American Cancer Society
Karen Freund has received the American Cancer Society Harry and Elsa Jiler Clinical Research Professor award for her program on understanding the impact of the health care system on disparities in cancer outcomes for vulnerable populations, determining how patient navigator programs help reduce barriers to care in vulnerable populations, and understanding the role of health insurance reform in reducing health disparities. The Clinical Research Professor is an award offered to mid-career investigators with leadership roles concerning contributions in the area of cancer control that have changed the direction of clinical, psychosocial, behavioral, health policy or epidemiologic cancer research.
Longitudinal Follow-up to the National Faculty Survey
In 1995, over 1,900 academic faculty from 24 medical school completed the National Faculty Survey (NFS). Under the leadership of Phyllis Carr MD as PI, the NFS collected information about demographics, professional goals, academic environment, perceptions of bias, discrimination, and harassment, compensation, and work/life balance. The original survey provided seminal data on recruitment, promotion and retention of women and underrepresented minority faculty in academic medicine.
In 2011- 2012, we invited 1,300 faculty members from the original survey to complete a follow up survey. The data serves as the first longitudinal follow up of a nationally representative sample of faculty in medical schools. The specific aims of the project are:
- To measure longitudinal career outcomes for women compared with men, and under-represented minority women faculty compared with majority women, along the following domains:
- Satisfaction with academic career
- Productivity, including grants and publications
- Academic rank
- Identify how individual (e.g., hours of work, family responsibilities), institutional environment (e.g., support, work environment) and factors that intersect the individual and institution (e.g., racial discrimination, sexual harassment) are associated with career advancement outcomes form women compared with me, and for under-represented minority women compared with majority women.
We also conducted key informant interviews with administrative faculty at the medical schools to collect information regarding institutional policies and practices that differentially facilitate or impede faculty advancement based on gender or under-represented racial/ethnic minority status.
Partners on this project include Multi- Principal Investigator Dr. Phyllis Carr (Massachusetts General Hospital), Dr. Norma Terrin, co-Investigator (Research Design Center/Biostatistics Research Center), Dr. Samantha Kaplan, co-Investigator (Boston University), and Dr. Anita Raj, co-Investigator (University of California, San Diego). Dr. Carr was the Principal Investigator of the 1995 survey. This work is supported by the National Institute of General Medical Sciences.
The National Patient Navigation Research Program
Dr. Freund serves as Chair of the Design and Analysis Committee of the National Patient Navigation Research Program (PNRP), an NCI funded cooperative group to conduct a controlled trial on the impact of patient navigation on timely cancer care in vulnerable populations. The PNRP looks at the impact of patient navigation interventions to reduce or eliminate cancer health disparities. The Avon Foundation provides additional support for the secondary analyses of the Patient Navigation Research Program (PNRP). Current research questions addressed through this initiative include:
- The impact of comorbidities on cancer care and patient navigation
- The influence of household size and composition on delays in cancer care, and the ability of navigation to ameliorate their impact
- Whether patient navigators with personal experience with cancer care are more effective in their position than navigators without cancer treatment experience
- Understanding which tasks that navigators perform are associated with best practices and more timely care for their patients
- The impact of patient navigation on the quality of breast cancer treatement
- The impact of patient navigation for patients with abnormal Pap tests.
- The impact of patient navigation in women with abnormal breast cancer screening
Insurance Instability and Disparities in Chronic Disease Outcomes
Racial and ethnic health disparities in the processes and outcomes of chronic disease care are pervasive, well documented, and consistently linked to health insurance coverage. Insurance instability (the frequency of switches in insurance coverage or gaps without coverage), may contribute to disparities in outcomes of chronic disease care. With the explicit goal of reducing disparities, Massachusetts (MA) Health Insurance Reform has now extended comprehensive health insurance coverage to 98% of the state’s residents, with disproportionately greater gains in coverage among racial/ethnic minorities and the poor. To examine if MA insurance reform has lessened health disparities through increased insurance stability, our specific aims are:
- To examine changes in insurance instability pre- and post-reform, overall and comparing racial/ethnic specific minority populations to whites. We hypothesize that (a) Insurance instability decreased in the post-reform period and (c) Insurance instability decreased more for racial/ethnic minorities.
- To examine whether patients receiving care post-insurance reform had better processes of chronic disease management and improved health outcomes, compared with patients receiving care pre-insurance reform, and whether such patterns vary by race/ethnicity. We hypothesize that improvements in processes and outcomes of chronic disease management were greater among racial/ethnic minorities who benefited the most from insurance reform, resulting in reduced disparities.
- To assess whether patients with more favorable insurance stability had better processes of chronic disease care and improved health outcomes compared to patients with less favorable insurance stability, and whether racial/ethnic minority patients experienced disproportionately greater gains. We hypothesize that greater insurance stability will be associated with improved processes and outcomes of chronic disease management, resulting in reduced disparities.
