Reducing Cancer Disparities in Colorado

CU Cancer Center sponsors research to help vulnerable populations

By Jessica Cordova

(October 2020) The CU Cancer Center has launched five studies that are focused on addressing disparities in care and outcomes for Black and Hispanic communities in Colorado.

According to the American Cancer Society, Black Americans have shorter survival rates and higher death rates among all racial groups in the United States. Also, Hispanics in Colorado are more likely to be diagnosed with late-stage cancer and have limited access to proper treatments.

To address these disparities, the CU Cancer Center’s Office of Community Outreach and Engagement is leading efforts to promote a better understanding of the causes and to improve access to timely care.

Richard Schulick, MD, MBA, director of the CU Cancer Center and chair of the Department of Surgery, said: “The vision of the CU Cancer Center is to prevent and conquer cancer. Together. Our physicians and researchers are working together to enhance the ability of all Coloradans to have access to the best cancer care.”

The CU Cancer Center’s Office of Community Outreach and Engagement, which was started in 2019, is leading these efforts. This program adds to the Cancer Center’s long-standing history of commitment to advocacy, education, outreach and engagement throughout the state of Colorado.

The office’s goal is to engage people closer to their homes and help them prevent and detect cancer early enough that there is still a chance for treatment to extend their life. These five studies, which each received a $100,000 grant, demonstrate the CU Cancer Center’s commitment to Colorado communities.

“I hope to see the CU Cancer Center be the catalyst of change through breakthrough research and state-of-the-art treatments that decrease the unequal burden of cancer in Colorado,” said Evelinn Borrayo, PhD, associate director of the Community Outreach and Engagement office in the CU Cancer Center and professor at the Colorado School of Public Health.

Head and neck cancer clinical trials  

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Jessica McDermott, MD, assistant professor in the Department of Medicine, aims to increase the representation of underserved populations in head and neck cancer clinical trials.

Because expert care for head and neck cancer is not widely available in community clinics, McDermott plans to identify historic patterns and locations of care for Spanish-speaking head and neck cancer patients. This study will compile data about when and where patients are receiving health care. With census and CU Cancer Center data, McDermott wants to establish longitudinal partnerships with community providers and patients.  

The initiative will also reach and engage key community partners to join in efforts to educate and advocate for sustained preclinical and clinical research involvement of Hispanic patients. A pilot clinic with Spanish-speaking doctors, nurses, and staff, will open within a year.

“This pilot clinic will focus on patients with head and neck cancer, but our ultimate goal is to broaden the scope to include all cancer types,” said McDermott.

The head and neck cancer project aims to improve the quality of patient care at the same time that it promotes research that uncovers racial and ethnic disease differences and treatment responses.

Tejas-PatilLung cancer and personalized care

The benefits of advanced lung cancer treatments, especially precision medicine care that targets specific genetic mutations, have been limited in Colorado depending on the racial and socioeconomic status of some patients.

Tejas Patil, MD, assistant professor of medicine, and his team are creating a database that gathers specific information about patients, including their sex, race, ethnicity, medical comorbidities, insurance status, and use of palliative care.

Analyzing information from the database should help physicians understand how therapies and side effects vary in their patients based on their racial or socioeconomic status. Due to limited representation of patients from diverse backgrounds in clinical trials of lung cancer treatments, information about predictive biomarkers, negative side effects, and effectiveness of the drugs is scarce.

“These disparities can have an incredibly negative impact on those patients. For example, potentially losing years of life that they could have had with precision medicine,” said Patil.


Brain and central nervous system cancer

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Black and Hispanic children diagnosed with brain and central nervous system cancers have worse outcomes than white children do. With a grant from the Office of Community Outreach and Engagement, researchers at CU Cancer Center and Children’s Hospital Colorado are collaborating to better understand these disparities, as well as develop ways to reduce the burden of disease in these populations.

Adam Green, MD, assistant professor of pediatrics, and his team will use clinical records of patient populations to add factors such as primary language and distance away from the hospital. They also will use molecular data collected from patients’ tumor samples to help determine whether there are biologic differences based on race and ethnicity.

“We will look at the effect of all these variables on how widespread patients’ tumors are when they’re diagnosed, their treatment, and their survival,” Green said. “We will analyze all these data to try to determine the source of demographic and socioeconomic disparities.”

With the data, they plan to develop two pilot interventions.

First, they will focus on educating primary care providers who are more likely to diagnose children from underserved, low-income, and rural populations. To do this, Green and his team will use an existing early diagnosis tool called HeadSmart that helps to identify pediatric brain tumor symptoms.

Second, they will conduct qualitative interviews with patients and their families to determine the challenges involved with treatment and enrollment in clinical trials. With the help of multilevel community engagement, Green and his team hope to improve the outcomes of underserved patients diagnosed with central nervous system tumors in Colorado and to develop and refine interventions. 

Leukemia treatments

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Newly diagnosed cases of leukemia depend on genetic and molecular testing. With this information, physicians can determine treatment options best suited for patients based on genetic mutations, fusions, and other biologic features. While these tests are crucial for care, not all patients with leukemia have access to them because they are uninsured or underinsured. As a result, some patients do not have access to cutting-edge treatments.

This study focuses on creating a mechanism that allows for molecular testing in metro Denver, where many uninsured or underinsured patients are treated. The goal is to provide access to this highly sophisticated molecular evaluation by pilot testing the program with 25 patients this year.

“If a patient’s leukemia has an identified abnormality that could be sensitive to a targeted therapy, recommendations for access to these therapies will be made,” said Lia Gore, MD, professor of pediatrics and co-director of the CU Cancer Center’s Developmental Therapeutics Program. “Some patients may also be eligible for newer treatments like our on-campus chimeric antigen t-cell treatments, and this potential option would also be discussed.”

Gore and her team hope to create an approach that can be exported to sites around the state and Rocky Mountain region with minimal modification. The testing also could be modified to provide care to patients with other cancers.

Breast cancer care

Borges 400This year, approximately 4,500 women will be diagnosed with breast cancer in Colorado, according to the American Cancer Society. Among those diagnosed, Black and Hispanic women, younger women, postpartum mothers, and women living in rural parts of the state will have higher mortality rates and worse outcomes.

The breast cancer program at the CU Cancer Center aims to develop tools for better community outreach and engagement for women of color, Spanish-speaking women, and rural women.

The effort, led by Virginia Borges, MD, professor of medicine, starts by using virtual focus groups to identify the unmet needs to breast cancer awareness and survivorship, including understanding the risks and options of lifestyle modifications to reduce the risk of breast cancer and breast cancer recurrence in underserved populations.

Based on the information gathered from these groups, Borges and her team plan to overhaul the existing community outreach materials, which will be available online via social media, local programming, and community centers. They will provide a “breast cancer tool-box” to primary care and underserved care clinics across Colorado.

Finally, Borges and her team will expand the recruitment of breast cancer patients to the Oncology Research Information Exchange Network, which is a research partnership among top North American cancer centers. This effort will ensure diverse representation in translational breast cancer research.

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