October 20, 2020
Christine Veenstra, MD, MS, Assistant Professor in the Division of Hematology and Oncology, recently received news that her grant proposal for a National Institutes of Health (NIH) R01 grant, “A Registry-Based Study of Patterns of Use of Targeted Therapies for Metastatic Cancers in Diverse Populations”, received a first percentile score of 19 at the latest Health Services Organization and Delivery (HSOD) study section review. If Dr. Veenstra's research project is awarded funding, it will mark a significant step in improving targeted therapies across diverse populations of patients with metastatic cancer, and will provide an important framework for future population-based research of cancer care delivery and outcomes.
"Dr. Veenstra's innovative work builds on the longstanding CanSORT collaboration with SEER registries, and also moves this work into the metastatic cancer setting which is a first for our SEER partners. The results of her project will provide much needed knowledge around the utilization of targeted therapies across diverse populations of patients with metastatic cancer," says Sarah Hawley, PhD, MPH, Professor of Internal Medicine, Health Management and Policy, and Health Behavior and Health Education.
Dr. Veenstra tells us more about her research project, what she hopes to achieve, and why this research is important.
What is your project about?
In partnership with the Los Angeles County and State of Georgia Surveillance, Epidemiology, and End Results (SEER) Program registries, we will be studying patterns of use and disparities in use of targeted therapies (oral molecularly targeted kinase inhibitors and intravenous immune checkpoint inhibitors) among a population-based sample of patients with metastatic cancers. We will be investigating patient-level factors, such as race and ethnicity and socioeconomic status, that may be associated with variations in receipt of targeted therapies. We will also study factors among medical oncologists, including their knowledge and attitudes about targeted therapies and the resources for cancer care delivery available to them in their practices, that may impact their ability to prescribe targeted therapies for patients with metastatic cancers. Finally, we will quantify and explain how much of the variations and disparities in patient receipt of targeted therapies is influenced by oncologists.
"Our study is uniquely positioned to investigate patterns of use of targeted therapies in a contemporary cohort of diverse patients treated in a wide range of oncology practices." - Dr. Christine Veenstra
What do you hope to achieve with this research?
Currently, we know very little about about targeted therapy use across diverse populations of patients by age, race, ethnicity, and socioeconomic status (SES). The goal of this study is to address these gaps in our understanding, and characterize patterns of use in a diverse, population-based sample of patients with metastatic cancers in which these therapies are widely indicated:
- Non-small cell lung cancer,
- Genitourinary cancer (renal cell and bladder), and
- Melanoma
We will further determine the extent to which factors related to individual clinician knowledge and attitudes, as well as availability of resources and treatment delivery barriers at the practice level, influence variations in use.
Why is this research important?
Our study will lay the groundwork for future population-based research of cancer care delivery and outcomes among diverse patients with metastatic cancers, inform interventions, and advance population science in this clinically important and understudied area of research.
Together with our SEER partners we are developing novel, multipronged data collection methods to identify patients with prevalent metastatic cancers in the SEER registries and ascertain data regarding cancer treatments that will advance the science of population-level research into the delivery of cancer care to patients with metastatic cancer. Despite increasing recognition that patients living with metastatic cancer constitute a growing group of cancer survivors, there has been very little research of cancer care delivery among these patients.
Our study is uniquely positioned to investigate patterns of use of targeted therapies in a contemporary cohort of diverse patients treated in a wide range of oncology practices. The rapid dissemination of targeted therapies into the care of patients with metastatic cancer is one of the most important cancer care advances in recent history. However, we know very little about how these therapies are being used in routine clinical practice across diverse populations of patients. We know that minority patients are extremely underrepresented in clinical trials of targeted therapies, and that minority patients and patients treated in resource-limited settings are less likely to receive newer cancer therapies. It is possible that gaps in receipt of targeted therapies may widen existing disparities in cancer care delivery and patient outcomes.
Patients with metastatic cancer face the most immediately life-threatening impacts of a cancer diagnosis and thus may demonstrate enormous need for clinician navigation of their therapy options. In this patient population, clinician factors are likely to be particularly powerful in driving variations in cancer care delivery. Our study addresses the role of clinicians in variations and disparities in use of targeted therapies. We will survey the treating medical oncologist for every patient in our study. Many of these oncologists practice in resource-limited settings and may face barriers to prescribing targeted therapies to their patients with metastatic cancer. Our study will provide important insight into these barriers, and into the role of individual- and practice-level clinician factors in patient receipt of targeted therapies.
Finally, our study will include data regarding molecular alterations and evaluative molecular testing that is innovative and highly relevant to clinical practice. There has never been a study at the population level of associations between molecular alterations, clinician use of evaluative molecular testing, and variations in use of targeted therapies. This is in part because these data cannot be measured using medical claims alone and require innovative linkages of multiple streams of data, which we will perform.
Why about this research excites you?
I have learned in my clinical practice that patients living with metastatic cancer have important needs that have not been adequately described or addressed by existing research. I also know that there is still much work to be done to understand the factors that make it difficult for clinicians to provide new cancer treatments such as targeted therapies to their patients. I am excited that our project will be the first population-based study to generate understanding of patterns of and variations in use of targeted therapies in diverse patients with metastatic cancer. Our findings will provide targeted, actionable information; inform development of clinical policies to improve resources and educational opportunities for clinicians who care for underserved patients with metastatic cancer; and inform development of multilevel interventions to improve equitable receipt of targeted therapies and other emerging therapies across diverse patient populations and practice settings.
