communities, who may be more likely to hold fatalistic attitudes toward cancer and inaccurate beliefs regarding its preventability, are being adequately served.

Cancer Survivorship in Ethnic Minority and Medically Underserved Communities

Cancer survivors are, in the committee's view, perhaps the most underutilized resource in the War on Cancer. This is especially true among ethnic minority and medically underserved populations, who face numerous cultural, socioeconomic, and institutional barriers to cancer prevention and treatment services. Cancer survivors in these communities are often painfully aware of the lack of services and information that might assist neighbors, friends, and relatives either to avoid or to cope with a cancer diagnosis. Perhaps more important, however, they possess critical expertise on how to reach members of their communities with cancer education and services information. This expertise should be tapped to its fullest.

NCI, to its credit, has established an impressive infrastructure of research programs and resources to assist cancer survivors. Greater attention must be paid, however, to the unique needs of ethnic minority and medically underserved communities. As indicated above, the committee did not find evidence of a strategic plan that addresses the needs of these communities and has offered a number of specific recommendations for the establishment of such a plan.

Monitoring and Measuring Results

To assess progress toward reducing the disparities in the cancer burden among U.S. ethnic and socioeconomic groups, it is important that the U.S. Congress and the public receive regular information regarding NIH activities that include objective performance indicators. The progress that has been achieved toward this goal can be assessed at three levels: (1) reductions in cancer incidence and mortality rates and increased cancer survival rates; (2) changes in cancer risk behavior among affected populations, such as reductions in tobacco use or efficiency of vaccination programs against hepatitis B as a means of reducing risk for primary cancer of the liver; and (3) process-related changes at NIH that reflect new organizational standards, policies, and priorities designed to better address the needs of ethnic minority and medically underserved communities. It is assumed that changes at the organizational level will result in positive outcomes in the behavior of risk groups, which in turn will result in reductions in cancer incidence and mortality and increases in cancer survival.

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