Population Health Grant Awardees
The Population Health Program supports cancer research projects that aim to: (1) Improve health outcomes and cancer care, including equitable access to the standard of care, for populations in Washington State, especially among populations for which cancer disparities are most prevalent; (2) Contribute to the understanding of how biological, behavioral, environmental, social, and structural factors affect cancer-related health, especially among populations for which cancer disparities are most prevalent; or (3) Translate results or current knowledge into innovative interventions to improve the health of populations and eliminate cancer disparities.
Cycle 3
May 2023
Use of a Symptoms App and Biosensor to Address Disparities in Unplanned Emergency Department Visits Among Cancer Patients
Fred Hutchinson Cancer Center (Principal Investigator: Scott Ramsey, MD, PhD)
Evaluating the Effect of Rapid Expansion of Telehealth on Breast Cancer Screening Inequities
Washington State University (Principal Investigator: Ofer Amram, PhD)
Cycle 2
September 2022
Improving cancer survivorship care delivery in Washington: Telehealth & Lay Health Educators
Fred Hutchinson Cancer Center (Principal Investigator: Eric Chow, MD, MPH)
Over 40,000 Washington residents are diagnosed with cancer each year. Our proposal builds upon our existing work testing innovative strategies to disseminate more comprehensive cancer survivorship care to Washington residents. Given that disparities in cancer care, including survivorship, are felt most acutely among historically underserved populations, we will focus our proposed study among people of color, those living in rural areas and other neighborhoods with greater socioeconomic disadvantage. To accomplish this, we will work with the Fred Hutch-based Cancer Surveillance System, part of the US cancer registry system, to identify state residents who meet these criteria. We will offer these residents an opportunity to participate in a randomized telehealth intervention study, testing different ways of delivering survivorship care in collaboration with the US National Cancer Institute’s Cancer Information Service, which is operated out of the Fred Hutchinson Cancer Center. To ensure the relevance of our work to the community we serve at large, we will also conduct individual semi-structured qualitative interviews with both cancer survivors and stakeholders from community-based clinics. This effort will enable us to better understand the context and barriers to effective dissemination of survivorship care across Washington State.
Germline, Environmental, Social, and Structural (GEMS) Determinants of Lethal Prostate Cancer in Black Men
University of Washington (Principal Investigator: Yaw Nyame, MD, MS, MBA)
Black men are twice as likely to die from prostate cancer, reflecting a complex relationship among structural, social, health, and biologic factors. Investigators in our group first demonstrated that men with very aggressive prostate cancers were more likely to have inherited genetic mutations in DNA damage repair genes, impacting both screening and treatment of men with inherited prostate cancers. While our group continues to lead in the study of inherited and acquired genetic mutations in lethal prostate cancers, little is known about the effect these biologic, as well as non-biologic, factors have on racial inequities. The Andy Hill CARE Fund Distinguished Researchers grant supported our work building a community-based infrastructure for involving Black men in prostate cancer research design and implementation. Our collaborative will: 1) convene a patient-driven working group to design a culturally-competent and robust biorepository and longitudinal epidemiologic cohort; and 2) build a Washington State cohort to allow for the identification of structural, social, health, and biologic factors associated with lethal prostate cancer among Black men. We hypothesize that (1) involving Black men will facilitate the building of this cohort and (2) that structural and social determinants of health are the primary drivers among Black men. Identifying key drivers of lethal prostate cancer in Black men has significant implications for screening and treatment recommendations.
Multilevel Study of Cancer Inequities in Underserved Populations in Washington: Solutions from Public and Private Data and Patient and Provider Perspectives
Washington State University (Principal Investigators: Dedra Buchwald, MD; Patrik Johansson MD, MPH)
Cancer is the leading cause of death in Washington, but rates are disproportionately higher for rural, non-White, and underserved communities. In our study, we will obtain data from the WA State Cancer Registry (e.g., cancer diagnosis, treatment, death) and link cases with US Census, American Medical Association (practice location), and other data for geospatial analysis of risk factors (e.g., race, access, area deprivation) for cancer outcomes (e.g., stage at diagnosis, survival length). These data will generate maps of hot (negative) and cold (positive) spots for cancer outcomes. We will work with more than 200 Northwest Health Education Research Outcomes Network’s (NW HERON) primary care practices (70% rural) to identify 10 rural practices in cancer hot and cold spots. At each site, we will interview an administrator, providers, and cancer patients. Interviews will identify barriers to and facilitators of screening for preventable cancers (lung, colorectal, breast, cervical) and positive cancer outcomes. Interviews will help identify barriers to and facilitators of positive cancer outcomes to support future public health programs. Medical student ambassadors will assist in conducting interviews and in disseminating findings to participating practices. This work will be a collaboration with the emerging Community Centered Health Home Initiative at Washington State University, which centers on bringing quality healthcare to rural communities.
Cycle 1
April 2021
Night Shift Work as a Carcinogen: Molecular Mechanisms, Biomarkers, and Therapeutic Targets
Washington State University (Principal Investigator: Brieann Satterfield, PhD)
Shift work, which is regularly experienced by millions of individuals (approximately 15% of the US work force), is associated with increased risk of cancer. Evidence from our group and others indicates that disruption of the biological clock is a major contributing factor. Yet, the underlying mechanisms are not well understood, which hampers efforts in prevention and mitigation of this devastating health risk. Our preliminary data show that shift work schedules induce increased DNA damage and alter 24-hour rhythms in the cellular expression of molecular clock genes and DNA damage repair genes. DNA damage and repair mechanisms thus become misaligned, which enhances genomic instability and may underlie the elevated cancer risk in shift work. A logical next step would be to identify diagnostic biomarkers of misalignment between DNA damage and repair processes, and search for molecular targets to develop novel treatments. However, we must first ascertain that our preliminary data pertain to real-world shift work populations. Therefore, in a combined field/laboratory study design, we will investigate the 24-hour expression patterns of clock genes, DNA damage repair genes, other cancer hallmark genes, and markers of DNA damage, in 34 active night and day shift workers. By comparing the night and day shift workers, we will document the molecular mechanisms involved in elevated cancer risk and identify biomarkers and candidate treatment targets in real-world night shift workers.
Understanding the Contribution of the Immune Tumor Microenvironment to the Observed Regional Disparities in Mortality Among Different Lymphoma Types in Washington State
Fred Hutchinson Cancer Research Center (Principal Investigator: Kikkeri Naresh, M.B.B.S., D.C.P., M.D., FRCPath)
Lymphoma is a type of blood cancer; they are grouped into Hodgkin lymphoma (HL) & Non-Hodgkin lymphoma (NHL) types. Disease mortality as a relative proportion to its incidence appears to be higher in the Central region of Washington State as compared to other regions. It is important to understand the scientific basis responsible for these differences to achieve equity of cure rates. The proposal is an exploratory study probing the contribution of a patient’s location and race, to patient outcomes in lymphomas. The two main questions the study will address include:
1) Are there significant differences in the types and proportions of patients’ immune cells within the cancer samples from different regions in Washington State?
2) Does the variability in immune cells contribute to disparities in patient outcomes in Washington State?
The proposal will address these questions in the context of race/ethnicity and consider other socioeconomic and environmental factors that might contribute to these differences.