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Improving cancer health equity by targeting physician networks

Award Number: R37CA263936
ORGANIZATION: NATIONAL CANCER INSTITUTE
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 07/15/2021
PERIOD OF PERFORMANCE END DATE: 06/30/2025

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Improving cancer health equity by targeting physician networks - PROJECT SUMMARY Disparities in outcomes among cancer patients who are rural-residing, with lower SES, and a racial minority are well-documented and have garnered significant national media attention. Recent retrospective cohort studies reported minimal rural/urban and racial disparities in outcomes when patients had uniform access to care, highlighting the critical clinical importance of standardizing access to cancer care. Data made available which evaluates access to specialists typically determines access based on a per capita count of individual specialties, which does not adequately capture access to interdisciplinary teams of specialists. A relatively unexplored area of study is the extent to which relationships between cancer specialists can be characterized and then targeted to standardize access to cancer care, reduce cancer health disparities, and improve patient outcomes. By assessing the relationships between physicians based on patient-sharing and geographic proximity patterns observed in administrative data, we propose to apply our team’s expertise in network analysis and cancer care to provide a framework for evaluating patient access to cancer care which recognizes the coordination across medical oncology, radiation, and surgical specialists. We aim to develop and apply a novel network measure– linchpin centrality – which identifies cancer specialists who are the only specialist of their kind among their neighbors’ ties. We propose to evaluate variation of physician linchpin centrality by cancer patient race and geographic variables, building on previous work demonstrating that racial disparities vary significantly across US cities and rural subregions. We will further evaluate associations between physician linchpin centrality and timely treatment and cancer mortality. One avenue for increasing access to specialist care is through cancer specialists traveling to a secondary practice location, typically a rural hospital in a community too small to support a full-time specialist. However, little is known about the impact of traveling physicians on existing relationships between physicians and patient access to coordinated cancer care, a gap in knowledge our proposal will address. In analyses specific to rural areas, we will assess the extent to which physician travelers impact physician network structure and patient outcomes. Finally, we will conduct a qualitative study to inform further development of linchpin centrality and a network algorithm as an intervention to improve cancer care. The algorithm we develop will provide health systems with actionable data on the organization of cancer care providers for their catchment and can help guide interventions and allocate resources appropriately. In conclusion, this proposal uses network analysis to capture essential characteristics of the quality of care for cancer patients, with the goal of bridging theory and practice to improve access and outcomes with a network-guided intervention.


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: 2026 ( Subtotal = $0 )
2026	2024	TRUSTEES OF DARTMOUTH COLLEGE	7 LEBANON ST	HANOVER	NH	03755	GRAFTON	USA	Cancer Cause and Prevention Research	000	4	11/20/2025	NON-COMPETING CONTINUATION	$0
														Subtotal = $0

Issue Date FY: 2025 ( Subtotal = $812,123 )
2025	2025	TRUSTEES OF DARTMOUTH COLLEGE	7 LEBANON ST	HANOVER	NH	03755	GRAFTON	USA	Cancer Cause and Prevention Research	000	5	7/31/2025	EXTENSION WITH OR WITHOUT FUNDS	$812,123
														Subtotal = $812,123

Issue Date FY: 2024 ( Subtotal = $354,042 )
2024	2024	TRUSTEES OF DARTMOUTH COLLEGE	7 LEBANON ST	HANOVER	NH	03755	GRAFTON	USA	Cancer Cause and Prevention Research	000	4	6/20/2024	NON-COMPETING CONTINUATION	$354,042
														Subtotal = $354,042

Issue Date FY: 2023 ( Subtotal = $365,221 )
2023	2023	TRUSTEES OF DARTMOUTH COLLEGE	7 LEBANON ST	HANOVER	NH	03755	GRAFTON	USA	Cancer Cause and Prevention Research	000	3	6/28/2023	NON-COMPETING CONTINUATION	$365,221
														Subtotal = $365,221

Issue Date FY: 2022 ( Subtotal = $383,210 )
2022	2022	TRUSTEES OF DARTMOUTH COLLEGE	7 LEBANON ST	HANOVER	NH	03755	GRAFTON	USA	Cancer Cause and Prevention Research	000	2	6/16/2022	NON-COMPETING CONTINUATION	$383,210
														Subtotal = $383,210

Issue Date FY: 2021 ( Subtotal = $394,140 )
2021	2021	TRUSTEES OF DARTMOUTH COLLEGE	6001 PARKHURST HALL STE 207	HANOVER	NH	03755	GRAFTON	USA	Cancer Cause and Prevention Research	000	1	7/15/2021	NEW	$394,140
														Subtotal = $394,140

Grand Total All Awards = $2,308,736

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Improving cancer health equity by targeting physician networks

Award Number: R37CA263936

ORGANIZATION: NATIONAL CANCER INSTITUTE

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 07/15/2021

PERIOD OF PERFORMANCE END DATE: 06/30/2025

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