UTHSC team poised to make a real-world impact on vulnerable cancer patients

A University of Tennessee Health Science Center (UTHSC) research team is poised to make a real-world impact on vulnerable cancer patients, thanks to new support from the State of Tennessee.

Led by David Schwartz, MD, chair of the Department of Radiation Oncology in the College of Medicine, and founding director of the UTHSC Center for Health Equity, the team received $2.75 million from the Tennessee Department of Health for a project that marries an automated informatics strategy with a personalized patient-support system to tackle interruptions to radiotherapy in at-risk patients. Altha Stewart, MD, senior associate dean for Community Health Engagement at UTHSC and associate professor and chief of Social/Community Psychiatry, is a co-investigator.

The grant is part of the first round of funding released from the Tennessee Department of Health's Healthcare Resiliency Program. The program, announced in November 2022, awards competitive grants in two categories – Capital Investment, and Practice Transformation and Extension (PT&E). Dr. Schwartz's project answers the PT&E category, whose purpose is to encourage innovations in the delivery of health and healthcare services that foster improved health outcomes.

The project is the result of several years of multidisciplinary preparation at UTHSC focused on using population health data to automate individualized, high-touch patient support to improve cancer treatment access. All members of the project leadership team led large-scale public health responses to COVID-19 in Memphis and/or collaborated on the UTHSC-led COVID-19 data warehouse for Shelby County.

This funding program is a special opportunity to pilot our vision to meaningfully (and inexpensively) lower social barriers for Tennessee cancer patients who had the hardest time accessing care during the pandemic."

Dr. Altha Stewart, MD, senior associate dean for Community Health Engagement at UTHSC

The project focuses on radiotherapy interruptions. Cancer mortality in Tennessee has historically been high (currently 6^th worst in the United States), particularly in disadvantaged areas. Radiotherapy is used to cure cancer in over half of patients, but is not like other cancer treatments. Time is a make-or-break driver of its effectiveness. While surgery or chemotherapy can be pushed back several days without much issue, delaying as few as two appointments during a several week course of radiotherapy can threaten cure. Radiotherapy interruptions occur more often in vulnerable populations of low socioeconomic status. The researchers have found interruption disparities in Memphis are defined by patient race, insurance coverage, and neighborhood-level income, including home address in historically poor areas. The COVID-19 pandemic has further highlighted need for strategies to secure equitable radiotherapy access. COVID-19 has impacted poorer, socially vulnerable Americans disproportionately, in part due to underlying social factors contributing to high baseline cancer and COVID-19 risk. Dr. Schwartz's team published the first U.S. report to describe institutional radiation treatment referral volume and interruption patterns during the first year of the pandemic. Patient presentations to his clinic from high poverty areas never fully recovered from the initial decline seen during the early pandemic for over a year.

There are currently no proven methods to improve this situation outside of expensive, non-selective patient navigation services which can only be maintained by the large, wealthy, centralized facilities which require patients to be able to travel to them in the first place. This project is very novel, but is grounded by the team's data, expertise, and preparation. "We will validate the first automated informatics strategy ever developed to directly improve access to radiation treatment for vulnerable cancer patients via personalized social support," Dr. Schwartz said. "This is a cost-efficient virtual platform to democratize treatment access for all Tennesseans as we transition out of COVID-19. Since supportive care strategies such as this are not commonly funded by traditional academic sponsors, the Department's PT&E funding opportunity is a special chance for us to partner with the state to validate a fresh, community-centered approach, obtain longitudinal follow-on funding, and establish the platform as a durable asset appropriate for scaling to other clinical contexts and Tennessee centers."

The team will utilize first-of-its-kind data science to screen patient electronic health records against population-level social determinants of health data to automate clinic coordination of patient support to overcome modifiable barriers to radiotherapy access. This functioning platform, named X-CART ("eXplainable Cancer Radiation Therapy"), will provide secure access to individual and population-level social/health information to select patients most in need of support. X-CART will use social determinants of health data from community-level data resources, individual-level data about our patients, and clinical data from electronic health records to create a fully interoperable health information platform. X-CART can clearly explain to busy providers why individual patients are at risk for radiotherapy interruptions, and then immediately triage them toward intervention. This represents a fundamental advance by the data science team members towards real-world application of digital innovation to reduce cancer treatment access obstacles. "Nothing this sophisticated is available anywhere in the United States," Dr. Schwartz said.

This patient support strategy leverages a proven intervention model used by the group in its community engagement work supporting children experiencing mental illness. This intervention will be the first in the U.S. to utilize experienced community health support specialists to directly support cancer radiotherapy patients, particularly socially vulnerable patients.

UTHSC is uniquely suited to do this work through the College of Medicine's Office of Community Health Engagement led by Dr. Altha Stewart. "Adding this type of individualized social support to cancer patient radiation treatment regimens will significantly reduce the barriers leading to treatment disruption," Dr. Stewart said. The Community Health Support Specialists will address modifiable barriers, including social isolation, lack of personal and/or neighborhood resources such as food and transport access, and related issues of living in low-income, minority, and underserved communities. These specialists will maintain regular contact with each patient during early survivorship to collect treatment outcomes and to maximize stability of support. The specialists will determine frequency (weekly to at least monthly) and length (at least 3 months, up to 6 months) of follow-up to match the social situation and post-treatment physical recovery of each patient.

This work will allow the team to create formal explanatory frameworks and then apply these models to community health support specialist-led intervention strategies to overcome cancer care access barriers during COVID-19 and to keep providers prepared for immediate responses to future public health emergencies. Lessons from this work will be broadly transferrable to other cancer-related and unrelated healthcare contexts across the entire state.