Community Outreach, Engagement, and Equity

Novel Community Engagement/Research Effort in Head & Neck Cancer Launches

TheDuke University School of Medicine Department of Head and Neck Surgery & Communication Sciences (HNS&CS) recently launched Project CHECKERS (Community Head and NEck Cancer Knowledge, Engagement, Research and Screening) a Duke Cancer Institute-funded pilot project to bring head and neck cancer resources and education to the broader Durham community. Led by DCI head and neck surgeon Trinitia Cannon, MD, an associate professor in the Department, the project will be the Department’s first community-based participatory research project and the first such head and neck cancer screening and cancer prevention education project in North Carolina. Evolving Community Research The Project CHECKERS team will use a mixed methodology, which includes traditional surveys and screenings as well as interviews and focus groups. One of their community partners will be the Cedar Creek Apartment Complex community in North Raleigh. Many of these families are refugees — from at least seven different countries in Africa, Asia, and the Middle East — who speak Farsi, French, Swahili, Arabic, and other languages. They are building new lives in North Carolina, in a culture and language that is new to many of them. As is the case with many similar communities, their healthcare needs often go unmet. The investigators believe that, compared to traditional methods, mixed-method research is an improved way to establish a community partnership, highlight gaps in the community’s knowledge and risk perception, and pave the way for successful future health interventions. According to co-PI Nosayaba (Nosa) Osazuwa-Peters, BDS, MPH, PhD, an associate professor in the Department of Head and Neck Surgery & Communication Sciences, Project CHECKERS takes an important step in improving community engagement. “Traditional research is very systematic, very top-down. The researchers have knowledge and decide what they believe the community needs. But these outside scientific experts do not know the values, the culture, the knowledge, or the risks inherent in that community,” he explained. For example, traditional surveys restrict participants to answering either yes or no; for many people, that binary does not tell a complete story. “Project CHECKERS will help us understand the lived experiences of people in these communities,” added Osazuwa-Peters. “We’ll learn about context, and we’ll learn to ask questions that allow community members to express themselves. We’ll get responses we would never get based on yes or no.” Building a Partnership Project CHECKERS kicked off this fall with focus groups and interviews with community members facilitated by Laura Fish, PhD, MPH, assistant professor in Family Medicine and Community Health, Duke University School of Medicine, and program director for the Behavioral Health and Survey Research Core (a DCI shared resource). An advisory board will provide feedback from both clinical and community perspectives. Lessons learned from these conversations will help the team develop a knowledge and risk factor survey that will be administered during two head and neck cancer screening events with the community in 2024. The CHECKERS team will also recruit providers outside the department to participate in these events to address other health concerns in the community such as primary care, mental health, and women’s health. The long-term goal of Project CHECKERS is to show the benefits of tailoring head and neck cancer screening programs to the communities being served, and how that personalization can improve prevention, early detection, and overall survival in high-risk individuals who have limited access to care. Noted Osazuwa-Peters, “The mixed-methods framework helps us understand not just whether an intervention works, but how, why, and for whom.” Community Partners Another plus to mixed-methods research is its appeal to community partners who might otherwise be hesitant to work with researchers. “The design places a high value on the stories behind the numbers,” explained Cannon, “so these projects are especially attractive to community partners such as faith-based organizations, whose priority is improving practice and outcomes, more so than research and advancing knowledge.” Project CHECKERS will provide a valuable bridge between Duke and the North Raleigh International Baptist Church (NRIBC), which ministers to a large immigrant community. NRIBC’s Pastor, Patrick Warutere, invited Duke to participate in the church’s inaugural Health and Dignity for All Fair in Raleigh in 2022. Cannon and CHECKERS co-PI Leda Scearce,CCC-SLP, MM, MS, a Duke speech pathologist and director of Community Engagement for the Department of HNS&CS, recruited nurses, medical students, and resident volunteers to provide HNC screenings for the event. “We immediately felt a kinship with NRIBC’s Pastor Patrick Warutere and his leadership team,” shared Searce. “By the end of the day, we knew we wanted to continue to work together and set up a meeting the following week.” Duke HNS&CS and the NRIBC team worked closely to develop the research plan and ensure that the goals and expectations of each group were aligned and transparent. “That relationship with NRIBC has enabled us to incorporate the community’s perspectives into the development of Project CHECKERS,” said Scearce. “Our aim was to amplify the assets and expertise of the community members themselves.” Cannon anticipates that Project CHECKERS will become a framework for future projects. “We are looking forward to similar initiatives in hearing health for older adults, right-hemisphere stroke awareness, and more.”

