Cancer Equity
Health System and Contextual Factors Associated with Racial Equity in Lung Cancer Care
This explanatory sequential mixed methods study seeks to mitigate racial disparities in non-small cell lung cancer diagnosis, treatment, and outcomes, by identifying modifiable structural and health system/intermediary factors and strategies that influence equity in lung cancer care. We will combine retrospective, population-based studies of racial disparities in lung cancer care with a positive deviance analysis. Through qualitative interviews with key stakeholders in regions with high versus low racial disparities, we will reveal strategies and structures that influence equity in lung cancer care and outcomes. Our hypothesis is that the magnitude of racial disparities varies substantially across counties, and this variation does not arise by accident – there are specific contextual factors, such as structural racism, segregation, and health system factors, that exacerbate disparities.
Funding source: NIH (NIMHD)
Principal Investigator: Cary Gross
Comparative modeling of multiple myeloma across control continuum: prevention, treatment, and disparity reduction
The project, one of the Cancer Intervention and Surveillance Modeling Network (CISNET) Incubator Programs, aims to develop a natural history model for multiple myeloma progression in the United States. The overarching goals will evaluate the impact of novel interventions for multiple myeloma prevention and control, as well as assess whether, under what conditions, and in which ways the goal of eliminating racial disparities can be achieved through the proposed novel intervention strategies and treatment regimens.
Funding source: National Institutes of Health (National Cancer Institute)
Multiple Principal Investigator: Shi-Yi Wang (with Su-Hsin Chang & Graham Colditz)
Community-Rx Cancer: An IT-Enhanced Patient Navigation Program to Address Social Determinants of Health in Advanced Ovarian Cancer
Patients with cancer often have serious unmet health-related basic and self-care needs (HRSNs) that are not systematically assessed in routine cancer care. These potentially modifiable factors can exacerbate socioeconomic disparities and pose challenges to cancer care and recovery. This pilot study seeks to design, implement, and evaluate the effectiveness of a new tool called CommunityRx-Cancer (CRx-Can). CRx-Can will leverage novel technology that can: (1) assess for unmet HRSNs and financial toxicity using validated instruments at two distinct time points, and (2) navigate patients to care navigators and community resources based on their unique needs. Funding Patients with cancer often have serious unmet health-related basic and self-care needs (HRSNs) that are not systematically assessed in routine cancer care. These potentially modifiable factors can exacerbate socioeconomic disparities and pose challenges to cancer care and recovery. This pilot study seeks to design, implement, and evaluate the effectiveness of a new tool called CommunityRx-Cancer (CRx-Can). CRx-Can will leverage novel technology that can: (1) assess for unmet HRSNs and financial toxicity using validated instruments at two distinct time points, and (2) navigate patients to care navigators and community resources based on their unique needs.
Funding source: National Comprehensive Cancer Network & AstraZeneca
Principal Investigator: Cary Gross
Disparities in the Use of Oral Anticancer Agents in Kidney Cancer
We have long known that real-world black-white racial disparities have existed in the treatment and outcomes of patients with renal cell carcinoma (RCC). However, it is unclear how these disparities will change with the recent introduction and widespread adoption of oral anticancer agents (OAAs). As with any advance in medical technology, the introduction of these agents has the potential to significantly improve patient outcomes, but also has the potential to exacerbate current disparities if these advances in OAAs are not equally available or do not provide the same benefit to all patients. The proposed study addresses this critical gap in our knowledge by investigating a mix of nationally representative, yet diverse populations of patients with kidney cancer in the United States to better understand the current and future utilization, outcomes, and costs associated with emerging OAAs in patients with kidney cancer.
Funding source: NIH (NCI)
Principal Investigator: Michaela Dinan
Investigation of the bidirectional relationship between kidney cancer treatment and dementia
Our current R01 funded program of research investigates multilevel disparities in access, adherence, and outcomes related to the use of oral anticancer agents (OAAs) in patients with advanced renal cell carcinoma (RCC). However, disparities in cancer care can additionally be driven by issues of cognitive impairment such as dementia, including Alzheimer’s and related dementias (AD/ARD). AD/ARDs exhibit known racial and socioeconomic disparities in incidence, severity, and care, and are known to be increased in patients with renal dysfunction. Our R01 supplement will examine risk factors for development of AD/ARD in the RCC patient population, determine the initiation and adherence of OAAs in Medicare patients with dementia, and investigate the interaction between socioeconomic status, dementia, and management of patients with advanced renal cell carcinoma.
Funding source: NIH (NCI)
Principal Investigator: Michaela Dinan
Incarceration and Cancer-Related Outcomes
We will create the first comprehensive linkage of a tumor registry, correctional system data, and state vital statistics supplemented with in-depth interviews, to conduct a sequential explanatory mixed methods study of individuals with cancer. We will describe the burden of cancer among individuals with a history of incarceration at the population level in Connecticut. Among Connecticut residents who are diagnosed with cancer (2005-2014), we will assess the relation between incarceration and cancer mortality; the quality of cancer care; and the degree to which incarceration status moderates the relation between race, socioeconomic status and quality of cancer care and mortality. We will then use these data to inform a qualitative study of individual perceptions regarding accessing cancer care in the correctional system and in the immediate post-release period.
Funding source: National Institutes of Health (National Cancer Institute)
Principal Investigator: Emily Wang and Cary Gross