Accessed February 2, 2024. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.pewtrusts.org/-/media/assets/2019/04/philadelphia_state_of_immigrants.pdf\u003c/span\u003e\u003cspan address=\"https://www.pewtrusts.org/-/media/assets/2019/04/philadelphia_state_of_immigrants.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCity of Philadelphia Department of Public Health. Health of the city report (2021) Accessed February 2, 2024. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.phila.gov/media/20220718132807/HealthOfTheCity-2021.pdf\u003c/span\u003e\u003cspan address=\"https://www.phila.gov/media/20220718132807/HealthOfTheCity-2021.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePennsylvania Department of Health. EDDIE: Enterprise Data Dissemination Informatics Exchange. Accessed February 2 (2024) \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.phaim1.health.pa.gov/EDD/WebForms/CancerCntySt.aspx\u003c/span\u003e\u003cspan address=\"https://www.phaim1.health.pa.gov/EDD/WebForms/CancerCntySt.aspx\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDrexel University Urban Health Collaborative. Cancer in Philadelphia neighborhoods. Accessed February 2 (2024) \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://drexel.edu/uhc/research/projects/community-impact-reducing-cancer/Cancer%20in%20Philadelphia%20Neighborhoods/\u003c/span\u003e\u003cspan address=\"https://drexel.edu/uhc/research/projects/community-impact-reducing-cancer/Cancer%20in%20Philadelphia%20Neighborhoods/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDrexel University Urban Health Collaborative. The state of cancer in Philadelphia. Accessed February 2 (2024) \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://drexel.edu/~/media/Files/uhc/Cancer%20Philadelphia/Cancer%20Report.ashx?la=en\u003c/span\u003e\u003cspan address=\"https://drexel.edu/~/media/Files/uhc/Cancer%20Philadelphia/Cancer%20Report.ashx?la=en\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePaskett ED, Hiatt RA (2018) Catchment Areas and Community Outreach and Engagement: The New Mandate for NCI-Designated Cancer Centers. Cancer Epidemiol Biomarkers Prev 27(5):517\u0026ndash;519\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHiatt RA, Sibley A, Fejerman L, Glantz S, Nguyen T, Pasick R et al (2018) The San Francisco Cancer Initiative: A Community effort to reduce the population burden of cancer. Health Aff (Millwood) 37(1):54\u0026ndash;61\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSimon MA, Fitzgibbon M, Ciecierski C, Cooper JM, Martinez E, Tom L et al (2019) Building cross-institutional collaborative infrastructure and processes: Early lessons from the Chicago Cancer Health Equity Collaborative. Prog Community Health Partnersh 13(5):5\u0026ndash;13\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBarta JA, Erkmen CP, Shusted CS, Myers RE, Saia C, Cohen S (2023) The Philadelphia Lung Cancer Learning Community: a multi-health-system, citywide approach to lung cancer screening. JNCI Cancer Spectr 7(5):pkad071\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLeader AE, McNair C, Yurick C, Huesser M, Schade E, Stimmel EE et al (2022) Assessing the coverage of US cancer center primary catchment areas. Cancer Epidemiol Biomarkers Prev 31(5):955\u0026ndash;964\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePeterson EB, Ostroff JS, DuHamel KN, DAgostino T, Hernandez M, Canzona M et al (2016) Impact of provider-patient communication on cancer screening adherence: A systematic review. Prev Med 93:96\u0026ndash;105\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHult A, Lundgren E, Fr\u0026ouml;jd C, Lindam A, Jangland E (2023) Patient complaints about communication in cancer care settings: Hidden between the lines. Patient Educ Couns 114:107838\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePalmer Kelly E, McGee J, Obeng-Gyasi S, Herbert C, Azap R, Abbas A et al (2021) Marginalized patient identities and the patient-physician relationship in the cancer care context: a systematic scoping review. Support Care Cancer 29(12):7195\u0026ndash;7207\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDiamond L, Izquierdo K, Canfield D, Matsoukas K, Gany F (2019) A systematic review of the impact of patient-physician non-English language concordance on quality of care and outcomes. J Gen Intern Med 34(8):1591\u0026ndash;1606\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHaverfield MC, Tierney A, Schwartz R et al (2020) Can patient-provider interpersonal interventions achieve the quadruple aim of healthcare? A Systematic Review. J Gen Intern Med 35(7):2107\u0026ndash;2117\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGilligan T, Coyle N, Frankel RM et al (2017) Patient-Clinician Communication: American Society of