Often when the phrase “health disparities” is used, people automatically think of deleterious health outcomes in different racial/ethnic groups. While these disparities have perhaps been studied the longest, at the Office of Cancer Health Equity, we want to ensure that everyone has the same chance to survive cancer. That means that as we look at disparities among the communities we serve ( see Jan 2019 edition ), there are other conditions and factors that we explore. We know that in addition to cancer disparities among racial/ethnic minorities, other vulnerable populations exist. These include individuals from rural backgrounds, sexual and gender minorities, lower socioeconomic status, and younger or older age. Many don’t think of age as a potential risk factor for cancer disparities and for that reason April is designated National Young Adult Awareness Month. In solidarity, this issue of the OCHE ECHO explores cancer disparities among the adolescent and young adult population and what we at the Wake Forest Baptist Comprehensive Cancer Center are doing to close that gap.
AYAs: The Most Underserved Age Group in Cancer
Cancer is the leading cause of disease-related death in adolescents and young adults (AYAs) and includes 70,000 new cancer diagnosis each year in the US. The most common cancers in AYAs include: lymphoma, leukemia, testicular, melanoma, central nervous system, sarcomas, breast, cervical, thyroid, and colorectal. Though the number of cancer survivors is increasing, 5-year survival rates for AYA cancer survivors have stagnated and improvements are lagging behind children and older adults. Unfortunately, this makes AYAs an underserved population in oncology and to achieve cancer health equity, greater focus needs to be placed on their unique needs.

Disparities experienced by AYA patients with cancer that have led to poor outcomes and lack of progress over the years include high rates of un- and under-insured, differences in disease biology, delayed diagnosis and treatment, increased toxicities, lower socioeconomic status, low participation in clinical trials, unique supportive care needs, and overall lack of awareness in the medical field as to the special needs of this population. Additionally, AYA cancer occurs in the context of a critical period in human development and may be especially disruptive given unique emotional and social life changes that take place in adolescents and young adults such as, becoming more independent, exploring their sexuality, forming their own worldview and making decisions about higher education, careers, and family.

Spurred by AYA cancer patients and survivors, health care providers and the oncology community have begun to recognize the unique medical, social and emotional needs of AYA patients. Getting support to meet those needs is critical for enabling AYAs to adapt and cope as they navigate the course of their illness and beyond and to ultimately improve quality of care and health outcomes among AYAs. 
Empower Study
Young adult cancer survivors (YAs) face unique challenges given the physical, cognitive, and psychosocial developmental milestones disrupted as a result of cancer and are at greater risk of psychological distress compared to older adults (ages ≥40) with cancer. Dr. John Salsman and his team developed a novel, multicomponent intervention to reduce psychological distress and enhance psychological well-being that shows promise among patients with HIV, diabetes, and metastatic breast cancer, and we have piloted the intervention for YAs in an eHealth delivery format (EMPOWER: Enhancing Management of Psychological Outcomes With Emotion Regulation). EMPOWER targets 8 skills to enhance psychological well-being (noticing positive events, capitalizing, gratitude, mindfulness, positive reappraisal, goal setting, personal strengths, and acts of kindness). Preliminary data suggest EMPOWER is feasible and acceptable to YAs. The purpose of the project is to optimize EMPOWER for YAs by determining which components are effective in promoting well-being, identifying demographic or personality characteristics that moderate EMPOWER’s impact, and exploring mechanisms through which EMPOWER may yield benefits for YAs.
Dr. John Salsman

Dr. Salsman is a tenured Associate Professor in the Department of Social Sciences and Health Policy at the Wake Forest School of Medicine, the Director of Clinical Research in Adolescent and Young Adult Oncology and the Co-Leader of the Cancer Prevention and Control Program at the Comprehensive Cancer Center of Wake Forest University. He has been continuously funded by the NIH since 2006 and has served as a principal investigator on NCI-funded work since 2011. His work focuses on maximizing the health-related quality of life of AYAs with cancer both during and after treatment. He does this primarily through three ways, improving measurement of patient-centered outcomes in order to ‘give patients a voice’, identifying factors that promote resilience and thriving and implementing socio-behavioral interventions to foster psychological well-being.
Updates and Events
Event Spotlight: 2 nd Annual North Carolina Adolescent and Young Adult Oncology Symposium
The 2 nd Annual North Carolina Adolescent and Young Adult Oncology Symposium, on April 5 th , 2019 brought together multidisciplinary providers and researchers from across the state interested in improving care for this patient population. Jointly provided by Wake Forest Baptist Health Comprehensive Cancer Center and UNC Health Sciences MAHEC in collaboration with UNC Lineberger and the Duke Cancer Institute, the symposium focused on the unique palliative and end-of-life care needs of AYAs in North Carolina and featured keynote speaker Abby R. Rosenberg, MD, MS, MA Professor of Pediatrics at the University of Washington. Next year’s 3 rd annual symposium will be hosted by the Duke Cancer Institute- stay tuned!
Upcoming Events
June 14: American Cancer Society Relay for Life, Wilkes County

Rotary Park
1395 W D Street
Wilkesboro, NC 28659


Relay For Life is American Cancer Society’s signature fundraiser dedicated to helping communities attack cancer. The money raised helps to decrease the incidence of cancer, improve the quality of life for cancer patients and their caregivers, and improve survival. Join us for fun, food, and a cause!
Volunteer with us
The Office of Cancer Health Equity is looking for volunteers to help with outreach. If you are interested, contact our community outreach coordinator, Camry Wilborn at

Volunteers are needed for the following events:

  • Health & Wellness Fair | May 18 | 9AM-1PM
  • Relay for Life, Wilkes County | June 15 | 5:30-8:30 PM
  • Juneteenth Festival | June 22 | 1-8 PM

Can't stay the whole time? That's okay! We can accommodate your schedule.
Next Newsletter
Our next newsletter will focus on workforce diversity with a profile on Twin City Medical Society. 

The Office of Cancer Health Equity Team

Director: Karen Winkfield, MD, PhD
Assistant Director: Jimmy Ruiz, MD
Assistant Director: Kathryn Weaver, PhD, MPH
Program Manager: Carla Strom, MLA
Hispanic Patient Navigator: Maria Alejandra Combs, JD, OPN-CG
Rural Patient Navigator: Emily Britt, MSW
Community Health Educator: Aeriel Diaz, BA, CHES
Community Research Coordinator: Kelsey Shore, CCRC
Community Outreach Coordinator: Camry Wilborn, MA
P: 336-713-3665