Innovations in cancer treatments start with discoveries in the laboratory, which is where Fox Chase Cancer Center has made powerful inroads for more than 100 years to advance care for patients in the local community and throughout the world.
Cancer disparities reflect numerous interrelated factors coming into play to influence cancer occurrence, progression and treatment outcomes – including socioeconomic, demographic and neighborhood environmental factors. Such disparities tend to be found in underserved and marginalized communities that have unreliable access to healthcare or that face cultural, racial or economic obstacles – all common issues in many of the communities that Fox Chase serves.
To understand and reduce these disparities requires intensive study – and with the expertise of Drs. Charnita Zeigler-Johnson and Kevin Henry, Fox Chase is at the forefront of driving measurable change for the most vulnerable populations.
Dr. Zeigler-Johnson, Associate Director for Community Outreach and Engagement at Fox Chase, specializes in community-centric research to study cancer disparities and the influence of contextual factors that impact populations in specific neighborhoods. In alignment with this work is the research of Dr. Henry, Professor in the Department of Geography, Environment and Urban Studies at Temple University, which emphasizes place-based disparities in cancer and the role geographic factors play on outcomes and prevention. Collectively, these two pioneers are uncovering new insights in their shared mission to serve the highest-risk communities with more impactful care – in Philadelphia and throughout the nation.
Drs. Zeigler-Johnson and Henry share a key interest in using the characteristics of neighborhoods to study cancer disparities – with a primary focus on prostate cancer for Dr. Zeigler-Johnson. Although overall deaths from prostate cancer have dropped substantially in recent decades, African-American men are still more than twice as likely as White men to die of prostate cancer, and they continue to have the highest prostate cancer mortality rates among all U.S. racial/ethnic groups.
Through a previous study called Empowering Men about Prostate Cancer Together (EMPaCT), Dr. Zeigler-Johnson and her research team developed and tested a targeted intervention that helped patients improve not only their knowledge of prostate cancer, but also their confidence in speaking with a physician about the best options for screening.
“The utilization of healthcare – or the lack of it – is a cultural factor that is prevalent in many communities,” says Dr. Zeigler-Johnson. “For men and young men in particular, there’s an aversion to going to the doctor for anything, but especially anything that may have to do with cancer.”
To identify neighborhoods in Philadelphia with the highest prostate cancer burden, Dr. Zeigler-Johnson leveraged advanced methods such as geospatial analysis – and this is where her work intersects with the expertise of Dr. Henry as a medical geographer. Trained in geography and with experience in epidemiological work, Dr. Henry uses novel geographic methods with the goal of understanding and reducing disparities in all kinds of cancer.
A longtime specialist in disease mapping and spatial statistics, Dr. Henry has led and worked with interdisciplinary teams of researchers on several high-impact projects funded by the National Science Foundation, National Cancer Institute, American Cancer Society and Susan G. Komen. The data he analyzes through mapping provides insights into how residential location impacts health outcomes. This includes understanding cancer screening, the stages and rates of cancer in specific areas, survival rates post-diagnosis, and other contextual factors such as income and geographic access to healthcare.
“I like to think about our work in mapping as lending a voice in a way, with the hope that someone will see it and realize that there's a problem,” Dr. Henry says. “Without us doing this type of work, a lot of it might never be seen or perhaps just go unnoticed. We want to be able to tell the story about where the needs are and give these marginalized communities the best voice that we possibly could give them.”
To further advance insights into neighborhood factors on cancer disparities, Drs. Zeigler-Johnson and Henry are now working together on a grant-funded, multi-institutional research project called the Pennsylvania Residence Over Time and Outcomes in Treatment and Survival (PA-ROOTS) Study. This study, for which Dr. Zeigler-Johnson is principal investigator, combines geospatial analysis and mixed methods to study the role of patients’ residential histories over the past 20-30 years, as well as the history of neighborhoods themselves, to determine how prostate cancer disparities are associated with structural racism as measured by historical redlining, lending bias, gentrification and poverty.
“The underlying part is to be able to use spatial analysis techniques and methods to uncover disparities using data from population-based cancer registries,” Dr. Henry says. “We’re like disease detectives in a way by looking around to see where there are problems and then handing that off to researchers like Charnita who go into the community, because it gives them a basis and context to begin their work in reaching people personally.”
Working with Pennsylvania Cancer Registry data, the PA-ROOTS team is focusing on the Philadelphia area and surrounding counties, studying the demographics of those who have been diagnosed in about the last 10 years. With a focus on high-stage disease, they aim to understand various trends in what affects cancer diagnosis, progression and outcomes – including how often people change neighborhoods, where they live at diagnosis and afterward, the possible impact of neighborhood gentrification, and their ongoing exposure to environmental and/or social factors.
