Office of Cancer Health Disparities
Research Division of Cancer Prevention and Population Sciences
Deborah Erwin, PhD, Director of Health Disparities

Mission
To understand, reduce, eliminate, and prevent cancer disparities in vulnerable and medically underserved populations and patients through transdisciplinary research and programs

Goal
To assure that all cancer patients in Western New York can benefit from the clinical and scientific advances accomplished at Roswell Park Cancer Institute

Outreach/Educational Programs

Witness Project
The Witness Project (WP) is a national outreach model that was originally developed in Arkansas, and replicated in over 30 sites, nationally, including Buffalo, that incorporates survivors, narrative communication, and cultural components of spirituality. This is an intervention for increasing breast and cervical cancer screening for African American women. The WP Program currently has 23 community volunteers. We do over 2 programs a month in the Buffalo/Niagara area alone. We collaborate with Witness Project programs in Syracuse, Harlem, and Jamestown, New York. Funded by Komen for the Cure ($30K) and the Avon Foundation ($20K).

Prostate Advocates Committee
The OCHDR recently formed a Prostate Cancer Advocacy Committee in preparation for the proposed SPORE application in Prostate Cancer headed by Dr. James Mohler. The purpose of the committee is to ensure that Roswell Park provides culturally appropriate outreach and educational programs about the importance of prostate cancer screening especially for men of minority ethnic groups (African American and Latino) and men who are medically underserved and uninsured. Currently, the committee has 7 members both prostate cancer survivors and community members who meet on a monthly basis. The committee members are involved in the process of program development by offering their valuable input, ideas and suggestions as we form prostate cancer outreach and educational programs for the Buffalo and WNY community.

Arab Women’s Health Education Project
The International Institute of Buffalo is collaborating with Roswell Park Cancer Institute and the University at Buffalo to provide programming regarding breast cancer awareness, screening and treatment for medically underserved Arab immigrant women in Erie County. The Arab Women’s Health Education Project addresses the cultural and linguistic barriers faced by Arab immigrant women through the use of interpreters, culturally competent health educators, attention to cultural barriers in the health navigation process and through services provided in culturally appropriate methods (based on the Witness Project Model). The International Institute staff has conducted cultural sensitivity training that included Roswell Park Cancer Institute High-Risk Clinic, Breast Cancer Clinic & Patient Access. Issues presented included immigrant health care rights, language access issues, obtaining and using an interpreter effectively, and cross cultural communication skills. Funded by Komen for the Cure (25K).

Patient Navigation
This program assists those patients that face obstacles that prevent them from obtaining or utilizing the full benefit of the quality care that Roswell Park has to offer after they have been diagnosed with cancer. The “navigator” helps patients with transportation, child care, contact with support groups, financial help and other needs. Currently this program has serviced over 50 patients. Cancelled or no show appointments have been reduced by 40% since we started the navigation program.

Science to the Sidewalks
This program will move the science of Roswell into the community through dialogue on a local venue, engaging our Research Program leaders and scientists to share their passion about their research in community settings, and disseminate the importance of these studies to minority and underserved communities.

Clinic to the Community (Planning Stage)
This program will give our clinical staff the opportunity to promote clinical advances and studies through an educational format with local groups and professional organizations Tailoring clinical activities is important for ensuring that patients receiving Rx are given every opportunity to enter a study and/or complete their Rx.

Advisory Committee
Engaging the minority community of Buffalo begins with the establishment of our Community Advisory Steering Committee. These members are contributing ideas directly to RPCI leadership for strategic planning, give voice to the community, and inform policies and methods as we go forward. The Committee meets monthly.

Community Symposium
This presentation series began in 2007 on a platform of research and social justice by Dr. Vanessa Gamble, an outstanding scholar on the history and ethical consequences of the syphilis study at Tuskegee. Introduced by Mayor Brown, she initiated a lively dialogue with almost 200 members of our minority and urban community in Buffalo. Developing programs with the city and local minority leadership in our community is a new and very direct approach for Roswell for addressing these historical issues.

