Outside the laboratories where researchers pick apart the biology of cancer, and the clinics where doctors treat it, are the realities of cancer in populations of people. Who gets cancer? Which treatments work best in which settings? Do some groups of people have better outcomes than others? How does cancer affect patients’ lives beyond the disease? Does everyone receive the same quality of care? In Colorado, the University of Colorado Cancer Center Population Health Shared Resource (PHSR) collaborates with doctors and researchers to find the answers to these questions that influence the design and delivery of care.

Cathy Bradley, PhD

Cathy Bradley, PhD, director of the PHSR at CU Cancer Center

“The PHSR facilitates cancer prevention and control research in the clinic, community, and population settings,” says Cathy J. Bradley, PhD, director of the PHSR and the Grohne Chair in Cancer Prevention and Control Research at the Colorado School of Public Health.

As a “shared resource” this often means collaborating with other CU Cancer Center members. For example, CU radiologist and researcher Sana Karam, MD, PhD, often provides radiation treatment for patients also undergoing chemotherapy for head-and-neck cancer. But which chemotherapy drug works best in this setting? Karam worked with Bradley and her team to mine data contained in the Surveillance, Epidemiology, and End Results (SEER)-Medicare database to discover that two-year overall survival was better for patients treated with cisplatin than it was for patients treated with carboplatin or cetuximab (and at lower cost).

Another collaboration between Karam and the PHSR team explores possible anti-cancer effects of the diabetes drug metformin. Again, the PHSR explored the SEER-Medicare database for outcomes of head-and-neck cancer patients, finding that diabetics who happened to be taking metformin along with their cancer treatment had 73.4 percent 2-year survival, compared with 57.7 percent survival for diabetic patients who did not happen to be taking metformin, and 65.5 percent survival for non-diabetics.

In addition to SEER-Medicare, the PHSR commonly facilitates researchers’ access to other sources of comprehensive electronic patient and provider data, including those available through COMPASS, the University’s integrated health data warehouse, Practice-based Research Networks, and the Colorado Cancer Registry.

“Many of our members, whether they be basic, translational or clinical researchers, have questions that can only be answered with large population-based data. The PHSR offers help collecting, interpreting and representing data in ways that require skills that may be outside researchers’ areas of expertise,” Bradley says.

The PHSR is a relatively new resource, having opened its services to the CU Cancer Center research community in 2017. The first year involved recruiting staff including co-director, Myles Cockburn, PhD, manager Megan Eguchi, and data analysts Amy Mellies, Allison Valentine, Levi Bonnell, and Makenzie Hawkins. As a first-year research goal, the group prioritized understanding the landscape of cancer in the CU Cancer Center catchment area, namely Colorado.

“We show two ‘Coloradoes’: The Front Range and rural Colorado,” Bradley says, pointing out that Front Range residents have many healthcare options, whereas, “Not only are many rural counties without health care services, but they are also geographically isolated.”

The group’s analysis of cancer in Colorado also shows disparities in cancer outcomes between Hispanic and white populations, and between socioeconomically high and low populations.

“For example, the 5-year survival rate for all cancers combined for low poverty areas is 70 percent compared to 55 percent in high poverty areas,” Bradley says.

The group also shows that about half of men in Colorado and 40 percent of women will experience cancer at least once in their lifetimes.

According to the PHSR, ongoing goals now include the following: 1) provide pre-award development support for population health studies; 2) support database research activities (e.g., creating analytic datasets, managing and storing data); 3) provide population-based field research including study recruitment, site selection, and assistance with data collection; and 4) facilitate disparities research by providing relevant background data, outreach, education, and formative research with underserved populations, and engaging with community partners in efforts to improve access, screening and cancer care in minority populations.

“We continue to increase the number and representativeness of available datasets and to expand services to more programs and investigators,” Bradley says.

The group hopes that these expanded services will result in additional collaborations with CU Cancer Center members and the research community in Colorado as a whole.

Email the PHSR at cathy.bradley@ucdenver.edu