PROJECT ABSTRACT
Southeast Asian (SEA) Americans are diagnosed with hepatocellular cancer (HCC) at 8 times the rate of the
general population and at twice the rate of other Asian Americans. Poignantly, most of these patients are
never treated for their cancer. These troubling observations – coupled with the candidate/her mentoring team’s
preliminary data which point to persistent, contemporaneous disparities in cancer care among SEA Americans
– provide the impetus for this K23 mentored career development application. This proposal is the logical next
step to support Dr. Tran’s long-term goal of becoming an independent investigator in disparity research in
HCC. The current proposal includes one of the first comprehensive approaches that focuses on social
determinants of health; builds on this team’s prior data on transportation/distance to cancer care to explain the
foregoing disparities; leverages resources from within the multi-site Mayo Clinic (Minnesota, Arizona, Florida)
and the 3-state (Minnesota, Wisconsin, Iowa), community-based Mayo Clinic Health System; and capitalizes
on Dr. Tran’s passionate interests and growing expertise in HCC and disparities and on the capabilities of her
5 well-established mentors. This 2-aim proposal first seeks to characterize the social determinants of health –
specifically travel-limiting access to cancer care as well as other determinants including joblessness, trouble
finding childcare, limited education, and others – among Hmong and Vietnamese Americans and non-Asian
Americans. Dr. Tran will create and maintain a prospective cohort of patients with HCC – enriched with those
of SEA American heritage – to investigate the relationships between social determinants of health,
ethnicity/race, the rendering of cancer therapy, and cancer outcomes. Then, in aim 2, to understand barriers to
access of cancer care among SEA Americans with HCC, she will conduct one-on-one qualitative interviews to
learn directly from patients how to overcome barriers to the receipt of cancer care. She will also use these
interviews to explore low rates of viral hepatitis treatment and low rates of HCC screening. During the 5-year
grant period, Dr. Tran will acquire new skills in qualitative methods, statistics, and survey research through
coursework and hands-on experience. She will work closely with her outstanding multi-disciplinary team of
mentors (a medical oncologist, health disparity researchers, statistician, and qualitative researcher); develop
and hone skills in managing a multi-site team; acquire greater expertise in writing manuscripts, grants and
become more adept in presenting her data. The long-term impact of this research is to further understand and
obtain strong preliminary data on the social determinants of health in SEA Americans with liver cancer and to
position Dr. Tran to implement novel and feasible interventions in a future R01 application with the goal of
eliminating these disparities in SEA Americans with HCC.
