Cancer Health Disparities Research

Grantee: Brittany M. Charlton, ScD
Institution: Boston Children's Hospital
Area of Focus: Cancer Control
Grant Term: 7/1/2017 to 9/26/2022

The Challenge: People who identify as lesbian, gay, bisexual, transgender, and queer (LGBTQ+) may have a higher risk of getting certain cancers than those who identify as heterosexual. These cancers include breast, colorectal, and lung cancer, as well as others. But because healthcare experts don’t always ask about sexual orientation or gender identity, that information isn’t always available to researchers.

The Research: Brittany M. Charlton, ScD, is looking at data from 4 large, national studies that include about 15,000 people who identify as lesbian, gay, bisexual, or queer/questioning. Charlton was not able to include transgender or transsexual people in her work because that data wasn’t available.

Together, the studies will provide multiple dimensions about sexual orientation, including identity, behavior, and attraction. She’ll also be able to study subgroups, such as lesbians and bisexuals, rather than just heterosexuals and sexual minorities.

She and her team are reviewing the data to see whether lesbian, gay, bisexual, and queer/questioning people are more likely to develop certain types of cancer, have specific risk factors for cancers, and have differences in health insurance coverage as well as in health care. The team is studying all types of cancer but will focus on colorectal and breast cancer.

Goals and Long-Term Possibilities: Charlton’s goal is to provide more accurate estimates of cancer diagnoses across sexual orientation groups and a more nuanced understanding of risk factors. She hopes her findings will help improve cancer prevention, detection, and diagnosis. 

Grantee: Curtis J. Wray, MD 
Institution: University of Texas Health Science Center in Houston
Area of Focus: Cancer Control 
Grant Term: 7/1/2012 to 5/31/2020

The Challenge: The number of liver cancer diagnoses and deaths from liver cancer are rising. People who don’t have access to routine medical care because of a low income or too little or no health insurance coverage may have the worst outcomes. They are more likely to have advanced-stage liver cancer at the time of diagnosis. They are also more likely to have advanced liver disease, such as cirrhosis.

The Research: Curtis Wray, MD, and his team are collecting data from two hospitals that serve people with low incomes and people who have no or limited health insurance. They are using it to develop a model that will help predict which factors might affect survival in this high-risk group. A diagnosis of late-stage liver cancer often means there is no cure available, so patients may benefit more from palliative care to control and ease symptoms, which can improve their quality of life. Being able to better predict a prognosis may give these patients the ability to make more informed choices about their treatment. Wray is also looking at how the timing of palliative care affects the quality of life for patients in this study.

The Goals and Long-Term Possibilities: Wray’s model may help other healthcare facilities that provide care to cancer patients with low incomes and inadequate or no health insurance.

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: Many cancer patients and survivors lack adequate health insurance coverage  People who are uninsured or under-insured have a greater chance of having cancer diagnosed at a later stage, when it is  harder to treat. Cancer patients who lack adequate health insurance also have a higher chance of dying from cancer compared to patients with adequate insurance.

The Research: Mary C. Politi, PhD, interviewed cancer survivors to understand the challenges they face in selecting and using health insurance. Many survivors said that they weren’t clear about the cost of their cancer care and what their insurance would cover.

Politi used her findings to create a cancer-specific health insurance decision-support tool called Improving Cancer Patients’ Insurance Choices (I Can PIC). It shows cancer patients a personalized out-of-pocket cost estimate for different insurance plans, gives tips on how to use insurance, and lists resources for financial and emotional support.

A randomized clinical trial with cancer patients and survivors showed that patients using I Can PIC felt more confident in understanding health insurance terms than those using a generic tool. They also report a smaller financial burden.

The Goal and Long-term Possibilities: By helping cancer patients and survivors better understand and make an informed choice about health insurance, this tool could improve patients’ access to care. It may also help reduce financial distress and improve how well patients do after cancer treatment.

Grantee: Michael Hassett, MD, MPH 
Institution: Dana-Farber Cancer Institute in Boston
Area of Focus: Cancer Control 
Grant Term: 7/1/2018 to 6/30/2021

The Challenge: Research has shown that disparities in cancer care exist for people who are African American, have low incomes, and who live in rural areas. But few studies have looked at whether race, income level, or location might affect the possibility of recurrence, when cancer returns after it’s been treated. That’s largely because cancer registries that collect and store information about patients who have been diagnosed with cancer haven’t routinely asked doctors to report information about recurrence. 

The Research: Michael Hassett, MD, MPH, and his team developed a set of tools that works with databases of health records determine which patients had a recurrence of breast, lung, and colon cancer – three of the most common types of cancer.

Hassett’s team will use those tools to see whether race or ethnicity, income, or living in a rural area affects recurrence rates. They’ll also look at whether the type of hospital where people received cancer care makes a difference.  

The Goal and Long-term Possibilities: Hassett’s work may help others develop ways to address the health disparities that disadvantaged groups with cancer face.