Advancing Health Equity, Inclusion, and Belonging in Integrative Oncology

Journal of Integrative and Complementary MedicineVol. 29, No. 8 SIO CommentaryFree AccessAdvancing Health Equity, Inclusion, and Belonging in Integrative OncologyAna María López, Leigh Leibel, Doreen Stein-Seroussi, Carolina Salvador, Rebecca Leary Safon, Tanya T.J. Riggs, Melvin D. Mann, Jodi MacLeod, and Eleanor M. WalkerAna María LópezSidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA.Search for more papers by this author, Leigh LeibelColumbia University Irving Medical Center, New York, NY, USA.Search for more papers by this author, Doreen Stein-SeroussiIndependent Yoga and Mind/Body Therapist Specializing in Oncology, Carrboro, NC, USA.Search for more papers by this author, Carolina SalvadorWashington University School of Medicine, St. Louis, MO, USA.Search for more papers by this author, Rebecca Leary SafonIndependent Yoga and Mind/Body Therapist, City Cancer Support Community of Atlanta, GA, USA.Search for more papers by this author, Tanya T.J. RiggsTuba City Regional Health Care Corporation, Tuba City, AZ, USA.Search for more papers by this author, Melvin D. MannMajor, US Army Retired, World's Longest Living Gleevec, TKI, & Kinase Inhibitor Survivor, 28 Year Terminal Leukemia Survivor, Atlanta, GA, USA.Search for more papers by this author, Jodi MacLeodAddress correspondence to: Jodi MacLeod, BA, Society for Integrative Oncology, Memorial Sloan Kettering Cancer Center, 985 King Way, Breinigsville, PA 18031, USA E-mail Address: [email protected]https://orcid.org/0000-0002-3434-9011Society for Integrative Oncology, Memorial Sloan Kettering Cancer Center, Breinigsville, PA, USA.Search for more papers by this author, and Eleanor M. WalkerHenry Ford Cancer Institute, Detroit, MI, USA.Search for more papers by this authorPublished Online:9 Aug 2023https://doi.org/10.1089/jicm.2023.0316AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail Ana María López, MD, MPH, MACP (ABOIM)Leigh Leibel, MScDoreen Stein-Seroussi, MA, MPA, C-IAYTCarolina Salvador, MDRebecca Leary Safon, NMT, RYT500, C-IAYT, CMLDTTanya T.J. Riggs, MAdmMelvin D. Mann, MBA, MEdJodi MacLeod, BAEleanor M. Walker, MDThe Society for Integrative Oncology® (SIO®) is the premier international interprofessional society whose mission is to advance evidence-based, comprehensive integrative healthcare to improve the lives of people with cancer. SIO's overarching goal is stated in its 2023 conference theme, “Integrative Oncology as Standard of Care: The Time is Now.”1BackgroundIn response to the cancer health inequities exposed by the pandemic and the social unrest in the United States related to the murders of George Floyd, Breonna Taylor, and Ahmaud Arbery in the summer of 2020, SIO's board of trustees established social justice and health equity as priorities. In the fall of 2020, SIO named a “Health Equity Liaison to the Board,” and during the 2020 Virtual Board Retreat, a Health Equity Task Force was established. Dr. Ana Maria Lopez and Dr. Eleanor Walker, health equity leaders from minoritized communities, were named cochairs of this task force. In this article we will share our progress on the journey to health equity as we continue to learn from the experiences of others, with the hope that these actions and resources may be utilized and adapted by other organizations.Value Affirmation CommitmentsThe task force voted in 2021 to amend its name to “Health Equity, Inclusion & Belonging (HEI&B) Task Force.” The first action the task force chose to undertake was to prepare a mission statement that reflected the society's values, the “SIO Health Equity Mission Statement” and a “Land and Labor Acknowledgment Statement.”2 The latter would be adapted to be relevant to the location of each annual SIO meeting. The board of trustees adopted these commitments in May 2021. Both statements are posted on the SIO website. The board elevated the task force to a committee in 2022.Gathering Data: SIO Diversity & Inclusion SurveyThe second major task of the SIO HEI&B Committee in 2021 was to ask, “Who is at the table in SIO?” The committee thoughtfully adapted an existing survey to create a six-question, multiple choice, SIO Diversity and Inclusion Assessment Survey. The six questions asked about age, gender identity, sexual orientation, racial/ethnic identity, geographic location, and disability. This survey was sent to the board of trustees and to the general SIO membership in September of 2021. Approximately 20% (121 of 558) of SIO members responded to this initial survey.To improve response, the survey invitation has been linked to all new and renewing membership applications. Figure 1 shows the results of this survey, and actions we