publication date: Oct. 9, 2020

First-ever TCL-AACI study of the leadership pipeline points to urgent need for more diversity at elite cancer centers

By Matthew Bin Han Ong and Katie Goldberg

How diverse are the upper rungs of leadership at America’s academic cancer centers?

Are these institutions promoting women and underrepresented minorities into top leadership positions? How prevalent are diversity recruitment programs? Do they work?

Data on cancer center directors is more or less available, but a tally of deputy and associate directors didn’t exist. To examine the leadership pipeline, The Cancer Letter, in collaboration with the Association of American Cancer Institutes, conducted a survey focused on diversity and recruitment.

“To our knowledge, the AACI/The Cancer Letter survey is the first analysis of cancer center leadership diversity, and we hope it will provide a benchmark to compare progress toward goals for individual centers, and serve as the basis for meaningful dialogue,” AACI President Roy Jensen and AACI Vice President and President-Elect Karen Knudsen write in an editorial in this issue of The Cancer Letter.

“As cancer center leaders, we have a responsibility to tackle these issues on behalf of our patients who are most affected by cancer health disparities,” write Jensen and Knudsen, directors of, respectively, The University of Kansas Cancer Center and the Sidney Kimmel Cancer Center at Jefferson. “A core issue in confronting cancer disparities is our leadership pipeline and the need to attract and retain underrepresented minorities in oncology care and cancer research.

“Results from a leadership diversity survey, co-created by the AACI and conducted in partnership with The Cancer Letter, show that there’s a long road ahead.”

The editorial by Jensen and Knudsen appears here.

Here are the highlights from the survey:

  • In the sample, two in nine cancer center directors are non-white, and two in 13 cancer center directors are women.

  • One in four deputy and associate directors are non-white, and two in five deputy and associate directors are women.

  • Cancer centers led by women directors have the highest level of diversity in leadership, compared to other groups. Paradoxically, women directors are the most likely to report that their institutions’ diversity recruitment programs are “ineffective.”

  • The leadership pipeline at centers led by white men is the least diverse. Nonetheless, white men directors are nearly as likely as non-white directors to assess their institutions’ diversity recruitment efforts as “successful.”

  • NCORP Minority/Underserved Community Sites have the highest levels of diversity in leadership. One in five of all Black and three in 10 of all Hispanic/Latino deputy and associate directors work at these centers. Half of these centers are led by non-white directors.

The Cancer Letter curated a 20-question survey, with the goal of documenting representation of women as well as racial and ethnic minorities at the director, and deputy and associate director levels. The survey was then administered electronically by AACI.

Between June and August 2020, directors of 78 cancer centers responded to the survey, which asked them to:

  • Provide information on their gender and racial or ethnic identities,

  • Provide the same demographic data on their deputy and associate directors,

  • Rate their institutions’ diversity recruitment efforts, and

  • Assess the state of diversity in the oncology workforce.

Directors of 61 NCI-designated cancer centers—out of 71—responded. The 78 cancer centers in this sample, including one Canadian institution, represent 606 deputy and associate directors.

The data obtained is largely representative of academic oncology in the United States. The results are blinded.

The survey data is benchmarked against population-level data (section J).

“If we’re not diverse enough, we will lose the opportunity to learn something from the differences among us,” Rohit Bhargava, director, Cancer Center at Illinois at the University of Illinois Urbana-Champaign, said to The Cancer Letter. “It may not come out from the commonalities among us, and those differences might hold the key to actually developing new approaches for everyone.”

“Diversity, inclusion, and equity are essential in leadership and in the conduct of science. Our patients want ‘people who look like me,’” Cheryl L. Willman, director and CEO of the University of New Mexico Comprehensive Cancer Center, said to The Cancer Letter. “The conduct of cancer science is full of often ‘well-meaning,’ but unconscious and conscious bias.”

“It is now for the readers to decide what should be done with this information, and this will likely and appropriately include a call to increase female and minority leadership positions in cancer centers,” David A. Tuveson, president-elect of the American Association for Cancer Research and director of Cold Spring Harbor Laboratory Cancer Center at Cold Spring Harbor Laboratory, said to The Cancer Letter.

Bhargava, Willman, and Tuveson are among nine cancer center directors who were asked to review the findings of the TCL-AACI survey. Their comments appear here.

