Bristol-Myers Squibb Foundation Research Articles

Special Convening and Listening Session on Health Equity and Community Outreach and Engagement at National Cancer Institute-Designated Comprehensive Cancer Centers.

In recent years, the cancer research and care community has been more attuned to health equity, increasingly pursuing coordinated and comprehensive action to achieve equitable health outcomes. In addition to its support of a joint research agenda for health disparities in 2017, the National Cancer Institute (NCI) has demonstrated its commitment to addressing health inequities with its 2012 requirement for cancer centers to define and address the needs of a local “catchment area” and the 2016 mandate for Community Outreach and Engagement (COE). With several years of experience with the COE requirements, there is an opportunity to reflect on the experience to-date and identify opportunities to bolster the impact of COE on equitable cancer outcomes for the future. To do so, the Bristol Myers Squibb Foundation (BMSF) hosted a special convening and listening session in April 2019. The session agenda was cocreated by BMSF and NCI leaders and staff. It brought together 41 individuals, including representatives from the NCI Cancer Centers Program, Division of Cancer Control and Population Health and Center to Reduce Cancer Health Disparities, 22 NCI-designated, emerging or affiliated comprehensive cancer centers, and the broader cancer community. This article captures key themes from that meeting, including an overview of current COE efforts, with a deeper look at how four cancer centers are embedding health equity and COE efforts into their institutions and work, and the successes and challenges they have encountered.

Effective Collaborative Project to Reduce Disparities and Inequities in Cancer Care and for Cancer Control in Low-Resource Setting Countries: South African Experience

PURPOSE The Northern Cape Province is the largest province in South Africa; however, it has the fewest resources for cancer care. There is a high incidence and prevalence of mesothelioma and lung cancer as a result of the previous indiscriminate mining of asbestos without proper legislation for the protection of miners and the environment. Mine dumps remain near villages and schools after the banning of asbestos mining, resulting in continuous exposure to asbestos fibers. Unfortunately, majority of cancers are diagnosed in late stages because of a lack of awareness and the misdiagnosis of lung cancer and mesothelioma as tuberculosis. METHODS The Northern Cape Department of Health, Bristol-Myers Squibb Foundation, and Cancer Charity Workers formed a collaboration in May 2017 to reduce disparities and inequities in cancer care and for cancer control. The Northern Cape Department of Health also collaborated with Project ECHO at the University of New Mexico to use the ECHO model for training community health care workers, training in palliative care, and mentorship and empowerment of doctors and nurses in rural areas. The aim is to recognize early symptoms and signs of cancers affecting the lung and to make referrals for early diagnosis and treatment. RESULTS An advocacy group has engaged the Provincial and National Department of Mining and Environmental Affairs for rehabilitation of asbestos mine dumps. Community health care workers have been trained and are assisting with community awareness and patient navigation. Doctors have been trained in palliative care and are training other health care workers in palliative care. A center of excellence for the diagnosis and treatment of lung cancer, palliative care, survivorship, and research has been established. Retention of doctors and nurses in rural areas for cancer care and early referral is improving. A lung cancer research laboratory is being set up. CONCLUSION Effective collaborative projects can help address disparities in cancer care and effective cancer control in areas with limited resources.

Abstract B007: Developing community-primary care-specialty care partnerships to address cancer disparities in Asian Americans, Native Hawaiians, and Pacific Islanders

