Tuesday, July 1, 2025 7/1/2025

Reducing health disparities in foregut cancers by using modifiable barriers to predict risk for inequitable care: a novel implementation sciencebased approach

Award Number: K23MD018383
ORGANIZATION: NATIONAL CENTER ON MINORITY HEALTH AND HEALTH DISPARITIES
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: TRAINING/TRAINEESHIP
PERIOD OF PERFORMANCE START DATE: 05/09/2023
PERIOD OF PERFORMANCE END DATE: 04/30/2028

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Reducing health disparities in foregut cancers by using modifiable barriers to predict risk for inequitable care: a novel implementation sciencebased approach - PROJECT SUMMARY Foregut (esophageal, gastric, liver, biliary and pancreatic) cancers account for approximately 20% of new cancer deaths in the United States each year, with an incidence that is projected to increase by almost 70% over the next ten years. These are aggressive malignancies, with complex therapies that require coordinated, specialized multidisciplinary care. There are significant racial and location-based disparities in the utilization of evidence-based guideline concordant therapy (GCT) in foregut cancers. Race and location serve as proxies for multiple, potentially modifiable, barriers along the cancer care continuum, that threaten access to and receipt of care. Identifying these barriers is critical to reduce disparities. Accurate identification of patients at risk for non-GCT is a vital first step to intervene. However, there is no screening tool to identify patients at risk for non-GCT. This project aims to address racial and location-based disparities in foregut cancers by using mixed methods research to develop a risk prediction model and clinic-based screening tool that utilizes modifiable barriers to identify patients at risk for non-receipt of GCT. Together, this clinically applicable and statistically valid model and the high-yield screening instrument will inform an emerging model that identifies patients at risk for non- receipt of care, and facilitates the administration of personalized, solution-focused interventions that can redirect the course of care. My long-term objective is to become an independent researcher focused on identifying, understanding and addressing disparities in access to cancer care. This career development award will help achieve my objective by filling gaps in knowledge and skills through a personalized training program that will include didactics, mini-sabbaticals, experiential training and mentorship in three areas: (1) mixed methods with a focus on patient-oriented research (2) statistical modeling and measure development and (3) implementation science. This training plan will support my proposed project and enable my transition to an independent surgeon-scientist. The specific aims are (1) to identify barriers in access to GCT in patients with foregut cancers through a patient-centric and stakeholder-informed approach (2) to examine the extent to which modifiable barriers predict risk for non-GCT using quantitative modeling and (3) to develop and pilot test a clinic-based screening tool to prospectively identify patients at risk for non-GCT. This proposal is novel in its exploration of underlying modifiable barriers to inform the development of a model that predicts receipt of inferior care, and a clinic-based screening tool to identifiy individuals at risk for disparities in access to oncologic care. While there are currently a range of successful interventions such as patient navigation that have shown promise in decreasing treatment disparities, there is no streamlined way for clinicians to identify patients at risk for non- GCT. This proposal will allow for the identification of patients at risk for health disparities (non-GCT) in a consistent way across providers and embedded in health systems.The results of this study will be used to apply for an R01 to prospectively evaluate the utility of the developed screening tool in a multi-institution study to predict disparities in care and test its invariance by race/ethnicity, location (rural versus urban), socioeconomic status and type of institution.


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 = $161,797 )
2025	2025	UNIVERSITY OF ALABAMA AT BIRMINGHAM	701 S 20TH STREET	BIRMINGHAM	AL	35294	JEFFERSON	USA	Minority Health and Health Disparities Research	000	4	4/25/2025	NON-COMPETING CONTINUATION	$161,797
														Subtotal = $161,797

Issue Date FY: 2024 ( Subtotal = $161,645 )
2024	2024	UNIVERSITY OF ALABAMA AT BIRMINGHAM	701 S 20TH STREET	BIRMINGHAM	AL	35294	JEFFERSON	USA	Minority Health and Health Disparities Research	002	3	7/31/2024	NON-COMPETING CONTINUATION	$161,797
2024	2023	UNIVERSITY OF ALABAMA AT BIRMINGHAM	701 S 20TH STREET	BIRMINGHAM	AL	35294	JEFFERSON	USA	Minority Health and Health Disparities Research	001	2	3/6/2024	CHANGE OF GRANTEE / TRAINING INSTITUTION / AWARDING INSTITUTION	$161,797
2024	2023	UNIVERSITY OF SOUTH ALABAMA	307 N UNIVERSITY BLVD	MOBILE	AL	36608	MOBILE	USA	Minority Health and Health Disparities Research	000	1	3/6/2024	NEW	-$161,949
2024	2023	UNIVERSITY OF SOUTH ALABAMA	307 N UNIVERSITY BLVD	MOBILE	AL	36608	MOBILE	USA	Minority Health and Health Disparities Research	003	1	9/16/2024	NEW	-$1
2024	2023	UNIVERSITY OF ALABAMA AT BIRMINGHAM	701 S 20TH STREET	BIRMINGHAM	AL	35294	JEFFERSON	USA	Minority Health and Health Disparities Research	004	2	9/16/2024	CHANGE OF GRANTEE / TRAINING INSTITUTION / AWARDING INSTITUTION	$1
														Subtotal = $161,645

Issue Date FY: 2023 ( Subtotal = $161,950 )
2023	2023	UNIVERSITY OF SOUTH ALABAMA	307 UNIVERISTY BLVD 380 ADMINISTRATION BLDG	MOBILE	AL	36688	MOBILE	USA	Minority Health and Health Disparities Research	000	1	5/9/2023	NEW	$161,950
														Subtotal = $161,950

Grand Total All Awards = $485,392

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Reducing health disparities in foregut cancers by using modifiable barriers to predict risk for inequitable care: a novel implementation sciencebased approach

Award Number: K23MD018383

ORGANIZATION: NATIONAL CENTER ON MINORITY HEALTH AND HEALTH DISPARITIES

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: TRAINING/TRAINEESHIP

PERIOD OF PERFORMANCE START DATE: 05/09/2023

PERIOD OF PERFORMANCE END DATE: 04/30/2028

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