New UI Cancer Center lung cancer screening, smoking cessation programs finding success

A new multi-level program to help African Americans quit smoking and undergo lung cancer screening initiated by the University of Illinois Cancer Center is proving to be successful.

African Americans have a greater chance of contracting lung cancer and dying from the disease than any other racial/ethnic group. It remains the leading cause of cancer deaths in the United States, with a projected estimate of 234,030 new cases and 154,050 deaths in 2018, according to the American Cancer Society.

According to new research published in the journal Frontiers in Oncology, the UI Cancer Center is developing a five-step plan that involves uniting the community and patient to create an epigenetic lung cancer research program at Federally Qualified Health Centers (FQHC) such as Mile Square. The goal, said Karriem Watson, DHSc, MPH, MS, associate director of Community Outreach and Engagement and co-corresponding author on the paper, is to reduce lung cancer disparities in underserved communities.

Karriem Watson headshot“More than 500 patients from Mile Square have been navigated to tobacco cessation and lung cancer screening using our socio-ecological model,” Watson said. “This is a great start.”

Navigators play an integral role at the program’s initial stage, interviewing patients to assess their knowledge and beliefs about risk factors and screening for lung cancer. The second level – interpersonal – utilizes the role of friends, family, health care providers, community health workers, and patient navigators to address or lessen the barriers to screening that result from socio-cultural norms or logistical barriers, Watson said.

There are multiple reasons that impact tobacco cessation and lung cancer screening among African Americans, Watson said. Historically, there have been beliefs of fatalism or that a diagnosis of lung cancer was a death sentence. Medical mistrust could also play a role in tobacco cessation and lung cancer screening, he said.

“Interactions between navigator and patient, along with education and culturally appropriate tailored services, build trusting relations that increase a patient’s likelihood to participate and complete screening and follow-up care,” Watson said. “The partnerships that navigators have with providers at each of the Mile Square Health Center clinics also enhances the outcomes.”

The organizational level – the third in the program – examines what can be implemented at the systems level within FQHCs and other clinical settings that serve high risk, low-resource populations to support activities at the interpersonal level. Utilizing electronic medical records to develop client and provider reminders, implement provider level training, or utilizing the Uniform Data Systems metrics to develop and evaluate goals for mitigating risk factors for lung cancer such as tobacco are a few of the practices that can be implemented.

The fourth level – community – is especially important to the UI Cancer Center’s “bench to community model,” as it is building coalitions and collaborations with national organizations such as the American Lung Association and the American Cancer Society Lakeshore Division, as well as local health departments, FQHCs and schools of public health. This, Watson said, can lead to a better public awareness of risk factor reduction for lung cancer and promote the awareness of screenings and screening recommendations.

The final level of the socio-ecological model is policy, where the UI Cancer Center’s Office of Community Engaged Research and Implementation Science (OCERIS) identifies and develops health policy and research priorities that are relevant to the catchment population, Mile Square Health Center, community agencies and other health delivery stakeholders.

One such priority is conducting epigenetics research in lung cancer disparity. Epigenetics is the study of biological mechanisms that switch genes off and on. The UI Cancer Center is employing the five levels of the socio-ecological model – navigation, interpersonal, organizational, community and policy – to learn why African Americans are insufficiently represented in current translation and epigenetic research despite having greater lung cancer exposure and unexplained associations between biological and socio-environmental factors, said Alicia Hulbert, MD, UI Cancer Center member and co-corresponding author on the paper.

The UI Cancer Center is partnering with Hulbert’s laboratory, the Cancer Epigenetic Liquid Biopsy Laboratory (CELLI), to develop screenings to be utilized in underrepresented communities. Using a panel of DNA methylation based biomarkers, the CELLI team will collect blood and urine specimens from patients at three Mile Square sites that are located in high-risk communities – Englewood, Back of the Yards and Near West (Main). Cell free DNA from the circulating fluids will be isolated and undergo bisulfite conversion in preparation for epigenetic screening.

“Epigenetic research rooted in an ecological model may serve as the bridge connecting the various factors that impact lung cancer outcomes in African Americans and other racial/ethnic minority communities,” Hulbert said.

Funding for the research was provided by the National Institutes of Health, grant numbers U54CA202995, U54CA202997, U54Ca203000, U54MD012523, P20CA202907 and P20CA202908. Watson and Hulbert co-authored the paper with Vida Henderson, PhD, PharmD; Beverly Chukwudozie, MPH, MBA; Lisa Aponte-Soto, PhD; Lane Lerner; Erica Martinez, MPH, MBA; Sage Kim, PhD; and Robert Winn, MD.

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