Minority populations have multiple impediments to proper health care. This disparity is particularly noted for cancer where African-Americans have an overall cancer death rate that is greater than for all other ethnic groups. Furthermore, the ratio of black:white cancer related mortality continues to worsen for both males and females. Considering these facts, it is clear that meaningful efforts for cancer care is required for minority populations. One focus of this effort is the necessity to increase minority and underserved patient accrual to cancer therapy (CT) and cancer prevention and control (CP/C) trials where minority populations are substantially underrepresented, even correcting for their relative frequency to Caucasian populations. This proposal continues the successful initial accomplishments of the MBCCOP at Meharry Medical College (MMC) that established and sustained a mechanism to bring state-of-the-art cancer clinical trials to minority populations and to involve community practicing physicians in NCI-sponsored clinical trials. This application will continue and enhance the specific aims that are to 1) broaden access to cancer treatment by entering substantial numbers of minority patients onto NCI approved CT and CP/C studies, 2) involve communities and community health centers in cancer trials and investigate their impact on community medical practices, 3) increase community practicing physician participation on NCI approved studies and 4) transfer new technology to health care providers caring for minority and underserved populations. MMC, with greater than 40% of newly diagnosed cancer patients representing minorities, will serve as the central core supported by its active cancer research and treatment trials program. The catchment region will be Metropolitan Davidson County (MDC) where minority populations make up approximately 33% of the entire population. The CT affiliate components of the MBCCOP will continue to include the areas largest multi- physician oncology practice (Sara Cannon Research Institute/Tennessee Oncology) and the sole minority directed hematology/oncology practice in MDC, Nashville Oncology Associates. Together, these groups care for large numbers of minority patients and have proven successful in placing substantial numbers of patients on NCI approved protocols. The CP/C program will continue to use an established consortium of primary care health clinics that focus on minorities and the underserved as well as accruing to CT studies that have CP/C components. The community health centers are particularly well-suited to perform CP/C studies requiring non-cancer patients such as breast cancer prevention trials. The overall design of the MBCCOP with its established infrastructure together with affiliates and well-defined clinical trial methods will continue to accrue substantial numbers of patients onto NCI approved CT and CP/C studies.
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