The BRIDGE Project: Broadening the Reach of Imaging, Diagnostics, and Genetic Evaluation
Abstract
Recent years have seen an expansion in imaging and molecular diagnostics for prostate cancer. These tools allow more precise diagnosis and treatment of prostate cancer, limit toxicities and overtreatment, and may open the door for new interventions that are guided by patients’ unique genetic background. Unfortunately, racial and ethnic minority groups often lag behind white men in the receipt of new technologies. We don’t yet know whether this is also the case for advanced imaging and diagnostic testing in prostate cancer. What’s more, as these tools become more widely used, strategies to ensure adequate dissemination of these services are needed. There are reasons to believe advanced testing (incorporating advanced imaging and genetic testing) and targeted interventions (incorporating image guided therapeutics and molecularly targeted therapies) are likely to be underused but also of particular importance for Black men at risk from prostate cancer. For example, Black men are more likely to meet criteria for genetic testing. Imaging can reduce overdiagnosis and limit toxicities of treatment—issues implicated in our finding that Black men are 22% less likely to be treated for potentially lethal cancer than white men. We will begin by using national insurance claims data to assess patterns of these services. First, are Black men truly less likely to receive these advanced services? What other patient characteristics play a role? Second, we will use national data to assess whether difference in use of these tests are due to sociodemographic factors, to the physician or hospital where these men are treated, or to regional practice patterns. Once potential contributory factors have been identified we will move on to an assessment of the diagnostic and treatment pathway for Black men at a group of local clinics in our region. We will involve stakeholders including patients, providers, clinic employees and patient advocates to understand potential barriers to performing these tests. Ultimately, we believe this work will provide a list of potential targets that can be addressed health policy and novel implementation projects. Prior work by our team strongly supports the thesis worse access to care (and specifically worse access to high quality care) is likely to be a major determinant of unequal prostate cancer outcomes in Black men. When Black men are treated in equal access systems and have access to uniform, high-quality care (e.g., in the context of an equal access health system or in a clinical trial) we find they the experience outcomes which are similar to those of white men. This means that efforts to ensure both quality and equity of cancer care have the potentially to dramatically improve outcomes for Black men at risk from prostate cancer. I am a urologist and health services researcher at Brigham and Women’s Hospital/Dana Farber Cancer center. My clinical focus is on the treatment of prostate cancer with an emphasis on image-based approaches, including MRI-based diagnostics, image-based surveillance, and image-guided therapeutics. As a researcher, I have developed a body of work that strongly supports access to care as a critical determinant of racial disparities in prostate cancer outcomes among Black men. Having shown the critical importance of access to high quality care as a strategy to overcome the quality gap in prostate cancer care, the logical next step is to move directly into the clinic and use a mixture of quantitative and qualitative data gathering to define the landscape of care around advanced testing and targeted interventions. This project will do this. It will provide a roadmap for innovating and implementing change to ensure equitable use of advanced testing and targeted interventions for prostate cancer. My mentorship team and research development plan are designed to support me in moving beyond my existing body of health services research in descriptive disparities
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Jan 04, 2024
- Source ID
- HT94252310531
Entities
People
- Alexander P Cole
Organizations
- United States Army