National Cancer Institute-funded Research Articles

Cancer health disparities among Asian Americans

Asian Americans are the nation's fastest growing racial group in terms of percentages, and they constitute a very heterogeneous population. The author reviewed the literature and proposed an agenda to reduce cancer health disparities based on this review and the accomplishments and aspirations of the National Cancer Institute-funded Asian American Network for Cancer Awareness, Research, and Training. The Asian American cancer burden is unique, unusual, and, to a certain extent, unnecessary. The Asian American cancer burden is unique, because Asians are the only racial/ethnic population to experience cancer as the leading cause of death. The unusual aspects of the cancer burden among Asian Americans include experiencing proportionally more cancers of infectious origin, such as human papillomavirus-induced cervical cancer, hepatitis B virus-induced liver cancer, and stomach cancer, than any other racial/ethnic population and, at the same time, experiencing an increasing numbers of cancers associated with "Westernization." To a certain extent, the cancer burden for Asian Americans is unnecessary if barriers to cancer screening, overcoming resistance to physician visits, and culturally competent interventions to reduce smoking, unhealthy diet, and increasing proper exercise can be instituted. Reducing cancer health disparities among Asian Americans will involve research into their unique, unusual, and unnecessary cancer burden.

Disparities in Cancer Funding

In his Editorial, “Perceived threats and real killers” (14 May, p. [927][1]), R. I. Glass makes important distinctions between the health impact and scientific effort devoted to common and often controllable infectious agents such as influenza and rotaviruses and rare and unpredictable agents such as Ebola virus. Similar comparisons between perceived threats, real killers, and scientific emphasis could be made with human cancers. Although the threat of developing common cancers such as breast or prostate cancer is real and not perceived, the cancer that is most proficient at killing humans is lung cancer and the etiologic agent is tobacco. Tobacco is responsible for ∼30% of all cancer deaths ([1][2]), and deaths from lung cancer in the United States exceed those of breast cancer, colorectal cancer, and prostate cancer combined ([2][3]). Yet the amount of dollars spent per cancer death by funding agencies has historically favored breast and prostate cancers over lung cancer (sixfold less spent per lung cancer death than per prostate cancer death and ninefold less per lung cancer death than per breast cancer death for National Cancer Institute funding in 2001). The disparity between funding and mortality is consistent with a low level of commitment from the scientific community to study lung cancer: The number of investigators studying rare cancers such as those derived from bone marrow exceeds the number studying the biology of tobacco and lung carcinogenesis. State governments also appear not to perceive tobacco-related illnesses as a real threat because many have opted to use hundreds of millions of dollars in tobacco settlement money to balance skewed budgets and not to address tobacco addiction that fuels these illnesses. Important health issues such as diarrhea, influenza, and lung cancer may not be sexy, but they deserve the public's attention and commitment from policymakers and the scientific community. 1. 1.[↵][4]1. J. Mackay, 2. M. Eriksen , The Tobacco Atlas (World Health Organization, Geneva, Switzerland, 2002). 2. 2.[↵][5]1. A. Jemal 2. et al. , CA Cancer J. Clin. 54, 8 (2004). [1]: /lookup/doi/10.1126/science.304.5673.927 [2]: #ref-1 [3]: #ref-2 [4]: #xref-ref-1-1 View reference 1. in text [5]: #xref-ref-2-1 View reference 2. in text

The ACR imaging network: A retrospective on 5 years of conducting multicenter trials in radiology and plans for the future

The ACR Imaging Network (ACRIN) provides a complete infrastructure to conduct multicenter clinical trials of medical imaging technologies as they relate to cancer. During its first 5 years of National Cancer Institute funding, ACRIN initiated work on 18 trials, a number of which are closed, in analysis, with results approaching publication. During its next funding cycle, ACRIN intends to pursue a more strategic approach to its selection of trials, focusing on key clinical questions in which imaging can improve the care of cancer patients. ACRIN represents a critical resource for the specialty in which all interested parties can participate. The results of ACRIN trials will improve the appropriateness of the use of imaging and benefit both those with cancer and those who are concerned that they might have the disease.

