In partnership with VCU Massey Cancer Center, the Department of Health Behavior and Policy conducts extensive research around the prevention and control of cancer. We focus on translating research findings into practice as it relates to the following:

Reducing cancer risk
Improving cancer-related care
Improving cancer screening and decision-making
Enhancing patient and caregiver experience
Identifying Medicaid and other policy impacts on access to cancer care
Identifying barriers to care and developing methods to overcome those barriers

We’re proud to collaborate across multiple disciplines and academic units to engage in research that will contribute to cancer prevention and control and access to care.

Ongoing Projects

Principal Investigator: Michael Preston, Ph.D.

Funding Source: CDC Cooperative Agreement Number CDC-OT18-1802

Project Summary: The major goal is to build the capacity of hospital systems to improve public health outcomes related to cancer and address colorectal cancer disparities.

Principal Investigator: Bernard Fuemmeler, Ph.D.

Funding Source: National Cancer Institute

Project Summary: Both smoking and secondhand smoke (SHS) exposure are established risk factors for chronic disease and cancer. While the prevalence of smoking has decreased in the population as a whole, there are subgroups that are particularly vulnerable to smoke exposure, such as pregnant women and children, and it is recommended to eliminate exposure almost entirely among these subgroups.

Many states are active in either planning or proposing new regulations limiting tobacco retail outlet (TRO) density as a means of reducing smoking. Presumably, reducing TRO density should lead to lower levels of adult smoking, which should also reduce maternal smoking during pregnancy and SHS exposure in children. There is scant evidence that TRO density is related to smoking behaviors, and there is no evidence showing that reducing TRO density will extend to vulnerable subgroups and those passively exposed, like pregnant women and children.

The purpose of the proposed study is to examine the extent to which TRO density is related to biomarkers of smoke exposure (cotinine) in 1000 women during their pregnancy and in 400 children aged 4-10 born of these mothers. In addition, the study will determine the degree to which cotinine levels and TRO density relate to health care utilization and costs during pregnancy and early childhood. To accomplish this study, the team will integrate data on biomarkers of smoke exposure and health-care utilization data from a longitudinal pre-birth cohort with publicly available data sources on TROs and census data. By better understanding the link that TROs have with smoke exposure and the related health-care costs associated with such exposure, we will be better positioned to make data-driven policies that aim to modify the TRO landscape. Successful completion of this project will provide evidence supporting continued efforts to expand policies reducing TRO density and retain them where they are being enacted.

Site Principal Investigator: Richard Brown, Ph.D.

Funding Source: UVA/NINR

Project Summary: Many patients with advanced prostate cancer along with their decision partners/proxies (DPP) struggle with complex treatment decisions, such as when to start, change or stop cancer directed treatment. Despite the utility of decision aids (DAs) to address decisional conflict, little is known about treatment decision-making for advanced cancers.

The study's primary aim is to test the effects of a theory-based mHealth DA (CHAMPION) administered by Registered Nurse (RN)-Community Patient Navigator (CPN) teams to advanced prostate cancer patients and decision partners/proxies on the following outcomes: less decisional conflict/uncertainty, higher psychosocial quality of life domain (HRQL-PSY) and less regret at the time of making an anti-cancer treatment decision. The secondary aim is to evaluate the CPN role in delivery of the mHealth DA (CHAMPION) from the patients' and DPPs' perspective.

Preliminary estimates of treatment effects by race to see if the data support a larger effect among African Americans vs. others in the primary and secondary aims will also be explored. This mixed-methods population-based randomized controlled trial will gather data from 158 patient/DPP pairs at three sites: University of Virginia Emily Couric Cancer Center, the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University and Virginia Commonwealth University Massey Cancer Center.

The pretest/posttest design will measure a time period that includes three single-event decisions over the course of their cancer-directed treatment. A qualitative retrospective design will allow exploring the experiences of both patients and their DPPs separately in an interview at the completion of the study. Stratification by race (African American and Caucasian/other) and decision point (starting vs. changing vs. stopping anticancer treatment) will be used. There will be two groups: the control (enhanced usual care [EUC]) group and the decision intervention (DI) group. The DI group will receive an interactive seven-component cognitive-behavioral skills mHealth program (DA) with a RN-CPN team, primarily focusing on decision-making during cancer treatment. Self-report measures will be used for all participants in addition to probes for the taped interviews with DI.

