The University of Pennsylvania Prevention Research Center (UPenn PRC) has been awarded a grant totaling $6.5 million over five years from the Centers for Disease Control and Prevention (CDC) to work with communities in the Philadelphia area to develop, test, and evaluate solutions to public health problems, with a particular focus on cancer.
The center is led by Karen Glanz, PhD, MPH, a Penn Integrates Knowledge University Professor and the George A. Weiss University Professor in the Perelman School of Medicine and School of Nursing; Oluwadamilola “Lola” Fayanju, MD, MA, MPHS, the Helen O. Dickens Presidential Associate Professor in the Perelman School of Medicine and chief of the Breast Surgery Division at Penn Medicine; and Meghan Lane-Fall, MD, MSHP, the David E. Longnecker Professor of Anesthesiology and Critical Care, professor of Biostatistics, Epidemiology, and Informatics, professor of Medical Ethics and Health Policy, and director of the Penn Implementation Science Center (PISCE) in the Leonard Davis Institute of Health Economics.
The CDC’s PRC Program funds academic research centers conducting community-based prevention and public health research across the United States. The UPenn PRC is one of 20 CDC-funded centers in the 2024-2029 cycle.
Helping older adults with cancer decide on the care that’s right for them
The signature initiative of the UPenn PRC will be its five-year core research project. Penn researchers will collaborate with colleagues at Penn Medicine’s Abramson Cancer Center and Thomas Jefferson University’s Sidney Kimmel Cancer Center (SKCC) to implement a study focused on improving communication between doctors and older patients with early-stage breast, rectal, or lung cancer.
“I’m excited by this ambitious new core research project, where we’re drawing on the expertise of clinicians and surgeons, geriatrics experts, social work, communication science, psychology, and epidemiology to tackle issues that are especially important to older adults with cancer,” Glanz said. “Many factors can impact treatment decisions for this age group, including frailty, cognitive function, medication use, financial toxicity and other effects of living with cancer, the ability to carry out daily tasks and activities, personal values, and levels of family and community support.”
Worldwide, new cancer diagnoses are projected to double in adults aged 65 years and older over the next few decades. However, patients, caregivers, and their care teams often lack the tools to have effective shared decision-making conversations that incorporate guidelines for care, as well as the patient’s overall goals and preferences. As a result, some patients end up deciding on a treatment plan without fully understanding the potential impact on their health and their lives. Finally, there is evidence that patients from racial and ethnic minorities have less satisfactory experiences with shared decision-making than white patients.
This hybrid effectiveness-implementation study—titled BEACON (Best Case/Worst Case Equity-centered Adaptation to Communicate with Older oNcology patients)—will assess impact of the Best Case/Worst Case decision-making framework, a shared decision-making tool designed to help patients make treatment decisions based on what is important to them. This study aims to enroll a diverse group of more than 500 adults aged 65 and older who have been diagnosed with stage I or II breast, rectal, or lung cancer and are undergoing a pre-treatment surgical consultation. The UPenn PRC team will collaborate with a wide group of people important to patient care, including care teams, caregivers, and community health workers. The team will also leverage state-of-the-art technology, including deploying patient-reported outcome (PRO) and experience measures directly via the electronic health record.
“By working with a great multi-disciplinary, multi-institutional team to adapt the Best Case/Worst Case framework among diverse cancer patients in Philadelphia, we have a real opportunity to better align patients’ goals and values with the type of care and post-treatment follow-up their disease warrants,” Fayanju said. “Our hope is that this project will improve racial and ethnic disparities in shared decision making and guideline-concordant care among older patients with new early-stage cancers.”
PRC’s history and broader impact
The UPenn PRC was established in 2014 with a $4.35 million grant from the CDC that ran from 2014-2019. The center’s track record of success includes community-engaged research in weight management, cancer prevention and control, health disparities, and cognitive health.
In addition to the current center grant, the UPenn PRC was awarded a supplement to be a Collaborating Center in the Cancer Prevention and Control Research Network (CPCRN). CPCRN is a national network of academic, public health, and community partners who work together to implement evidence-based strategies to reduce the burden of cancer. The UPenn Collaborating Center research project will study community- and patient-engaged approaches to encourage risk assessment, counseling, and referral to risk-stratified services for underserved adults at increased-risk for breast and colorectal cancer.
The UPenn PRC’s leadership team and collaborators come from a wide range of specialties and hold a broad array of affiliations across the University of Pennsylvania, the city of Philadelphia, and the country. Glanz, Fayanju and Lane-Fall are all fellows of the Leonard Davis Institute of Health Economics (LDI) and hold leadership roles in other university-wide interdisciplinary research programs.
“We hope to engage, encourage and motivate scientists, clinicians, students, and community members from many disciplines and perspectives to come together to build healthier communities,” Glanz said. “We are fortunate that there are already many initiatives in progress at Penn, and we aspire to forge even more productive academic-healthcare-community partnerships that can be sustained long-term.”
The UPenn PRC leadership team also includes Amy Leader, DrPH, of Thomas Jefferson University, who will serve as the site PI at SKCC. Collaborators across Penn include Rebecca Brown, MD, MPH, Anne Marie McCarthy, ScM, PhD, and Nicole Saur, MD, all of the Perelman School of Medicine; Tamara J. Cadet, PhD, LICSW, MPH of the School of Social Policy & Practice; and Andy Tan, MBBS, PhD, MPH, MBA, of the Annenberg School for Communication. Olugbenga Okusanya, MD, of Thomas Jefferson University and Margaret “Gretchen” Schwarze, MD, MPP, of the University of Wisconsin, Madison, are also collaborators.