The Value and Process of Inclusion: Using Sensitive, Respectful, and Inclusive Language and Images in NCCN Content

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Deborah A. Freedman-Cass National Comprehensive Cancer Network, Plymouth Meeting, Pennsylvania

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Tanya Fischer National Comprehensive Cancer Network, Plymouth Meeting, Pennsylvania

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Ash B. Alpert Center for Gerontology, Brown University School of Public Health, Providence, Rhode Island
Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York

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Juno Obedin-Maliver Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California

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Pamela L. Kunz Yale School of Medicine, New Haven, Connecticut

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Wui-Jin Koh National Comprehensive Cancer Network, Plymouth Meeting, Pennsylvania

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Robert W. Carlson National Comprehensive Cancer Network, Plymouth Meeting, Pennsylvania
Stanford University School of Medicine, Palo Alto, California

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A core component of NCCN’s mission is to improve and facilitate equitable cancer care. Inclusion and representation of diverse populations are essential toward this goal of equity. Within NCCN’s professional content, inclusivity increases the likelihood that clinicians are prepared to provide optimal oncology care to all patients; within NCCN’s patient-facing content, it helps ensure that cancer information is relevant and accessible for all individuals. This article describes changes that have been made in the language and images used in the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) and the NCCN Guidelines for Patients to promote justice, respect, and inclusion for all patients with cancer. The goals are to use language that is person-first, nonstigmatizing, inclusive of individuals of all sexual orientations and gender identities, and anti-racist, anti-classist, anti-misogynist, anti-ageist, anti-ableist, and anti–fat-biased. NCCN also seeks to incorporate multifaceted diversity in images and illustrations. NCCN is committed to continued and expanding efforts to ensure its publications are inclusive, respectful, and trustworthy, and that they advance just, equitable, high-quality, and effective cancer care for all.

Submitted for publication March 10, 2023; accepted for publication March 27, 2023.

Disclosures: A.B. Alpert has disclosed receiving honoraria from CME Outfitters. J. Obedin-Maliver has disclosed serving as a consultant for Folx, Inc., and Hims Inc.; and receiving royalty income from Current Medical Diagnosis and Treatment, Lange Publishers. P. Kunz has disclosed serving on an advisory board for Amgen, Genentech, Crinetics, Natera, HUTCHMED, Ipsen, and Isotopen Technologien München AG (ITM); serving on steering committees for Novartis (Advanced Accelerator Applications) and Rayze Bio; and receiving grant/research support from Novartis (Advanced Accelerator Applications). The remaining authors have disclosed that they are employed by NCCN.

Correspondence: Deborah A. Freedman-Cass, PhD, National Comprehensive Cancer Network, 3025 Chemical Road, Suite 100, Plymouth Meeting, PA 19462. Email: freedman-cass@nccn.org
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