DCI/NIH/DGHI-Funded Study Highlights Diversity Deficit in U.S. Surgical Leadership

A study initiated at Duke University School of Medicine lays bare significant racial and gender disparities in America’s surgical leadership. Of the 2,165 faculty members included across 154 departments, men overwhelmingly claimed the top spots in surgical leadership, making up 85.9% of department chairs, 68.4% of vice chairs, and a staggering 87% of division chiefs. What’s more a mere 8.9% of these leadership roles were filled by those from underrepresented racial or ethnic groups. While women made a modest showing as vice chairs at 31.6%, they remained underrepresented elsewhere. Many of these women and those from underrepresented racial or ethnic groups were clustered in roles linked to diversity and faculty development, which might not pave the way to top department positions. The study in JAMA Surgery — led by Oluwadamilola “Lola” M. Fayanju, MD — stands out because the research team of surgeons, trainees, and biostatisticians looked in detail at different leadership roles and the implications these disparities have for the pipeline to department chair. CONTINUE READING at the Duke University School of Medicine Newsroom

WATCH: Patierno, Worthy, to Participate in Meeting of President's Cancer Panel

On Tuesday, Oct. 17, DCI patient navigator and navigation manager Valarie Worthy, MSN, RN, and Deputy Director of DCI Steven Patierno, PhD, will participate in the first of a series of in-person meetings of the President’s Cancer Panel in New Orleans on "Opportunities for Enhancing Patient Navigation." The topic on that date is "Reducing Cancer Care Inequities: Leveraging Technology to Enhance Patient Navigation." The President’s Cancer Panel is a Federal Advisory Committee that monitors the activities of the National Cancer Program and reports to the President of the United States on barriers to progress in reducing the burden of cancer. The panel (Elizabeth Jaffee, Mitchel Berger, and Carol Brown) is convening key experts to discuss gaps and opportunities related to the use of technology to support cancer patient navigation. Information gathered during this meeting series will guide the development of the Panel’s report to the President. This all-day meeting — to be held from 8:00 AM to 5:00 PM — is open to the public and will be broadcast live. REGISTER

Worthy to Spearhead White House Cancer Moonshot Project Geared Toward Black Breast Cancer Patients

On September 13, the White House Cancer Moonshot program announced its support for and commitment to several new projects to "end cancer as we know it," including a new initiative led by TOUCH, the Black Breast Cancer Alliance, to bolster Black women’s breast cancer clinical trial participation by 2025 — with the goal of reaching 350,000 Black women and motivating 25,000 into trial portals. The White House also announced a connected program, TOUCH Care, the first program to provide a nurse navigator service to assist Black breast cancer patients in clinical trials. This will include developing culturally-agile recruiting materials, training trial staff, and coaching patients. TOUCH Care is being led by TOUCH co-founder and Duke Cancer Institute patient navigator and patient navigation manager Valarie Worthy, MSN, RN, and piloted with Genentech, which will add five breast cancer clinical trials annually. Worthy, a two-decade-plus breast cancer survivor, has been a nurse for more than 38 years and worked at Duke for the past 19 years. Her hometown is Ahoskie, in northeastern North Carolina. VIEW White House Fact Sheet VIEW Genentech Press Release

Akinyemiju, Garman, and Zani Receive Faculty Awards

Social and molecular cancer epidemiologist Tomi Akinyemiju, PhD, associate director ofthe Duke Cancer Institute Community Outreach, Engagement, and Equity (COEE) program, is one of four recipients of a 2023 Michelle P. Winn Inclusive Excellence Award from the Duke University School of Medicine. Akinyemiju is an associate professor in the Department of Population Health Sciences and associate research professor of Global Health, Duke Global Health Institute. She is also an instructor in the Duke Department of Obstetrics and Gynecology, Clinical Science Departments. The Michelle P. Winn Inclusive Excellence Award recognizes individuals who have made significant contributions to diversity and inclusion within the School of Medicine community. Nominees should exemplify excellence, innovation, and leadership in helping to create a more diverse and inclusive environment.

