This program pursues a set of overarching scientific goals: (1) to identify environmental, biological, psychosocial, epigenetic, and genetic factors that influence cancer risk, occurrence, and progression through basic, genetic and epigenetic, and epidemiologic research;(2) to clarify the impact of cancer and cancer treatment through outcomes research;(3) to develop, implement, evaluate, and disseminate educational, behavioral, and psychosocial interventions aimed at preventing cancer, improving eariy detection, enhancing symptom management, improving health and quality of life for cancer survivors, caregivers, and families, and advancing the science to improve palliative and end-of-life care;and (4) to advance cancer prevention, detection, and control within the broader contexts of institution and society through quality, economic, and policy studies. Program activities target five prioritized themes: disparities, tobacco cessation, obesity and nutrition, geriatric oncology, and survivorship (including symptom control and palliative care). Structurally, research within three main program sections - Epidemiology and Genetics Research, Behavioral Sciences Research, Applied Research - address these cross-cutting themes. Leading-edge research is underway in each section;examples are studies of epigenetic markers of cancer risk (Epidemiology and Genetics Research), neural correlates of nicotine addiction (Behavioral Sciences Research), and impact of Medicare policy change on access to chemotherapy (Applied Research). The program is integrally involved in forerunning national and institutional initiatives. Among these directions are: personalized medicine;patientreported outcomes;survivorship care, including palliative and end-of-life care;increasing minority enrollment in clinical trials, incorporation of bioinformatics and complex data functions across the full research spectrum; development of quality assessment approaches;and creation of a learning healthcare environment. This program currently comprises 46 Duke Comprehensive Cancer Institute members across 21 departments, divisions, schools and institutes. Grant funding has increased since our last submission, from $13,177,478 direct funding in 2004 to $21,317,489 in 2008 (11% NCI funding, 40% NIH funding). During the recent fiveyear period, we have published over 1,100 peer-reviewed papers;152 papers (13%) demonstrate intraprogrammatic collaboration and 162 papers (14%) demonstrate inter-programmatic collaborations.
Despite a proliferation of novel treatment approaches, cancer continues to pose a major public health threat. Improved prevention, through higher screening rates and new strategies enabling eariier detection, will help reduce cancer incidence. For cancer patients at all stages, better symptom management - employing pharmaceutical, cognitive-behavioral, communication, and psychosocial approaches - will minimize suffering and optimize quality of life. Applied research will support the translation of epidemiologic, genetic, and behavioral research findings to improve outcomes, and the quality and cost effectiveness of cancer care.
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