Overcoming Racial Disparities in Curative Therapies for Hepatocellular Carcinoma

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ABSTRACT Lauren D. Nephew MD, MA, MSCE's long-term career goal is to become an independent, externally funded researcher and leader in developing multilevel interventions to reduce disparities in access to treatments for liver disease and gastrointestinal malignancies. She has identified improving access to curative therapies for hepatocellular carcinoma (HCC) as a critical issue to address to achieve this goal. This proposal describes a 4-year comprehensive program of training and mentored research for an academic career in health services research with a special focus on advancing health care equity. This is in line with NIDDK's commitment to combating health disparities. While Dr. Nephew has a strong background in epidemiology, this K23 will provide key training in using human centered design research methods for intervention development, randomized controlled behavioral trials, and implementation of interventions within health systems. Black patients with chronic liver disease are approximately 50% less likely than White patients to receive curative therapies for hepatocellular carcinoma (HCC) even when presenting with early stage disease. Reasons for disparities in mortality are in part related to failure to progress through the complex HCC care continuum to access curative therapies as a result of the unequal distribution of social and structural determinants of health (SSDOH). The HCC-EduLink intervention we propose to develop is designed to: a) improve patients' HCC-related knowledge; b) screen patients for social needs and substance use and refer to social work for linkage to local services; and c) use our multidisciplinary HCC tumor board to facilitate linkage to subspecialty HCC cancer care. The objectives of this application are to develop the education program component of the HCC-EduLink intervention and pilot test the full multi-level intervention designed to address patient- and system-level SSDOH variables and facilitate access to HCC curative therapies in a cohort of Black patients HCC. Dr. Nephew's multidisciplinary mentorship team including a world-renowned gastroenterologist, an expert in interventions to reduce cancer disparities, and a behavioral health statistician will provide expert guidance to complement her course work and experiential learning. The environment including the Indiana University Simon Cancer Center, Clinical and Translational Science Institute, the Eskenazi Safety-net Hospital and the Indiana University Academic Health Center, make this an ideal environment for her training and to complete the proposed aims. Upon completion of the proposed research and training, Dr. Nephew will submit a competitive R-level grant to test the pilot intervention in a larger randomized trial and will possess the skills and experience needed to make a sustained and impactful contribution to reduce HCC mortality through evidenced-based interventions in other vulnerable populations.