Cancer Takes its Toll on Woman, but Can’t Steal Her Joy for Life

Eleanor Scott Bell, 79, was born and raised in Lumberton, the capital of Robeson County in North Carolina. One of her earliest memories is of picking tobacco to supplement the family income. They were a family of nine with a large extended family — part of the Lumbee Tribeof NC, "People of the Dark Water." “My daddy was in construction. He did brickwork, but he let us work with the local farmers. I started when I was probably 9 years old standing up on a cinder block handing tobacco to my momma,” she said. Her first full-time job, once she turned 18, was at a local linen supply company. She began working for Temptation Hosiery Mills in Lumberton — maker of L’eggs pantyhose and other Hanes products — after it opened in 1974. Her sister Carolynworked at the large Converse factory in Lumberton, which had opened in a former B.F. Goodrich tire manufacturing facility in 1972 to makeChuck Taylor All-Star shoesand other sneaker styles. In 1970, Eleanor Scott married Travis Bell, also a member of the Lumbee community.In 1977, the couple moved out of their single trailer in a Lumberton mobile home park and bought land and a double-wide further north in St. Pauls — a “Small Town with a Big Heart” located closer to the Fort Bragg U.S. Army base where Travisworked as a barber. St. Pauls and Lumberton were part of the late 19th/early 20th-century textile boom that created mill communities across the Piedmont region of the state. The communities’ prosperity really took off in the 1940s when a big textile corporation purchased several area cotton mills. By 1953, North Carolina was a manufacturing powerhouse,leading the nation in hosiery production. Textiles (including hosiery, clothing, and footwear) were woven into the fabric of many lives in the region. But beginning in the mid-1980s and through the 1990s production shifted to Latin America, China, and Southeast Asia — leaving thousands of workers, including in the Lumberton area, jobless. As noted in theOur Statemagazine article“Heart & Soles,”“if you grew up in the Piedmont in the half-century prior to the mid-’90s, chances are good that someone in your family — your grandfather or grandmother, your mom or dad, your aunts or uncles, your siblings or cousins — worked in a hosiery mill.These days it’s common to find mentions of Temptation Hosiery (bought by the Sara Lee Corporation, then closed in 1994), Kaiser Roth Mills, Converse (whichclosed their Lumberton plant in 2001), and other prominent factories of that era inThe Robesoniannewspaper obituary pages. In 1980, at the age of 37,Eleanor Bell was forced to resign from Temptation for medical reasons. She had developed rheumatoid arthritis in her legs at around age 35 and stayed active — working and attending church on a regular basis — for as long as she could. But after undergoing surgery on her legs,her ankles then hips started “giving out.” She began using a walker, and one day fell and broke her knees. In 1999, she started using a wheelchair off and on to get around and in 2007, at age 64, became a full-time wheelchair user.Her churchprocured her a bed with a remote control that helps lift her up and out of the bed into her electric wheelchair each morning, which has allowed her to stay active.

DCI Launches Cancer Health Disparities and Equity Lecture Series

Duke Cancer Institute announced the launch of a new Cancer Health Disparities & Equity lecture series. The series is a collaboration between DCI’sDisparities SPORE(National Cancer Institute-designated Specialized Program of Research Excellence) and DCI’sCommunity Outreach, Engagement, and Equity (COEE) Program. It features distinguished speakers presenting innovative research and strategies that seek to reduce cancer health disparities and promote cancer health equity. The series’ inaugural event, held on March 28 via Zoom, featuredLourdes Baezconde-Garbanati, Ph.D., MPH,professor of Preventive Medicine, associate dean for Community Initiatives, associate director for Community Outreach and Engagement, Institute for Health Promotion & Disease Prevention, Keck School of Medicine, University of Southern California, and the Norris Comprehensive Cancer Center. Baezconde-Garbanati’s talk was titled “Addressing Cancer and Other Health Disparities via Edutainment and Engagement in Vulnerable Communities.”

COEE Hosts the Inaugural MaryAnn Black Distinguished Health Equity Lecture

The Duke Cancer Institute Community Outreach, Engagement, and Equity program (COEE) hosted the inaugural MaryAnn Black Distinguished Health Equity Lecture on Feb. 9, 2023, in honor of the lateMaryAnn Black, "for her extraordinary leadership, enduring impact, and powerful advocacy across the community." The event will be annual. Black was a career social worker in Durham, North Carolina, who served on the County Board of Commissioners, worked as the associate vice president of community relations at Duke University Health System, and served in the North Carolina House of Representatives. Black died of cancer in March 2020, but her legacy lives on in the thousands of lives touched by her work in the areas of healthcare and education.

