Community Outreach, Engagement, and Equity

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.

New Directions: DCI, UNC, & Wake Forest Partner with NC Indigenous Communities on Cancer Health

The community outreach and engagement teams from Duke Cancer Institute, Wake Forest Baptist Comprehensive Cancer Center and UNC Lineberger Comprehensive Cancer Center have launched a unique initiative that focuses on understanding and addressing the cancer-related health needs of American Indian communities in their catchment areas and beyond. Called the Southeastern American Indian Cancer Health Equity Partnership (SAICEP), the three institutions are collaborating on several initiatives within the partnership to address the stark disparities in cancer experienced by American Indian communities in North Carolina. The state is home to the largest American Indian population in the Eastern U.S., represented by eight tribes and four urban Indian centers. The SAICEP partnership is co-led by Ronny A. Bell, PhD, MS, director of the Office of Cancer Health Equity at Wake Forest Baptist Comprehensive Cancer Center and a member of the Lumbee Tribe; Tomi Akinyemiju, PhD, MS, associate director of the DCI Community Outreach Engagement and Equity program (COEE); and Stephanie B. Wheeler, PhD, MPH, associate director of Community Outreach and Engagement at UNC Lineberger Comprehensive Cancer Center. SAICEP will leverage the resources and expertise of the three comprehensive cancer centers in North Carolina and partner with state and federally recognized tribes and urban Indian organizations across North Carolina to co-develop culturally relevant and effective cancer prevention and control initiatives among American Indian tribal communities. “The striking disparities in cancer incidence and mortality in American Indian tribes in our catchment area is a public health emergency. SAICEP will help us build a strong coalition of community leaders, state and local organizations, and scientists in each of our comprehensive cancer centers for co-learning and co-developing effective strategies to eliminate this disparity,” said Akinyemiju. "Strategies to reduce these disparities must include eliminating cancer-related risk factors such as tobacco use and obesity, as well as ensuring equitable access to quality health care, including regular cancer screening so that cancers can be detected and treated as early as possible." According to the U.S. Department of Health and Human Services Office of Minority Health, American Indian men are 30% more likely to have stomach cancer compared with non-Hispanic White men, and American Indian women are more than twice as likely to develop and die from liver cancer compared with non-Hispanic White women. American Indian men in North Carolina also have higher prostate cancer mortality rates compared with non-Hispanic White men. A SAICEP lecture series targeting researchers and providers is already underway and a COVID-19 vaccine event in the Lumbee community is scheduled for Nov. 30, during which informational and educational materials on cancer screening will be provided for community members. A symposium is being planned for 2022 involving American Indian community leaders, researchers, clinicians and various organizations. The Partnership’s inaugural event, held in September, was a talk on “Meeting the Cancer Prevention and Care Needs of North Carolina’s Indigenous Communities" led by Marc Emerson, PhD (an assistant professor in the Department of Epidemiology at UNC Gillings School of Global Public Health and a member of the Navajo Nation) and SAICEP co-director Bell. SAICEP’s second event, held on Nov. 17, was a virtual lecture by Rodney Haring, PhD, MSW, on “Building Cancer Care Collaboratives for the Seventh Generation.” Haring, an enrolled member of the Seneca Nation of Indians (Beaver Clan), is director of the Center for Indigenous Cancer Research at Roswell Park Comprehensive Cancer Center, an associate professor of Oncology, a research faculty member with the Center’s Office of Community Outreach and Engagement (Department of Cancer Prevention and Control), and adjunct faculty at the Native American Research and Training Center at the University of Arizona. Both SAICEP lectures were targeted at academic researchers and clinicians. Recordings of all SAICEP lectures, when possible, will be made available through the UNC Lineberger Cancer Network Learning Portal at a later date. Stay tuned for a lecture in the new year by Hannah Woriax, MD, a member of the Lumbee Tribe who recently joined DCI as a Duke Health fellowship-trained breast surgeon and assistant professor in the Duke University School of Medicine Department of Surgery, Division of Surgical Oncology. Woriax is currently practicing at the Duke Cancer Network-affiliated Scotland Health Cancer Treatment Center where she specializes in surgical care for patients with benign breast disease and breast cancer. The Southeastern American Indian Cancer Health Equity Partnership (SAICEP), is represented by a special cancer ribbon with four distinctive colors — black, red, yellow and white — symbolizing, depending on the tribe: each of the four directions: east, south, west, and north the four human races the four stages of life: birth, youth, adult (or elder), death the four seasons of the year: spring, summer, winter, fall the four aspects of life: spiritual, emotional, intellectual, physical the four elements of nature: fire (or sun), air, water, and earth the four animals: eagle, bear, wolf, buffalo (and many others) the four ceremonial plants: tobacco, sweet grass, sage, cedar

