Research we fund

This study will evaluate the effectiveness of two integrated initiatives aimed at enhancing enrollment of minoritized patients in blood cancer clinical trials. The first initiative aims to increase access to trials by utilizing procedures and technology that facilitate referral of patients from community sites of care to an academic cancer center, fostering physician collaboration, and supporting patient navigation. The second initiative seeks to lower trial design-related barriers at the cancer center through equity-focused alterations to the trial development infrastructure and processes combined with a comprehensive staff engagement strategy.

Cancer clinical trials (CTs) provide high-quality care and are important for advancing treatment options, yet most Veterans Administration (VA) facilities do not have CTs available for veterans with blood cancer and face challenges in enrolling veterans on the CTs that do exist. With an innovative, multi-faceted approach to supporting VA research teams as well as educating and assisting veterans, this study will address barriers at the institutional, clinician, and patient levels to increase enrollment of veterans with blood cancer on CTs.

Telehealth could improve access for Medicaid patients with a blood cancer who experience barriers to specialty care, but not all specialists offer it. Using Medicaid data, this study will provide novel information on whether blood cancer specialists are continuing to use telehealth following the COVID-19 pandemic when telehealth use increased dramatically. This study will also examine if telehealth helps address inequities in access to specialists, including for racial/ethnic minoritized groups and those living in rural areas.

This study will implement a skill-based didactic course for providers to improve the quality of communication around structural racism, mistrust, implicit biases, and clinical trial counseling. This study will also implement a culturally competent, specialized clinical trials nurse navigation program that connects patients to educational resources around clinical trials and standardizes pre-screening for new patients prior to the initial clinic visit.​

In collaboration with 10 community-based oncology practice sites, this study will implement a multi-level intervention trial to test the effectiveness of two community oncology strategies designed to increase trial accrual by focusing on a) enhancing the relationship between community oncologists and trial PIs and reducing barriers to referral, and b) an interactive online training focusing on improving community oncologists’ knowledge and attitudes about trials, as well as their ability to discuss clinical trials with their patients. ​

Fertility preservation (FP) treatments can prevent infertility caused by blood cancer. However, FP costs are high, and these services are typically not covered by insurance, contributing to low utilization. New state laws require insurers to cover FP, but it is unknown if they improve access to care. Using national insurance data, this study will examine how much out-of-pocket costs remain, whether patients’ share of costs is like that of other cancer services, and whether and which types of laws increase use and affordability.

Black and Hispanic individuals diagnosed with Hodgkin lymphoma (HL) face worse survival rates across all ages. Using an innovative data source, this study will examine differences by insurance status in the receipt and quality of HL treatment in Aim 1 and care engagement and support after treatment (survivorship care) in Aim 2. Using diverse patient voices, this study will characterize and understand how patients make decisions about treatment and survivorship care by insurance type in Aim 3.

Patients with blood cancers from racial and ethnic minority groups are more likely to experience suboptimal end-of-life (EOL) care. These disparities may be partially driven by health insurance differences but there is limited research examining insurance access as a potential contributor to EOL care disparities for this population. We will leverage complementary local and national datasets to assess the relationship between insurance status and type with EOL quality measures. We will also develop a Blood Cancer Health Insurance Initiative to translate our research findings to policy initiatives to dismantle disparities in access to high-quality EOL care for patients with blood cancers. We will translate our research findings to policy initiatives to dismantle disparities in access to high-quality EOL care for patients with blood cancers.

This project will evaluate the association of insurance type with insurer rejection and patient abandonment of new OAM prescriptions for blood cancers, overall and by sociodemographic factors. It will also evaluate the association of cost sharing with patient abandonment of OAM prescriptions for blood cancers and conduct simulations under alternative cost sharing scenarios to inform policy reform proposals among commercially insured enrollees. Finally, the study will evaluate the effect of cost-sharing reductions under the Inflation Reduction Act on patient abandonment of new OAM prescriptions for blood cancers among Medicare Part D enrollees, overall and by sociodemographic factors.

In this proposal we will investigate the association between insurance coverage and access to care, survival, and financial hardship among patients across Non-Hodgkin lymphoma (NHL) subtypes and to what extent insurance coverage explains and modifies racial disparity in access to care and outcomes. To this end, we will use the Optum Clinformatics DataMart database, the Texas Cancer Registry, the Harris Health System Cancer Database and Data from the Lymphoma Epidemiology of Outcomes (LEO) Cohort Study. These four databases will provide a sample that covers a diverse patient population in terms of insurance coverage, race and ethnicity, and geographic regions. The LEO Cohort Study also provides information on self-reported financial toxicity that is not available in cancer registries, administrative claims data, or surveys. This study will reveal whether insurance coverage, neighborhood socioeconomic factors and healthcare resources are associated with access to care and outcomes of NHL patients.