Cancer Disparities: Overview, Emerging Research Issues and Models in Prevention, Diagnosis, and Treatment

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Cancer Disparities Overview, Emerging Research
Issues and Models in Prevention, Diagnosis, and
Treatment

• Claudia R. Baquet, MD, MPH
• Associate Professor Epidemiology/Preventive
  Medicine
• Director Cancer Disparities Research
• University of Maryland School of Medicine and
  Greenebaum Cancer Center
• Chair, Maryland Subcommittee on Cancer
  Disparities
• November 2003

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HHS Overarching Goal

• Healthy People 2010 Overarching
• Goal
• Elimination of Health Disparities

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Disparity Definition

• Health Disparity Definition
• differences in the incidence, prevalence,
  mortality and burden of diseases and other
  adverse health conditions that exist among
  specific population groups in the United States.
  Research on health disparities related
  socioeconomic status is also encompassed in the
  definition.
• NIH Strategic Plan to reduce and ultimately
  eliminate health disparities. October 6, 2000

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Disparity Classifications

• Racial/ethnic
• Geographic urban and rural
• Gender
• Age
• Socioeconomic groups
• Other

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Health Disparities Research

• Definition is evolving
• Multidisciplinary
• Covers the continuous spectrum of
• characterization,
• explanation
• intervention
• translation and application
• policy formulation
• Baquet C, et al JAAMP

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Cancer Disparities

• Known for decades
• Rates
• Incidence
• Mortality
• Survival
• Stage distribution
• Contributing factors
• Access to quality care and treatment
• Access to pain management and palliative care

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Major Cancer Disparities Affecting African
Americans

• Cancer Incidence, Mortality and Survival Rates
• Female breast
• Colon-Rectum
• Lung
• Prostate
• Other tobacco related cancers cervical,
  esophagus, oral, pancreas, stomach
• Multiple myeloma
• Pain Management and Palliative Care

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Cancer Incidence and Mortality Rates
Incidence and death rates for all cancer sites
and races, 19962000. Hispanic is not mutually
exclusive from whites, blacks, Asian/Pacific
Islanders, and American Indians/Alaska Natives.
Incidence data for Hispanics excludes cases from
Detroit and Hawaii. Mortality data for Hispanics
excludes cases from Connecticut, Oklahoma, New
York, and New Hampshire. Rates are per 100 000
persons and are age-adjusted to the 2000 U.S.
standard population 5-year age groups. Incidence
data are from the National Cancer Institutes
Surveillance, Epidemiology, and End Results
Program for 12 geographic areas and cover 14 of
the U.S. population. Death data are from the
Centers for Disease Control and Preventions
National Vital Statistics System and cover the
entire U.S. population. Data are adapted from
http//www.seer.cancer.gov/csr/1975_2000/.
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Cancer Survival Rates for Blacks and Whites
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Contributing Factors

• Major risk factors/markers and exposures
• Tobacco
• Alcohol
• Occupation
• Diet and nutrition
• Socioeconomic status and environment

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Contributing Factors (continued)

• Delay in seeking diagnosis and treatment
• Access and availability of quality prevention,
  screening and follow up services
• Disparities in cancer treatment and end of life
  care
• Biology and other emerging factors

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Contributing Factors (continued)

• Access, availability, use and delivery of quality
  prevention, screening and follow up services
• Inadequate or no health insurance
• Delay in diagnosis and treatment
• Treatment disparities
• SES
• Low participation rates in clinical trials

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Barriers to Participation in Clinical Research
and Trials

• Patient
• Community
• Health Care Professionals
• Investigator
• Research Institution
• Health System

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University of Maryland Models To Eliminate Cancer
Disparities

• University of Maryland Statewide Health Network
  (CRF)
• Maryland Special Populations Cancer Research
  Network (NCI 5UO1CA-08624904)
• UMES-UMB Comprehensive Cancer Research Planning
  Grant (U 56 NCI)
• Comprehensive Health Disparities Research,
  Training and Outreach Center (P 60 NIH)

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UMSHN Overview

• Mission To reduce morbidity and death resulting
  from cancer and tobacco-related diseases and to
  reduce the disparity in cancer deaths
  attributable to racial/ethnic, cultural,
  geographic, or socioeconomic barriers.