Seneca Nation Project
This is a comprehensive Epidemiological study designed to investigate cancer patterns among the Seneca Nation by Art Michalek and Martin Mahoney. This long-term collaboration and established relations with the Seneca Nation Tribal Council sets the stage for further collaborations and outreach efforts.

Research Grants

Testing the Effectiveness of an Intervention to Increase Screening
Esperanza y Vida (Hope and Life), a study funded by American Cancer Society ($1.8 million) and the John R. Oishei Foundation ($304K) is obtaining findings about behaviors to help us understand barriers to access and improve outreach methods for breast and cervical cancer screening with the Hispanic population. Esperanza y Vida has current programs in Buffalo New York (Roswell Park Cancer Institute), New York City (Mount Sinai School of Medicine) & Little Rock, Arkansas (University of Arkansas for Medical Science). The study will determine the effectiveness of the intervention to increase screening based on education alone or education plus navigation to services. To date, Esperanza y Vida has conducted approximately 50 programs (27 cancer programs, and 23 diabetes programs) and have educated over 600 Latino men and women.

Community Based Participatory Research
Alliance & R03 (Pending) We formulated a 1-year CBPR seed grant (funded by the Roswell Alliance Foundation in April 2007) to study local attitudes and mechanisms to increase awareness of and involvement in research.3,45 We piloted a user-friendly approach for obtaining quantitative data through PowerPoints and an audience response system (ARS) using electronic keypads. Qualitative methods included key community leaders, and all participants were recruited through Walker and the CLG. Strategic findings from the 2 focus groups and 7 key informant interviews included a) Specific factors that influence participation in research studies (e.g., Reported greater trust with RPCI than pharmaceutical companies because of fear of exploitation from “big business”); b) Perceptions of the relationship between research and social justice (e.g., Poor people and minorities were more likely to participate in cancer research than wealthier White patients; and many respondents thought cancer treatment trials paid patients to go on studies); c) Collaborative ways to build community capacity to mediate challenges (e.g., Working with local councils and the NACC to educate residents); and d) Strategies to increase knowledge, understanding, and participation in research (e.g., Extended educational programs that allowed residents to meet and develop relationships with RPCI scientists; building social capital). The study included a pilot test of affectively-based decision making factors and intent to participate in the data banking and bio-repository (DBBR) at RPCI. We will have these preliminary findings and technical experience to further inform our methods for the proposed R03 (pending) study to begin July 2008.

Roswell Park Cancer Institute (RPCI) and Niagara Falls community members are creating power-neutral collaborations to meet the needs of vulnerable communities in order to reduce cancer disparities and improve cancer research. The proposed R03, “ARTS” (Arts, Research, T-cells & Socio-demographics) study, creates a collaborative opportunity linking a diverse, relatively low income population with an NCI Comprehensive Cancer Center to test the feasibility of studying the relationship among various contributing factors (e.g., socio-demographics, including poverty and race/ethnicity) to health disparities (e.g., immune function, risks for cancer). The goal of this study is to investigate strategies to engage residents in the Niagara Falls region with scientists at RPCI to increase mutual understanding of each other and participation in cancer prevention research, and to obtain pilot data on variations in Treg cell levels.

Got Screened?
Building Capacity through Community Collaboration (NYS Health Foundation -- pending) The goal of this project is to build community capacity among two public benefit insurance corporations (Univera Health Care, Independent Health), Roswell Park Cancer Institute and various community organizations to develop and assess methods to increase screening adherence to screening from a previously non-adherent subgroup of Medicaid recipients in Buffalo. The objectives to meet this goal include 1) Developing community-based participatory programs to offer screenings; 2) Working with community members to determine the most effective incentives for improving behavior; 3) Assessing the yields and costs of program methods; and 4) Creating a plan for disseminating results to other insurance providers and replication for other health issues and screening. The proposed initiative directly addresses the RFP to improve “services for the State’s most vulnerable populations,” and the processes will be sustained by the insurance companies upon completion. This initiative will support bringing institutions and individuals together to develop more effective methods than have been created individually to improve adherence, and reduce mortality from breast cancer in the poorest and most vulnerable women in Buffalo.