**5. Revitalization of cancer care: cancer competencies framework**

410 Cancer Prevention – From Mechanisms to Translational Benefits

particular for those involved in clinical research they can be instrumental in bringing the research experience into a comparable position with overall access to health care services in

"Imagine that you possess an indicator for a disease or illness that has nothing to do with your body. It is not a genetic predisposition to acquire cancer or a vice that raises the probability of contracting some dread disease, though estimates of its health risks have placed it on par with having diabetes. It has nothing to do with the environmental pollutants you are exposed to or whether you can afford health care. It is not a physical susceptibility that renders you more easily reachable by the clutches of pathology. No, this indicator of health hinges on certain learned abilities and skills, and it is a barrier to health that is totally within the health field's power and resources to lift. The condition hinted at above is the inability to speak English proficiently in the United States."(Bustillos 2009)

Correcting for this will not be easy. Little data exists on issues such as this in the clinical research enterprise. What will be important is the ability to recognize that it will be both a combination of policy and programs that culminate in a competent corps of health care workers. Indeed as an evidence base is developed we must recall that those currently in the cancer workforce can make a significant step by striving for cultural competence. The nature of funding and conducting randomized clinical trial research is changing to reflect the evolution of the science base, the need to increase diversity among study participants, to establish trust among certain communities by acknowledging the need for social justice and health equity, and of course the globalization of drug development and emerging markets. In response, there are significant efforts underway to address the barriers to participation in

The National Cancer Institute recently conducted research with oncology professionals that identified unmet accrual needs. As a result they have developed a comprehensive platform for accrual resources, AccrualNet.(NCI 2011) Their methodology used a variety of techniques including literature and resource searches to identify the content for the site. Certainly, as noted throughout EDICT's recommendations, designing interventions to support a broader the workforce must meet different barriers AccrualNet represents a unique, centralized comprehensive-solution platform to systematically capture accrual knowledge for all stages of a clinical trial. It is designed to foster a community of practice by encouraging users to share additional strategies,

For those who recognize the importance of clinical trials there is an opportunity to educate, encourage, and inform others. It is important to learn how to intervene with members of the cancer workforce who today have the ability to increase awareness about clinical trials and provide patients the opportunity to consider participation in a clinical trial. We need to make this part of our education and training of future workforce, if not, we are likely to have medicine's role in improving the quality of life diminish rather than

The lesson of EDICT is that there are many things that need our attention if we are truly to overcome the barriers to increasing participation in clinical trials. However, it is clear that if those (our cancer workforce) who can do something will, ultimately we will

clinical trials, which remain low.(Wilkinson and Marmot 2003)

resources, and ideas.(NCI 2011)

flourish.

succeed.

general.

Nearly all of the professional disciplines that play a role in the delivery of comprehensive cancer services are experiencing a shortage including physicians, nurses, social workers, pharmacists, public health workers, researchers, technologists, and cancer registrars. The rising incidence of cancer, an aging population, and an increased rate of cancer survivorship all predict an increased demand for health services. These trends threaten our ability to provide timely and comprehensive cancer care. Many cancer-focused organizations are investing in efforts to expand the number of cancer specialists in anticipation of a worsening cancer workforce crisis.