We will assess the processes and outcomes of care for six highly prevalent, chronic conditions before and after the implementation of MA Health Insurance Reform: diabetes, hypertension, hyperlipidemia, congestive heart failure, asthma, and chronic obstructive pulmonary disease. We will utilize existing electronic medical records on over 110,000 subjects from Boston Medical Center and eight of its affiliated federally qualified Community Health Centers, the largest safety net institution in New England that serves African American and Hispanic communities, and Tufts Medical Center, which serves a large Asian American community in Boston’s Chinatown. When the study is completed, we will provide empiric data on the direct impact of insurance reform and insurance instability on health disparities in multiple populations.
Partners on this project include Multi- Principal Investigator Dr. Nancy Kressin (Boston Medical Center), Dr. Amresh Hanchate, co-Investigator (Boston University School of Medicine), Dr. Norma Terrin, co-Investigator (Tufts Research Design Center/Biostatistics Research Center), and Dr. Tracy Battaglia, co-Investigator (Boston Medical Center). This work is supported by the National Institute on Minority Health and Health Disparities.
Cancer Health Disparities Network (CDRN) Cohort
The aim of this study is to evaluate the feasibility of recruiting, collecting survey and biospecimen data, and following a cohort of 450 diverse individuals from underserved populations from various geographic areas of the United States. This study proposes to establish the Cancer Disparity Research Network (CDRN) Cohort, a resource for studies of factors related to cancer incidence among underserved populations. The CDRN Cohort will pool data and initiate new studies not previously undertaken in underserved populations. Targeted underserved populations that will compose the CDRN cohort will be recruited by research teams from the following study sites:
- The Ohio State University Comprehensive Cancer Center (100 residents of Appalachia)
- University of Illinois at Chicago (100 Hispanics)
- Fox Chase Cancer Center (Philadelphia, PA) (100 African Americans)
- University of Pennsylvania (50 African Americans)
- Tufts Medical Center (100 Asians)
The Ohio State University Comprehensive Cancer Center is the Coordinating Center for the CDRN cohort feasibility study. The goals of the Tufts study site are to:
- Recruit 100 Asians to the CDRN cohort
- Collaborate with the CDRN Coordinating Center to refine study procedures, forms, questionnaires, and process for collecting and mailing biospecimen data.
- Interact with the other cohorts/study sites to conduct two pilot studies:
- Determine the impact of the Affordable Care Act (ACA) on cancer prevention and screening behaviors; and
- Explore the response to chronic stress (telomere length and Tumor Necrosis Factor (TNF) and C-reactive protein (CRP) concentrations) with the characteristics of cancer risk profiles for each of the populations and the cohort as a whole.
Patient Navigation Research Program Database
The national Patient Navigation Research Program recruited nearly 10,000 subjects with abnormal cancer screening, and over 2000 subjects with incident cancer and precancerous lesions into a controlled trial of patient navigation compared with the control of usual care. Subjects were predominantly from under-insured and minority populations. Subjects were recruited from nine centers (comprised of 21 local community health centers or ambulatory care sites). We collected clinical and patient navigation information for eligible participants 18 years and older who had an abnormal breast, cervical, colorectal, or prostate concerning screening result. Clinical information included type of screening abnormality, type and stage of cancer, dates and types of clinical services, and clinical outcomes. Patient navigation information barriers identified as part of the care delivery process, activities to address the barriers, and services provided are also in the database. Other information included race/ethnicity, gender, primary language, and health insurance coverage.
The program highly values collaborative research partnerships. Current collaborations include the following:
Collaborations within Tufts Medical Center
- The Center for Health Solutions – Susan Parsons MD MRP, Laurel Leslie MD, and Carolyn Leung Rubin EdD
- The Research Design Center/Biostatistics Research Center – Norma Terrin PhD
- Lahey Clinic Medical Center – Zoher Ghoghawala MD
- Addressing Disparities in Asian Populations through Translational Research (ADAPT)
- Asian Women for Health and the Asian Breast Cancer Project – Chien Chi Huang MS
- Greater Boston Chinese Golden Age Center
- Boston University/ Boston Medical Center, Women’s Health Unit – Tracy Battaglia, MD, MPH, Bonnie Sherman, PhD, Sharon Bak, MPH, Ann Han, MPH
- Boston University/ Boston Medical Center, Health Disparities/Equity Unit – Nancy Kressin, PhD, Amresh Hanchate, PhD
- Boston University/ Boston Medical Center, Obstetrics and Gynecology – Samantha Kaplan, MD, Rebecca Perkins, MD, MSc
- Boston University/ Boston Medical Center, Pediatrics – Natalie Pierre Joseph, MD
- University of Utah School of Medicine – Carrie Byington, MD
- Massachusetts General Hospital – Phyllis Carr, MD
- University of California, San Diego – Anita Raj, PhD
- Ohio State University – Electra Paskett, PhD
- University of Illinois, Chicago – Elizabeth Calhoun, PhD, Julie Darnell, PhD
Program on Equity in Science and Health
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