To enable further discussion, a slideshow presenting the data published in this issue is made available for download here.

The study was not designed to establish statistical significance, cause-and-effect relationships, and correlations. Averages were used to assess all quantitative responses.

The following variables were not taken into consideration:

  • Duration of directorship, and director’s purview over recruitment,

  • Diversity of the population each institution serves,

  • Impact of location on diversity recruitment efforts,

  • Status of—or funding for—diversity recruitment programs, and

  • Job descriptions of deputy and associate directors.

The survey also does not accurately represent the percentage of women directors at NCI-designated cancer centers. All women directors are represented in the survey—the remaining 10 NCI-designated center directors who didn’t respond to the survey are men. Overall, women make up 12.7% of the directorship at the 71 centers.

The results provide context for the findings The Cancer Letter’s earlier survey that focused on gender bias and sexual harassment in academic oncology. That survey found that women who have experienced inequities or harassment do not report such incidents, because they do not trust their institutions.

One of the respondents to the gender bias survey made this suggestion: “Give the male leadership, specifically those over 65, training in ‘leaning out’—getting out of the way for the next generation of leaders.”

“Each search committee should have a specific charge to increase diversity of applicants, and to more carefully consider gender and race in candidate selection,” suggested another respondent.

That gender bias study, published in the Oct. 2 issue of The Cancer Letter, is available here.

The year 2020 has been, by any reckoning, traumatic for many racial and ethnic minorities in the United States.

SARS-CoV-2 decimated Black and brown households. The killing of George Floyd—and Breonna Taylor, and more—spurred one of the largest racial justice movements in U.S. history. In the midst of the COVID-19 pandemic, Asian Americans began taking defensive measures against widespread anti-Asian sentiment.

Throughout 2020, The Cancer Letter’s coverage focused on the interplay between the pandemic and systemic racism in American society (The Cancer Letter, Aug. 7, 2020).

Two reports, published by AACR in September, detail how science and health equity have always been inseparable: The first calls for legislative action to address the outsized toll that cancer exacts on racial and ethnic minorities and other underserved populations; the second describes the chilling impact of COVID-19 on cancer (The Cancer Letter, Sept. 25, Sept. 18, 2020).

The Cancer Letter’s analysis of the leadership pipeline survey data follows:

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A. Cancer center directors: Demographics, designation, education and specialty

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  • Fig. 2a: 2 in 9 cancer center directors are non-white.

  • Fig. 3a: 2 in 13 cancer center directors are women.

  • Fig. 2b:

    • The director cohort for NCI-designated cancer centers (n=61) is up to 15% less diverse, compared to cancer centers without NCI designation.

    • Cancer centers with NCORP Minority/Underserved Community Sites (n=11), regardless of NCI designation, are the most diverse in top-tier leadership, with 50% non-white directors.

  • Fig. 3b: All 9 women directors of NCI-designated cancer centers responded to this survey. The actual percentage of women directors of NCI-designated cancer centers is 12.7% (9 of 71). 10 out of the total of 71 NCI-designated centers did not respond to the survey.

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B. Racial/ethnic diversity in the leadership pipeline and distribution of non-white deputy and associate directors across institutions

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  • Fig. 7a: 1 in 4 deputy and associate directors in the survey sample are non-white.

  • Fig. 7b: 2 in 3 institutions (n=52) have 30% or fewer non-white deputy and associate directors. 2 in 5 (n=31) have 20% or fewer.

 


C. Gender parity in the leadership pipeline and distribution of women deputy and associate directors across institutions

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  • Fig. 8a: 2 in 5 deputy and associate directors in the survey sample are women.

  • Fig. 8b: Half of institutions (n=38) have 40% or fewer women deputy and associate directors. There are no institutions with over 90% women deputy and associate directors. One-third of institutions (n=26) have 41-50% women deputy and associate directors.

 


D. Proportions of racial/ethnic minorities and gender relative to NCI designation

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  • Fig. 9: Cancer centers with NCORP Minority/Underserved Community Sites (n=11), regardless of NCI designation, have the most diverse cohort of deputy and associate directors (~32%, ~8% non-white vs. average), notably with greater representation of Blacks and Hispanics/Latinos.

