Despite advances in cancer prevention, diagnosis, treatment and survival, disparities in cancer outcomes continue to persist with increased mortality among people living in poverty. Populations in poverty—in particular high poverty and/or persistent poverty (definition and map of persistent poverty counties in the United States can be found at: https://www.ers.usda.gov/data-products/county-typology-codes/descriptions-and-maps/#ppov) are at an increased risk of cancer due to greater carcinogen exposure, low educational attainment, lack of adequate housing, challenges accessing food and food insecurity, and the lack of access to care. All these factors result in increased cancer incidence and delayed cancer diagnosis, treatment, and subsequently, lower rates of survival. In particular, people living in poverty have higher rates of cancers caused by occupational, recreational, or lifestyle exposures (e.g., colorectal, laryngeal, liver, lung) and by human papillomavirus infection (e.g., anal, cervical, oral).
These issues are further exacerbated in areas lacking (or ineligible to qualify as HPSAs) health facilities designated by the Health Resources and Services Administration (HRSA) as HPSAs. However, these populations in the ‘geographically underserved areas’ have previously not been a significant component of cancer control research. Geographically underserved areas refers to (1) areas and populations with high and/or persistent poverty, or (2) areas and populations living with high and/or persistent poverty in Health Professional Shortage Areas (HPSAs) or Frontier and Remote (FAR) area zip codes (definition and FAR codes can be found at: https://www.ers.usda.gov/data-products/frontier-and-remote-area-codes).
GUA Administrative Supplement Initiative: NOT-CA-20-035
The NCI funded six Administrative Supplement applications in September 2020 that proposed to address cancer control research in geographically underserved areas. This administrative supplement provided funding for one year to NCI R01 grantees with an aim to extend their current cancer control research study into GUAs (within the scope of their parent grant) in areas including but not limited to, social and behavioral sciences research, and healthcare delivery.
Lists of geographically underserved areas eligible for research:
PIs: Cathy Bradley, Marcelo Perraillon
Geographic disparities in cancer outcomes are considerable and continue to persist. With the rise of the COVID pandemic, rural and frontier, low-income, and health shortage areas are the least prepared to meet emerging needs caused by the pandemic. Data compiled from our parent grant can be uniquely used to inform what is known about patterns of disparities in these areas and provide insight about the future impact of cancer on the population. In this supplement, we propose to expand our linkage of the Colorado Central Cancer Registry and the Colorado All Payer Claims Dataset to specifically consider areas of High and Persistent Poverty, Frontier and Remote Areas (FAR), and Health and Professional Shortage Areas (HSPAs) in Colorado. We expand the scope of the linkage to incorporate the most current data including time before and after the start of the COVID-19 pandemic and the resulting statewide lockdown that considerably restricted access to routine preventive care as well as assessment of emergent conditions.
PIs: Debra Friedman, Tuya Pal
TIPS: Tool for Inherited cancer Predisposition counseling and testing Study (Point-of-Care Genetic Services) Identifying and providing appropriate genetic counseling (GC) and genetic testing (GT) services is critical to guide care for 5-10% of breast, colorectal, endometrial, pancreatic, and prostate cancer patients and up to 18% of those with ovarian cancer. There are, however, logistical barriers to accessing GC and GT services, given the shortage of credentialed genetic health professionals. This is particularly salient in rural populations and those living in persistent poverty. Consequently, strategies to streamline the delivery of GC and GT services could greatly improve access among these populations. Specifically embedding these services within the existing oncology care setting, referred to as ‘Point-of-Care’ (POC) testing, has shown great promise. Through an existing effort, we developed and tested a web-based 12-minute pre-test GC educational video aligned with national practice standards, which successfully increased knowledge and informed/empowered decision-making in the majority of patients. We have also built an electronic resource in REDCap through which patients may complete components of a GC visit in the comfort of their own home through automated collection of personal and family history and viewing of the GC educational video online. Through this supplement, we plan to study the implementation of this platform, to automate delivery of POC web-based GC services together with GT for inherited cancer, with a rural underserved population who otherwise have limited access to these specialized services. In addition, we aim to assess barriers and facilitators to and impact of this process on these patients and their providers.