intend to implement relevant to each result to improve diversity and inclusion within the society.FIG. 1. A four-column table detailing survey questions, survey results, interventions, and strategies.The results (Fig. 1) revealed that most respondents were either in the 40–55 years or the 56–74 years age bracket and were predominantly white, heterosexual, with the gender identity of “woman,” and did not report a disability. Most SIO members resided in the United States, followed by Canada. Survey results identified the absence of diversity in our membership with regard to persons under the age of 40 years, men, nongender binary, nonheterosexual, nonwhite, not living in North America, and people with disabilities. Based on these findings, SIO HEI&B and membership committees are working together to develop inclusive engagement and outreach strategies that focus on early-career engagement, enhancing diversity, and fostering a welcoming environment for all.SIO Inclusion Engagement StrategiesOngoing commitment to educationSince its inception, the HEI&B Committee has compiled educational resources for ongoing self-education. Education and reflection opportunities offered to the board include discussions on articles such as “Levels of Racism: A Theoretical Framework and a Gardener's Tale,” by Camara Phyllis Jones, MD, MPH, PhD, webinar recordings on LGBTQ+ inclusion, and an implicit bias video training module for health professionals.3–5Webinars and podcastsThe committee collaborated with the SIO Yoga Special Interest Group (SIG) to offer webinars on LGBTQ+ Cancer Health Equity and Black Family Cancer Awareness Weeks, including “Healing and Community Building through African Drumming,” featuring Mel D. Mann, MBA, MEd, and moderated by Dr. Eleanor Walker.4,6–8 The SIO 2021 and 2022 June webinars were coordinated in support of the FDA's Oncology Center of Excellence's newly created initiative, National Black Family Awareness Week during the week of Juneteenth.Juneteenth is a federal holiday in the United States commemorating June 19, 1865, the final emancipation of black people still enslaved in Texas two years after the Emancipation Proclamation had declared slavery abolished.9 The cochairs' Integrative Oncology Talk podcast episode titled “Health Equity and Integrative Oncology” was released on January 5, 2023.10In addition, in 2020, SIO patient advocates and Yoga SIG leaders cultivated a relationship with Tony Redhouse, a recording artist and spiritual healer, and other members of the Navajo Nation who are health care professionals at the Tuba City Regional Health Care Corporation (TCRHCC). TCRHCC is the only cancer treatment center on American Indian land in the United States. Through a webinar, podcast, social media content, and a special virtual conference performance by Mr. Redhouse,11–13 SIO elevated awareness of the COVID-19 pandemic and cancer inequities experienced by the Navajo People. SIO sponsored a fundraiser during 2020 to provide community health supplies to the Navajo Nation and medical equipment to TCRHCC.Social mediaThe committee contributes SIO social media content based on a diversity calendar and using the hashtag “#SIO HealthEquity.” The December 2022 social media content shared recipes and traditions from multiple faith celebrations. In an effort toward inclusion, social media posts will be prepared in multiple languages in collaboration with SIO's Global Task Force.Visual artsThe 2021 Original Artwork Project began when Chicago artist-in-resident, Antonia Ruppert, who had created art for people with cancer at a local cancer support organization, asked SIO patient advocates how she could contribute to the mission of SIO. The Patient Advocate Committee collaborated with the HEI&B Committee on this project with the goal of highlighting diversity and inclusion in integrative oncology. Ms. Ruppert painted portraits of Mr. Mel D. Mann, Dr. Ana Maria Lopez, and yoga therapist Marsha Banks-Harold, BSEE, C-IAYT, which were displayed at the SIO 2021 conference in Baltimore, MD (Fig. 2). Conference attendees remarked on the welcoming inclusive tone set by these portraits, as the artist and subjects are from minoritized communities.FIG. 2. Four photos and corresponding descriptions for the SIO Original Artwork Project.At the SIO 2021 and 2022 conferences, scrolling slides featured the multicultural and multiethnic origins of commonly utilized integrative oncology therapies. Please see Figure 3 as an example.FIG. 3. A 42-word statement.On the SIO conference website and at the venue in Scottsdale, AZ, SIO featured the poster, “You Are Welcome Here” adapted with permission from the George Washington Cancer Center.14 This poster, shown in Figure 4, was shared