Cancer Health Disparities Research

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 its 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 aims to help cancer patients and survivors make an informed choice about which health insurance plan best meets their financial and health needs. By helping patients understand their needs and the best insurance to meet them, her tool has the potential to improve their access to care. It may also reduce overall disparities in outcomes, which is how well patients do after cancer treatment.

The Challenge: Cervical cancer is preventable. And, it can be treated successfully. Yet, 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: Autumn Kieber-Emmons, MD, MPH, a family physician at Lehigh Valley Health Network in Allentown, Pennsylvania, wants to know why. She’s studying families, communities, medical systems, local and regional policy, and insurance regulation. She’s looking for the specific factors that can affect cancer survivorship care and that may contribute to the greater number of deaths in Hispanic and other minority women.

Kieber-Emmons will use data from the Centers for Disease Control (CDC) about differences (disparities) in the treatment and survivorship of women with cervical cancer. She’s looking at factors such as education level and insurance status. She’s also traveling to the regions of interest and interviewing people. Her goal is to identify any modifiable elements that would most easily be addressed through policy and 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 needs after treatment for any type of cancer.

The Goal and Long-term Possibilities: Kieber-Emmons’ ultimate goal is to help correct disparities in cancer care. She hopes her team’s work in system changes and physician education will help minority women with cervical cancer live longer.

The Challenge: Cancer of the cervix is avoidable and treatable if it’s found early. Yet each year, nearly 500,000 women worldwide are diagnosed with this type of cancer. Almost half of them die from it. Almost 90% of women who develop cervical cancer live in developing countries.

The East African country of Malawi has the highest rates of women developing and dying from cervical cancer it in the world. Many Malawian women are affected by HPV and HIV, which increases their risk for cervical cancer. Plus, they don’t have access to adequate preventive, diagnostic, and treatment services.

The Research: Jasintha Mtengezo, MPH, is working on her doctorate degree in nursing at the University of Massachusetts, in Boston. As part of that work, she’s studying women who are HIV positive in Malawi. She’ll focus on how knowledge, attitudes, and other factors affect these women’s cancer-screening behavior.

The Goal and the Long-term Possibilities: Mtengezo hopes her work will spur culturally-appropriate efforts to screen for cervical cancer among HIV-positive women in other first-world countries. Her research may help reduce the differences (disparities) in health care and number of deaths for women with cervical cancer.

The Challenge: Research shows that women with ovarian cancer whose treatment follows National Comprehensive Cancer Network (NCCN) guidelines live longer than those who do not. Yet, fewer than half of women with the disease receive this guideline-based treatment. Black women and women who are uninsured or who receive Medicaid are even less likely to receive guideline-recommended treatment than women who are white or have health insurance. It’s not clear why so many women receive substandard care.

The Research: Rachel Pozzar, MSN, is a PhD candidate in nursing at Northeastern University in Boston. As part of her studies, she’s exploring how women make decisions about treatment and about where they’ll get it and which health professional they’ll see. She’s also looking at barriers to guideline-based care and how women can overcome them.

The Goal and the Long-term Possibilities: Pozzar’s work may reveal ways to promote high-quality care for women with ovarian cancer. Her work has the potential to reduce racial, socioeconomic, and geographic differences (disparities) in outcomes, which is how well women do after treatment, and their survival.

The Challenge: African American men in the United States are 2-times more likely to get prostate cancer and 3-times more likely to die from it compared to European American men. We know socio-economic problems and poor access to health care contribute to these differences. Now recent evidence suggests genetic differences in susceptibility may play a major role in this disparity. Information in a tumor’s genes may provide hints about where the tumors are located in the prostate, making them easier to find with standard biopsy procedures.

The Research: At H. Lee Moffitt Cancer Care & Research institute in Tampa, Florida, Kosj Yamoah, MD, PhD, is developing a genetically-based predictive tool for prostate cancer. His research team’s goal is to make it easier for doctors to find and treat aggressive tumors within the prostate gland, particularly in African-American men.

The Goal and Long-term Possibilities: Yamoah’s findings may improve diagnostic techniques and treatment recommendations from doctors about prostate cancer. His work also may help reduce health disparity among African-American men with prostate cancer.