The primary outcome measures are:

Decisional conflict (uncertainty)
Decisional regret
HRQL-PSY
Decision-making participation preference

Generalized linear models will be used for data analysis for the quantitative component, and qualitative evaluation of the intervention will be conducted to capture each pair's experience of the CHAMPION intervention. This innovative mHealth DA delivered by a CPN is expected to increase acceptability and the uptake of both the DA and the technology components. This addresses several NIH/NINR innovative questions, through the use of information technology to promote health-related decision-making for providers and patients, examining patient outcomes for improvement in healthcare, as well as to engage and support individuals such as extended family, lay coaches, etc. to augment provider care and recommendations.

Principal Investigator: Vanessa Sheppard, Ph.D.

Funding Source: American Cancer Society 133800-RSG-19-182-01-CPPB

Project Summary: Black breast cancer (BC) survivors experience the worst mortality outcomes. Most are recommended effective systemic therapies (chemotherapy or adjuvant hormonal therapy), but adherence is often suboptimal. Patient-centered communication (PCC) is central to high-quality care and to treatment adherence. Unfortunately, Black patients experience lower PCC with providers. Improving communication in black survivors around systemic treatment adherence may reduce disparities. Our preliminary data found that black breast cancer survivors wanted: more involvement in their cancer care, communication support, peer-based strategies, streamlined treatment information, and culturally relevant materials.

This study is responsive to research priorities and national recommendations to empower cancer patients in their medical encounters. Guided by an integrative theoretical framework and our promising preliminary data we will employ a two-arm RCT to test whether SIS (N=230) vs. enhanced usual care (EUC N=230) improves communication with providers and systemic therapy adherence in newly diagnosed black BC patients. The EUC arm consists of a low-literacy treatment recommendation summary form. To our knowledge this will be the first study to rigorously test a multifaceted intervention to address communication disparities and cancer treatment adherence.

If successful, with the help of key stakeholders (e.g. community partners, clinicians), we will disseminate and implement our intervention and materials in various settings including NIH's Research Tested Intervention Programs (RTIPs) and oncology clinics.

Principal Investigator: Maria Thomson, Ph.D.

Funding Source: Temple University, National Cancer Institute

Project Summary: As health systems and insurers emphasize increased system efficiencies and reduced hospital stays, the responsibility of care for cancer patients is shifting to informal caregivers (CGs) in the home. An estimated 4 million CGs spend an average of eight hours per day providing care for adults with cancer in the U.S.

Caregiving includes emotional support, financial assistance and personal care, as well as coordination of services and skilled nursing. Negative effects, which include emotional, social and financial disruptions and lessened quality of life, intensify as a cancer patient approaches death. Current research does not fully describe the extensive range of care provided by CGs, how care changes as disease progresses and whether and when care needs exceed CGs' skills and emotional and financial resources.

High subjective burden, such as stress and distress, has been documented for CGs. However, little is known about CGs' objective burden in this population, specifically scope and intensity of tasks. This proposed study would be the first to comprehensively examine the lived experiences of CGs of patients with advanced solid tumor cancers. To accomplish this, the multi-site cohort study will employ a prospective, longitudinal design that will follow CGs of patients with life limiting cancer for up to 12 months or until one month after patient death. Data will be collected bi-weekly and in-person from CGs in their homes using qualitative interviews, quantitative surveys, CG diaries and structured observation.

The overall goal of this study is to understand CG objective burden, a key and understudied contributor to overall CG burden and how it affects both health and economic outcomes of CGs and to identify potentially modifiable factors impacting CG overall burden.

Principal Investigator: Vanessa Sheppard, Ph.D.

Funding Source: National Cancer Institute R21CA236496

Project Description: Breast cancer is the most diagnosed cancer for Black women. Black women suffer from more aggressive forms of breast cancer (e.g. triple-negative breast cancer) and higher mortality and recurrence rates than their White counterparts. Additionally, Black women, specifically young Black women, have the highest prevalence of BRCA1 or BRCA2 gene mutations, which significantly increases their lifetime risk of developing hereditary breast and ovarian cancer (HBOC). While genetic cancer risk assessments for women at high risk of carrying a mutation inform treatment for survivors and risk management decisions in unaffected women, Black women underutilize this resource when compared to White women. The reasons for disparities in genetic counseling and testing are multifaceted (e.g. access, lack of knowledge); however, studies indicate that increasing access and awareness alone may be insufficient to address disparities. Addressing cultural and psychosocial factors may enhance uptake of genetic counseling and testing. Culturally appropriate information is needed.