by Dr. Pratt-Chapman during her presentation on LGBTQ+ Cancer Health Equity.4FIG. 4. A poster with translations in several languages and a logo.Book clubIn January 2023, the SIO HEI&B Committee hosted its inaugural SIO Health Equity Book Club discussion with Eileen Fuentes, MA, CHHC, serving as facilitator. The group discussed themes from “Why Are Health Disparities Everyone's Problem?” by Lisa Cooper, MD, MPH.15 Copies of the book were purchased with funding from a mini-grant from SIO on behalf of the first 50 respondents to an email invitation to join the twice-yearly book club. In March of 2023, the committee selected its second book, “My Grandmother's Hands: Racialized Trauma and the Pathway to Mending Our Hearts and Bodies,” by Resmaa Menakem.16 The book discussion will be a Juneteenth event and will take place on June 14, 2023.Policy developmentFor the upcoming 20th International SIO conference in Banff, Alberta, the committee developed a “Code of Conduct, Freedom from Harassment Plan and Inclusivity Statement” to support safety and inclusion. The statement is posted on the SIO conference website.17Conference presentationsAt the 2022 conference in Scottsdale, HEI&B Committee presentations included posters, a workshop by Dr. Eleanor Walker, Dr. Kavita Mishra, and Eileen Fuentes, MA, CHHC, titled, “Ethnomedical Traditions Throughout the World,” and “The 1st SIO Diversity & Inclusion Survey: Who's at the Table?” by Dr. Ana Maria Lopez, Dr. Carolina Salvador, and Jodi MacLeod, which was included in the “Best of SIO” session. Joette Walter, RN, MBA, CEO of TCRHCC, also presented the TCRHCC Specialty Care Center's initiative to provide culturally appropriate integrative oncology care to people of the Navajo, Hopi, and San Juan Southern Paiute Nations.Global engagementOn the occasion of World Cancer Day in 2021, the SIO Yoga SIG produced a cancer prevention webinar in conjunction with SIO for Project Pink Blue & Psychological Trust Centre, a nonprofit cancer organization in Abuja, Nigeria, which shared the video on social media.18 Moderated by Dr. Darlingtina Esiaka, the webinar presenters included SIO President-Elect Dr. Santosh Rao, who gave background on the work of SIO; Dr. Eleanor Walker, who gave the main presentation; Dr. Santhosshi Narayanan, who spoke on prevention; and Marsha Banks-Harold, who led a yoga practice.MisstepsPart of our work addresses how we manage missteps, and we want to share this as well. The upcoming 20th International SIO conference in Banff, Alberta, was mistakenly scheduled during the Jewish holiday of Rosh Hashanah. We were unable to change the dates of the event and issued an apology in the April 2023 SIO Newswire.19 The SIO board conferred with the HEI&B Committee, which has developed a calendar of religious holidays to guide future scheduling of events that we will consult before setting dates, with the hope of preventing such conflicts in the future.Conclusions and Next StepsThe SIO HEI&B Committee has provided SIO leadership with guidance, so the values of diversity and inclusion are reflected in all SIO activities. Its members are intentional members of other SIO committees, task forces, and SIGs, and currently, both committee cochairs and five committee members are trustees of the board. In these groups, members serve as partners toward health equity and work together to address systemic barriers to inclusion. Together, they create a safe and welcoming environment where all our members may feel at home and that they belong. See Figure 5 for more information.FIG. 5. A box with text about finding more information.Authors' ContributionsConcept and design were contributed by A.M.L., E.M.W., L.L., and J.M. Acquisition, analysis, or interpretation of data were by A.M.L., E.M.W., L.L., J.M., D.S.-S., C.S., R.L.S., T.T.-J.R., and M.D.M. All authors reviewed and edited the article.Author Disclosure StatementC.S. discloses she is a unit holder with HiberCell. All other authors report no financial disclosures.Funding InformationNo funding was received for this article.References1. SIO® International Annual Conference. Society for Integrative Oncology®; 2022. Available from: https://www.sioconference.org [Last accessed: April 19, 2023]. Google Scholar2. Society for Integrative Oncology®. Health Equity Mission Statement and Land and Labor Acknowledgment Statement; 2021. Available from: https://integrativeonc.org/latest-news/367-health-equity-mission-statement-and-land-acknowledgment-statement [Last accessed: April 19, 2023]. Google Scholar3. Jones CP. Levels of racism: A theoretic framework and a Gardener's Tale. Am J Public Health 2000;90(8):1212–1215; doi: 10.2105/ajph.90.8.1212 Crossref, Medline, Google Scholar4. Scout NFN, Pratt-Chapman