Every year, over 40,000 people are diagnosed rectal cancer in the US. Many of these patients will receive radiation treatment. Sadly, radiation does not cure all rectal cancers. Many non-genetic, or “epigenetic,” factors control how cancer cells are built and how they respond to treatment. Often, these factors mimic biology seen in normal, non-cancer cells. Radiation causes normal intestine cells to change into stem cells that repair damage. We suspect these radiation-induced stem cells also occur in rectal cancer. We propose to test whether these radiation-induced stem cells cause rectal cancer to resist radiation. We will also map out the epigenetic factors that allow these stem cells to arise. To do this we will use new methods we have developed to show the fine details of epigenetic regulation. From our data, we will discern new mechanisms of rectal cancer radiation response. We hope these studies will yield novel treatments to combine with radiation for rectal cancer.
African Americans have the highest percentage of new cancer cases in the U.S. but are less likely to be in research. People ages 13-39 partake in research less than any other age group. Hispanic patients also participate less if they do not speak the language or their culture is different, so they need different care. Patients from rural areas have a hard time getting to a cancer treatment center or need help figuring out the system once they are there. People without health insurance or poor insurance plans have access to care and research issues. AHWFBCCC wants to make sure everyone has access to the best cancer care possible. The best care possible may mean a patient joins a clinical trial. It is important to make sure all people are spoken for in studies that look at new treatments or supports for cancer patients. To meet that goal, we started a population health navigator program- people who are from the community who can help people learn about cancer, how to prevent it, what screening is needed and what treatments are available. If someone is diagnosed with cancer, the navigator will help to remove barriers to care and will talk with them about research as part of their care.
The low number of minority populations in clinical trials leads to higher mortality in these groups. It is important to address these inequities in order to address these cancer disparities. By developing a program that addresses the needs of patients, clinics, institution and communities, we hope to support minority patients seeking care at DCI to lower the barriers to accessing life-saving cancer clinical trials.
North Carolina (NC) has the largest American Indian (AI) population east of the Mississippi River. Yet, we do not know much about the health and health care of AIs in NC. We do know cancer is their number one cause of death. We need to better understand cancer and cancer-related needs in this group to reduce the burden of cancer. Three NC cancer centers joined together in 2021 to learn more about how to help AIs with cancer. We will study how cancer of the liver and stomach affects American Indians in NC. And we want to find and create resources for our AI community. First, we will use the NC Cancer Registry and health insurance files to learn more about how and where AIs in NC get cancer care and any potential disparities. We will then have a community event to test for and treat the top cause of stomach cancer. Lastly, we will educate about liver and stomach cancer to help prevent them. This work will help AIs in NC by showing what the greatest needs are and the opportunities for better care. The long-term goal is to improve cancer outcomes in all AIs.
Clinical trials are used to test new cancer treatments that may improve patient survival. Black or African American (AA) patients are less likely to be treated in a clinical trial than White patients. One way to try to reduce this inequality is to use specially trained staff to help people with cancer better understand clinical trials. These staff are called patient navigators. In this project, we will use patient navigators to teach and support patients with cancer and help them overcome barriers to joining clinical trials and gaining access to new treatments. These navigators will focus on making sure all Black/AA patients with endometrial cancer or prostate cancer who receive care at the Cancer Center are considered for cancer clinical trials. In addition to teaching patients about clinical trials, the navigators will also help them better understand the hospital system and make and keep appointments. They will assist patients who live far from the cancer center with travel and with finding a place to stay when they come for appointments. They can connect patients to finance counselors, social workers, and other helpful community services. To understand if the project is a success, we will compare the total number of patients, by race, treated on cancer clinical trials before and after the project. We will also study why patients chose not to be on clinical trials even when they are eligible. This information will help us design new projects in the future.
