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UNC Lineberger researchers have received a two-year, nearly $400,000 grant from the American Cancer Society (ACS) and Pfizer to address racial disparities in breast cancer care quality in North Carolina. The grant is part of a national campaign focused on optimizing cancer outcomes for people of color by identifying and eliminating systemic race-related barriers and disparities in the delivery of care that impact outcomes across all cancer types.

UNC Lineberger’s Katherine E. Reeder-Hayes, MD, MSc, MBA.

Katherine Reeder-Hayes, MD, MSc, MBA, associate professor and chief of breast oncology at UNC School of Medicine and UNC Lineberger, and Stephanie Wheeler, PhD, MPH, professor of health policy and management at the UNC Gillings School of Global Public Health and associate director of Community Outreach and Engagement at UNC Lineberger, are heading the UNC-led study.

Pfizer and ACS launched the Addressing Racial Disparities in Cancer Care Competitive Grant Program to promote equity in factors that impact cancer outcomes for Black men and women. The UNC Lineberger grant is one of 10 grants awarded in the program’s first year. In all, the grants totaled more than $3.7 million.

“The work Katie and Stephanie and their colleagues will be undertaking is critical to further identify the factors that drive the disparities in breast cancer prevention, incidence and care. Black women in North Carolina are at far greater risk for dying from this disease, and we need to understand why,” said Shelley Earp, MD, director of UNC Lineberger. “Having breast cancer is challenging enough, and no group should have reduced odds of survival. Drs Reeder-Hayes and Wheeler ‘s research will seek a solution for these disparities.”

Optimizing breast cancer care delivery and outcomes

In the United States, white women have a 3% greater chance of being diagnosed with breast cancer, but Black women are up to 40% more likely to die of the disease, according to the ACS. In North Carolina, Black women are 50% more likely to die of breast cancer than white women, according to state data.

UNC Lineberger’s Stephanie Wheeler, PhD, MPH.

Wheeler said the grant will enable a first step toward building a truly equity-oriented quality improvement effort statewide focused on optimizing cancer care delivery and outcomes.

“Importantly, this work leverages lessons learned over the past decade in reducing the burden of colorectal cancer in North Carolina through the Carolina Cancer Screening Initiative,” Wheeler said. “It also positions us well to extend this approach to other cancers, including lung, bladder and gynecologic cancers where we observe inequitable access to care and disproportionately worse outcomes in medically underserved populations statewide.”

There is a large amount of variation in how breast cancer is treated, Reeder-Hayes said, even within a single state like North Carolina. “Of course, we expect some variation,” she said. “However, we also want to make sure every patient is able to get prompt, high quality care for their cancer, no matter where they live or what resources they are using to pay for care.”

Identifying patterns and engaging communities

The grant will allow the researchers to conduct geospatial research to better understand how those patterns of care vary around North Carolina and where patients and communities could partner with researchers to make sure each patient and doctor has the tools they need to be successful.  Reeder-Hayes and Wheeler agree that bidirectional engagement of community partners, including patients, providers and local leaders, is essential interpret the results and brainstorm solutions.

They will analyze several years of data on breast cancer cases and their treatment across North Carolina, using information from the North Carolina Central Cancer Registry and UNC Lineberger’s Cancer Informatics and Population Health Resource (CIPHR) database of insurance claims information, as well as information about communities from sources like the United States Census’ American Community Survey. In addition, the researchers will compare treatment patterns to national quality standards and build a geographic picture of the strengths and weaknesses of breast cancer care delivery in North Carolina.

One of the strengths of this research approach, Wheeler said, is that it will bring together diverse methodologies, including large secondary database analytics, simulation modeling and community-engaged qualitative methods, as well as a multidisciplinary lens to identify North Carolina sub-populations at greatest risk for poor breast cancer outcomes. “The key to our success will be the extent to which we can build upon and grow community partnerships as we reflect upon the data gathered and consider a range of potential interventions and policies that can drive change and move the needle on persistent cancer health disparities.”

Building upon prior work to fill ‘one more piece of the puzzle’

Reeder-Hayes said the new research will build on UNC studies currently investigating cancer care delivery across the state funded by other sources, including testing interventions to reduce the financial toxicity of cancer treatment and analyzing geographic variation in the timeliness of treatment after a breast cancer diagnosis. The insights generated, she said, will provide one more piece of the puzzle.

“I believe most North Carolinians agree with the core issue at stake in our research – that every person should have a fair opportunity to get high quality cancer care that matches their needs and values,” Reeder-Hayes said. “Fortunately, high quality care doesn’t actually have to cost more, and most health care systems and providers really want to provide the best care. They just need good information on where to improve and where to focus.”

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