An Integrated Academic Oncology Ecosystem for Hawai'i and the U.S.-Affiliated Pacific Islands

Background: Delivering comprehensive cancer prevention, diagnosis, and treatment across Hawai'i and the U.S.-Affiliated Pacific Islands (USAPI) is constrained by geographic isolation, oncology workforce shortages, and persistent cancer inequities. Objectives: The University of Hawai'i Cancer Center, the state's only National Cancer Institute-designated cancer center, partners with community healthcare systems to address cancer health disparities. Here, we describe an implementation-focused strategy initiated in December 2024 that is designed to improve equitable access to evidence-based oncology services across the catchment area. Approach: This program description integrates publicly available demographic and health system data and presents a structured implementation framework centered on (1) workforce development and oncology training pathways; (2) a statewide clinical oncology network supported by telehealth; (3) community-engaged screening and early detection outreach; and (4) strengthening clinical research and trial infrastructure with deliberate inclusion of underserved populations. Evaluation: We outline an evaluation framework incorporating process and outcome metrics spanning workforce capacity, screening participation, timeliness of care, clinical trial enrollment, and equity indicators stratified by county, island, and population group. Conclusions: This approach offers a scalable, implementation-oriented model for developing an academic oncology ecosystem that emphasizes measurement, accountability, and equity, with potential applicability to other geographically dispersed and ethnically diverse regions.