WATCH RECORDING: How Studying Genes Can Lead to More Personalized Cancer Care

The February installment of the DCI Office of Health Equity's "Conversations with Our Community" — How Studying Genes Can Lead to More Personalized Cancer Care (recorded on 2.24.21) — featured co-director of the Patierno/George/ Freedman Lab for Cancer Research Jennifer Freedman, PhD, and postdocs in the lab Tyler Allen, PhD, and Sean Piwarski, PhD — all of whom shared their research into identifying genes in cells that drive cancer disparities and developing treatments that block those genes. The community forum was moderated by Angelo Moore, PhD, RN, who leads the Office of Health Equity (OHE). “We welcome any input we can get from the community. We really want to work with the community side by side to address the questions we are trying to address and do all the work that we do," Freedman said, leading off her presentation. “We have a lot of evidence in cancer and other diseases that it really needs to be personalized, that members of different population groups get cancer at very different rates.They have cancers that vary in risk, in aggressiveness and in response to treatment.” Freedman referenced some of these striking disparities: African American women are nearly twice as likely as white women to be diagnosed with triple-negative breast cancer and are much more likely than white women to die from breast cancer. The highest rates of kidney cancer cases in thee U.S. occur among American Indians/Alaska Natives. Rates of liver cancer are higher among American Indians/Alaska Natives and Asian and Pacific Islanders than other racial/ethnic groups African American men are more than twice as likely as white men to die from prostate cancer. Women in rural areas are twice as likely to die from cervical cancer as women in more urban areas. African Americans are twice as likely as Whites to be diagnosed with and die from multiple myeloma. White people are much more likely to get glioblastoma and to die from it than members of other racial and ethnic groups. While this particular set of talks focused on genetic drivers of cancer, Freedman emphasized that there are other factors, including society-level factors such as racism and discrimination; neighborhood-level factors such as diet, lifestyle, the environment, pollution; and institutional-level factors such as access to getting care. "All of these factors — genetics, what’s happening at the society level, what’s happening in our neighborhoods and what’s happening with our access to institutions all influence our risk of getting cancer, how bad our cancer is, how it progresses and if we have cancer how we respond to treatment," said Freedman. "We really need to think about these factors together, how they interact, when we’re doing the work we are doing." Allen described his work in the lab studying cancer metastasis and how it’s different in different racial or ethnic groups and how the lab is using CRISPR gene editing to control RNA splicing. Splicing dysfunction underlies many conditions and diseases, including cancer. "The information gained from studying these genes allows us to then develop drugs to target the identified changes in genes and RNA splicing," Allen explained. "These therapies can be tested in the lab and clinical trials and, if safe and effective, can then be used to treat cancer patients." Piwarski zeroed in on prostate cancer disparities among racial and ethnic groups, including incidence rates and death rates. He also spoke about the group’s ABI-Race clinical trial in which they trialed a particular treatment for advanced prostate cancer in African American patients and in White patients — both equally represented — and what they learned about the differences in response to treatment. (Data presented at the 2018 ASCO Annual Meeting suggested that African-American patients responded better to the treatment, per study PI Dan George, MD, who co-directs the Patierno/George/Freedman Lab.)

Duke Presidential Award to LATIN-19 Includes DCI Faculty and Staff

The Presidential Awards program, organized by the Office of the President in partnership withDuke Human Resources, recognizes individuals and teams from the University and Health System who best demonstrate the values that define and shape Duke as an institution. The awards are the highest honor given by Duke to staff and faculty members.Many of thisyear's winners helped Duke rise to the challenge of the COVID-19 pandemic and the difficult national dialogue on race and social justice.

Mexican Consulate, DCI OHE Community Conversation (in Spanish)

The Mexican Consulate in Raleigh and the Duke Cancer Institute Office of Health Equity collaborated on a community forum on breast and cervical cancer prevention and screening. Watch the seminar on Facebook.

Duke GI/DCI/Durham Cty Wins Social Media SCOPY Award

The Durham County Colorectal Cancer Screening Workgroup, Duke Division of Gastroenterology, and Duke Cancer Institute received a SCOPY Award from the American College of Gastroenterology (ACG) for "Best Culturally Inclusive Social Media Event” for their entry“Duke Cancer Institute Facebook Live Event for Colorectal Cancer Awareness Month.” The SCOPY Awardrecognizes the achievements of groups in their community engagement, education, and awareness efforts for colorectal cancer prevention. “We are inspired by your commitment to raising colorectal cancer awareness during a difficult time and wish you, your family, colleagues, and community well during a challenging year,” wrote Becky Abel, M.Ed., Manager, Communications & Member Publications, American College of Gastroenterology, in her email to the event planners and participants announcing their selection to receive the award. “All of the SCOPY submissions for 2020 will be featured in a booklet shared with the members of the College. Though we cannot safely convene in person this year, the College will continue to honor innovative and impactful community education programs to raise awareness of colorectal cancer.”

A Fair Shake

When Nadine Barrett, PhD, was 15, she and her mother traveled from their home in Wimbledon, England to New York City and ended up staying; making a home in Brooklyn. They were immigrants seeking “new opportunities to advance their education and career,” Barrett said, and undocumented. “We lived in Wimbledon, and were of one the few black families in the area,” said Barrett. “I came to Brooklyn and saw so much diversity and a strong representation of black people, essentially, people who look like me in the community. I thought, 'This is fabulous.'” But the novelty of a new life in America quickly wore off. Barrett’s mom, who had been a district nurse in England, could not practice in the America because of her immigration status. As result, she had to initially accept low-paying jobs outside of her professional experience, until she received her green card and was able to practice as a geriatric nurse, a career she held for 30 years. Barrett enrolled in Lafayette High School, which though integrated in the classroom, was far from integrated on the playground — “Italian white students on one side, black and Puerto Rican students on the other.” With her very strong British accent, Barrett didn’t entirely fit in with either group, she said. “The black kids didn't like me because of my accent, the white kids didn't like me because I was black,” explained Barrett. “I figured that out very quickly. I became keenly aware of how race, racism, and the social, cultural and political environment in which we live impacts our lives and our opportunities.” Barrett has traveled far — literally and figuratively — since those days in Brooklyn. For 20 years, she’s worked to reduce health disparities among historically underrepresented populations by increasing their access to care and research; ensuring that diverse voices and perspectives are included as stakeholders that can influence and improve community and population health, and equipping health systems and researchers with tools, resources, and strategies to effectively engage these diverse populations in the development and full participation in healthcare and research. About a third of that time has been spent at Duke.