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

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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.