Lessons learned from a failed multi-institutional randomized controlled study

Background/Purpose: In 1996, the Surgical Sections of the Children's Cancer Group (CCG) and the Pediatric Oncology Group (POG) received National Cancer Institute funding to conduct a prospective, randomized, controlled, surgeon-directed study to evaluate the role of minimally invasive surgery (MIS) in children with cancer. Because of lack of patient accrual, the study was closed in 1998. The purpose of this study is to evaluate and describe those factors that impacted on study failure to ensure future successful clinical trials. Methods: One hundred forty surgeons representing the surgical membership of CCG and POG as well as 111 institutions within CCG and POG were asked to complete a questionnaire about the failed clinical trial. The questionnaire focused on study objectives, organization, and institutional review board (IRB) submission. It also examined the surgeon's ability to perform the minimal access operation, the influence of the pediatric oncologist, and the existence of preconceived biases by surgeons, oncologists, and families. Statistical analysis was performed as appropriate. Results: Eighty-six of 140 (62%) surgeons responded to the questionnaire. Only 23% of the potential protocols were submitted for IRB approval. Of responding surgeons, 39% were not actively performing MIS when the study opened. A surgeon's support of the study was directly related to when the surgeon received the protocols ( P [lt ] .001) and whether the participating surgeon was actively participating in MIS ( P [lt ] .016). The oncologist's knowledge and support of the study affected IRB submission and approval ( P [lt ] .02) and was influenced by whether MIS was practiced at the institution ( P [lt ] .05). The majority of responding surgeons believed the experimental question was relevant ( P [lt ] .05). However, responding surgeons believed that a preconceived bias existed within both their local surgical and oncology communities favoring a particular surgical approach ( P [lt ] .001), but this bias did not extend to the families ( P [gt ] .05). Conclusion: The study failed because of lack of accrual for a variety of reasons: failure to submit to the institution's IRB, lack of surgical expertise with MIS procedures, and preconceived surgeon bias toward either an endoscopic or traditional open approach.

Tobacco industry allegations of "illegal lobbying" and state tobacco control.

This study assessed the perceived effect of tobacco industry allegations of "illegal lobbying" by public health professionals on policy interventions for tobacco control. Structured interviews were conducted with state health department project managers in all 17 National Cancer Institute-funded American Stop Smoking Intervention Study (ASSIST) states. Documentation and media records related to ASSIST from the National Cancer Institute, health advocates, and the tobacco industry were analyzed. The tobacco industry filed formal complaints of illegal lobbying activities against 4 ASSIST states. These complaints had a temporary chilling effect on tobacco control policy interventions in those states. ASSIST states not targeted by the tobacco industry developed an increased awareness of the industry's tactics and worked to prepare for such allegations to minimize disruption of their activities. Some self-reported self-censorship in policy activity occurred in 11 of the 17 states (65%). Public health professionals need to educate themselves and the public about the laws that regulate lobbying activities and develop their strategies, including their policy activities, accordingly.

Recruitment and retention of families in clinical trials with longitudinal designs.

The Family Home Visitation Program: Nurse as Coach was a 3-year, National Cancer Institute-funded, multisite, randomized trial of a nursing intervention. It tested the effectiveness of an in-home coaching intervention designed to enhance long-term adjustment of breast cancer's effect on family functioning. We summarize our recruitment and retention experiences, review accrual and retention issues identified from our experiences and those of other researchers, and suggest 24 specific strategies to maximize sample size in future clinical trial studies. Our target sample consisted of 200 women with early stage breast cancer and their male partners and children. We obtained 313 eligible referrals from 91 sites: 217 participants (69.3%) were accrued, 96 families (30.7%) refused, 181 participants (83.4%) were retained, 11 (5.1%) were dropped because of changes in eligibility status or because of scheduling error, and another 25 (11.5%) elected to withdraw.

