The Cancer Disparity Research Program (CDRP) is a program that supports the conduct of radiation oncology clinical research trials in institutions that care for a disproportionate number of medically underserved, low income, ethnic and minority populations, but that traditionally have not been involved in NCI-sponsored research. The CDRP supports collaborative partnerships between grantee institutions and experienced institutions actively involved in NCI-sponsored cancer research;and they are linked to those centers by TELESYNERGY(R), a telemedicine system capable of transmitting a wide variety of diagnostic-quality images, including radiology and pathology images. This sophisticated telemedicine system provides the community hospital and their experienced cancer center partners'support and advances the mentoring process, provides clinical research advice and guidance, and imports continuing educational activities, despite the community hospitals'geographic isolation. NCI's Patient Navigation Research Program (PNRP) is also a component of the CDRP. The PNRP is focused on developing interventions to reduce the delivery time of standard cancer services, cancer diagnosis, and treatment in medically underserved and disadvantaged populations. CMRP has provided administrative support the CDRP since October 2002. The Grant Specialist serves as the primary contact for the grantees and coordinates the efforts of the awarded institutions (currently five) and their partners, in order to: (1) support the implementation of their programs;(2) ultimately enroll special population patients on clinical trials at their respective sites;and (3) help develop more effective outreach educational and prevention programs. In early 2007, CMRP staff began to assist with the overall grant administrative functions of the CDRP. In spring 2006, the NIH Evaluation Branch awarded set-aside funding to support the evaluation process and outcome evaluation of the CDRP. The purpose of the evaluation was to measure relevance, effectiveness, and impact of the program in a consistent fashion, to identify the program's attributes to be applied to other settings. In addition, the evaluation would also collect data, prospectively, over the years of the grants to produce meaningful annual reports to stakeholders of interest, both within and outside NCI. During the past year, the Grants Specialist assisted NOVA Research Company, the evaluation contractor, as it conducted its evaluation, and will continue to do so for the remainder of the of the grant period. The Clinical Trials Working Group (CTWG) Report published in June 2005 identified that it is vital that minority populations be better represented in cancer clinical trials. The CTWG called for the promotion and expansion of best practices for recruitment of minority populations by providing additional funding to proven initiatives such as the PNRP. In the summer of 2006, three of the CDRP institutions?Rapid City, Singing River, and McKeesport?received supplemental funding to increase the recruitment of minority populations in cancer clinical trials. Site visits were performed by NCI and SAIC-Frederick, Inc., employees to evaluate the institutions'participation for this supplemental funding, and identified that the sites were well suited for the supplemental funding and that several surgeons were very interested in pursuing this endeavor. In August 2007, these same three sites were approved for additional supplemental funding from the NCI's Clinical Trials Operations Committee based on their successful recruitment of patients from disparate areas to clinical trials. The additional funding will cover a combination of patient navigators and research nurses to recruit more patients to interdisciplinary clinical trials. Despite the setbacks created by Hurricane Katrina at one of our sites and a resignation of a principal investigator in another, the accrual at CDRP sites to clinical trials has been very successful during the past year. The CDRP nontraditional funding model has been deemed successful in developing clinical trial research capacity at these community-based hospitals that care for a disproportionate share of underserved, ethnic and racial minorities, and the poor. Partnering with experienced academic research institutions has been beneficial in guiding several of the CDRP sites by advising and collaborating on research studies, expanding local clinical investigators treatment knowledge and skills, and by sharing via tumor boards. As grantee investigators have become more experienced, many have found that having a second partner with specific expertise has been valuable. Examples include Rapid City's work with the Mayo Clinic related to research with Native Americans, and Centinela Freeman's relationship with the Rand Corporation that has expertise in health services research. Given that clinical trials research is new to most of the grantee localities, community outreach activities have helped the target population gain knowledge about cancer, to become aware of locally available treatment, and to be exposed to the purpose and availability of clinical trials. Theories such as Diffusion of Innovation support the long-term impact of community outreach activities on willingness to participate in research. In addition, patient navigation has demonstrated to these local communities that the grantee institutions are vested in helping the patient eliminate or cope with common barriers to cancer care services. Based on experiences over the last three to four years, much has been learned about implementing and maintaining the CDRP and similar projects. These range from choosing grantee sites to the use of technology such as TELESYNERGY(R). By providing support to the CDRP and NOVA Research Company, a Pre-Evaluation Snapshot from NOVA will assist the CDRP in the reissuance of the CDRP initiative. The re-issuance of the RFA/concept is tentatively scheduled for spring 2008.
