Table 1.

Intervention targets and data elements for addressing health equity using modeling of care delivery along the cancer control continuum

Place in cancer control continuum	Intervention targets associated with cancer outcomesa and amenable to disparities modeling research	Required frequency distributions or rates of data elements specific to the population of interestb
“Upstream” structural factors	Health, social, and economic policies; social and environmental factors	Income, education, health literacy, health insurance coverage, employment, medical debt, residential segregation and mortgage lending practices, neighborhood factors (resources, violence), environmental quality (air, water), voting participation, local media and advertising exposure
Prevention and risk assessment	Individual cancer risk prediction, risk reduction behaviors and policies, access to genetic counseling	Risk factors (eg, family history of cancer, smoking status, environmental and occupational exposures), genetic test results if conducted, availability of genetic counseling
Early detection	Modality of screening test, availability and affordability of screening including new modalities, hours facilities are open	Test performance values including rates of false-positive results and biopsies after false-positives, test uptake and adherence, distributions of distance to screening facilities and facility characteristics such as area segregation and insurance accepted
Diagnosis	Local and regional health-care capacity including transfer of care between primary and specialty clinicians, health-care facility availability, screening failures (eg, interval cancers and advanced-cancer diagnoses despite recommended screening)	Follow-up rates, completeness of workup, time to follow-up after a positive screening test, work leave policies, time to treatment initiation, distance to facilities, facility characteristics including clinic workflow, stage at diagnosis, subtype of cancer
Treatment	Availability and quality of health care, challenges in transition of care between primary and oncology care, insurance coverage, out-of-pocket costs of care, insurance network restrictions, pre-authorization requirements, availability of tumor biomarker testing	Facility characteristics including clinic workflow, availability of patient navigation, insurance type, costs of care, medical debt, treatment effectiveness, completion of guideline-concordant care, treatment type and quality
Patient-reported outcomes	Treatment shared decision making, symptom management, care coordination	Quality of life (utilities), satisfaction with care, symptoms (eg, pain, sleep quality, fatigue), documentation of shared decision making, type and timing of physician appointments, community resources, social determinants of health (eg, food insecurity), social capital and support, resilience, availability of paid sick days, patient navigation
Survival	Behavioral risk factor modification, surveillance testing, availability of maintenance therapy, survivorship care plans	Risk factors assessed pre- and postdiagnosis, patterns of surveillance screening tests and cancer care for recurrence and new cancers, receipt of survivorship care per plan

^aOutcomes produced by models include cancer-specific incidence, survival, and mortality; life-years and quality-adjusted life-years; stage distribution of cancers diagnosed; false-positive screening tests; overdiagnosed cases; and health-care costs.

^bSimulation models use group-level summary data as parameter inputs and calibration targets. Summary data include frequency distributions (eg, percent of persons in each category of a factor) and other statistics such as means or medians, rate ratios, relative risks, hazard ratios, and 95% confidence intervals.