Cancer care can be tough to navigate. Atrium Health Wake Forest Baptist Comprehensive Cancer Center (AHWFBCCC) wants to make sure all patients can access the best cancer care as easily as possible. Sometimes the best treatment outcomes are achieved by joining cancer research studies. To be sure treatments studied in cancer research are reliable and consistent for all patients, it is important that all groups are represented. African Americans have the highest percentage of new cancer cases in the U.S. and the worst outcomes, yet are less likely to be represented in research. Due to language and cultural barriers, Hispanic patients also have low research participation rates. Adolescents and Young Adults have the lowest research participation rate of any age group. It can also be harder for patients who live outside of the city to get cancer treatment because of where they live. To help ensure all groups are included in studies, AHWFBCCC created a population health navigator (PHN) program to help community members learn about cancer, how to prevent it, what screening is required, and what treatments are available. If someone is diagnosed with cancer, the PHN can help to remove barriers to care and help patients learn about the benefits of cancer research. With PHNs, AHWFBCCC hopes to increase research participation so that all can be represented.
New treatments for cancer patients are developed through studies called clinical trials. All cancer patients should understand what treatment options are available to them, including clinical trials. However, few patients are treated on clinical trials. Minority groups are even less likely to be treated on clinical trials. One way to encourage more diverse participation is to offer education. We will create a short video that shows the basics of clinical trials. The video will include diverse patients and doctors from UNC that have experience with clinical trials. The video will teach cancer patients about the basics of clinical trials and encourage them to ask their doctor if a trial could be right for them. We will also place printed materials in waiting areas for patients to take home and discuss clinical trials with their family and caregivers.
North Carolina (NC) has the largest American Indian population east of the Mississippi River. Many American Indians in NC smoke cigarettes, which can lead to lung cancer. Yet, we do not know much about the needs of NC American Indians related to tobacco use and lung cancer. Three NC cancer centers joined together in 2021 to learn more about how to help American Indians improve cancer outcomes. In this study, we will first explore how often American Indians use treatment to help them quit tobacco. We will also explore whether they have been screened for lung cancer and what cancer treatments they receive. Second, we will ask American Indian community members about quitting tobacco, lung cancer screening, and their healthcare. Finally, we will work with American Indian community members to modify a quit smoking program to make it more relevant to them. We will also work with them to modify materials that tell people about lung cancer screening. This information will help American Indians by helping them quit tobacco and detect lung cancer sooner, which will help improve the health of American Indians in NC.
Black patients are more likely to die from breast, prostate, lung, and colorectal cancers than White patients. There are many reasons for these differences, including difficulty receiving life-saving treatment. New treatments that match the type of cancer a patient has to specific drugs have been developed and has changed the way we treat the disease. The first step to getting these new treatments is for patient’s tumors to be tested for specific changes. However, Black patients are less likely to receive these tests and to receive the relevant treatment. If progress is not made in improving access to testing, Black patients will continue to have lower access to these lifesaving treatments, causing even bigger differences in survival. In this study, we will develop a program to understand the needs of Black cancer patients and provide support to ensure that they receive appropriate tests and treatment. To help design the program, we will interview Black patients and healthcare providers on what the needs are and provide navigation support to patients. We will measure how effective the program is in increasing testing and treatment among Black patients. In the future, we hope to use this data to develop broader strategies that will improve Black patients’ access to tests, clinical trials, and treatment.
Funded by the Dick Vitale Pediatric Cancer Research Fund in partnership with Mat Ishbia and Justin Ishbia
Years of cancer research have shown that combining therapies that work differently virtually always works better than when therapies are used alone. New medications are being discovered that change the way that genes are turned on and off. At this same time, treatments are also being developed that use the body’s own immune cells to find and attack cancers. Both of these treatments have been shown to work alone on specific cancers. But each have known limits. We are asking whether combining these treatments will result in a new approach to fight two aggressive cancers: Ewing sarcoma and osteosarcoma. We predict that combining these treatments will result in an effective and well tolerated therapy.
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