At a time of intensifying national polarization over critical race theory and affirmative action, leaders of cancer centers are faced with two challenges that appear to be diametrically at odds with each other:
- Avoid running afoul of the law as it pertains to the June 29 Supreme Court ruling that reverses 45 years of legal precedent in race-conscious admissions (The Cancer Letter, June 30, 2023), and
- Fulfill their institutional commitment to building a diverse, world-class faculty and staff that meets NCI’s requirements for cancer centers to develop a Plan to Enhance Diversity (PED) as a component of the core grant review process (The Cancer Letter, Dec. 3, 2021).
These two goals are indeed mutually exclusive—at least where the law is concerned, said David Acosta, chief diversity and inclusion officer at the Association of American Medical Colleges.
“Remember that the [Supreme Court] decision itself did not aim at restrictions at outreach, recruitment pathway programs, retention and support services, or scholarships,” Acosta said Oct. 1 at the annual meeting of the Association of American Cancer Institutes in Washington, DC. “Because you’re all involved in recruitment, the best candidates that you can have, it’s important.
“This does not include residents, postdocs, and fellows and faculty. They’re under a whole different law—they’re under Title VII [of the Civil Rights Act], because they’re considered employees.
“And so, the SCOTUS decision, again, was really aimed at undergraduate admissions, and the professional schools as well. So, let’s not overinterpret.”
What are academic cancer centers to do?
They need to track demographic and work culture data for their faculty as well as develop measurable endpoints for assessing the impact of their programs on health equity, NIH, NCI, AAMC, and DEI experts agree.
For example, researchers can rely on evidence-based approaches that have been shown to reduce or eliminate health disparities to build meaningful metrics for tracking clinical outcomes in certain populations.
Making a solemn vow to develop DEI policies is not enough.
Under NCI’s Cancer Center Support Grant rules, cancer center directors have to demonstrate to reviewers that they have actual, realistic plans to improve diversity, equity, and inclusion, said Henry Ciolino, director of NCI’s Office of Cancer Centers.
“It’s too late to say you’re planning to do things. You need to be there already, to be able to show something,” Ciolino said at the meeting. “You need to show baseline data, because reviewers quite rightly think if you don’t know where you are, you don’t know how you’re going to get to the next step.
NCI reviewers will be looking for data that robustly describes each cancer center’s workforce and the institution’s strategy to meet the requirements of the Plan to Enhance Diversity, NCI’s Ciolino said.
“You need benchmarks; logic models are being incorporated into the reviews,” Ciolino said. “Surveys are not only what your workforce looks like, but their attitudes towards diversity.”
What cancer center directors can do is go through the ‘groan zone’—I think that’s a healthy thing to do—understand what are the issues, what are the challenges in your head, what are the things you want answers to.
David Acosta
Example: cancer centers should design program evaluation plans to document progress in recruitment or allocation of funds to community engagement programs, said Kevin Williams, director of the Office of Equity Diversity and Inclusion at NIH.
“Make sure that you tie whatever it is that you’re doing in this space to measurable goals,” Williams said at the AACI meeting. “And I think it’s staring each of us in the face. You’re trying to do health equity in this space, and who wouldn’t want Americans to be healthy?
“So, I think it’s a huge opportunity, and you all should lean into it. And I would focus on having measurable goals with specific endpoints.”
To navigate the aftermath of the Supreme Court ruling on affirmative action, cancer center directors can make use of the guidance documents and FAQs from the U.S. Department of Justice, the U.S. Department of Education, AAMC, and The Chronicle of Higher Education’s DEI Legislation Tracker to inform their institutional policies.
“I think what cancer center directors can do is go through the ‘groan zone’—I think that’s a healthy thing to do—understand what are the issues, what are the challenges in your head, what are the things you want answers to,” AAMC’s Acosta said.
The leaders of cancer centers have to explain (and explain again) that efforts to recruit a diverse workforce provide tangible payoffs.
For starters, people are more likely to trust in a healthcare system that employs people who look and speak like them. Minority researchers, too, are more likely to come up with research questions and design studies that are informed by the needs of people who share their background and culture.
“We could do a much better job in being able to show the legislators and the policymakers that having a diverse force makes a stark difference with regards to the vulnerable populations, morbidity, mortality, their life expectancy, their use of more preventative services to diagnose cancers,” Acosta said.
“How has these basically helped us to achieve health equity—really meaningful metrics—that I think are missing in our literature? We do have some literature around that.”