Abstract Cancer continues to be the leading cause of death in Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPIs), with over one-third of the AANHPI population residing in California and Hawai’i. Due to linguistic, cultural, and sociodemographic differences, cancer prevention, control, and treatment remains a challenge. These compounded factors hinder AANHPIs from seeking care or following through with provider’s recommendations as they experience high level of dissatisfaction in care, risk of misdiagnosis or ineffective treatment plans, resulting in low levels of engagement with the healthcare system. This has called for a need to create partnerships and improve coordination between community, primary care, and specialty care. The Bristol-Myers Squibb Foundation’s Specialty Care for Vulnerable Populations initiative addresses inequities in access to and utilization of specialty care services by medically underserved and vulnerable populations in the US. The goal of this national initiative is to catalyze sustainable improvement and expansion of specialty care and health service delivery by safety net providers for people at high risk of cancer and cardiovascular disease. In response to the cancer disparities and inequities faced by AANHPI populations, the Bristol-Myers Squibb Foundation’s Specialty Care for Vulnerable Populations awarded 4 organizations $750,000 each to support 3 year health service delivery demonstration projects to improve access to quality cancer care, patient engagement, and supportive services to AANHPIs. Objectives for this session will be: • Describe the cancer disparities in Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPIs) • Explain current research and new partnerships to improve cancer outcomes and access for AANHPIs • Disseminate different models of care bolstering community, primary care, and specialty care in AANHPI cancer patients This session will delve into the cancer disparities apparent in AANHPIs and highlight the 4 AANHPI-dedicated projects to create better coordination between community, primary care, and specialty care: 1. University of California Davis Cancer Center/Health & Life Organization 2. University of California San Francisco 3. University of California Irvine Chao Family Comprehensive Cancer Center 4. University of Hawai’i John A. Burns School of Family Medicine These projects include forming new partnerships between a NCI comprehensive cancer center + FQHC-lookalike; testing an in-person and virtual patient navigation portal; utilizing a hub-and-spoke model between primary care, FQHCs, and specialty care; and bolstering telehealth capabilities to train workers in USAPI territories and Hawai’i on cancer topics and services. Citation Format: Priscilla Ko, Patricia Doykos, Moon Chen, Scarlett Lin Gomez, Neal Palafox, Sora Park Tanjasiri. Developing community-primary care-specialty care partnerships to address cancer disparities in Asian Americans, Native Hawaiians, and Pacific Islanders [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B007.

666-P: Predictors and Effects of Participation in Peer Support: A Prospective Structural Equation Modeling Analysis

Peer support provides benefits across varied health concerns. As opposed to simple offer of support, however, predictors of and importance of levels of participation are not well understood. Analyses of 7 peer support interventions, with 1,612 participants address these questions, first identifying characteristics that predict participation, and then examining whether, controlling for those characteristics, participation itself predicts benefit, using reduced HbA1c as an indicator of benefit. From the U.S. (5 sites), Hong Kong, and the UK, interventions shared emphases on peer supporters helping adults with type 2 diabetes improve disease management. Common data included pre/post hemoglobin A1c (HbA1c), contacts of participants with peer supporters, health literacy, availability/satisfaction with support for diabetes management from family/clinical team, and gender, age, education, and years with diabetes. From structural equation modeling, significant findings indicated 1) older age and lower levels of support for diabetes management predicted more contacts with peer supporters, and 2) more contacts predicted lower levels of final HbA1c. Effects of contacts on HbA1c included those with baseline HbA1c > 7.5% or > 9%. No contacts and tertiles of low, moderate, and high contacts showed a linear, dose-response relationship with final HbA1c (p < 0.001). Baseline and covariate-adjusted, final HbA1c was 8.19% versus 7.85% for those with no and high contacts, respectively. Among those using insulin (29.7%), only those in the high group achieved greater benefit than those with no contacts. Reflecting other findings that peer support reaches/benefits those at greater disadvantage, those reporting less social support for diabetes management were more likely to participate in peer support. Participation in turn predicted better glycemic control across levels of baseline glycemic control and in a dose response relationship across levels of participation. Disclosure G.X. Ayala: None. J.C. Chan: None. A. Cherrington: None. J.P. Elder: None. E.B. Fisher: Research Support; Self; Merck Foundation, Sanofi China. M. Heisler: None. A. Howard: None. H. Parada: None. M. Safford: None. D. Simmons: None. T.S. Tang: None. Funding Merck Foundation; Eli Lilly and Company Foundation; Bristol-Myers Squibb Foundation

$100M Africa Initiative Targets Childhood Cancer.

The Bristol-Myers Squibb Foundation have teamed up with Texas Children's Cancer and Hematology Centers and Baylor College of Medicine on a $100 million initiative to improve pediatric cancer care in sub-Saharan Africa. Organizers are partnering with local governments to increase access to specialty care in countries where the mortality rate from cancer in children is as high as 90%.

