Illustration by Justin Tran
For decades, cancer research has typically only looked at individual risk factors. Now, thanks to $9 million in funding from a National Cancer Institute grant, a group of Virginia researchers is hoping to rewrite the script for how the disease is investigated.
This year, a cohort of scientists called Virginia Advancing Cancer Control Equity Research Through Transformative Solutions Center, also known as the VA-ACCERT Center, has begun a five-year-long research project that aims to offer health and cancer prevention services to understudied residents of Virginia’s public housing communities.
The collective is a partnership between researchers at Virginia Commonwealth University, VCU Health and Eastern Virginia Medical School at Old Dominion University and federally supported, income-based housing communities throughout the state. VA-ACCERT will focus its research efforts on structural and environmental factors that cause health disparities, rather than individual behaviors, according to Jessica LaRose, a co-leader of the project from VCU's School of Public Health.
“We know that many of the cancers that are out there can be prevented. We estimate that 50% of cancer could be prevented if we were able to support changes in cancer risk factors and support changes in increasing screening,” says Bernard Fuemmeler, associate director of population sciences at VCU’s School of Public Health and one of the cohort's lead researchers.
“The project looks at cancer equity outcomes, such as nutrition quality and physical activity, and targets structural and social drivers such as discrimination, access to health care, food insecurity and health literacy,” says Brynn Sheehan, an associate professor and researcher at EVMS-ODU, another VA-ACCERT lead.
Risk factors for cancer include age, diet, tobacco use, hormone levels and alcohol consumption, according to the NCI. A study published in the National Library of Medicine found a significant link between housing inequality and worse cancer treatment and outcomes. The study, which analyzed more than 31 reports on cancer care and housing dating back to 1984, also found a long-term impact from housing discrimination on patients diagnosed with cancer.
Though the trial will officially launch in the fall, research is already underway in 12 income-based housing communities in the Hampton Roads and greater Richmond areas. This pre-trial period is meant to shape the years-long effort to best support the needs of the studied communities.
A major focus of the partnership is approaching research and advocacy from the bottom up, starting with residents of public housing developments. Those who come from low-income neighborhoods often experience a greater burden when diagnosed with cancer than those from high-income neighborhoods, according to Fuemmeler. The goal is that community members who face health inequities will act as partners with researchers to help broaden their scope.
The researchers will learn about the present health disparities directly from community members and introduce interventions to improve residents’ well-being. Some of these interventions are broad changes, such as increasing access to food, and individual changes, including improving internet access
for neighborhood members and educational events led by experts from within the community.
The study’s novel approach will involve residents and researchers “co-leading, co-developing, co-implementing things together,” according to Sheehan. “It’s like this constant bi-directional communication from the community to the researchers and then back to develop the interventions and the programs, it’s going to be implemented and then getting feedback from them as well.”
VA-ACCERT will also host bi-monthly meetings with community advisory boards, which currently have around 15 members total. The members — residents of the housing communities participating in the research — are able to share feedback and pitch ideas for funding proposals, while researchers can give updates on the project.
One of the goals is ... to build trust as researchers by being there and listening and understanding where they're coming from.
—Bernard Fuemmeler, a lead researcher with VA-ACCERT
Community engagement is fairly new to health research, according to Fuemmeler. The NCI funded three similar projects this past summer with a focus on addressing social drivers of health, such as economic opportunities, while working with community members in other cities in the U.S. The four projects together create a consortium that addresses these issues.
“This is really changing the paradigm a little bit and saying, 'This is a cornerstone; community partnership, community engagement is a cornerstone to successful research, and we want to figure out how to make that part of the research process and support that, and figure out what we can learn about the science around community partnerships and engagement,’” Fuemmeler says.
LaRose adds that institutional distrust of health researchers is common for many vulnerable populations, such as those living in public housing communities. Overcoming that distrust is a hurdle that the VA-ACCERT team aims to clear with inclusivity, changing the narrative on how cancer research is typically performed now and for the future.
“One of the goals of what we’re trying to do with the center, as we’re working with communities, is really figure out ways to build trust with public housing residents, to build trust as researchers by being there and listening and understanding where they’re coming from and understanding their perspective on the challenges,” Fuemmeler says.