M, Garza D, et al. LGBTQ Equity in Cancer Care and a Patient Advocate Experience. Society for Integrative Oncology®; 2023. Available from: https://www.youtube.com/watch?v=rBC2SGcjcCw&list=PLVZRNLNieieGjsMzABfECGaR4M2H_KVQo&index=2 [Last accessed: April 19, 2023]. Google Scholar5. DCRX: The DC Center for Rational Prescribing. Implicit Bias: A Practical Guide for Healthcare Settings; 2021. Available from: https://www.dcrxce.com/content/implicit-bias-practical-guide-healthcare-settings#group-tabs-node-course-default2 [Last accessed: April 19, 2023]. Google Scholar6. Mann MD, Walker EM. Healing and Community Building through African Drumming. Society for Integrative Oncology®; 2022. Available from: https://www.youtube.com/watch?v=CbdqfPFt5v4&list=PLVZRNLNieieGjsMzABfECGaR4M2H_KVQo&index=1 [Last accessed: April 19, 2023]. Google Scholar7. Walker EM, Leibel L. Black Family Cancer Awareness: Engaging the Generations. Society for Integrative Oncology®; 2022. Available from: https://www.youtube.com/watch?v=va5Ag8Dt6HI&t=9s [Last accessed: April 19, 2023]. Google Scholar8. Walker EM, Leibel L, Banks-Harold M, et al. Minding the Gap: Disparity in Cancer Care & the Role of Yoga Therapy in Advocacy and Community Building. Society for Integrative Oncology®; 2020. Available from: https://www.youtube.com/watch?v=maJFDG2ZxTE&t=336s [Last accessed: April 19, 2023]. Google Scholar9. The White House. A Proclamation on Juneteenth Day of Observance, 2022. The White House; 2022. Available from: https://www.whitehouse.gov/briefing-room/presidential-actions/2022/06/17/a-proclamation-on-juneteenth-day-of-observance-2022/ [Last accessed: April 19, 2023]. Google Scholar10. Rao S, Lopez AM, Walker EM. Health Equity and Integrative Oncology. Society for Integrative Oncology®; 2023. Available from: https://podcasts.apple.com/us/podcast/health-equity-and-integrative-oncology/id1468586421?i=1000592723599 [Last accessed: April 19, 2023]. Google Scholar11. Redhouse T, Leibel L. Native American Healing Meditation Practice. Society for Integrative Oncology®; 2020. Available from: https://www.youtube.com/watch?v=fZlS7-jVmCk&t=30s [Last accessed: April 19, 2023]. Google Scholar12. Rao S, Redhouse T, Leibel L. Sound Healing and Spirit. Society for Integrative Oncology®; 2020. Available from: https://podtail.com/en/podcast/integrative-oncology-talk/sound-healing-and-the-spirit-tony-redhouse/ [Last accessed: April 19, 2023]. Google Scholar13. Redhouse T, Walker EM, Rao S, et al. SIO2020 Virtual Conference—Special Performance by Navajo Recording Artist Tony Redhouse. Society for Integrative Oncology®; 2020. Available from: https://www.youtube.com/watch?v=qHMX-ZG4-a4&t=5s [Last accessed: April 19, 2023]. Google Scholar14. George Washington University Cancer Control. You Are Welcome Here Poster; 2021. Available from: https://cancercontroltap.smhs.gwu.edu/news/you-are-welcome-here-posters [Last accessed: April 24, 2023]. Google Scholar15. Cooper L. Why Are Health Disparities Everyone's Problem? Johns Hopkins University Press: Baltimore, MD; 2021. Crossref, Google Scholar16. Menakem R. My Grandmother's Hands: Racialized Trauma and the Pathway to Mending Our Hearts and Bodies. Central Recovery Press: Las Vegas, NV; 2017. Google Scholar17. Lopez AM, Walker EM, Carlson LE, et al. Code of Conduct, Freedom from Harassment Plan and Inclusivity Statement. Society for Integrative Oncology®; 2023. Available from: https://www.sioconference.org/codeofconduct [Last accessed: April 19, 2023]. Google Scholar18. Walker EM, Narayanan S, Banks-Harold M. Project Pink Blue: A World Cancer Day Webinar; 2020. Available from: https://www.youtube.com/watch?v=bko3unJ0e3I&t=45s [Last accessed: April 19, 2023]. Google Scholar19. Carlson LE. April 2023 SIO Newswire. Society for Integrative Oncology®; 2023. Available from: https://integrativeonc.org/knowledge-center/newswire-archive [Last accessed: April 25, 2023]. Google Scholar20. Rao S, Paller CJ, Lopez AM, et al. The Society for Integrative Oncology: Two decades of global leadership in Evidence-based Integrative Health Care. J Integr Complement Med 2022;28(9):702–704; doi: 10.1089/jicm.2022.0660 Link, Google ScholarFiguresReferencesRelatedDetails Volume 29Issue 8Aug 2023 InformationCopyright 2023, Mary Ann Liebert, Inc., publishersTo cite this article:Ana María López, Leigh Leibel, Doreen Stein-Seroussi, Carolina Salvador, Rebecca Leary Safon, Tanya T.J. Riggs, Melvin D. Mann, Jodi MacLeod, and Eleanor M. Walker.Advancing Health Equity, Inclusion, and Belonging in Integrative Oncology.Journal of Integrative and Complementary Medicine.Aug 2023.462-467.http://doi.org/10.1089/jicm.2023.0316Published in Volume: 29 Issue 8: August 9, 2023Online Ahead of Print:July 27, 2023PDF download