Tuesday, July 1, 2025 7/1/2025

Geospatial drivers of cancer care disparities and their susceptibility to health policy changes

Award Number: K08CA263546
ORGANIZATION: NATIONAL CANCER INSTITUTE
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: TRAINING/TRAINEESHIP
PERIOD OF PERFORMANCE START DATE: 07/01/2022
PERIOD OF PERFORMANCE END DATE: 06/30/2027

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Geospatial drivers of cancer care disparities and their susceptibility to health policy changes - Project Summary Lack of insurance coverage and individual income have been associated with considerable disparities in cancer care for patients with solid organ malignancies, including later stage disease at time of presentation, decreased probability of undergoing cancer-directed surgery, and decreased survival. However, much less is understood about upstream geospatial determinants of health that influence access to and receipt of care for the 20% of Americans that live in rural communities. Furthermore, the degree to which recent health policy changes have impacted cancer care delivery for patients living in rural and socioeconomically vulnerable communities remains unclear. To address these gaps, Dr. Loehrer plans to conduct a population-based observational and quasi-experimental cohort study to evaluate the influence of rural residence, community- level socioeconomic deprivation, and their interaction with insurance coverage on presentation with and management of solid organ malignancies. Additionally, we will evaluate the degree to which Affordable Care Act associated insurance expansion influenced cancer care delivery across rural and socioeconomically diverse communities. The study capitalizes on the novel use of select state cancer registries with geographically linked measures of community-level socioeconomic deprivation. Multilevel quantitative methods, geovisualization, geocomputational approaches, spatiotemporal analyses, and econometric modelling will all be used to describe and visualize complex relationships between insurance coverage, rural residence, local community-level socioeconomic factors in addition to determining the influence of state-level insurance expansion on disparities in cancer care delivery. The study will provide important information on upstream geospatial drivers of cancer care disparities while also evaluating the heterogeneous influence of health policy on rural cancer disparities. Dr. Loehrer is a surgical oncologist and health services researcher at Dartmouth-Hitchcock Medical Center and The Dartmouth Institute for Health Policy and Clinical Practice. His clinical practice includes care for patients with skin, soft-tissue, and liver malignancies while his academic focus is at the intersection health policy, social determinants of health, and equity of cancer care delivery. His long-term career goal is to become an innovative and independently funded health policy researcher with a focus on vulnerable populations. The research plan presented complements both career development and training plans that are focused on geospatial methodologies and application. The award will lay the methodological and policy foundation for follow-up studies on state-specific waivers in Medicaid delivery that are too early to be evaluated at present.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2025 ( Subtotal = $173,880 )
2025	2025	DARTMOUTH-HITCHCOCK CLINIC	1 MEDICAL CENTER DR	LEBANON	NH	03756	GRAFTON	USA	Cancer Research Manpower	000	4	6/3/2025	NON-COMPETING CONTINUATION	$173,880
														Subtotal = $173,880

Issue Date FY: 2024 ( Subtotal = $173,880 )
2024	2024	DARTMOUTH-HITCHCOCK CLINIC	1 MEDICAL CENTER DR	LEBANON	NH	03756	GRAFTON	USA	Cancer Research Manpower	000	3	6/25/2024	NON-COMPETING CONTINUATION	$173,880
														Subtotal = $173,880

Issue Date FY: 2023 ( Subtotal = $173,880 )
2023	2023	DARTMOUTH-HITCHCOCK CLINIC	ONE MEDICAL CENTER DR	LEBANON	NH	03756	GRAFTON	USA	Cancer Research Manpower	000	2	6/15/2023	NON-COMPETING CONTINUATION	$173,880
														Subtotal = $173,880

Issue Date FY: 2022 ( Subtotal = $173,880 )
2022	2022	DARTMOUTH-HITCHCOCK CLINIC	ONE MEDICAL CENTER DR	LEBANON	NH	03756	GRAFTON	USA	Cancer Research Manpower	000	1	7/1/2022	NEW	$173,880
														Subtotal = $173,880

Grand Total All Awards = $695,520

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Geospatial drivers of cancer care disparities and their susceptibility to health policy changes

Award Number: K08CA263546

ORGANIZATION: NATIONAL CANCER INSTITUTE

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: TRAINING/TRAINEESHIP

PERIOD OF PERFORMANCE START DATE: 07/01/2022

PERIOD OF PERFORMANCE END DATE: 06/30/2027

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