Presentation on theme: "Cancer Disparities: Overview, Emerging Research Issues and Models in Prevention, Diagnosis, and Treatment Claudia R. Baquet, MD, MPH Associate Professor."— Presentation transcript:
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/.http://www.seer.cancer.gov/csr/1975_2000/ Cancer Incidence and Mortality Rates
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 AlleganyWashington Frederick Carroll Howard Montgomery Baltimore Balt. City Anne Arundel St. Mary’s Harford Prince George’s Charles Cal- vert Garrett AlleganyWashington Garrett AlleganyWashington Cecil Kent Queen Anne’s Talbot Dorchester Wicomico Somerset Worcester Car- oline Cecil Kent Queen Anne’s Talbot Dorchester Wicomico Somerset Worcester Caroline Frederick Carroll Howard Baltimore Balt. City Anne Arundel St. Mary’s Harford Prince George’s Charles Cal- vert Frederick Carroll Howard Baltimore Balt. City Anne Arundel 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 County Allegany 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 Office 2.Baltimore City Regional Office 3.Chester (ES Office) 4.Salisbury (ES Office 5.Hagerstown (WM Office) 6.LaVale (WM Office) 5. 3. Telemedicine/Videoconference Linkages (17) 1. 4. 6. 2. (3) (7) (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 firstname.lastname@example.org