Cancer Disparities: Overview, Emerging Research Issues and Models in

Prevention, Diagnosis, and Treatment

Claudia R. Baquet, MD, MPHAssociate Professor Epidemiology/Preventive Medicine

Director Cancer Disparities ResearchUniversity of Maryland School of Medicine and

Greenebaum Cancer CenterChair, 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

QueenAnne’s

Talbot

Dorchester

Wicomico

Somerset

Worcester

Car -oline

Garrett

Allegany Washington

Frederick

Carroll

Howard

Montgomery

Baltimore

Balt. City

AnneArundel

St. Mary’s

Harford

Prince George’s

CharlesCal -vert

Garrett

Allegany Washington

Garrett

Allegany WashingtonCecil

Kent

QueenAnne’s

Talbot

Dorchester

Wicomico

Somerset

Worcester

Car -oline

Cecil

Kent

QueenAnne’s

Talbot

Dorchester

Wicomico

Somerset

Worcester

Caroline

Frederick

Carroll

Howard

Baltimore

Balt. City

AnneArundel

St. Mary’s

Harford

Prince George’s

CharlesCal -vert

Frederick

Carroll

Howard

Baltimore

Balt. City

AnneArundel

St. Mary’s

Harford

Prince George’s

Charles

Calvert

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

cbaquet@som.umaryland.edu