“Although cultural factors play a key role in whether people seek care, there are differences in resources that have been allocated to these neighborhoods – the type of education available, whether there are grocery stores nearby, all those social determinants that influence so much of our lifestyles,” says Dr. Zeigler-Johnson.
Dr. Henry adds: “Years prior to diagnosis, living conditions could have been markedly different compared to their situation at the time of diagnosis. People might have faced restricted access to care, resources, or education, or endured significant stress and instability due to frequent residential moves. If we go back 10-15 years, did they always not have access or did they have to travel far for care? Did they always live in an impoverished neighborhood? What were they exposed to while living at different residences? Now, by utilizing residential histories, we can trace the life paths and trajectories of individuals over time, moving beyond the limited snapshot provided by only knowing their residence at the time of diagnosis.”
Linking population-based cancer data to residential histories is relatively new, giving researchers the opportunity to open a whole new realm of information regarding cancer surveillance and health disparities – which could facilitate earlier interventions. “With this study, we’re one of those at the forefront, especially for prostate cancer,” Dr. Henry says.
The PA-ROOTS team already has knowledge of existing trends in area “hotspots” where younger African-American men are presenting with cancer – not only at much higher rates compared with the rest of the city, but also with more advanced disease and a higher likelihood of death. The need for more intensive awareness, education, and access to screening in these hard-hit areas requires personal interaction – and this is where the Community Outreach and Engagement (COE) team plays a crucial role.
“It’s surprising how many people just aren't aware of what's going on with prostate cancer or that it's even an issue, that it’s something they can be screened for,” says Dr. Zeigler-Johnson. “Many men are more familiar with breast cancer than prostate cancer – and there’s a lot of misinformation out there, or even a lack of information. So there's a lot of important groundwork that we have to do.”
The COE team engages prostate cancer survivors and holds health-related focus groups with men in the community – not only to get the right messages out, but to understand what the men are thinking and how they feel about engaging with their doctor. In addition, the team has developed educational programs targeting the high-risk areas of the city, so community members learning more about prostate cancer can then take that information to their peers.
“The messenger is just as important as the message – we need to have that trust already established for people to listen more and take action earlier,” Dr. Zeigler-Johnson says. “We can't just wait for people to finally walk through the doors of a hospital or an emergency room. We have to be in the community because prevention and early detection are really what's key. Having our survivors and our community members provide that information is the best way – and then people can more easily see prostate cancer is not necessarily a death sentence.”
Working with minority and marginalized populations is where the team sees the opportunity to make the biggest impact, not just for cancer disparities but also the overall rates of disease. Ideally, the high-level outcome is improved health across the entire community that Fox Chase serves.
“I like to tell my COE staff we are the first people many of them see from Fox Chase,” Dr. Zeigler-Johnson says. “We have to make sure that we are presenting ourselves in a way that is engaging and makes them want to stay involved with us, because with some people we may never get a second chance.”
Fox Chase is home to many of the nation’s top cancer specialists, with robust research programs and cutting-edge clinical trials that are not easily accessible elsewhere. As research is accelerating to address the numerous factors in cancer disparities, new insights are becoming available that will help change the course of health in underserved communities.
That is the ultimate goal of the studies by researchers like Drs. Zeigler-Johnson and Henry – and a key benefit of Fox Chase’s elite standing as an NCI-designated Comprehensive Cancer Center. The extraordinarily talented specialists at Fox Chase thrive in an environment that is ideal for making fundamentally important discoveries that keep patients healthier and facilitate better outcomes, right where it matters most.
“We are situated right in the hottest spot in the city for cancer, and prostate cancer is no exception. We’re positioned to do a lot of great work here that can go on to be shared with many others,” Dr. Zeigler-Johnson says. “Understanding what the underlying issues are here is what we're set up to do, probably better than any other cancer center in our area because we're already serving this population in so many ways.”
Together, Drs. Zeigler-Johnson and Henry are driving a higher level of cancer awareness in underserved communities while working to dismantle the structural barriers to care that allow disparities to exist. Along with support from Temple Health’s research, treatment and prevention programs, they are helping Fox Chase make a world of difference for high-risk patient populations in the northern sections of Philadelphia and all other communities it serves.
As Dr. Zeigler-Johnson says: “In the long run, through the work we are doing now, we're hoping that we'll have not just new information to share with the research community, but we'll also have some community-driven solutions about what's needed so that we can begin to fix it.”
As one of the four original cancer centers to receive comprehensive designation from the National Cancer Institute, Fox Chase Cancer Center has been at the forefront of cancer research for more than 100 years. With a singular focus on cancer, we combine discovery science with state-of-the-art clinical care and population health.
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