Publication of research on controversial topics: The early acceptance procedure

Research with the potential to produce controversial findings is important to progress in the sciences. But scientific innovators often meet with resistance from the scientific community. Much anecdotal evidence has been provided about the reception accorded to researchers who have obtained controversial findings. While many of these cases occurred long ago (e.g., Copernicus and Galileo), the problem continues to the present. This problem has been addressed to some extent in that nearly all universities grant their faculty tenure to protect their right to publish their findings. Still, the right to publish one's findings does not remove the barriers to publication of controversial findings. Perhaps the major barrier to publication is peer review. Peer review serves many useful functions such as correcting errors and providing a fair way to allocate journal space and research funds. But it also suppresses innovation. Below, I discuss how peer review affects the publication of controversial findings, discuss what is currently being done, and then recommend another solution to this problem. Comments Postprint version. Published in International Journal of Forecasting, Volume 12, Issue 2, June 1996, pages 299-302. Publisher URL: http://dx.doi.org/10.1016/0169-2070(95)00626-5 This journal article is available at ScholarlyCommons: http://repository.upenn.edu/marketing_papers/106 Published in International Journal of Forecasting, 11, 1995, Notes: 1-4. Publication of Research on Controversial Topics: The Early Acceptance Procedure J. Scott Armstrong The Wharton School, University of Pennsylvania Research with the potential to produce controversial findings is important to progress in the sciences. But scientific innovators often meet with resistance from the scientific community. Much anecdotal evidence has been provided about the reception accorded to researchers who have obtained controversial findings. While many of these cases occurred long ago (e.g., Copernicus and Galileo), the problem continues to the present. This problem has been addressed to some extent in that nearly all universities grant their faculty tenure to protect their right to publish their findings. Still, the right to publish one's findings does not remove the barriers to publication of controversial findings. Perhaps the major barrier to publication is peer review. Peer review serves many useful functions s uch as correcting errors and providing a fair way to allocate journal space and research funds. But it also suppresses innovation. Below, I discuss how peer review affects the publication of controversial findings, discuss what is currently being done, and then recommend another solution to this problem. Effects of Peer Review on the Publication of Controversial Findings Papers with findings that challenge existing beliefs are often treated harshly by journal reviewers. For example, Gans and Shepherd (1994) examined the reception given, to new ideas in economics. In this paper, leading economists discuss their frustrations because their best work has often received unfavorable reviews. This perception of a bias against innovative findings was found in a systematic survey of applications for National Cancer Institute funding in 1980. Respondents were asked about their attitudes toward reviewers. For example, in response to the question whether reviewers were “biased against women and/or minorities,” only 4.9% of the 336 respondents agreed. When asked whether reviewers were “reluctant to support unorthodox or high-risk research,” 60.8% agreed (Chubin and Hackett, 1990, p. 66). In a survey of the editors of 16 leading American Psychological Association journals, Armstrong and Hubbard (1991) found that the editors were discouraged because few papers with controversial findings were submitted. Furthermore, of those submitted, few were favorably reviewed by the referees. For the two year period covered by the survey, only one paper with controversial findings had received all favorable reviews. (In this case the editor told us that he was determined to publish the paper so he sought out referees who would provide favorable reviews.) This represents one favorably reviewed paper for 32 “journal years.” Reviewers arc unlikely to say they reject a paper because they disagree with the findings. They are probably not even aware of such a prejudice. However, experimental studies (Goodstein and Brazis, 1970; Abramovitz et al., 1975; Mahoney, 1977) show that such a bias does exist. This prejudice poses a risk for those who would study controversial topics. For example, the findings about the poor predictive performance of Box-Jenkins procedures were greeted with a negative response (e.g., see the commentary on Makridakis and Hibon, 1979). Some researchers even thought that these findings should not have been published.

In the Image of Science? Negotiating the Development of Diagnostic Ultrasound in the Cultures of Surgery and Radiology