New models for elevating the practice and status of community-based nursing across the spectrum of cancer care in Central and Eastern Europe

PurposeThis supplement comprises an evaluation of Bridging Cancer Care, an initiative of the Bristol-Myers Squibb Foundation first conceived in 2007, addressing disparities in cancer care between Central and Eastern Europe and Western Europe. The strategic focus was refined in 2010 to put particular emphasis on capacity building of nurses in terms of education, training and empowerment. MethodsThe evaluation was based on review of data and information from the program's monitoring and evaluation framework and from biannual reports submitted by grantees to the Bristol-Myers Squibb Foundation. Eleven of the grantees were selected to develop case studies, which illustrate a) the role of nurses in tobacco cessation, b) expansion of the scope of practice for general practice nurses in health promotion, prevention and early detection of cancer, c) capacity building for nurses in contemporary models of cancer care, care navigation and psychosocial support and d) establishment of nurse training programs in palliative care in Central and Eastern Europe. ResultsBetween 2010 and 2013, 22 grants were awarded in Russia, Poland, Czech Republic, Hungary and Romania. The evaluation characterized the program's impact in terms of improved health equity, health outcomes, capacity building of nurses and public awareness about cancer. With regard to health equity, all projects targeted disproportionately affected populations (children, poor, rural, ethnic) among whom 35,493 individuals were reached either through cancer screening or community and clinical care. In relation to capacity building, overall 5724 healthcare workers, primarily nurses, received training in various aspects of cancer care, while more than 50,000 patients and more than 470,000 members of the general public were reached through educational initiatives. Most of the programs have been sustained beyond Bristol-Myers Squibb Foundation funding. ConclusionThe positive results were achieved predominantly through greater nurse empowerment, supported by the development of 17 different, customized and nurse-focused curricula. Such training can increase nurses' knowledge and skills as demonstrated by examination testing and evaluation of nurses in the workplace. Several projects also resulted in enhanced nurse leadership attributes and eleven lead to positive changes in models of clinical or community care involving nurses. In eight cases, these changes were subsequently embodied in new health policies.

Foundation Activities To Improve Health Around The World

Foundation Activities To Improve Health Around The World

HIV/AIDS In African Children: The Bristol-Myers Squibb Foundation And Baylor Response

In 2000, 1.4 million children were living with HIV/AIDS in sub-Saharan Africa, according to the Joint United Nations Programme on HIV/AIDS. Few of them were receiving lifesaving antiretroviral therapy because public health systems lacked the clinical infrastructure and trained health care workers to implement and disseminate high-quality care. Research has shown that without treatment, half of HIV-infected infants die by age two. From 2000 to 2011 the Bristol-Myers Squibb Foundation worked with the Baylor International Pediatric AIDS Initiative, governments in sub-Saharan Africa, and other funders to help ensure that children received needed treatment and care. The partnership led to the creation of seven Children's Clinical Centers for Excellence and the Pediatric AIDS Corps of physicians. The mortality rate for the 13,154 children receiving antiretroviral therapy at the centers was 3.35 deaths per 100 patient-years, which compares favorably with results of similar programs in Africa. The experience showed that strategic investments by foundations and others can have a positive impact on health service delivery and the training of health professionals to meet the specific needs of HIV-infected children for the short and long terms.

Sustainability of NGO capacity building in southern Africa: successes and opportunities

Despite an increase in organizational capacity building efforts by external organizations in low and middle income countries, the documentation of these efforts and their effects on health programs and systems remains limited. This paper reviews key frameworks for considering sustainability of capacity building and applies these frameworks to an evaluation of the sustainability of an AIDS non-governmental organization (NGO) capacity building initiative. From 2004-2007 Bristol-Myers Squibb Foundation's Secure the Future(TM) initiative in southern Africa funded a five country program, the NGO Training Institute (NGOTI), to build capacity of NGOs working to address HIV/AIDS. Lessons learned from this project include issues of ownership, the importance of integrating planning for sustainability within capacity-building projects, and the value of identifying primary capacity-building objectives in order to select sustainability strategies that are focused on maintaining program benefits. Sustainability for capacity building projects can be developed by discussing key issues early in the planning process with all primary stakeholders.

Validating Novel Targets for Pharmacological Interventions in Schizophrenia

Validating Novel Targets for Pharmacological Interventions in Schizophrenia

Building capacity for AIDS NGOs in southern Africa: evaluation of a pilot initiative

In this paper, we present the evaluation results of an AIDS non-governmental organization (NGO) capacity building 20-month pilot initiative in five countries in southern Africa called the NGO Institute. A five-person international team conducted a 2 week evaluation of the pilot in 2004 to assess the strength of the model, designed and funded by Bristol-Myers Squibb Foundation. The NGO Institute functioned through a separate consortium in each country. Results of the pilot indicate variations in adaptation and implementation of the model in each of the five countries. Each consortium took considerable time to develop its own governance and management systems. There were examples of strengthened NGO capacity in each country although it was too soon to establish overall impact. The strengths and weaknesses of this NGO capacity building model are presented along with the implications for other funding agencies and NGOs.

