An intervention study to improve outcomes for cancer survivors and enhance primary care capacity, funded with a $4.8 million grant from the National Cancer Institute, will be implemented by UTHealth Houston researchers in partnership with eight Texas primary care community health centers that treat under- and uninsured patients.
“Project CASCADE focuses on how primary health care teams provide whole-person and coordinated care to underserved patients who have a history of cancer,” said Bijal Balasubramanian, MBBS, PhD, professor of epidemiology and the Rockwell Distinguished Chair in Society and Health at UTHealth Houston School of Public Health, who is a multiple principal investigator of the study. “Primary care is uniquely suited to deliver whole-person and coordinated care for cancer survivors because, at its core, it prioritizes, personalizes, and integrates health care for all conditions, not just the cancer.” Project CASCADE stands for Community and Academic Synergy for Cancer Survivorship Care Delivery Enhancement.
Balasubramanian, who is co-director of the UTHealth Houston Institute for Implementation Science and regional dean of the School of Public Health in Dallas, said 70% of cancer survivors have other chronic conditions and receive care from multiple clinical teams, which can create gaps in the coordination of care. Cancer survivors are also at higher risk for developing other cancers and chronic conditions. This, coupled with a growing number of cancer survivors and an anticipated shortage of oncology subspecialists, makes the study even more timely and significant.
Project CASCADE is one of only four National Cancer Institute-funded U01 grants awarded in response to a special request for applications focused on addressing the primary care needs of cancer survivors. It is part of a growing portfolio of research on cancer survivorship that Balasubramanian developed in partnership with Simon Lee, PhD, MPH, chair and Sosland Family Professor in Preventive Medicine at the University of Kansas, who is a co-principal investigator.
The intervention will help community health center clinics improve identification and tracking of cancer survivors by modifying existing clinic workflows and coordinating survivors’ care through a designated care coordinator champion. It will also use Project ECHO – a telementoring strategy to enhance primary care clinicians’ knowledge about cancer survivorship care, recognition and management of the effects of cancer and its treatments, and communication between oncologists and primary care team. Researchers expect this intervention to increase rates of guideline-recommended screenings for secondary cancers, primary care clinician knowledge of cancer survivorship care, and patient-reported experience of care coordination. Researchers will also measure adherence to the National Comprehensive Cancer Network surveillance guidelines for survivors with the most prevalent cancer types, such as breast, colorectal, prostate, and lung.
“Community health centers are the primary care homes for patients who are underinsured or uninsured. In collaboration with community health center clinics, this study will develop a model of cancer survivorship care that can be disseminated and scaled up to be used across other health systems in Texas,” Balasubramanian said. Roxana Cruz, MD, chief innovation officer for the Texas Association of Community Health Centers, will be an advisor for the study.
This study is also a partnership between The University of Texas System institutions, including UT Southwestern Medical Center (Rebecca Eary, DO, MPH) and The University of Texas MD Anderson Cancer Center (Hilary Ma, MD).
UTHealth Houston co-investigators include Samiran Ghosh, PhD; Melissa Valerio-Shewmaker, PhD, MPH; L. Aubree Shay, PhD, MSSW; Suja Rajan, PhD, MHA, MS; and Derek Craig, PhD, MPH.
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