Our experienced multidisciplinary team will conduct a risk communication intervention designed to target emotions and cultural values. Guided by the two evidenced-based theories (Theory of Planned Behavior, Social Cognitive Theory) and our preliminary data, we will conduct a two-phase mixed methods study. In Phase I we will develop a narrative YouTube video intervention that will target key psychosocial factors. In Phase II we will pilot the intervention in Black women at risk of HBOC. Women will be randomized either the YouTube video arm (n=25) or a Print education arm (n=25); all women will be contacted by a scheduler to make an appointment for genetic counseling. Our primary outcome is genetic counseling at 3-months following the receipt of the intervention or print materials; secondary outcomes include psychosocial factors (e.g. knowledge, self-efficacy).

This study meets the Healthy People 2020 goals to enhance GCT in at-risk populations, and the national priorities to increase diversity in genetics research participation while incorporating emotions into cancer research. Findings will inform new strategies for behavioral interventions targeting Black women at risk of hereditary breast and ovarian cancer and will inform a future multicenter trial.

Principal Investigator: Vanessa Sheppard, Ph.D.

Funding Source: National Cancer Institute, Grant No. 1UG1CA189869-01

Project Summary: Massey Cancer Center (MCC) will serve as the primary component site for an NCORP Minority/Underserved Community Site award in partnership with nine collaborating community component sites. The overall objectives of this partnership are to extend novel, innovative and effective minority recruitment approaches to an expanded base of community component sites, increase opportunities for minority and medically underserved individuals to participate in cancer clinical trial research (CCTR) and to integrate cancer care delivery research (CCDR) into the overall MB-NCORP.

Accordingly, the specific aims of this proposal are to:

establish a research infrastructure that will further enable community component sites to conduct CCTR with an emphasis on trials relevant to minority and medically underserved populations
conduct NCI-approved CCTR at the MCC primary component site and throughout the community component sites
integrate CCDR into the overall MB-NCORP.

The research design of the MB-NCORP offers a full menu of cancer studies including those in cancer prevention and control, screening, treatment, imaging and CCDR. The proposed research is relevant to the mission of the NCI as MCC and the community component sites will bring cancer clinical trials and research to low-income, minority, and medically underserved individuals who otherwise would not have access to such studies. These studies will address many diverse factors from patient, provider, organizational, and policy perspectives that contribute to known disparities in cancer detection, treatment, and outcomes. Targeting the minority/underserved populations in their communities is a critical step toward alleviating the cancer care disparities prevalent in these populations.

Principal Investigator: Kathy Tossas, Ph.D.

Funding Source: Pfizer Inc. and American Cancer Society

Project Summary: Project COALESCE will facilitate the development and execution of quality improvement initiatives (QI) that address systemic barriers to colorectal (CRC) and cervical (CCa) cancer screening and diagnostic follow-up, prioritizing those that disproportionately impact Black populations. We propose to do this in the primary care settings of selected Federally Qualified Health Centers (FQHCs) located in some of the most underserved communities in southcentral and eastern Virginia. Uniquely, the QI initiatives will utilize community engagement approaches, executing dyadic partnerships between participating FQHCs and local community organizations identified by the FQHC. The purpose of such partnership is to increase the lay community’s input on the development and implementation of QI initiatives, beyond what is traditionally done through FQHC boards of directors, often inclusive of community members. Such closer involvement from the target community may lead to deeper understanding, higher trust, uptake, innovation, and sustainability of QI initiatives, and ensure that approaches chosen truly to represent what is critically needed.

Principal Investigator: Bernard Fuemmeler, Ph.D.

Funding Source: National Cancer Institute, R21CA239188

Project Summary: To advance research in this area, we propose the development of a novel tool to assess ECIG power objectively. To do so, we leverage our experience by adapting an existing, validated smartphone-based research tool – the SmartIntake® app. Using SmartIntake®, participants take pictures of food before and after they eat and their images are transmitted to a central server where they are analyzed using a computer-assisted and validated visual comparison procedure that estimates participant energy and nutrient intake. We will adapt this app and software platform so that ECIG users can take a picture of their device and liquids and, using a similar backend database, researchers will be able to determine the device’s power (V and Ω) and amount of liquids consumed.

The ultimate goal of the proposed project is to develop a fully deployable smartphone app – SmartVape – that uses photography to capture real-time data allowing for objective assessment of the power of any marketed ECIG device and the amount of liquids being consumed with that device. We believe this tool will pave the way for more accurate studies on the behavioral and health effects of ECIG use.

Project Investigator: Micheal Preston, Ph.D.