Clinical Oncology Consensus Guideline. J Clin Oncol 35(31):3618\u0026ndash;3632\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang T, Molassiotis A, Chung BPM, Tan JY (2018) Unmet care needs of advanced cancer patients and their informal caregivers: a systematic review. BMC Palliat Care 17(1):96\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWolyniec K, Sharp J, Lazarakis S, Mileshkin L, Schofield P (2020) Understanding and information needs of cancer patients regarding treatment-focused genomic testing: A systematic review. Psychooncology 29(4):632\u0026ndash;638\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFerraris G, Monzani D, Coppini V, Conti L, Pizzoli S, Grasso R et al (2023) Barriers to and facilitators of online health information-seeking behaviours among cancer patients: A systematic review. Digit Health 9:20552076231210663\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGrimes DR (2022) The struggle against cancer misinformation. Cancer Discov 12(1):26\u0026ndash;30\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNational Cancer Institute. Health Information National Trends Survey 6 (2022) Accessed February 2, 2024. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://hints.cancer.gov/view-questions/all-hints-questions.aspx\u003c/span\u003e\u003cspan address=\"https://hints.cancer.gov/view-questions/all-hints-questions.aspx\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHousten AJ, Gunn CM, Paasche-Orlow MK, Basen-Engquist KM (2021) Health literacy interventions in cancer: a systematic review. J Cancer Educ 36(2):240\u0026ndash;252\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChan RJ, Milch VE, Crawford-Williams F et al (2023) Patient navigation across the cancer care continuum: An overview of systematic reviews and emerging literature. CA Cancer J Clin 73(6):565\u0026ndash;589\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMosquera I, Todd A, Balaj M et al (2023) Components and effectiveness of patient navigation programmes to increase participation to breast, cervical and colorectal cancer screening: A systematic review. Cancer Med 12(13):14584\u0026ndash;14611\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOkoli GN, Lam OLT, Reddy VK et al (2021) Interventions to improve early cancer diagnosis of symptomatic individuals: a scoping review. BMJ Open 11(11):e055488\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu D, Schuchard H, Burston B, Yamashita T, Albert S (2021) Interventions to Reduce Healthcare Disparities in Cancer Screening Among Minority Adults: a Systematic Review. J Racial Ethn Health Disparities 8(1):107\u0026ndash;126\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRoland KB, Milliken EL, Rohan EA et al (2017) Use of community health workers and patient navigators to improve cancer outcomes among patients served by Federally Qualified Health Centers: A Systematic literature review. Health Equity 1(1):61\u0026ndash;76\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOwoyemi O, Aakhus E (2021) Underrepresentation in oncology: Identifying and addressing structural barriers. Oncologist 26(8):630\u0026ndash;634\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDeville C Jr, Charles-Obi K, Santos PMG, Mattes MD, Hussaini SMQ (2023) Oncology physician workforce diversity: Rationale, trends, barriers, and solutions. Cancer J 29(6):301\u0026ndash;309\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEstape ES, Quarshie A, Segarra B et al (2018) Promoting diversity in the clinical and translational research workforce. J Natl Med Assoc 110(6):598\u0026ndash;605\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLocklear T, Lewis R, Calhoun F et al (2022) Advancing workforce diversity by leveraging the Clinical and Translational Science Awards (CTSA) program. J Clin Transl Sci 7(1):e30\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOyer RA, Hurley P, Boehmer L et al (2022) Increasing racial and ethnic diversity in cancer clinical trials: An American Society of Clinical Oncology and Association of Community Cancer Centers Joint Research Statement. J Clin Oncol 40(19):2163\u0026ndash;2171\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWinkfield KM, Regnante JM, Miller-Sonet E, Gonz\u0026aacute;lez ET, Freund KM, Doykos PM (2021) Development of an actionable framework to address cancer care disparities in medically underserved populations in the United States: Expert roundtable recommendations. JCO Oncol Pract 17(3):e278\u0026ndash;e293\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"cancer-causes-and-control","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"caco","sideBox":"Learn more about [Cancer Causes \u0026 Control](https://www.springer.com/journal/10552)","snPcode":"10552","submissionUrl":"https://submission.nature.com/new-submission/10552/3","title":"Cancer