A Systems Theory Approach to the Study of Colon and Lung Cancer Survivorship Using Novel Data Linkages

We will conduct innovative linkages between our state cancer registry, all-payer claims data, and mental health treatment sources from the South Carolina Integrated Data Warehouse to create a population-based cohort of cancer patients (including < 65 years of age) that will allow us to comprehensively examine utilization of emerging and novel targeted therapies, the joint and individual effects of treatment and co-morbidities, and multi-level contributors across multiple domains to cancer survival trajectories. While we have made significant improvements in cancer prevention and control since the 1950’s, a significant number of individuals do not receive novel treatments such as targeted therapies. Lung and colon cancer survival can be significantly improved with utilization of novel and emerging targeted therapies. Furthermore, a comprehensive (including diagnosis and all treatment courses) and national cancer surveillance system that includes younger cancer survivors (< 65 years of age) is completely impossible in our current cancer registry infrastructure. Consequently, the goal of this investigation is to examine novel targeted therapies, effects of co-morbidities, and modifiable, multi-level contributors on treatment outcomes and survival trajectories. To achieve this goal, we propose the following specific aims: 1) to examine patterns of novel targeted therapies for lung and colon cancer patients by varying access to care and their impact on survival trajectories., 2) to examine the individual and joint effects of cancer treatment and concurrent co-morbid diseases (CVD, diabetes, depression, and opioid use disorder) among cancer patients by varying access to care on survival trajectories, 3) by applying geospatial approaches to examine multi-level and system-level contributors (biological, behavioral, socio-cultural, environmental, physical environment, and health systems) to survival for lung and colon cancer patients to identify modifiable targets for intervention, and 4) disseminate and translate our research findings into multiple levels of cancer care and among a community of stakeholders. Through the extensive networks and community partners previously established by this outstanding, inter-disciplinary research team, we will partner with our community advisory panel to interpret and disseminate these findings throughout professional and lay communities in order to identify targets for future intervention at the individual, community, and policy level. The SC-Midlands Chapter of the American Cancer Society and South Carolina Cancer Alliance will be key partners in our dissemination efforts. In this way, our application is poised to make a significant impact on cancer survivorship.