In the Image of Science f Negotiating the Development of Diagnostic Ultrasound in the Cultures of Surgery and Radiology ELLEN B. KOCH Between 1948 and 1952, two physicians working in the United States independently developed a method of producing cross-sectional images of soft tissues, using ultrasound, or sound waves at a frequency above the range of human hearing. One was Douglass Howry, who graduated from the University of Colorado Medical School in 1947 and began an internship in radiology at the Denver General Hospital. The other was John Julian Wild, a British surgeon who had trained at Cambridge University; Wild began a U.S. Public Health Service surgical research fellowship at the University of Minnesota Medical School in 1946. Both Howry and Wild, who were unaware of each other’s work for several years, pursued their ideas for using ultrasound for clinical diagnosis by borrowing—and subsequently modifying—pieces of military equipment. Both also sought funding from various sources in order to pursue their research. By 1957 both men had been working on improved instrumentation under grants from the National Cancer Institute (NCI), one of the National Institutes of Health; Wild began receiving NCI funds in 1949, and NCI began support of Howry in 1954. Combined, the two projects were costing NCI about $50,000 a year.1 Officials at the institute were understandably concerned that the projects were duplicative, especially as they had overcommitted their annual budget in that particular year.2 A specially convened Dr. Koch is an independent scholar working on the dynamics of the invention and use of medical technologies. This article is based on her Ph.D. dissertation “The Process of Innovation in Medical Technology: American Research on Ultrasound, 1947-1962” (University of Pennsylvania, 1990), supported in part by a University Fellowship from the University of Pennsylvania. She extends her thanks to Ruth Schwartz Cowan and the Technology' and Culture reviewers for their valuable comments on an earlier version of the article. 'The majority of NCI extramural projects in this period were funded at about SI0,000 or less per year. "Stephen Strickland notes that 1957 was a year in which the budget for the NIH was not increased, as it had been quite predictably in previous years. The NIH may have© 1993 by the Society for the History of Technology. All rights reserved. 0040-165X/93/3404-0005S01.00 858 Negotiating the Development of Diagnostic Ultrasound 859 group of scientific reviewers, familiar with ultrasound, was asked to assess the scientific merit of the two grant applications. They concluded, What Dr. Wild wishes to do is in effect to adopt the techniques of Dr. Douglass Howry in the application of transducers to this type of work. Dr. Howry has been working in this field for a number of years and has developed equipment which probably is superior to Dr. Wild’s. ... It was suggested that instead of supporting the transducer development proposed by Dr. Wild, he be provided with the necessary funds, probably in the neighborhood of $50,000, to purchase a machine from Dr. Howry. This would enable Dr. Wild to concentrate on the detection and diagnostic aspects of the work with the latest equipment. Future efforts of Dr. Wild’s group, on equipment development, could then be directed toward modifications of the Howry apparatus for spe­ cific applications instead of duplicating the work already accom­ plished by Dr. Howry’s group? Why did the experts think that Howry’s instrument was probably superior to Wild’s and that Wild was merely duplicating Howry’s work on instrumentation? The answer to this question necessitates under­ standing not only the history of both research projects but also the historical context of American academic biomedical research in general and medical technology in particular in 1957. Howry’s and Wild’s research projects on ultrasound were both harbingers of a new style of collaborative, cross-disciplinary clinical research that did not match existing institutional settings and funding sources. This new style of research, incorporating physics and engi­ neering into clinical medicine, only slowly gained acceptance as a legitimate partnership in American medical research. But Howry’s research gained acceptance more readily than did Wild’s because...

The scientific data audit system of the cancer and leukemia group B (CALGB)

The National Cancer Institute funds and coordinates a large international system of clinical trials, involving many large and small institutions and thousands of patients, which is organized into a dozen cooperative groups. Compliance with the study requirements and data accuracy are monitored at several levels within these collaborative groups. In addition, for approximately 9 years an on‐site data audit process has been conducted by each group. We report the organization and audit methods of one of these groups, the CALGB. In 3 cycles of auditing each CALGB institution, involving over 2300 patients, there have been only 2 instances of scientific improprieties, a rate of only 0.4% in 459 institutional audits. A more worthy result of this on‐site data auditing has been the improvement in compliance with protocol and administrative requirements. Although a system of on‐site reviews of patient records expends both scarce research funds and investigator time, the CALGB has demonstrated the value of such audi...

Applications of a method for setting air quality standards based on epidemiological data.

A method for setting air quality standards for long-term cumulative exposures of a population based on epidemiological studies has been developed. It uses exposure estimates interpolated from monitoring stations to zip code centroids, each month applied to zip code by month residence histories of the population. Two alternative cumulative exposure indices are used--hours in excess of a threshold, and the sum of concentrations above a threshold. The indices are then used with multiple logistic regression models for the health outcome data to form dose response curves for relative risk, adjusting for covariates. These curves are useful for determination of at what exposure amounts and threshold levels, effects which have both statistical and public health significance begin to occur. The method is applied to a ten year follow-up of a sub cohort of 7,343 members of the National Cancer Institute-funded Adventist Health Study. Up to 20 years of residence history was available. Analysis for prevalence of symptoms was conducted for four air pollutants--total oxidants, sulfur dioxide, nitrogen dioxide, and total suspended particulates. For each pollutant, cumulated exposures were calculated above each of five different thresholds. Statistically significant effects were noted for total suspended particulates, total oxidants, sulfur dioxide, past and passive smoking.