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  • Fig. 10: As a group, cancer centers with NCORP Minority/Underserved Community Sites have about 10% fewer women deputy and associate directors.

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  • Fig. 11:

    • 14.1% of all cancer centers surveyed are also NCORP Minority/Underserved Community Sites. The proportion of Black and Hispanic/Latino deputy and associate directors are notably greater than 14.1% at these centers.

    • 1 in 5 of all Black and about 3 in 10 of all Hispanic/Latino deputy and associate directors work at cancer centers with NCORP Minority/Underserved Community Sites.

 


E. Proportions of racial/ethnic minorities and gender relative to directorship

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Fig. 12:

  • Women directors (n=12): Institutions led by women have greater proportions of Black (1.8% difference), Hispanic/Latino (4.5% difference), and Asian (3.9% difference) deputy and associate directors, compared to institutions led by directors who are men (n=66), regardless of race.

  • Non-white directors (n=18): Institutions led by non-white directors have greater proportions of Hispanic/Latino (4.9% difference) and Asian (4.5% difference) deputy and associate directors, compared to institutions led by white directors (n=60), regardless of gender. However, institutions led by non-white directors have the lowest proportion of Black deputy and associate directors—by about half compared to other groups, and by more than half compared to institutions led by women.

  • White men directors (n=50): As a group, institutions led by white men have the largest majority of white deputy and associate directors, at 79.9%. By comparison, institutions led by non-white or women directors are up to 10% more diverse—Hispanics/Latinos and Asians make up most of that difference, with no meaningful change in the proportion of Black deputy and associate directors

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Fig. 13:

  • Women: The proportion of women in deputy and associate director positions in the survey sample is consistent—at about 40%—regardless of the gender or racial identity of the director. There is little variation to this proportion, regardless of the NCI designation of the center or of directors’ reported success in diversity recruiting. In contrast, only 15.4% of directors in the sample are women.

 


F. Self-reported measures of success in diversity recruitment programs:

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Fig. 14:

  • Successful (n=10): Institutions with directors who reported that their diversity recruitment programs were successful do not have a much larger proportion of non-white deputy and associate directors (1.17% difference) compared to institutions directors who reported that their programs were moderately successful. Of note, however, is the fact that these institutions, as a group, have equal proportions of Asian, Black, and Hispanic/Latino deputy and associate directors (7.35%, respectively).

  • Moderately successful (n=48): Institutions in this group have proportionally fewer Hispanic/Latino (2.95% difference) and Black (1.39% difference) deputy and associate directors compared to the Successful group, but a notably larger proportion of Asian (4.83% difference) deputy and associate directors.

  • Ineffective (n=17): Institutions in this group have proportionally fewer Hispanic/Latino (up to 3.59% difference) and Black (up to 2.84% difference) deputy and associate directors compared to the Successful and Moderately Successful groups. The proportion of Asian/Asian Americans deputy and associate directors are comparable (1.65% difference) to the Moderately Successful group.

  • No diversity recruitment (n=3): Although a minority, institutions without diversity recruitment programs have the least diversity in their leadership pipeline, with about 10% non-white deputy and associate directors (2 in 19). These institutions have no deputy and associate directors who identify as Hispanic/Latino or Black. Two of these institutions are 100% white at the deputy and associate director levels.

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G. Self-reported success in recruitment by gender and race/ethnicity of directors, and by NCI designation

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Fig. 16:

  • Women directors (n=12): Women directors are the least likely of all groups to report that their institutions’ diversity recruitment programs are effective (8.3%). A greater proportion of men directors (n=66), regardless of race or ethnicity, reported that their diversity recruitment programs are “successful” (13.6%). Institutions led by women directors all reportedly have diversity recruitment efforts.

  • Non-white directors (n=18): A greater proportion of non-white directors reported that their recruitment programs are “successful” (16.7%), compared to other groups. An equal number of non-white directors rated their recruitment programs as “ineffective”. In the cohort of white directors (n=60), 11.7% rated their recruitment programs as successful, 61.7% as moderately successful, and 23.3% as ineffective.

  • White men (n=50): The proportion of white men directors who reported that their diversity recruitment programs are “successful” is comparable to the same for non-white directors (2.7% difference). As a group, white men directors are nearly twice as likely to report that their diversity recruitment programs are “successful” (14%), compared to women directors (8.3%).

