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Closing the treatment gap

Pink breast cancer image

Boston is home to the world’s best health care, including groundbreaking research in cancer. But while mortality rates from breast cancer are decreasing across the board, black women here are still 25 percent more likely to die of the disease.

So why are so many black women dying of breast cancer here?  

“It’s true that there have been tremendous discoveries in our understanding of the disease in recent years,” said Karen Freund, MD, MPH of Tufts MC Clinical and Translational Science Institute. “Yet we are not translating those discoveries consistently into day-to-day clinical practice. This new study will help us do that.”


The new study, called Translating Research Into Practice (TRIP), brings together six of Boston’s top hospitals and institutes to develop information sharing and systems that will reduce health disparities for vulnerable patients. Research teams from each hospital will assist in the care of 1,100 Boston women seeking breast cancer care over a five-year period. The collaboration is made possible by an $8.6 million grant from the National Institutes of Health (NIH) National Center for Advancing Translational Sciences (NCATS).

“While we are looking specifically at breast cancer, the goal is to find a system that provides consistent care for any disease, so no one falls through the cracks,” said Dr. Freund, one of four lead investigators on the project.

Consistent care

Through TRIP, researchers will implement an intervention that includes three evidence-based strategies known to reduce delays in care but that have never made it into practice for a number of reasons.  

  • A navigator for every patient to solve problems and provide support and guidance through the complex health care system
  • A regional registry to help providers and navigators track their patients
  • Resources to help navigators identify social determinants of health that could act as barriers to care (e.g., food and housing insecurity)

“Many hospitals and clinics have something called ‘patient navigators’ to assist in providing all types of care,” noted Dr. Freund. “But there is no standard definition of what a patient navigator does or what type of skills or training they should have. Some navigators are social workers or provide social services, others are nurses or nurse practitioners, and still others have administrative skills. This leads to inconsistencies.”  

Dr. Freund says part of the work will be to write a job description, complete with a standard scope of work and list of necessary trainings, so delete the ambiguity of the navigator position.

A regional registry will ensure women with the disease receive needed treatment and follow up care, even if they change hospitals. Partner organizations – including the Boston Breast Cancer Equity Coalition, Boston Patient Navigator Network, the University of Chicago and the Institute for Translational Medicine, will build a coalition of stakeholders and provide community engagement support.  

Patient enrollment is expected to begin in the summer of 2018 following a start-up phase, consisting of stakeholder interviews, implementation planning, and development of the registry and screening tools. Patients will be enrolled from Tufts Medical Center and the six other sites: Boston Medical Center, Brigham and Women’s Hospital, Brigham and Women’s Faulkner Hospital, Beth Israel Deaconess Medical Center, Dana-Farber Cancer Institute and Massachusetts General Hospital.