Government–NGO collaboration and sustainability of orphans and vulnerable children projects in southern Africa

Given current donor attention to orphans and children made vulnerable by HIV/AIDS, and the need for a new framework that recognizes the complementary roles of nations and non-governmental organizations (NGOs), this analysis reviews NGO-operated community-based orphans and vulnerable children (OVC) projects in Botswana, Lesotho, Namibia, South Africa, and Swaziland. There has been a lack of attention within the field of evaluation to inter-organizational relationships, specifically those with government agencies, as a factor in sustainability. We analyzed evaluations of nine OVC projects funded by the Bristol-Myers Squibb Foundation for the influence of government–NGO collaboration on project sustainability. For eight of the nine projects, evaluations provided evidence of the importance of the government partnership for sustainability. Government collaboration was important in projects designed to help families access government grants, initiate community-based solutions, and advocate for OVC rights through legislation. Government partnerships were also critical to the sustainability of two projects involved in placing children in foster care, but these showed signs of tension with government partners. In addition to the more common factors associated with sustainability, such as organizational characteristics, donors and NGOs should concentrate on developing strong partnerships with local and national government agencies for the sustainability of their projects.

Don’t Leave Home Without Them

The urge to perform medical service abroad has always been present at some level among U.S. physicians. In the early years, this often took the form of missionary work. The growth of nongovernmental organizations (NGOs) in the twentieth century provided the vehicle for many others. In recent years, the number of voluntary organizations sponsoring people participating in health in the developing world has proliferated, and the U.S. government itself—through the Centers for Disease Control and Prevention (CDC), U.S. Agency for International Development (USAID)–sponsored programs, and even the military—has provided physicians, nurses, and public health experts for service in the developing world. The magnitude of this “mission” is hard to measure. Johns Hopkins professor Timothy Baker published an estimate in 1987, putting the figure at something less than one-third of 1 percent of U.S. physicians at that time—a victory or an embarrassment, depending on one’s expectations. Today the numbers are surely higher, although quantification remains a challenge, since the length of service, clinical focus, and sponsoring organizations are so numerous and variable. There can be no question, however, that interest in global health among young Americans in the health sciences is on the rise. A recent survey of U.S. medical students concluded that 20 percent had gone abroad (largely to the developed world) during medical school, as compared with only 4 percent in the 1980s. A Pediatric AIDS Corps, sending physicians to Africa, sponsored by the Baylor College of Medicine and the Bristol-MyersSquibb Foundation, recently tried to recruit fifty physicians. They were overwhelmed by applications from superbly trained young pediatricians and family physicians. But working abroad is not a simple matter. The organizations, countries, clinical needs, obstacles, hazards, and potential for mismatches are many. Once abroad, the U.S. health professional will be working amid a welter of national and international programs, initiatives, and campaigns. A baseline set of questions for anyone considering health work in the developing world should be asked and answered before departure. Edward O’Neil Jr., a U.S.-trained emergency medicine physician, has devoted his young career to exploring and answering many of these questions. He is the founder and president of Omni Med, an organization that tracks medical service opportunities and supports service/teaching programs in four developing countries (Belize, Guyana, Kenya, and Thailand, as of April 2007). O’Neil has published two enormously useful volumes on the subject. The first, Awakening Hippocrates, is a superb introduction to the subject of international

Building Community-Based Short-Term Psychosocial Counseling Capacity for Cancer Patients and Their Families

Research studies show that 30% of cancer patients experience significant disease-related psychosocial distress, which is often under-recognized and undertreated. To satisfy the need for increased capacity to deliver accessible, affordable, community-based psychosocial counseling for cancer patients and their families, the Bristol-Myers Squibb Foundation developed the Individual Cancer Assistance Network (ICAN) demonstration project. Results of a 3-phase evaluation in diverse community settings in Florida show that ICAN effectively provided “cancer sensitivity” training for social workers preparing them to deliver short-term individualized psychosocial counseling, on a sliding-fee scale, to cancer patients and their families, and to market it effectively to oncologists and the community.

