Addressing Cancer Disparities in Northern Manhattan

November 19, 2019

The risk of dying from breast, colon, liver, and prostate cancer is much greater for people who live in Washington Heights than for those living in other parts of New York City, New York state, and the United States. 

Researchers and physicians at the Herbert Irving Comprehensive Cancer Center at Columbia University Irving Medical Center and NewYork-Presbyterian—situated in the heart of this community—have been working to address this disparity.

For the past five years, the cancer center has participated in the National Cancer Institute’s Community Oncology Research Program (NCORP), which brings NCI-funded cancer trials to more communities through 46 sites across the United States. Columbia's cancer center is one of only 14 NCORP sites focused on offering the latest cancer treatments to minority and underserved patients, which make up the population of Washington Heights and adjacent neighborhoods. 

“NCORP allows us to engage in more of the research that will have the biggest impact on cancer patients from our local community,” says Gary K. Schwartz, MD, deputy director of the Herbert Irving Comprehensive Cancer Center and one of the three principal investigators of Columbia’s Minority/Underserved NCORP. 

Columbia’s cancer center received a new six-year grant from NCORP this year, and the CUIMC Newsroom talked to Dr. Schwartz about how NCORP mirrors and amplifies the cancer center’s mission and benefits patients in northern Manhattan.

 

What are some of the most pressing cancer disparities that you see in the Washington Heights community, and how is NCORP helping to address them?

We see many more patients in our neighborhood dying from breast, colon, liver, and prostate cancer, but the reasons for this are not clear. We don’t know if this is happening because these cancers are more aggressive in our local population or if there are underlying social causes delaying access to early diagnosis and treatment. 

One barrier we have encountered is financial toxicity, where the cost of cancer care prevents patients from getting the treatment they need. Through NCORP, we can participate in more studies to better understand this and other barriers to treatment encountered by patients in our community, so that we can improve their access to care.

In one national NCORP study, we are working to estimate the financial burden of cancer treatment on patients with newly diagnosed metastatic colorectal cancer and their caregivers. The study will look at whether financial hardship affects access to treatment and survival. For instance, the study will ask whether some patients had to quit their jobs while undergoing cancer treatment, which may have then made their medications unaffordable and had a negative impact on their survival. The study is also looking at the effect of financial hardship—from loss of income or the cost of care—on health-related quality of life. 

If this study identifies risk factors for financial toxicity, we may be able to develop strategies to help reduce the financial burden of cancer treatment on patients and their caregivers. 

 

Why is it important to increase participation in clinical trials among patients from minority underserved communities?

Part of our cancer center’s mission is to ensure that patients in our local community have access to major advances in cancer care—including therapies that are only available in clinical trials. Our cancer center is located in the heart of Washington Heights, a neighborhood that is largely populated by Dominican and other ethnic minority residents, and we work diligently to ensure that the enrollment in our clinical trials reflects the diversity of our patient population. 

Across the country, fewer than 20% of patients with cancer who enroll in clinical trials are from racial and ethnic minorities. In addition to serving our mission, it is very important from a scientific perspective to include volunteers from all racial and ethnic groups in clinical trials to study new treatments. The effectiveness of some therapies may vary among different racial and ethnic groups based on genetic makeup, so we need to ensure that our clinical trials include diverse groups of patients to develop the most effective therapies for all. 

Most NCORP sites are community cancer centers that work with small oncology practices. But we are different; our comprehensive cancer center is an academic institution with significant scientific expertise and a mission of helping patients in our own community access the latest advances in cancer treatment. 

As a Minority-Underserved NCORP site, we have access to and participate in clinical trials that help us diversify our clinical trial enrollment. These trials often ask specific research questions about the biology of cancer and the cancer experience in underrepresented groups. NCORP also supports cancer patient advocates and navigators who work with our clinical departments to identify and overcome barriers to clinical trial enrollment among our minority patients. 

During the first five years of our work with NCORP, we’ve consistently enrolled at least one-third of all clinical trial participants from underserved populations in our community. That’s an important reason why NCORP selected us for another six-year grant.

 

As a comprehensive cancer center, we run hundreds of trials. How does being a part of NCORP add to our clinical trial portfolio?

One of the cancer center’s goals is to understand why drug therapy ultimately fails for some of our patients, and NCORP has designed some trials to help us answer this question. 

In one study, the Early Onset Malignancy Initiative, we’re studying cancer in people diagnosed with six types of cancer—breast, prostate, colon, liver, kidney, and multiple myeloma. Many of these tumors occur at a younger age and are more aggressive in African Americans, but we don’t know why. Are these differences due to the tumor itself or genetic factors? Are there environmental or dietary factors that increase risk in patients from northern Manhattan? 

The study will look for differences in the way patients from our community respond to treatment and investigate whether there are genomic factors driving that process. We’re collecting tumor and blood samples from around 2,000 patients—before they start treatment and then when treatment stops working—to look for biomarkers of disease progression. It’s expensive to perform these biopsies because they rely on CT scans to access the precise location of the tumor, so the grant will help pay for this.

Another study, the NCORP Tissue Procurement Protocol: An NCI Cancer Moonshot Study, will focus on why some patients with metastatic cancer stop responding to targeted therapy. This study will be available to all patients with newly diagnosed advanced cancer who are being treated with targeted therapies at NCORP sites. The study will look at the molecular profile of these patients to help answer this question. 

In addition, the DNA sequencing results of these tumors will be made available to patients who may not otherwise be able to afford this advanced testing. If the sequencing results identify targetable mutations, we could offer additional treatment options to the patient. 

 

Are there other efforts at Columbia to address cancer disparities among underserved populations?

The cancer center has always prioritized community outreach and engagement to reduce the cancer burden and cancer-related health disparities in our local community and the surrounding areas that we serve. 

Gary K. Schwartz, MD (CUIMC)

Through our Community Outreach and Engagement program, we conduct health education programs in the community and on our campus to improve vaccination against HPV [the virus that causes cervical cancer], increase physical activity, reduce smoking, and encourage other behaviors that we know reduce the risk of cancer. Our community outreach also promotes cervical, colon, and breast screening to increase early detection of cancer.

The community engagement program is currently collaborating with us to increase enrollment in an NCORP trial comparing the effectiveness of conventional digital mammography with a new type of imaging called digital tomosynthesis, or 3D mammography. Together we are working with community-based organizations to educate people in our community about breast cancer risk and offer them the opportunity to participate in this important study.

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The Herbert Irving Comprehensive Cancer Center's Minority/Underserved NCORP site is supported by a grant from the National Cancer Institute (UG1CA189960). Subsites include James J. Peters VA Medical Center, Bronx, NY, and Lawrence Hospital, Bronxville, NY.

Principal investigators are Gary Schwartz, MD, Andrew Lassman, MD, and Alfred Neugut, MD, PhD.