Cancer Health Disparities: Recovery Act Investment Report

November 2009

Public Health Burden of Cancer

Cancer is the second leading cause of death in the United States after heart disease. In 2009, it is estimated that nearly 1.5 million new cases of invasive cancer will be diagnosed in this country and more than 560,000 people will die of the disease.

Cancer Health Disparities Overview

The National Cancer Institute (NCI) defines "cancer health disparities" as adverse differences in cancer incidence (new cases), cancer prevalence (all existing cases), cancer mortality (death), cancer survivorship, and the burden of cancer or related health conditions that exist among specific population groups in the United States. These population groups may be characterized by age, disability, education, ethnicity, gender, geographic location, income, or race. People who are poor, lack health insurance, and are medically underserved (have limited or no access to effective health care)—regardless of racial or ethnic background—often bear a greater burden of disease than the general population.

Cancer Health Disparities and ARRA

ARRA funding is enabling NCI to devote more resources to projects that address cancer-related health disparities in a wide range of areas—from community health networks to biospecimen collection, from training opportunities for minority researchers to patient navigators to assist cancer patients during their cancer "journey."

• Community Networks for Minority Groups:NCI's Community Networks Program (CNP) is designed to reach communities and populations that experience a disproportionate share of the cancer burden: African Americans, American Indians/Alaska Natives, Hawaiian Natives and other Pacific Islanders, Asians, Hispanics/Latinos, and underserved rural populations. The overall goal of the program is to improve access to—and utilization of—beneficial cancer interventions and treatments in communities that are experiencing cancer health disparities in order to reduce these disparities. ARRA funds have increased support to many CNPs that are already making a difference in the communities they serve. One program focuses on older African Americans in Detroit's socially and economically challenged urban neighborhoods(1); another, the Appalachian Community Cancer Network, addresses cancer health disparities in seven states and conducts community-based participatory research that ranges from focused needs assessments to intervention research to policy assessments and develops pilot research projects that focus on primary and secondary prevention of lung, cervical, and colorectal cancers in Appalachia.(2)
• Biospecimens and Biorepositories:Biobanking is the process of storing biospecimens (materials from the human body, such as blood, tissue, urine, plasma, or saliva) in biorepositories. Cancer researchers need access to an ample supply of high-quality biospecimens in order to explore new ways to diagnose and treat the disease. Samples from members of minority ethnic groups are essential to help understand, at the molecular level, cancer-related differences and similarities observed for these populations. One project will create a biorepository of blood, buccal cells, and/or urine from 90,000 men and women, nearly 70% of whom are African American, and will follow the participants prospectively to identify cancer incidence and deaths.(3) Another project will use a recently established biorepository of specimens collected from a large number of Japanese Americans, Latinos, Native Hawaiians, and whites to study the roles of over-nutrition, obesity, and/or chronic inflammation on carcinogenesis.(4)
• Patient Navigator Research Programs: Although a diagnosis of cancer is challenging for all patients, it is more so for patients and families that face economic and social barriers in accessing the health care system. Patient navigators help patients and their families through the cancer care continuum, from the time they are told about an abnormal finding from a screening or diagnostic test through treatment and survivorship, and assist them in overcoming common barriers to obtaining timely and appropriate treatment and care. ARRA funds are being used to enhance a patient navigator intervention project at six community health centers in Boston, where patient navigators trained in cultural competency will, with the help of Electronic Medical Records, identify cases, provide service coordination, and direct support for patients after an abnormal mammogram or Pap smear.(5) It is also important to develop these programs in a cost-effective manner, and another-ARRA supported project will develop a comprehensive research framework to assess the cost-effectiveness of a patient navigator program targeted at various points in the cancer-care continuum in comparison to usual care. It will address both short-term and long-term cost effectiveness of patient navigator services for three different interest groups—insurance payers, health care providers, and society as a whole.(6)
• Specific Cancers: African Americans/Blacks, Asian Americans, Hispanic/Latinos, American Indians, Alaska Natives, and underserved Whites are more likely than the general population to have higher incidence and death statistics for certain types of cancer. They may also respond to treatment differently. For example, evidence suggests that African American men often recover more slowly from the adverse effects of prostate cancer treatment than white men. These post-treatment difficulties can also affect the relationship with their partners. In an ARRA-supported study, researchers will test an intervention designed to enhance the coping skills of African American prostate cancer patients and their partners. The intervention will be given before treatment starts, and quality-of-life assessments will be made by the men and their partners before, during, and after therapy. The results will be compared with the results from individuals who did not receive the intervention.(7) Another study will address the low colorectal cancer screening rates among Vietnamese Americans using a trained lay health worker supported by a media campaign to increase colorectal cancer screening among 50-74 year olds in Northern California.(8)
• Faculty and Career Development: A diverse cancer research workforce is also critical to address cancer-related health disparities. In keeping with the spirit of the Recovery Act, ARRA funds are being used to hire new faculty and provide career development opportunities to researchers and investigators from diverse populations. Several "minority serving institutions" received faculty recruitment and development grants, enabling the hiring of a surgical oncologist, providing mentoring opportunities for researchers in cancer prevention and control, and improving outreach programs for minority communities.(9, 10, 11)

Selected References

1.  3U01CA114583-05S3 — CNP for Older Underserved African American Adults — Albrecht, Terrance L. (MI)
2.  3U01CA114622-05S3 — Appalachia Community Cancer Network — Dignan, Mark B. (KY)
3.  3R01CA092447-08S1 — Southern Community Cohort Study — Blot, William J. (TN)
4.  2P01CA033619-21A1 — Molecular Epidemiology of Nutrition and Cancer in the Multiethnic Cohort Study — Kolonel, Laurence N. (HI)
5.  3U01CA116892-05S4 — Patient navigation in the SAFETYNET: CONNECTEDD — Freud, Karen (MA)
6.  1RC1CA145799-01 — A comprehensive model to assess the cost-effectiveness of patient navigation — Shih, Ya-Chen Tina (TX)
7.  3R01CA122704-03S1 —  Prostate cancer recovery enhancement (PROCARE) for African American men —  Campbell, Lisa C. (NC)
8.  3R01CA132660-02S1 — Reducing disparities in colorectal cancer screening in Vietnamese Americans — Nguyen, Bang H (CA)
9.  3U54CA091408-09S-MMC and VICC: Partners in eliminating cancer disparities — Adunyah, Samuel E (TN)
10.  3U54CA118638-04S2 — Morehouse School of Medicine/Tuskegee Univ/Univ of Alabama Cancer Center Partnership — Blumenthal, Daniel (GA)
11.  3U54CA091431-09S1 — Howard University Cancer Center/Johns Hopkins Cancer Center Partnership — Smoot, Duane T. (DC)