Watts Named Associate Director of EDI at DCI

Duke Cancer Institute surgeon-scientist Tammara Lynn Watts, MD, PhD, has been named associate director of Equity, Diversity and Inclusion (EDI), DCI, effective July 1. In this new role, Watts, an associate professor in the Duke Department of Head and Neck Surgery & Communication Sciences, will be responsible for strategic oversight of EDI across DCI’s clinical and academic workforce. Watts will guide DCI on EDI best practices in recruitment, retention, and advancement, and lead us in expanding the pipeline of DCI clinicians, faculty, staff, and trainees from diverse backgrounds, including from groups that are under-represented in the national oncology workforce. She will partner with Disease Group administrative directors, faculty, clinicians, and staff leaders in the development and implementation of long- and short-term EDI strategic plans for DCI aligned with the core missions of the National Cancer Institute, Duke University, the School of Medicine, and DUHS. "Dr. Watts will promote and actively foster an equitable, diverse, and inclusive environment that encourages a culture of belonging across the entirety of DCI’s workforce," said Michael B. Kastan, MD, PhD, executive director of DCI. "Creating this new EDI role and naming Dr. Watts to this role is the next step forward in DCI’s mission to achieve cancer health equity." Duke Cancer Institute approaches cancer health equity from three separate, but related, vantage points. This includes, in addition to workforce EDI, DCI's Community Outreach, Engagement, and Equity (COEE) program and Office of Cancer Research Career Development (OCRCD). The COEE program, led by Tomi Akinyemiju, PhD, works toward the elimination of cancer health disparities in the community — with the goal that marginalized, underserved populations have equal access to DCI programs, services, and equitable outcomes. The OCRCD, led by Gerard Blobe, MD, PhD, has established an educational infrastructure for the training, mentoring, and professional development of DCI clinicians, staff, early-stage to mid-career investigators, and students (from high school through to postdocs), which prepares DCI's workforce to meet the needs of diverse populations in its catchment area. "Our vision for DCI’s workforce — a clinical and academic workforce that’s reflective of our catchment area — will complement COEE and OCRCD efforts within DCI’s health equity framework," explained deputy director of DCI Steven Patierno, PhD, who, for more than a decade has overseen programs that advance DCI’s mission to eliminate cancer disparities and achieve health equity in the community. Watts began her career as a surgeon-scientist in 2010 at the University of Texas Medical Branch at Galveston, where she remained until joining DCI and Duke in 2019. She takes care of patients with tumors in the head and neck, including oral cancers and skin cancers. Watts’ research interests include understanding the biology of racial disparities in head and neck cancers and investigations of how the tumor microenvironment contributes to treatment failures in patients with these cancers. She is co-leader of a Developmental Research Program Pilot Award focused on the genomics of racial disparities in head and neck cancer, as part of an NIH-funded Duke Cancer Health Disparities P20 SPORE grant project (2020-23) and NRG Oncology.

Advancing Cancer Care Equity for LGBTQ+ Individuals

Colorectal Conditions and the LGBTQ+ Community

The DCI Community Outreach, Engagement, and Equity program recently hosted a discussion on colorectal conditions that disproportionately affect the LGBTQ+ community — including colorectal cancer, perianal lesions and more.Billy Lan, MD Duke physicians Annapoorani Veerappan, MD (a specialist in general gastroenterology) and Billy Lan, MD (a colorectal surgeon who treats all diseases related to the colon, rectum and anus) discussed prevention and how LGBTQ+ identifying individuals can access medical support and resources for these conditions. The webinar was moderated by Shaun Jones, a second year MPH student in Applied Epidemiology at UNC Gillings School of Global Public Health and Adriana Parker, MPH, an evaluation research assistant with Abacus at the UNC Center for Health Equity Research. The COEE has planned a series of events to advance equity for the LGBTQIA+ community as it relates to cancer and other health disparities — as part of its ongoing "Conversations with the Community." This event was the second in the series. The first event — "Moving the Conversation Forward: LGBTQ+ Cancer Care Inclusion" — was held on April 5, 2022.

DCI and Mexican Consulate Raise Awareness about Women's Cancers

In October, the Duke Cancer Institute Office of Health Equity (DCI OHE) and the Mexican Consulate in Raleigh collaborated to bring awareness to breast, uterine, and cervical cancer detection and prevention through a webinar conducted in Spanish via Facebook LIVE. The event was part ofSemana Binacional de Salud 2021(Binational Health Week 2021), which was created by the Government of Mexico, through the Ministries of Health and Foreign Relations, to raise awareness and respond to the unique healthcare challenges of Mexicans and other Latinos living in the United States and Canada. The Oct. 26 community event included a pre-recorded presentation by DCI gynecologic oncologist Rafael Gonzalez, MD, and a live presentation by Nadia Aguilera-Funez, a certified patient navigator/health educator with OHE. The event was moderated byMónica ColinGutierrez, Consul for Community Affairs at the Consulate (pictured in the circle image above), and also included the participation ofMaría Sánchez, the Consulate's coordinator for La Ventanilla de Salud (VDS), a program of the Government of Mexico developed by the Department of Health and the Ministry of Foreign Affairs. Implemented through 50 Mexican consulates in the U.S. and local health organizations, the Ventanillas,according to the VDS website, "provide reliable information on health topics, counseling and referrals to available and accessiblehealthservices in local communities" and the program "was designed to improve the physical and mental health of Mexicans and their families living in the United States and to increase access to primary and preventive health insurance coverage and ensure culturally sensitive services in order to reduce the use of emergency services." This is the second women's health event that DCI OHE and the Mexican Consulate have partnered on in service to the community. On March 31, 2021,the two collaborated ona similar community-focused webinar(also in Spanish) onprevention and screening for breast and cervical cancer.