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

癌症是老年人第二大常见慢性病和死亡原因。到2030年，3- 2200万癌症幸存者中有四分之一将是65岁及以上， 少数民族将增加99%，而白人将增加31%。这些趋势正在创造一个民族老年学和财政 由于少数群体的老龄化，到2050年，差距的医疗保健成本将翻一番，达到500亿美元 生活质量和生存率持续低下。我们没有做好应对这些危机的准备， 有限的证据来指导临床护理或努力减少老年癌症幸存者之间的差异。这 少数民族科学家的代表性不足（URM）导致了数据的缺乏， 研究和少数群体利益攸关方的有限参与，以加强对研究的信任，导致 研究中的老年少数群体幸存者的代表性。进展进一步受到阻碍， 来自老龄化和肿瘤学的研究人员各自研究差异，没有整合这些差异的基础设施。 学科为了填补这一紧迫的空白，“平等、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，将老年科学和利益相关者的观点纳入 跨学科的研究弥合了老龄化，差距和癌症领域。I-REACH汇集了 四个癌症中心中心（乔治敦，马里兰州大学， Karmanos/韦恩州，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医学， 老年学和癌症组织。I-REACH的目标是：1）扩大科学劳动力， 增加URM科学家致力于老龄化交叉点的职业生涯并得到支持的比例， 差异和癌症，2）部署这支队伍，以加速发现，并提供证据， 采取干预措施，改善所有老年癌症幸存者的健康。这些目标将通过三个方面来实现。 核心和两个程序在重叠的阶段使用分布式资源，远程学习的方法。在 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：职业发展核心，提供指导计划和基础课程;数据 核心资源使我们能够利用二级数据来填补差距框架中的知识空白;以及 利益攸关方核心，以纳入利益攸关方的观点，并支持招聘老年少数群体。在 在为期三年的R33阶段，核心将被部署为提供为期两年的指导学者计划， 博士、博士和早期到高级科学家（目标2）和试点计划（目标3）资助小额赠款 解决我们的多层次框架中的证据缺口，建立可持续性并传播成果（目标4）。 86名科学家（65%为女性，36%为URM）已经同意参加。I-REACH将提供 通过桥接NIA和NCI优先事项并解决其他未涵盖的领域，为NIH增值 程序. I-REACH是解决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.