The PSDR Program themes encompass research to reduce and eliminate disparities across the cancer experience of adult and pediatric populations, and include a diversity of race/ethnic groups including African Americans, Middle Eastern Americans, Ultra-orthodox Jewish Americans and older adult populations. Research includes pre-clinical studies with healthy individuals (etiology, behavioral and educational interventions for risk stratification), diagnosis and treatment-related studies of patients and their families (identifying genetic biomarkers and screening for early detection, and clinical communication and informed decision-making regarding treatment choices and adherence), and outcomes-related studies focusing on survivorship and disease recurrence (post-treatment adaptation and transition back to the primary care system, palliative care and bereavement outcomes, and identifying prognostic/predictive markers).
Theme 1: Investigate the distribution and determinants of cancer and cancer risk, survivorship and outcomes with attention to racial and ethnic disparities.
This theme includes a focus on molecular and genetic epidemiology of diverse populations with a variety of cancers including lung, breast, colon, prostate, ovarian, and endometrial cancers. This theme encompasses the role of metabolic syndrome, inflammation, immunity and obesity in cancer risk and progression. Program members take advantage of our unique and highly diverse metropolitan Detroit population that is approximately 25% African American (>971,000), includes the largest concentration of Arab Americans (10%; >400,000) in the United States, and has targeted research in the smaller Orthodox Jewish (1%; >7,000) and Hispanic (4%; >161,000) populations. Our Metropolitan Detroit Cancer Surveillance System, a founding participant in the NCI’s Surveillance, Epidemiology and End Results (SEER) Program, serves as an important resource for major population-based studies, widely facilitating investigations into race- and ethnicity-related disparities in cancer risk, incidence and survival. A major focus is on the genetic/molecular epidemiology of cancer, with studies aimed at defining the contribution of familial risk, describing patterns of heritability, and discovering susceptibility genes through linkage, admixture and association studies. Expanded research into racial diversity in molecular characteristics and associated outcomes are being conducted. Cancer risks associated with diet, smoking, inflammation and other risk factors are being explored, with all studies including large minority populations and often providing the first findings of risk in understudied and underserved populations.
Theme 2: Examine patient, family member, physician and community interactions and behavior to understand and conduct interventions to address cancer risk, treatment and outcomes with attention to reducing and eliminating racial and ethnic disparities.
This theme includes a focus on communication and other behaviors that affect health outcomes in clinical and community settings. We focus on the clinical physician-patient-family member/companion interaction, where the quality of cancer care provided affects patient, family, and institutional outcomes. While these interactions traditionally have been closed to direct, systematic, and controlled observational communication research, we have worked to overcome these barriers by using customized video recording and other related approaches. We have been among the first research groups to establish a peer reviewed, funded communication research program inside an NCI-designated comprehensive cancer center, where our studies have been closely integrated within clinic sites since 2003. Understanding the role of verbal and non-verbal communication in determining how best to influence positive health behavior and improving the quality of care provided is particularly important for addressing the health needs of minority groups. Such groups bear the brunt of the impact of cancer because of relatively high risk, poor prognosis, bias/discrimination, and few support mechanisms in place to reduce risk and improve survival. Included in our behavioral and psychosocial research is a focus on better understanding factors that drive treatment and screening choices and risk behaviors. We study the impact of strategies for communicating cancer risk and clinical trial information to hard-to-reach populations in larger community settings. This work has been facilitated through our strong and long-standing community-based research and outreach projects, including the NCI-funded Community Network Program Center grant.