Causes \u0026 Control","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"cancer disparities, stakeholder coalition, cancer research, community-engaged research","lastPublishedDoi":"10.21203/rs.3.rs-4009521/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4009521/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction: \u003c/strong\u003eIn response to high levels of cancer disparities in Philadelphia, PA, three NCI-designated clincal cancer centers formed Philadelphia Communities Conquering Cancer (PC3) to bring stakeholders together and establish infrastructure for future cancer reducing initiatives. The PC3 coalition aimed to develop a prioritized cancer disparities research agenda in order to align cancer center resources and research interests with the concerns of the community about cancer, and to ensure that initiatives were patient- and community-centered.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e Agenda development activities culminated in a city-wide cancer disparities conference. The conference, attended by 55 diverse stakeholders, was the venue for small group discussion sessions about cancer concerns related to prevention, early detection, treatment, survivorship and quality of life. Sessions were guided by a moderator guide and were audiorecorded, transcribed, and analyzed by the PC3 leadership team. Results were reviewed and consensus was achieved with the help of PC3’s Stakeholder Advisory Committee.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eStakeholders identified four thematic areas as top priorities for cancer disparities research and action in Philadelphia: \u003cem\u003ecommunication\u003c/em\u003e between patients, providers, and caregivers; \u003cem\u003eeducation\u003c/em\u003e that reaches patients and community members with tailored and targeted information; \u003cem\u003enavigation\u003c/em\u003e that assists people in finding and accessing the right cancer screening or treatment option for them; and \u003cem\u003erepresentation\u003c/em\u003e that diversifies the workforce in clinics, cancer centers, and research offices.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eA community-informed, prioritized research agenda provides a road map for the three cancer centers to collaborate on future initiatives that are important to patients and stakeholders, to ultimately reduce the burden of cancer for all Philadelphians.\u003c/p\u003e","manuscriptTitle":"Developing a city-wide, community-engaged cancer disparities research agenda","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-05 11:10:54","doi":"10.21203/rs.3.rs-4009521/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-08-23T20:30:33+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-08-15T23:53:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"182899715336570900682338511230612114479","date":"2024-08-05T11:20:28+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-15T21:13:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"138956869006114974620425019668046509211","date":"2024-05-11T18:41:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"027c85b9-b980-4035-9df8-594d61020d1b","date":"2024-04-14T12:12:49+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-03-11T20:54:21+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-03-04T06:30:46+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-03-04T06:30:45+00:00","index":"","fulltext":""},{"type":"submitted","content":"Cancer Causes \u0026 Control","date":"2024-03-03T18:58:38+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"cancer-causes-and-control","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"caco","sideBox":"Learn more about [Cancer Causes \u0026 Control](https://www.springer.com/journal/10552)","snPcode":"10552","submissionUrl":"https://submission.nature.com/new-submission/10552/3","title":"Cancer Causes \u0026 Control","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"4dc65153-a407-4094-9b1b-51adeeffcb5f","owner":[],"postedDate":"March 5th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-09-30T16:06:14+00:00","versionOfRecord":{"articleIdentity":"rs-4009521","link":"https://doi.org/10.1007/s10552-024-01919-8","journal":{"identity":"cancer-causes-and-control","isVorOnly":false,"title":"Cancer Causes \u0026 Control"},"publishedOn":"2024-09-28 15:57:57","publishedOnDateReadable":"September 28th, 2024"},"versionCreatedAt":"2024-03-05 11:10:54","video":"","vorDoi":"10.1007/s10552-024-01919-8","vorDoiUrl":"https://doi.org/10.1007/s10552-024-01919-8","workflowStages":[]},"version":"v1","identity":"rs-4009521","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4009521","identity":"rs-4009521","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}