publication date: Oct. 9, 2020
A long road ahead but every reason to travel with purpose
Roy A. Jensen, MD
President, Association of American Cancer Institutes;
Director, The University of Kansas Cancer Center and Kansas Masonic Cancer Research Institute;
William R. Jewell Distinguished Kansas Masonic Professor;
Professor of pathology and laboratory medicine, anatomy and
cell biology, cancer biology and molecular biosciences
Karen E. Knudsen, MBA, PhD
Vice president/president-elect, Association of American Cancer Institutes;
Executive vice president of oncology services, Jefferson Health;
Enterprise director, Sidney Kimmel Cancer Center;
Hillary Koprowski Professor and Chair,
Department of Cancer Biology, Thomas Jefferson University
Diversity, inclusion, and equity are important issues, not only to our nation’s cancer centers, but to our nation as a whole. To embody these values, we must work to close gaps in cancer research and care.
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: patients who experience higher rates of cancer cases and deaths, compared to the general population, lower screening rates, and complications specific to certain racial, ethnic, and other groups.
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 Association of American Cancer Institutes (AACI) and conducted in partnership with The Cancer Letter, show that there’s a long road ahead.
Seventy-eight directors at AACI cancer centers responded, 61 of them from NCI-designated centers. One director identified as Black and 17 identified as either Hispanic, Latino, or Spanish; Middle Eastern or North African; Asian/Asian American; Pacific Islander; or multiracial.
Gender identity among directors also skews heavily toward men, with 66 respondents identifying as men and 12 directors identifying as women. These data alone underscore opportunities to expand diversity in cancer center director leadership at the highest level.
Below directors, at the deputy or associate director level, Black and/or African American representation increases slightly, from 1.2% to 5.6%. An improvement is also seen in Asian and/or Asian American representation, but there’s a troubling decline in Hispanic and/or Latino representation. Notably, there’s a significant improvement for women—who represent only 15.4% of directors but 40.1% of deputy and associate directors.
These data reveal interesting trends, which suggest that distinct challenges exist among underrepresented racial/ethnic and gender groups. These challenges are worth understanding as we explore how to meet goals for enhanced diversity and inclusion in cancer center leadership.
Awareness about diversity and inclusion strategies and effectiveness is emergent. When asked to evaluate our diversity programs and compare ourselves to other centers, cancer center leaders reported believing that we are diverse and that our diversity programs are somewhat effective, but the data show otherwise. For example, 70% of the directors who described their diversity recruitment programs as successful are white.
The key to moving the needle on diversity in cancer center leadership is to bring individuals from underrepresented groups into the field from the beginning.
This is especially true when it comes to Black and/or African American individuals entering and moving through the leadership pipeline. They are underrepresented at every step of the academic pipeline and the decline at the more senior levels of leadership is striking.
Workforce disparities are also seen among health researchers, few of whom identify as non-white, which can have a chilling effect on research into health equity, according to Cancer Disparities and Health Equity: A Policy Statement From the American Society of Clinical Oncology.
The lack of movement to the top rung of leadership is reflected in women’s trajectory as well. We see women enter the oncology care and discovery workforce in numbers close to parity, but most do not seek—or are not selected for—leadership roles.
As the majority of leading cancer centers are taking aim at eliminating cancer disparities, we appreciate that addressing the cancer-related needs of the communities we serve is greatly enabled through diversification of the oncology workforce. It follows that assessing diversity in our own leadership teams should be part of the solution, and that tackling disparities begins with our own home institutions.
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.
It is notable that enhancing diversity and inclusion is not only the right thing to do but has been shown to provide significant enhancement of business performance across a wide breadth of industries.
For example, in a recent report from McKinsey & Company, companies that scored in the top-quartile for gender diversity on executive teams proved to be 21% more likely to outperform using profitability as an endpoint, and 27% more likely to produce superior value creation.
Numbers are even more encouraging for ethnic and cultural diversity, with top quartile companies reporting 33% enhanced performance metrics. Conversely, companies in the bottom quartile for gender and ethnic/racial diversity were associated were 29% less likely to achieve greater than average performance metrics.
There is abundant data to suggest that increasing diversity in cancer center leadership has the capacity to enhance progress toward cancer, by positively impacting the patients we serve, generating scientific output, increasing engagement and retention of the oncology workforce, and indeed, the financial health of our own institutions.
As the leaders of the major 102 cancer centers in North America, we have an opportunity to lead in change. To be effective, cancer centers and their parent institutions need to make a commitment to durable, actionable change that can be measured with clear metrics. Mission statements are meaningless without concrete action.
AACI Presidential Initiative
Distinct from addressing challenges in the oncology biomedical workforce, the 2020-22 Presidential Initiative will leverage the expertise of North America’s 102 leading cancer institutes to understand and mitigate cancer health disparities, using a number of vehicles.
In the first phase—increasing awareness and understanding—AACI plans to engage leadership across each center to:
Coalesce knowledge and understand priority disparities identified in each of the major cancers, and
Identify geographic areas not yet been studied.
A separate thread of the first phase will develop podcasts with cancer center leaders and key stakeholders, such as community representatives and elected officials, with the aim of uncovering currently implemented mitigation strategies, best practices, and opportunities for improvement.
It is our hope that the podcast will help cancer center thought leaders drill down on what they would like to achieve and understand how their peer institutions are addressing disparities. It also presents an opportunity for cancer centers to collaboratively develop best practices and advocate for changes in public policy to reflect them.
Phase two will convert what we learn into action. During a session at the 2021 AACI annual meeting, we hope to review the knowledge we’ve gained and initiate action plans for advocacy and accelerating progress to mitigate cancer disparities.
Reflecting on 50 years of progress—and planning for the next 50 years
Throughout 2021, NCI and cancer centers throughout the United States will be commemorating the 50th anniversary of the National Cancer Act, which established the NCI and the nation’s standard-setting network of cancer centers.
Over the past 50 years, we have seen major developments in scientific discovery, cancer care, and quality of life for people with cancer. But until everyone has equal access to cancer treatment—and cures—there is still much work to do.
If not the 102 leading cancer centers, then who?
AACI cancer centers are well-positioned to work together to play a major part in reducing cancer disparities across North America, and beyond.