Funding Source: NCI/ Geographical Management of Cancer Health Disparities (GMaP) Program in Region 1 North Stimulus Award

Project Summary: The coronavirus disease 2019 (COVID-19) pandemic has many downstream effects. Over 16.9 million people have survived cancer in the United States. Although the overall death rate has declined, disparities exist among underserved populations. Black men, unfortunately, bear the greatest burden of suboptimal cancer outcomes and face the shortest life expectancy of any other group in the United States. Multiple studies suggest that Black survivors (particularly men) have poorer overall health, social support, and cancer care outcomes. Men who are diagnosed with cancer have unique needs (e.g., support after treatment); however, men who live in rural areas have unique barriers that may impact their quality of life and outcomes (e.g., recurrence, mortality). The major goal is to understand perspectives of cancer survivorship from Black men from rural areas.

Principal Investigator: Vanessa L. Sheppard, Ph.D.

Funding Source: National Cancer Institute, Grant No. 2T32CA093423-11

Project Summary: This application seeks continued support for the Training Program in Behavioral and Health Services Cancer Control Research (application # R25 CA093423-06A1) from the National Cancer Institute T32 mechanism. This training program is located within the Massey Cancer Center (MCC) of Virginia Commonwealth University (VCU) and provides transdisciplinary training for predoctoral and postdoctoral candidates in cancer prevention and control research.

The overall goal of this training program is to provide an environment that encourages the development of cancer prevention and control research at the highest levels. Training is targeted to individuals in the social sciences (psychology, sociology, economics, anthropology), public health, biostatistics and those who have completed their clinical requirements for specialty training in medicine and nursing. To accomplish this goal, a training program has been structured to foster transdisciplinary research, a precondition to conducting research in this field. The predoctoral training component aims to recruit potential future investigators to this research area at the earliest time in their careers. This is important if we are to speed up the development of focused cancer prevention and control research by creating a cadre of students who are focused on this research area at the outset of their research training.

The flexible two-year postdoctoral training component helps guide young investigators to this field of study and provides them with integrated but focused training to conduct fundamental and interventional studies in cancer prevention and control. This program will specifically and especially foster research that contributes to the understanding of the production of health disparities in cancer outcomes. VCU is uniquely positioned to provide this training because of its role as a safety net hospital, the population it serves and its standing as an NCI- designated cancer center. The goal of this program is to train the next generation of cancer prevention and control researchers.

To accomplish this goal we will do the following

Offer a multidisciplinary integrated research training program with a broad range of research opportunities
Meet the needs for training in emerging research areas in cancer prevention and control
Provide training to researchers from diverse academic and ethnic backgrounds and intensive mentoring
Provide a specialized curriculum that coalesces cancer control strengths at our institution

Principal Investigator: Michael Preston, Ph.D.

Funding Source: American Cancer Society Institutional Research Grant

Project Summary: Colorectal cancer (CRC) is the second most common cancer in the U.S. CRC is one of the most preventable cancers and causes of cancer disparities. There are a higher number of new cases and deaths in areas that are rural, low-income, and medically underserved. The higher death rate affects minorities and low-income residents living in rural areas the most. Fortunately, CRC screening can lower both new cases of CRC the number of residents who die from CRC. Unfortunately, Massey Cancer Center Catchment Area includes a large number of low-income communities that face economic and location barriers to CRC screening. Federally Qualified Health Centers (FQHCs), also commonly called Community Health Centers, specialize in caring for these underserved communities that are affected by CRC. Data suggests that Virginia FQHCs (include 30 Organizations, 150 Health Care Delivery Sites) CRC screening rates in 2018 vary widely from a low of 14% to a high of 63%. Reasons for this difference if screening rates may include awareness, staffing, costs, patient needs, and insurance status; yet, little is known about why such variation exists. The major goals of this project are to assess preventive service use and cancer risk factors that influence CRC screening in FQHCs and to understand perceptions, knowledge, and beliefs about CRC evidence-based interventions.

Principal Investigator: Michael Preston, Ph.D.

Funding Source: CDC, Virginia Department of Health

Project Summary: The purpose of the project is to decrease the burden of colorectal cancer in an area identified as a colorectal cancer hotspot. This project will increase screening rates and help decrease the number of preventable deaths from colorectal cancer. Building on the mobile Health Initiatives Resource Experts (mHIRE), this project will help reduce the physical and economic burden of colorectal cancer by increasing awareness and participation in colorectal cancer screening and prevention. The major goals of this project are to decrease the burden of colorectal cancer in Virginia by providing access to colorectal cancer screenings and patient navigation for residents from rural and underserved communities.