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Fig. 17:

  • As a group, NCI-designated cancer centers are the least likely to assess their diversity recruitment efforts to be “successful.” Two in 3 of these centers report “moderate success.” On the other hand, all cancer centers that acknowledged a lack of diversity recruitment efforts are also NCI-designated. No centers in this group rated their diversity recruitment efforts as “ineffective.”

  • As a group, cancer centers without an NCI designation are most likely to assess their diversity recruitment efforts as “successful” (1 in 3). Half of these centers report moderate success. On the other hand, all cancer centers that rated their diversity recruitment efforts as “ineffective” do not have NCI designation.

  • Cancer centers with NCORP Minority/Underserved Community Sites, regardless of NCI designation, are the most likely to assess their diversity recruitment efforts to be “moderately successful” (3 in 4), with 1 in 4 rating their efforts as “successful.”

 


H. Assessing diversity in the oncology workforce at North American cancer centers

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Fig. 18:

  • Women directors (n=12): Women directors in the survey sample rated the diversity of the oncology workforce lower than other groups.

  • Non-white directors (n=18): Non-white directors rated the diversity of the oncology workforce highest out of all groups. On all other measures, their responses track closely to the averages for women directors.

  • White men directors (n=50): As a group, white men directors rated the importance of diversity in the oncology workforce lower than other groups. These directors also report that it’s harder for them to recruit a diverse workforce, and rated their institutions as less supportive, compared to institutions led by women and non-white directors.

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Fig. 19:

  • Successful (n=10): Directors who reported that their diversity recruitment programs were successful rated the diversity of the oncology workforce higher than other groups, and unequivocally say that it’s important to cultivate a diverse workforce. Compared to other groups, these directors also report that it’s easier to recruit a diverse workforce, and that their institutions are supportive.

  • Moderately successful (n=48): As the largest cohort, the responses from directors in this cohort track closely to the average numbers.

  • Ineffective (n=17): Directors who reported that their diversity recruitment programs were ineffective rated the diversity of the oncology workforce lower than other groups, and rank below average in their rating of the importance of cultivating a diverse workforce. These directors also report higher than average difficulty in recruiting a diverse workforce, and below-average support from their institutions.

  • No diversity recruitment (n=3): Although a minority, directors at institutions without diversity recruitment programs rank above average in their rating of the diversity of the oncology workforce, falling only behind directors who report success. These directors rank lowest in their rating of the importance of cultivating a diverse workforce. They also report the most difficulty in recruiting a diverse workforce, and least support from their institutions.

 


I. Summary of observations:

  1. For some groups, self-reported measures of success in recruiting diverse deputy and associate directors do not necessarily represent the actual diversity of physicians, administrators, or researchers in the leadership pipeline.

Although white men directors are nearly as likely as non-white directors to report that their diversity recruitment programs are “successful,” institutions led by white men are the least diverse (deputy and associate directors) compared to institutions led by women directors and non-white directors.

Although women directors are most likely to report that their institutions’ diversity recruitment programs are “ineffective” compared to other groups, their leadership pipelines (deputy and associate directors) are the most diverse.

  1. Cancer centers with diversity recruitment efforts appear to have a more diverse leadership pipeline compared to institutions that don’t have these efforts.

There is notably greater diversity among deputy and associate directors at cancer centers with directors who report that their institutions’ diversity recruitment programs are “successful” or “moderately successful,” compared to directors who report that their institutions’ diversity recruitment programs are “ineffective” or non-existent (6% – 16% difference).

  1. Cancer centers with NCORP Minority/Underserved Community Sites are the most diverse, regardless of NCI designation.

NCI-designated cancer centers are up to 15% less diverse in directorship, compared to centers without NCI designation. Centers with NCORP Minority/Underserved Community Sites, regardless of NCI designation, are the most diverse, with 50% non-white directors—and with about 32% (~ 8% above average) non-white deputy and associate directors.

One in 5 of all Black and 3 in 10 of all Hispanic/Latino deputy and associate directors work at these centers with NCORP MU sites.

 

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Alexandria Carolan contributed to this story.

Copyright (c) 2020 The Cancer Letter Inc.