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A Holistic Approach to Cancer Health Disparities

, by L.M. Bennett, W. McCaskill-Stevens, S. Springfield

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Share your thoughts below in the comments. And be part of a Twitter chat on cancer health disparities research being held on November 18 at 3:00 p.m. ET. Visit our social media events page for more information.

The following is the fourth in a series of posts from senior NCI scientists and leaders on NCI’s Annual Plan and Budget Proposal for Fiscal Year (FY) 2017, which was submitted to the President on September 17, 2015. The proposal provides an overview of NCI’s priorities and key initiatives and the institute’s funding request for the President to consider in formulating his own FY 2017 budget proposal.

In this fourth post, L. Michelle Bennett, Ph.D., director of the NCI Center for Research Strategy; Worta McCaskill-Stevens, M.D., chief of the NCI Community Oncology and Prevention Trials Research Group; and Sanya Springfield, Ph.D., director of the NCI Center to Reduce Cancer Health Disparities, discuss NCI’s holistic approach to addressing cancer health disparities.

Although we are making progress against cancer, little progress has been made in one important area: reducing the unequal burden of cancer borne by many racial and socioeconomic groups.

Such cancer health disparities are a critical problem for affected individuals, their families and communities, and the nation as a whole. As we move toward a precision medicine approach to cancer prevention, diagnosis, and treatment, it is important to make sure that every person—regardless of their background—has the opportunity to benefit from research advances.

Accelerating progress against this frustratingly stubborn problem will require breaking down research silos, fostering collaboration among researchers from different disciplines, and attracting new investigators. Recognizing that complex factors underlie health disparities, NCI is taking a holistic approach in our efforts to address this serious public health issue.

James Cherry, Ph.D. (left), is a Scientific Program Director at the National Cancer Institute at Frederick, and also serves as the scientific advisor for high school and college student interns there.

Credit: National Cancer Institute

Priority Setting and Collaboration

To involve the research community in setting priorities in cancer health disparities research, NCI has organized a meeting of leading researchers, to be held later this month in Atlanta. Information gained from the workshop will be used to develop a strategy to move research forward in this area.

Also in Atlanta this month, the American Association for Cancer Research (AACR) will host the Eighth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved, where NCI Acting Director Doug Lowy, M.D., will deliver the keynote address.

As with many other areas of science today, a multidisciplinary approach is needed to address the complex problem of cancer health disparities. By taking such an approach, the advances made in different disciplines and the increasing knowledge about the factors that contribute to unequal outcomes can be more readily integrated to advance progress.

It will be critical to include and involve a wide variety of experts to truly solve this problem in the laboratory, clinic, and community. The effort will benefit from involving scientists, clinicians, patients, consumer advocates, educators and community leaders, as well as others.

NCI has a strong foundation upon which to continue building research capacity and breaking down barriers to advancing science in this important area. We see new opportunities before us even as we continue to make strides and witness important accomplishments. Some examples include:

  • Funding research on the biology of cancer health disparities
  • Ensuring equitable access to clinical trials and cancer care
  • Training a new generation of researchers who have a special understanding and focus on underserved populations

The Biology of Health Disparities

The role of genetics and biology in cancer health disparities is a crucial area of research with much potential for directly and indirectly improving this problem. Studies have consistently revealed a higher incidence of aggressive forms of breast cancer in African American women, prostate cancer in African American men, and liver cancer in Hispanic populations. Given the advanced biomedical tools and approaches available today, there is a tremendous opportunity for us to better understand the biological factors that contribute to these health disparities.

Last year, for example, NCI funded several research projects to develop cell lines and animal models specifically designed to improve our understanding of the biological factors associated with cancer health disparities. This basic research is necessary to create new approaches to addressing such disparities, including precise methods for identifying biological markers of risk and new targets for treatment for affected patients.

We’re also funding individual researchers who are delving deeper into the genetic and epigenetic mechanisms that may be associated with cancer health disparities. For example, Marta Torroella-Kouri, Ph.D., a researcher at the University of Miami School of Medicine, has received NCI funding to investigate the role of obesity and inflammation in African American women with breast cancer.

Clinical Trials and Care Delivery Research

Clinical trials are crucial to ensuring that research advances improve health. However, accruing patients from diverse ethnic and racial backgrounds to trials is challenging. Barriers to participation include a higher likelihood of comorbidities, costs of care, lack of trust in the health care system, and lack of education about clinical trials.

NCI supports investigators at community-based hospitals located in areas that serve underrepresented populations to help ensure equitable access to clinical trials. We also fund community health educators who provide much needed education and outreach to communities of color, and to connect patients to research opportunities and clinical trials.

Much of this is being done through the NCI Community Oncology Research Program (NCORP), a relatively new network of investigators who participate in an array of research in cancer control, prevention, symptom science, and screening. NCORP also focuses on cancer care delivery research. This area of investigation evaluates strategies for improving care through the study of health systems and clinicians.

Cancer Research Education and Training

NCI is committed to training underrepresented minorities in cancer research in general and in catalyzing interest in doing research in the area of cancer health disparities in particular. A diverse scientific and clinical workforce lends important perspectives to all areas of cancer research, including disparities research.

One such program, the Continuing Umbrella of Research Experiences (CURE), supports underrepresented students from high school through their first academic appointment. As part of the program, high school and undergraduate students from underserved and under-represented populations have the opportunity to perform laboratory and clinical research.

We have also created NCI programs such as the Partnerships to Advance Cancer Health Equity (PACHE), which partners NCI-designated cancer centers with minority-serving institutions. These partnerships not only increase minority students’ involvement in cancer research, but also provide the cancer centers with access to minority patient populations that are needed to participate in clinical trials.

Join the conversation! Tell us what you think in the comments section on this important topic as well as the NCI priorities outlined in the Annual Plan and Budget Proposal for FY 2017. We also invite you to participate in a Twitter chat on cancer health disparities research, scheduled for November 18 at 3:00 p.m. ET.

NCI FY 2017 Annual Plan & Budget Proposal Upcoming Blog Series

November 19: Precision Medicine Part I: Understanding Precision Medicine

December 10: Precision Medicine Part II: Clinical Trials for Adults and Children

January 13: Cancer Prevention: The Best Defense

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