Cancer Health Disparities Research

Grantee: Mark Lazenby, APRN, PhD, FAAN
Institution: Yale School of Nursing in New Haven, Connecticut
Area of Focus: Cancer Nursing Practice
Grant Term: 7/1/2015 to 6/30/2020

The Challenge: Palliative care offers patients relief from pain and may help improve mood, extend life, and reduce the use of medical services. That’s why the American Society of Clinical Oncology (ASCO), an organization for cancer doctors and other cancer professionals, advises patients meet with a palliative care expert at the same time they’re planning other treatment and care—as soon as they learn they have advanced cancer.

Research shows, though, that doctors may not know much about palliative care. That lack of knowledge includes being unaware of how much religious and cultural beliefs influence people’s lives, especially during the dying process.

The Research: With support from the American Cancer Society (ACS), Mark Lazenby, APRN, PhD, FAAN, is studying how well doctors understand the palliative care needs for Muslims, since Islam is the fastest growing religion in the US. He’s an advanced practice nurse and has a doctorate degree in religion.

Lazenby cowrote a review article published in the Journal of Palliative Care, looking at 20 articles that focused on the care needs of adult Muslims with advanced cancer. He identified 4 major themes in all 20 articles: patient experiences, patient care delivery suggestions, Muslim provider experiences, and definitions of death.

The review ultimately found that the care provided to Muslim patients does not meet the standard for culturally-competent care. Muslim patients end-of-life needs are not being met and neither are the needs of their families.

Now, he’s using those findings to develop strategies in health care systems to address these disparities.

Goals and Long-Term Possibilities: Lazenby believes the findings of his work can help improve the quality-of-life for Muslims who are in treatment for cancer, as well as reduce the barriers to care that may arise from providers not understanding patients’ spiritual beliefs. 

Grantee: Veronica W. Setiawan, PhD
Institution: University of Southern California in Los Angeles
Area of Focus: Cancer Control and Prevention: Health Policy and Health Service
Grant Term: 1/1/2017 to 12/31/2019

The Challenge: Research shows a consistent link between diabetes and pancreatic cancer. In fact, people who have diabetes have double the risk of getting pancreatic cancer than people without diabetes. The risk is highest during the first 3 years after a diagnosis of diabetes. However, there haven’t been many studies about the relationship between recently diagnosed diabetes and pancreatic cancer in minority groups.

The Research: Veronica W. Setiawan, PhD, and her fellow researchers found that African Americans and Latinos with diabetes who developed pancreatic cancer followed the same trends seen in previous studies in whites. They used a well-established database from the ongoing Multiethnic Cohort Study (MEC)  to gather information about both of these  understudied populations.

Their results suggest that being diagnosed with diabetes after age 50 (called late-onset diabetes) can be used as a marker to identify people who have a high risk for pancreatic cancer. In fact, as part of the US Consortium on Chronic Pancreatitis, Diabetes and Pancreatic Cancer, Setiawan’s team is working to develop tests that can better identify patients with recent onset diabetes who actually have cancer at its earliest stage.

Finding pancreatic cancer at an early stage and treating it with surgery provides the best chance of cure.

The Goals and Long-Term Possibilities: Setiawan’s work suggests that patients with recent-onset diabetes who go on to develop pancreatic cancer can be studied for more risk predictors. The group may also be used to develop liquid biopsies, which are needed in the field of cancer research to discover cancer earlier.

Grantee: Mary C. Politi, PhD
Institution: Washington University in St. Louis, Missouri
Focus of Research: Cancer Control and Prevention: Health Policy and Health Service
Grant Term: 7/1/2017 to 6/30/2020

The Challenge: The Affordable Care Act increased access to health care. Still, many cancer patients and survivors lack adequate health insurance coverage. A diagnosis is often delayed in patients who are uninsured or under-insured. That results in their cancer being more advanced before it is found, which makes it harder to treat. Cancer patients without proper insurance are also more likely to die from their illness than those with it.

The Research: To help change this, Mary C. Politi, PhD, at Washington University in St Louis, Missouri is creating a cancer-specific health insurance decision-support tool. In a randomized experiment with cancer patients and survivors, Politi is evaluating the tool compared to insurance decision-support tools on healthcare.gov and a generic insurance decision-support tool.

The Goal and Long-term Possibilities: Politi's study aims to help cancer patients and survivors make an informed choice about health insurance. By helping patients understand their needs and options for the best insurance to meet them, her tool has the potential to improve their access to care. It may also help reduce overall disparities in outcomes, which is how well patients do after cancer treatment.

Grantee: Autumn Kieber-Emmons, MD, MPH
Institution: Lehigh Valley Health Network in Allentown, Pennsylvania
Area of Focus: Cancer Control Career Development
Grant Term: 7/1/2017 to 6/30/2020

The Challenge: Cervical cancer can be treated successfully, especially if it’s found early. Yet, in the US, Hispanic and other minority women are dying of the disease at higher rates than white women. That’s especially true in Texas, California, and the Northeast states.

The Research: Family physician Autumn Kieber-Emmons, MD, MPH,  is studying looking for specific factors that can affect care in cervical cancer survivors that may contribute to the greater number of deaths in Hispanic and other minority women.

Using data from the Centers for Disease Control (CDC) about disparities in the treatment and survivorship of women with cervical cancer. She’s looking at factors that might be linked to the disparities, such as different education levels and insurance coverage. She’s also traveling to 3 counties in Texas and interviewing people. Her goal is to identify any factors that can possibly be changed and might be easiest to address through better health policy and health systems approaches.

Kieber-Emmons’ grant includes funds to train medical students and residents who plan to be primary care doctors about how to meet a survivor’s follow-up needs after treatment for any type of cancer.

The Goal and Long-term Possibilities: Kieber-Emmons’ hopes her team’s work in system changes and physician education will help minority women with cervical cancer live longer. Her ultimate goal is to help correct disparities not only with care for cervical cancer but all cancer care.