PI: Allen K. Greiner
The Aim to Screen Rural Health Supplement leverages the success of the parent Aim to Screen award by moving the touch screen program delivered in underserved urban safety-net clinics to an online delivered intervention with program team support available by telephone and positioned locally in rural southeast Kansas. To ensure sustainability, the project has and will continue to engage local stakeholders – patients, clinicians, and staff – to learn how to best implement the program to result in highest impact (colorectal cancer screening) with the lowest clinic burden. The study will be conducted with 100 patients eligible for CRC screening at the Community Health Center of South East Kansas (CHCSEK), a large rural safety-net primary care setting. Participants will complete an online version of the parent award touch screen program that includes a screening form, informed consent, a baseline survey, and they will receive information on CRC test options including a free FIT test. Three and six-month phone surveys will be completed with all participants. The primary outcome will be CRC screening completion at 6 months.
PI: Aimee James
This supplement study, titled “Picturing Supportt,” will take place in six counties located in rural Southern Illinois. It will examine patients’ supportive care needs during and after a colonoscopy procedure. Colonoscopies require more time and effort from patients than other cancer screening tests, and many providers require that a family member or friend accompany the patient to the procedure. Participants in this study will include patients and the family members or friends who support the patient. Participants will receive cameras to document and contextualize the support they give and receive before and after the procedure. The study will provide findings to identify unmet needs of rural patients and families and inform the development of appropriate clinic and health system tools to support patients and their families. The work will directly inform the intervention for the parent R01 and support both completion of CRC screening and follow-up of positive FITs.
PI: Victoria Seewaldt
The eastern portion of both San Bernardino and Riverside counties are very isolated, with residents traveling long distances to see a physician and not having access to cancer treatment available to Los Angelinos in our word-class academic hospitals. Key health issues facing our rural counties include obesity and diabetes.
PI: Kerri Winters-Stone
Remote delivery of Exercising Together to Geographically Underserved Couples Coping with Cancer. Rural cancer survivors are at elevated risk for a variety of poor health outcomes, even many years after their cancer diagnosis, but are the least likely to have access to programs and resources to improve their health and well-being. Improving health behaviors, such as physical activity, can have a substantial impact on quality of life and survival in cancer survivors and their partners, but rural and poor adults, and particularly cancer survivors, have low rates of physical activity. Survivors living in rural areas and/or in poverty face many barriers to exercise, particularly facility-based, supervised programs which can provide a more effective, safe and supportive engaging environment than unsupervised training. However, delivery of supervised, group programs can be challenging because of limited resources in rural/poor communities. Because we have recently adapted our supervised, group exercise intervention programs to remote delivery due to COVID-19, we now have an opportunity to expand the reach of our studies to cancer survivors and their partners in geographically underserved areas. For this supplement, we will conduct a community readiness assessment to understand the needs of cancer survivors living in geographically underserved counties in Oregon to participate in an exercise trial, and then we will pilot test our remotely delivered, supervised, group-based exercise in a cohort of 30 couples coping with breast, prostate or colorectal cancer. If successful, this supplement could completely widen the scope of how structured evidence-based supportive care programs, like exercise, could reach cancer survivors and their partners regardless of their resources and access.
