I-REACH: Infrastructure for Research in Equity, Aging, Cancer and Health

癌症是老年人第二常见的慢性病和死亡原因。到2030年，三个- 在2200万癌症幸存者中，四分之一的人将在65岁及以上，来自种族/民族的幸存者人数 少数族裔群体将增加99%，而白人将增加31%。这些趋势正在创造一种种族老年化和财政 势在必行，由于少数群体老龄化，到2050年，差距的医疗成本将翻一番，达到500亿美元 生活质量和生存质量持续低迷。我们对解决这些危机准备不足，因为 指导临床护理或努力减少老年癌症幸存者差异的证据有限。这 数据的匮乏因代表不足的少数族裔(URM)科学家人数较少而加剧 少数利益攸关方为增强对研究的信任而进行的研究和有限的参与，导致研究不足 老年少数族裔幸存者在研究中的代表性。进展受到进一步阻碍的事实是，虽然 老龄化和肿瘤学的研究人员各自研究差异，没有基础设施将这些整合在一起 纪律。为了填补这一紧迫的空白，“公平、老龄化、癌症和健康研究基础设施”(I- REACH)将使用多层次差异框架，将老龄科学和利益攸关方的观点整合到 跨学科研究在老龄化、差异和癌症领域架起了桥梁。I-Reach将在 一把伞将四个癌症中心(乔治敦大学、马里兰大学、 卡尔马诺斯/韦恩州立大学，加州大学洛杉矶分校)，利益相关者，所有主要的NIA中心项目和国家老年病学， 老年学和癌症组织。I-REACH的目标是：1)扩大科学劳动力和 增加URM科学家在老龄化交汇点致力于并支持职业生涯的比例， 差异和癌症，以及2)部署这支队伍以加速发现并提供证据 旨在改善所有老年癌症幸存者健康的干预措施。这些目标将通过三个方面来实现 核心和两个方案在重叠阶段，使用分布式资源和远程学习方法。在……里面 在为期两年的R21阶段，我们开发、实施并开始评估核心(目标1)，并为R33做准备 过渡：提供指导计划和基础课程的职业发展核心；数据 能够利用次级数据填补我们差异框架中的知识差距的资源核心；以及a 利益攸关方核心，以整合利益攸关方观点并支持招募老年少数群体。在 三年R33阶段，核心将被部署，以提供为期两年的指导学者计划 面向高级科学家的博士、博士和早期阶段(目标2)和资助小额赠款的试点方案(目标3) 填补我们多层次框架中的证据差距，建立可持续性并传播成果(目标4)。 已有86名科学家(65%为女性，36%为URM)同意参与。I-REACH将提供 通过连接NIA和NCI的优先事项并解决其他未涵盖的领域，为NIH增加价值 程序。I-REACH是满足快速增长的多样化老年人口需求的理想时机。

Cancer is the second most common chronic disease and cause of death in older adults. By 2030, three- quarters of the 22 million cancer survivors will be 65 and older and the number of survivors from racial/ethnic minority groups will increase by 99% vs. 31% for Whites. These trends are creating an ethnogeriatric and fiscal imperative, with healthcare costs of disparities doubling to $50 billion by 2050 due to aging of minority groups and persistently low quality of life and survival. We are ill-prepared to address these crises because there is limited evidence to guide clinical care or efforts to reduce disparities among older cancer survivors. This paucity of data is exacerbated by the low numbers of underrepresented minority (URM) scientists leading studies and limited engagement of minority stakeholders to enhance trust in research, resulting in an under- representation of older minority survivors in studies. Progress has been further hampered by the fact that while researchers from aging and oncology each study disparities, there is no infrastructure integrating these disciplines. To fill this urgent gap, the “Infrastructure for Research in Equity, Aging, Cancer and Health” (I- REACH) will use a multi-level disparities framework to integrate geroscience and stakeholder perspectives into transdisciplinary research bridging the fields of aging, disparities and cancer. I-REACH brings together under one umbrella the accumulated expertise of four cancer center hubs (Georgetown, University of Maryland, Karmanos/Wayne State, UCLA), stakeholders, all the major NIA Center programs and national geriatrics, gerontology and cancer organizations. The goals of I-REACH are to: 1) expand the scientific workforce and increase the proportion of URM scientists committed to, and supported in careers at the intersection of aging, disparities and cancer, and 2) deploy this workforce to accelerate discovery and provide evidence for interventions to improve the health of all older cancer survivors. These goals will be accomplished with three Cores and two Programs in overlapping phases using a distributed resource, distance-learning approach. In the two-year R21 phase, we develop, implement and begin to evaluate Cores (Aim 1) and prepare for R33 transition: a Career Development Core providing a mentoring program and a foundational curriculum; a Data Resources Core enabling use of secondary data to fill knowledge gaps in our disparities framework; and a Stakeholder Core to integrate stakeholder perspectives and support recruitment of older minorities. In the three-year R33 phase, the Cores will be deployed to provide a two-year mentored Scholars program for pre- doctoral, doctoral and early stage to senior scientists (Aim 2) and a Pilot program (Aim 3) funding small grants to address evidence gaps in our multi-level framework and build sustainability and disseminate results (Aim 4). Eighty-six scientists (65% women and 36% URM) have already agreed to participate. I-REACH will provide value-added to the NIH by bridging NIA and NCI priorities and addressing areas not covered in other programs. I-REACH is ideally timed to address needs of a rapidly growing diverse, older population.