Working to Eliminate Care Disparities in Liver Cancer in Southeast Asian Americans: Transportation and Other Social Determinants of Health.

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PROJECT ABSTRACT Southeast Asian (SEA) Americans are diagnosed with hepatocellular cancer (HCC) at 8 times the rate of the general population and at twice the rate of other Asian Americans. Poignantly, most of these patients are never treated for their cancer. These troubling observations – coupled with the candidate/her mentoring team’s preliminary data which point to persistent, contemporaneous disparities in cancer care among SEA Americans – provide the impetus for this K23 mentored career development application. This proposal is the logical next step to support Dr. Tran’s long-term goal of becoming an independent investigator in disparity research in HCC. The current proposal includes one of the first comprehensive approaches that focuses on social determinants of health; builds on this team’s prior data on transportation/distance to cancer care to explain the foregoing disparities; leverages resources from within the multi-site Mayo Clinic (Minnesota, Arizona, Florida) and the 3-state (Minnesota, Wisconsin, Iowa), community-based Mayo Clinic Health System; and capitalizes on Dr. Tran’s passionate interests and growing expertise in HCC and disparities and on the capabilities of her 5 well-established mentors. This 2-aim proposal first seeks to characterize the social determinants of health – specifically travel-limiting access to cancer care as well as other determinants including joblessness, trouble finding childcare, limited education, and others – among Hmong and Vietnamese Americans and non-Asian Americans. Dr. Tran will create and maintain a prospective cohort of patients with HCC – enriched with those of SEA American heritage – to investigate the relationships between social determinants of health, ethnicity/race, the rendering of cancer therapy, and cancer outcomes. Then, in aim 2, to understand barriers to access of cancer care among SEA Americans with HCC, she will conduct one-on-one qualitative interviews to learn directly from patients how to overcome barriers to the receipt of cancer care. She will also use these interviews to explore low rates of viral hepatitis treatment and low rates of HCC screening. During the 5-year grant period, Dr. Tran will acquire new skills in qualitative methods, statistics, and survey research through coursework and hands-on experience. She will work closely with her outstanding multi-disciplinary team of mentors (a medical oncologist, health disparity researchers, statistician, and qualitative researcher); develop and hone skills in managing a multi-site team; acquire greater expertise in writing manuscripts, grants and become more adept in presenting her data. The long-term impact of this research is to further understand and obtain strong preliminary data on the social determinants of health in SEA Americans with liver cancer and to position Dr. Tran to implement novel and feasible interventions in a future R01 application with the goal of eliminating these disparities in SEA Americans with HCC.