cancer disparities: overview, emerging research issues and models in prevention, diagnosis, and...
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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
HHS Overarching Goal
Healthy People 2010 Overarching Goal:
Elimination of Health Disparities
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
Disparity Classifications
Racial/ethnic Geographic: urban and rural Gender Age Socioeconomic groups Other
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
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
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
Incidence and death rates for all cancer sites and races, 1996–2000. 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 Institute’s 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 Prevention’s National Vital Statistics System and cover the entire U.S. population. Data are adapted from http://www.seer.cancer.gov/csr/1975_2000/.
Cancer Incidence and Mortality Rates
Cancer Survival Rates for Blacks and Whites
Contributing Factors
Major risk factors/markers and exposures Tobacco Alcohol Occupation Diet and nutrition Socioeconomic status and environment
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
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
Barriers to Participation in Clinical Research and Trials
Patient Community Health Care Professionals Investigator Research Institution Health System
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)
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.
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.
UMSHN Goals
To expand the University of Maryland’s efforts related to screening, early detection, follow-up and prompt treatment, pain management and palliative care for patients in Maryland’s 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.
Targeted Cancers
Lung Colorectal Breast Cervical
Prostate Skin Oral Other Tobacco-
Related Cancers
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
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.
University of Maryland Statewide Health Network Sites and Telemedicine/Videoconference
Linkages
Cecil
Kent
Queen
Anne’s
Talbot
Dorchester
Wicomico
Somerset
Worcester
Car -
oline
Garrett
Allegany Washington
Frederick
Carroll
Howard
Montgomery
Baltimore
Balt.
City
Anne
Arundel
St. Mary’s
Harford
Prince
George’s
CharlesCal -
vert
Garrett
Allegany Washington
Garrett
Allegany WashingtonCecil
Kent
Queen
Anne’s
Talbot
Dorchester
Wicomico
Somerset
Worcester
Car -
oline
Cecil
Kent
Queen
Anne’s
Talbot
Dorchester
Wicomico
Somerset
Worcester
Ca
rolin
e
Frederick
Carroll
Howard
Baltimore
Balt.
City
Anne
Arundel
St. Mary’s
Harford
Prince
George’s
CharlesCal -
vert
Frederick
Carroll
Howard
Baltimore
Balt.
City
Anne
Arundel
St. Mary’s
Harford
Prince
George’s
Charles
Ca
lvert
Montgomery
Baltimore City Regional Office
Area Served
Baltimore City
Western Maryland Regional Office
Area Served
Garrett CountyAllegany County
Washington County
Eastern Shore Regional Office
Area Served
Caroline, Cecil, Dorchester, Kent, Queen Anne’s, Somerset, Talbot, Wicomico, and
Worcester Counties
UMSHN Sites
UMSHN Offices – 1. Central Office2. Baltimore City Regional Office 3. Chester (ES Office)4. Salisbury (ES Office5. Hagerstown (WM Office)6. LaVale (WM Office)
5.
3.
Telemedicine/Videoconference Linkages (17)
1.
4.
6.
2.(3) (3)
(7) (1)
(1)
(1)
(1)
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.
UMSHN Expansion
Additional counties Charles, St.Mary’s, Calvert Prince Georges (P 60) Montgomery (P 60) Frederick (MSPN) Baltimore metro region
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
Overall Goal:
To promote cancer disparities research, cancer awareness for minority and medically underserved communities, and increased participation in clinical trials.
MSPN -- Goal
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
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)
Resources
University of Maryland Statewide Health Network (CRF) www.mdhealthnetwork.org
Maryland Special Populations Cancer Research Network (NCI) http://mspn.umaryland.edu