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UMSHN

• The statute states that the Network will support
  a wide variety of prevention and control
  activities related to cancer and tobacco-related
  diseases, including
• Activities aimed at increasing participation of
  diverse populations in clinical trials
• Development of Best Practices Models and
• Coordination among local hospitals, community
  clinics, physicians, and other health care
  providers.

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UMSHN Goals

• To expand the University of Marylands efforts
  related to screening, early detection, follow-up
  and prompt treatment, pain management and
  palliative care for patients in Marylands urban
  and rural underserved regions
• To reduce morbidity and death resulting from
  cancer and tobacco-related diseases and to reduce
  the disparity in cancer deaths attributable to
  racial/ethnic, cultural, geographic, or
  socioeconomic barriers.

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Targeted Cancers

• Lung
• Colorectal
• Breast
• Cervical

• Prostate
• Skin
• Oral
• Other Tobacco-Related Cancers

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Specific Areas of Accomplishment

• Infrastructure Development
• Leveraging Resources
• Partnerships Local Hospitals, Community
  organizations, Faith Based, Local health
  departments, Schools
• Telemedicine Linkages
• Grand Rounds, Tumor Boards, Clinical Trials,
  Consults
• Community education
• Planned home telehealth pilot project Chronic
  disease management in Rural Maryland
• Intensive Clinical Trials Awareness and Education
• Clinical trials infrastructure support for local
  hospitals
• Field Outreach Projects
• Professional Education
• Baseline Health Behavior Needs Assessment

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Telemedicine Linkages

• UMSHN has established 17 telemedicine linkages
  throughout Maryland.
• Linkages provide rapid access to UM clinical and
  research resources.
• Faculty Telemedicine Projects in Radiation
  Oncology, Home telehealth pilot project,
  Psychiatry, and Ophthalmology.
• Increases access to clinical care for urban and
  rural remote regions.

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University of Maryland Statewide Health Network
Sites and Telemedicine/Videoconference Linkages
2.
(3)
1.
(3)
5.
6.
3.
(7)
(1)
(1)
4.
(1)
(1)

• UMSHN Offices
• Central Office
• Baltimore City Regional Office
• Chester (ES Office)
• Salisbury (ES Office
• Hagerstown (WM Office)
• LaVale (WM Office)

Telemedicine/Videoconference Linkages (17)
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Program Implementation

• Sponsors a wide range of community education
  programs.
• Focus on prevention, screening, early detection,
  and treatment of cancer and other tobacco-related
  diseases.
• Programs are conducted at UMSHN offices,
  community-based organizations, churches, schools,
  Head Start programs, youth programs, health
  fairs, and worksites.

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UMSHN Expansion

• Additional counties
• Charles, St.Marys, Calvert
• Prince Georges (P 60)
• Montgomery (P 60)
• Frederick (MSPN)
• Baltimore metro region

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Maryland Special Populations Cancer Research
Network (MSPN)

• One of 18 Special Populations Cancer Research
  Network grants in the Nation funded by NCI to
  address cancer disparities in minority and
  underserved communities by
• Promoting awareness of cancer and clinical
  trials
• Increasing the pool of researchers working to
  address and eliminate cancer disparities

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MSPN -- Goal
   Overall Goal To promote cancer disparities
research, cancer awareness for minority and
medically underserved communities, and increased
participation in clinical trials.
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MSPN -- Initiatives

• Intensive Outreach Efforts for Consumers
• Faith Based
• Ministerial Alliance Against Cancer
• Community-Based
• Lay health workers
• Health Fairs, community workshops
• Focus Groups
• Media-Based
• Baltimore Times, Shore Times, Right on Time
  Weekly Live Radio Program

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MSPN Initiatives

• Intensive Efforts To Reach Health Care Providers
• Clinical Trials Education and Recruitment
• Lecture Series on Clinical Trials and Cancer
• Pilot Project Initiatives
• Grant Writing Workshops (NIH)

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Resources

• University of Maryland Statewide Health Network
  (CRF)
• www.mdhealthnetwork.org
• Maryland Special Populations Cancer Research
  Network (NCI)
• http//mspn.umaryland.edu
• cbaquet_at_som.umaryland.edu