AVAILABILITY OF DEMOGRAPHIC DATA AT CANCER CENTERS
| Category | Available? | Source | Type of data available | ||||
| HR | Survey | Race | Disability | LGBTQIA+ | SES disadv | ||
| Faculty/members | 79% | 70% | 20% | 93% | 39% | 15% | 13% |
| Applicants to faculty searches | 42% | 75% | 25% | 83% | 43% | 4% | 4% |
| Faculty promotion & retention | 35% | 75% | 15% | 95% | 45% | 0% | 5% |
| Leadership | 81% | 50% | 37% | 96% | 39% | 20% | 17% |
| EAB | 38% | 0% | 62% | 95% | 14% | 14% | 5% |
| Trainees | 75% | 36% | 40% | 97% | 40% | 7% | 24% |
| Staff/workforce | 70% | 82% | 13% | 92% | 44% | – | 8% |
CHARACTERISTICS OF PED LEADERS AT PARTICIPATING CENTERS
| Category | PED Leaders | Cancer Center Leaders | Cancer Center Directors |
|---|---|---|---|
| Women | 68% | 36% | 14% |
| Race and ethnicity | |||
| Asian | 16% | 11% | 10% |
| Black | 46% | 4% | 5% |
| Hispanic | 26% | 4% | 7% |
| Non-Hispanic White | 20% | 82% | 76% |
| First Gen | 19% | ||
| Immigrant | 30% | ||
| LGBTQIA+ | 12% | ||
| Disability | 6% | ||
| Served in the military but not a protected veteran | 16% | ||
DEI Network recommendations
The Cancer Center DEI Network, a peer support consortium for administrative teams established in 2021, recommends that all cancer centers incorporate Plan to Enhance Diversity directors into the executive leadership teams.
“[At] most places, the PED leader is part of the executive leadership team, but in 12% of centers, that’s not the case. That should certainly be the case, we want to see that,” said Christopher Li, co-founder of the network, DEI associate director at the Fred Hutch/University of Washington Cancer Consortium, a professor in the Public Health Sciences Division, and Helen G. Edson Endowed Chair for Breast Cancer Research at Fred Hutch.
The Cancer Center DEI Network recently conducted a survey to identify challenges and best practices in implementing the PED. Of the 84 cancer centers invited to participate, 62 responded, including 81% of NCI-designated centers—corresponding to a survey response rate of 75%.
“Most people are reporting kind of a focus on the metrics and the data, looking at the demographics and how those are shifting, culture, climate metrics, demographics of people in their pathway programs,” Li said at the AACI meeting. “But perhaps somewhat concerning is that 26% say they have not yet defined what success looks like for their PED, which can be a limitation.
“This really needs to be something that’s not solely the responsibility of the PED leader, but is developed in concert with the leadership teams and that the executive leadership team really should be engaged and be held accountable for both the successes and the failures in the space,” Li said.
“This is work that can be resource-intensive. The PED leader needs sufficient salary support as well as staffing and other financial resources in order to be able to execute an effective PED program.”
Also critical to the success of PED programs are integration into the other aspects of the cancer center, particularly the Cancer Research Training and Education Coordination (CRTEC) and Community Outreach and Engagement (COE) programs, Li said.
“In terms of metrics, I think people are starting to collect what we call baseline demographic data, but there really is a need to go beyond just characterizing what that looks like and look at other metrics of climate culture, faculty satisfaction, promotion, retention,” Li said.
“And very few centers currently have this type of information as well as thinking about perhaps qualitative metrics as well—because especially in places where underrepresented groups comprise a very small percentage, relying on larger institution-wide data can hide some of the experiences that those individuals are having.”
The DEI Network recommends that cancer center External Advisory Boards include members who have expertise in building diverse workforces and engaging with populations that are underrepresented in the scientific workforce.
“I can say for myself, adding two members with this expertise to our EAB has been instrumental in improving the quality, I think, of our effort,” Li said. “The network has a list of a few dozen individuals who have volunteered and are interested in serving on EABs.
“So, if anyone is interested in identifying people to add, please reach out and we’re happy to share those names.”
Source for all tables/graphs: AACI
Strategies to enhance leadership diversity
Pathway Programs Specifically to Support URSWs
Strategies to Impact Climate/Culture
DEI Education, Employee Groups, and Implicit Bias Training
Does your center conduct culture/climate/ satisfaction surveys of its members/faculty?
How do you define progress of your PED efforts?
PED Leadership
PED Survey Preliminary Results
- 84% have an appointed PED leader
- 88% attend senior leadership meetings
- PED leader FTE: Highly variable (2-80% FTE)
41% have ≤10% FTE; 25% have ≥25% FTE - Support staff (FTE):
16% have 0 staff FTE
14% have ≥3.0 staff FTE (max: 5.0 FTE)
70% have ≥1.0 staff FTE - PED advisory boards: 72% have an IAB
19% also have an EAB