Cancer Control in Persistent Poverty Areas
Persistent poverty areas represent an important subgroup of U.S. counties with higher disease burden and greater cancer mortality where the health consequences of elevated and continuous levels of poverty over time have not been fully investigated. The intersectionality of structural and institutional level factors along with persistent poverty results in increased cancer incidence, delayed cancer diagnosis and treatment, increased morbidity, treatment-related toxicity, and subsequently lower rates of survival. People living in poverty have higher rates of cancers associated with occupational, recreational, and/or lifestyle exposures (e.g., colorectal, laryngeal, liver, lung) and by infectious agents (e.g., anal, cervical, oral cancers due to the human papillomavirus). It is therefore important to understand the interrelated effects of persistent poverty and other social, economic, and health factors, including race and ethnicity at the structural and institutional levels to implement interventions
Cancer Control Research in Persistent Poverty Areas – Census Tract Level: NOT-CA-22-030
The National Cancer Institute in working with USDA’s Economic Research Service defines persistent poverty areas at the census tract level, wherein 20% or more of the population is below the federal poverty line based on the 1990, and 2000 decennial censuses and 2007-11 and 2015-2019 American Community Survey 5-year estimates. By adopting a definition that includes a much smaller geographical area at the census tract level (compared to county level), there is broader representation across all the states and Puerto Rico to include communities in extreme poverty. Based on the above definition, the enclosed PDF provides a list of census tracts in the U.S. and Puerto Rico that are in persistent poverty.
Notice of Special Interest (NOSI): Expanding Cancer Control Research in Persistent Poverty Areas (P01) NOT-CA-21-071
This NOSI is to provide resources to support highly collaborative, multi-disciplinary Program Projects (P01s) that focus on the development and conduct of cancer control research in low-income and/or underserved populations living in persistent poverty areas. NCI is interested in programs that address the challenges and opportunities related to working in partnership with local clinics and other health-related organizations to enhance the prevention of cancer and delivery of cancer care strategies to reduce the burden of cancer in persistent poverty areas.
Expiration Date: May 08, 2023
For more information: https://grants.nih.gov/grants/guide/notice-files/NOT-CA-21-071.html
Impact of COVID-19 on the Cancer Continuum Consortium (IC4)
A consortium of 17 cancer centers across the U.S. have come together to better understand the impact of the COVID-19 pandemic on the continuum of cancer care from prevention to survivorship, including the potential delays in cancer detection, care, and prevention. This work will further examine whether differences in demographics impact cancer prevention and control, cancer management, and survivorship during the pandemic.
COVID-19 Supplement Sites
To explore COVID-19 Supplement Sites and see more details about funding across cancer centers, click on the icon in the top left corner of the map, click on any pin on the map, or scroll down to view a list of all COVID-19 supplement sites.
|Alvin J. Siteman Cancer Center||660 S. Euclid Ave., St. Louis, MO 63110|
|The Barbara Ann Karmanos Cancer Institute||4100 John R, Detroit, MI 48201|
|Fred Hutchinson/University of Washington Cancer Consortium||Seattle Cancer Care Alliance 825 Eastlake Ave E PO Box 19023 Seattle, WA 98109-1023|
|Holden Comprehensive Cancer Center||200 Hawkins Drive Iowa City, IA 52242|
|Huntsman Cancer Institute||2000 Circle of Hope, Salt Lake City, UT 84112|
|Knight Cancer Institute||3181 S.W. Sam Jackson Park Road, Portland, OR 97239|
|Markey Cancer Center||Elm & 800 Rose St., Lexington, KY 40536|
|The Ohio State University Comprehensive Cancer Center||650 Ackerman Road, Columbus, OH 43202|
|O'Neal Comprehensive Cancer Center at UAB (Coordinating Center)||1824 Sixth Ave. South, Birmingham, AL 35294|
|Stephenson Cancer Center||800 NE 10th Street, Oklahoma City, OK 73104|
|Sylvester Comprehensive Cancer Center||1475 NW 12th Avenue, Miami, FL 33136|
|UC Davis Comprehensive Cancer Center||2279 45th Street Sacramento, CA 95817|
|University of Colorado Cancer Center||13001 E. 17th Place, Aurora, CO 80045|
|The University of Kansas Cancer Center||3901 Rainbow Blvd., Kansas City, KS 66160|
|The University of Texas MD Anderson Cancer Center||1515 Holcombe Blvd., Unit 91, Houston, TX 77030|
|University of Virginia Cancer Center||1300 Jefferson Park Ave, Charlottesville, VA 22903|
|Vanderbilt-Ingram Cancer Center||691 Preston Research Building, Nashville, TN 37232|