A SYSTEMS THEORY APPROACH TO THE STUDY OF COLON AND LUNG CANCER HEALTH DISPARITIES USING NOVEL DATA LINKAGES

Abstract We will conduct innovative linkages between our state cancer registry, all-payer claims data, and mental health treatment sources from the South Carolina Integrated Data Warehouse to create a population-based, diverse cohort of cancer patients (including < 65-years of age) that will allow us to comprehensively examine

disparities in novel targeted therapies, the joint and individual effects of treatment and co-morbidities, and multi-level contributors across multiple domains to cancer survival trajectories. While we have made significant improvements in cancer prevention and control since the 1950’s, we have failed in our attempts to narrow the

gap of cancer disparities experienced by minority and rural peoples. In our state with higher African American (AAs; 28%) and rural (34%) representation, we have previously documented excess mortality of 60 to 75% for African Americans (AA) compared to whites. Furthermore, a comprehensive (including diagnosis and all

treatment courses) and national cancer surveillance system that includes younger cancer survivors (< 65-years of age) is completely impossible in our current cancer registry infrastructure. Consequently, the goal of this investigation is to examine novel targeted therapies, effects of co-morbidities, and modifiable, multi-level

contributors to AA treatment outcomes, survival trajectories, and disparities. To achieve this goal, we propose the following specific aims: 1) describe and compare patterns of novel targeted therapies for lung and colon cancer by race, socioeconomic status, and urban/rural designation and their impact on survival disparities, 2)

describe and compare the individual and joint effects of cancer treatment and outcomes for concurrent co- morbid diseases (CVD, diabetes, depression, and opioid use disorder) in a population-based cohort of lung and colon cancer survivors by race, socioeconomic status, and urban/rural designation and their impact on

survival trajectories, 3) applying geospatial approaches within the context of NIMHD’s Research Framework for minority health, to examine multi-level and system-level contributors (biological, behavioral, socio-cultural, environmental, physical environment, and health systems) to racial, socio-economic, and rural survival

disparities for lung and colon cancer survivors to identify modifiable targets for intervention, and 4) disseminate and translate our research findings into multiple levels of cancer care and among a diverse community of stakeholders. Through the extensive networks and community partners previously established by this

outstanding, inter-disciplinary research team, we will partner with our community advisory panel to interpret and disseminate these findings throughout professional and lay communities in order to identify targets for future intervention at the individual, community, and policy level. The SC-Midlands Chapter of the American

Cancer Society and South Carolina Cancer Alliance will be key partners in our dissemination efforts. In this way, our application is poised to make a significant impact on cancer health disparities.