Consumption of sugar‐sweetened beverages is associated with an increase in body mass index in a cohort of Mexican adolescents

The objective was to evaluate the association between consumption of sugar-sweetened beverages (SSBs) and changes in body mass index (BMI) in a cohort of Mexican adolescents. Data from a prospective cohort study conducted from 1998 to 2002 were analyzed. Consumption of SSBs was evaluated by means of a semiquantitative food frequency questionnaire. BMI was calculated as weight in kg divided by height in m2. Information on sociodemographic characteristics, sexual maturity and physical activity was also obtained. A total of 3,070 Mexican adolescents 11 to 19 y (mean 13.5 ± 2.0 y) were evaluated. Duration of follow-up was 3 y. Mean percent energy intake from SSBs (%SSB) at baseline was 3.1 ± 2.6. Change in %SSB was 0.9 ± 4.4. Mean BMI at baseline was 21.6 ± 3.6 kg/m2. Change in BMI was 1.4 ± 2.6 kg/m2. 50 % of adolescents increased their %SSB. A positive association was observed between %SSB and BMI over time (p<0.01). After adjusting by age, gender, baseline BMI, baseline %SSB, energy intake, sexual maturity, physical activity, and area of residency (urban or rural), OLS regression analysis showed that adolescents who increased their energy intake from SSBs had a greater increase in BMI (β= 0.4, 95% CI: 0.19, 0.57), compared to those who maintained or decreased their consumption of SSBs (p<0.01). Baseline BMI was negatively associated with increase in BMI (p<0.01). It was concluded that consumption of SSBs is positively associated with an increase in BMI in Mexican adolescents. Supported by Bristol-Myers Squibb Foundation, NY, and CONACyT, Mexico.

Burnout in the practice of oncology: Results of a follow-up survey

6053 Purpose: Stress burnout among oncologists is a continuing concern, particularly as professional, economic, and political challenges have intensified over the past decade. In a 1991 study of ASCO members [SurveyI], 56% of respondents reported feeling burnout in their professional lives. SurveyII (2002) addressed whether the prevalence and scope of burnout among oncologists had changed in the intervening decade. Methods: The 1991 survey instrument was used. Additional questions from the Maslach Burnout Inventory (Maslach & Jackson, 1981) were added to enrich the burnout measure. The web-based survey was sent to 16,635 ASCO members. Results: 1,299 (12.8%) surveys were completed. SurveyII respondents were comparable to ASCO membership in sex and age ratios. 57% SurveyII respondents had >10 years in practice since their training vs 17% in SurveyI. 34% of SurveyII respondents reported burnout in their professional lives (vs 56% in SurveyI). The most often cited reasons for burnout continue to be lack of personal or vacation time (40% SurveyII vs 57% SurveyI) and exposure to fatal illness (31% SurveyII vs 53% SurveyI). Frustration with limited therapeutic success diminished over the decade (22% SurveyII vs 45% SurveyI), and the sense of frustration or failure also dropped (38% Survey II vs 56% SurveyI). Ways to alleviate stress differed slightly, with fewer SurveyII respondents choosing sabbaticals (25% vs 44%) and more personal or vacation time (46% vs 69%). A third in both surveys recommended a smaller patient load to alleviate burnout. Over half said that burnout affected their personal lives and over one-third said it affected patient care. In SurveyII, 40% said they never considered a change in job or career, and 22% considered a change a few times per year. Conclusions: Burnout continues to be reported by over one third of oncologists surveyed. The reduced sense of failure and frustration may account for the reduction in burnout from 12 years ago. More than one-third still report symptoms affecting their personal well-being and patient care. These data suggest that ASCO's programs should address burnout. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Bristol-Myers Squibb Foundation

Atom-Transfer Tandem Radical Cyclization Reactions Promoted by Lewis Acids This work was supported by The University of Hong Kong and the Hong Kong Research Grants Council. D.Y. acknowledges the Bristol-Myers Squibb Foundation for an Unrestricted Grant in Synthetic Organic Chemistry and the Croucher Foundation for a Croucher Senior Research Fellowship.

Eine Vielzahl polycyclischer Ringgerüste (z. B. 3) entsteht in einer durch Lewis-Säuren katalysierten Atomübertragungs-Tandem-Radikalcyclisierung aus ungesättigten α-Brom-β-ketoestern (z. B. 1) in akzeptablen bis guten Ausbeuten und ausgezeichneten Stereoselektivitäten. Mit chiralen Komplexen wie [Yb(Ph-pybox)(OTf)3] 2 gelang die enantioselektive Cyclisierung mit bis zu 84 % ee. OTf = Trifluormethansulfonat, pybox = 2,6-Bis(2-oxazolin-2-yl)pyridin.

International grant making by U.S. foundations.

International grant making by U.S. foundations.