Connecting the Dots: Improving Cancer Outcomes for the Underserved

Reducing the burden of cancer among underserved populations is a lofty goal, but Melinda Stolley, PhD, is well-positioned to generate some big ideas. The cancer incidence rate for Hispanics and African Americans continues to rise, and Dr. Stolley is employing every option she can to change this. It is a mission that stems, in part, from her childhood experiences with her parents, especially the conversations they had around the dinner table.

"My dad covered the civil rights movement for Life magazine, and my mother wrote on social justice issues and was very service-oriented," says Dr. Stolley, associate director of cancer prevention and control for the MCW Cancer Center and professor of medicine. "I was raised in a house with a social justice bent, and I've tried to apply that to my career."

Cancer disparities are more prevalent in low-income and racial/ethnic minority groups, likely owing to the interaction of socioeconomic, cultural, dietary, stress, environmental and biological factors. These factors can impact incidence rates (new cases), prevalence (all existing cases), cancer deaths (mortality) and cancer survivorship.

Dr. Stolley came to MCW in 2015 from the University of Illinois Chicago College of Medicine with an established research portfolio in the areas of health disparities and cancer survivorship, and extensive experience building successful community-based research programs and connecting with minority populations to address cancer disparities. Her research has been consistently funded by the National Institutes of Health for 16 years.

She was recruited to continue her research and help the MCW Cancer Center build a community-engaged cancer research infrastructure, which requires establishing relationships with government agencies, private entities and faith-based institutions, building trust within communities in need, and creating advisory boards to help direct the research. The collective goal of these efforts is to determine which modifiable factors her team should focus on to impact cancer risk, survivorship and recurrence outcomes. Her team includes Kathleen Jensik, MSW, community program manager; Lauren Matthews, MPH, community program coordinator III; Magdalisse Henderson, community program coordinator II; Jermaine Murry, MS, community program coordinator I; and Karmel Cardenas, clinical research assistant II.

Shortly after arriving at MCW, Dr. Stolley received a Greater Milwaukee Foundation grant to help achieve greater health equity. As part of this project, her team conducted focus groups with African American and Hispanic community members to better understand their perceptions of healthcare and the unequal cancer burdens. Themes emerged from these groups, including the desire for more educational opportunities to learn about cancer prevention, screenings and care; the desire for a more diverse workforce; and a general mistrust of physicians. These results were shared at a follow-up Cancer Town Hall at the Wisconsin Black Historical Society.

"From these focus groups, we got personal stories that allow us to think more about next steps instead of just crunching numbers," comments Dr. Stolley. "Plus, these events helped us build trust within these communities because nobody had ever asked them about their cancer experiences before."

Milwaukee resident Samuel Thompson, diagnosed in 2013 with inoperable prostate cancer, was asked to participate in the focus group to share his story with others – and was very thankful for the opportunity. "I learned about the importance of watching my diet and staying physically fit," says Thompson. "It also helped me realize the need to do more outreach in the central city among male African Americans. They need to understand it is ok to talk about prostate cancer and get tested early. Like it or not, we are at a greater risk for getting cancer."

Because one in five African American males will be diagnosed with prostate cancer in their lifetimes, and in response to community feedback seeking prostate cancer information and access to screening, Dr. Stolley's team organized a prostate cancer program, held at Milwaukee's Pilgrim Rest Baptist Church. This event provided timely presentations and materials to help men at risk for the disease as well as survivors. More than 70 men and women attended, and almost 30 men were screened for prostate cancer.

Darryl Davidson, City of Milwaukee men's health manager, works with Dr. Stolley and her team on a variety of projects including the prostate cancer program. He says that they can take credit for helping raise awareness in the community about cancer, screening, treatment options and survivorship. "Dr. Stolley and her team assisted with getting the men who attended the prostate cancer program to consider prioritizing their health and take an active approach to knowing their health status. This is a committed team of professionals who have prioritized our community to reduce cancer disparities," Davidson remarks.

Since conducting the focus groups, Dr. Stolley and her team have begun implementing and planning a variety of interventional and educational programs that help address breast cancer and prostate cancer disparities in the greater Milwaukee area; these all have a research component to help gauge effectiveness.

The team also partnered with Milwaukee High School of the Arts to launch a six-week cancer health education curriculum, which included basics on cancer biology, prevention and risk factors, screening and early detection, treatment and clinical trials, and survivorship. The curriculum was integrated into the high school's health education course. More than 500 students have received the curriculum, and, upon completion, exhibited knowledge and behavioral changes. "Students showed a greater knowledge of these topics and increased fruit consumption," notes Dr. Stolley. "Our hope is that there also will be intergenerational knowledge transfer from the students to their parents and grandparents about topics such as getting a mammogram." She adds that the Milwaukee Public School System is interested in disseminating the curriculum into more schools.

In May 2017, the national faith-based breast cancer awareness program, Pin-A-Sister, was held in Milwaukee for the first time because of Dr. Stolley's team. Three churches participated, and approximately 1,000 women committed to obtaining regular mammogram screenings. The program was held again in October 2017, and a Pin-A-Brother program will be added to encourage regular prostate cancer screenings.

While in Chicago, Dr. Stolley undertook Moving Forward, a National Cancer Institute-funded interventional study of 250 African American breast cancer survivors that helped them make and maintain positive changes in weight, eating habits, physical activity and social support networks. "We knew that weight loss interventions for breast cancer survivors do work, but few of these programs were designed for or targeted African Americans," notes Dr. Stolley. "By deliberately including assets and addressing barriers specific to this community, we created a program that truly resonated with these women, who were then able to make positive changes for themselves, their families and their community."

"African American women who've had breast cancer have higher rates of death from cancer and other causes," adds Dr. Stolley. "We wanted to show that a deliberately designed program of social support, access to exercise programs and help to change eating habits that encouraged weight loss would have a positive impact. We're now bringing the program to Milwaukee, a city with some of the most significant breast cancer disparities in the country."

Dr. Stolley’s team is launching similar intervention programs to help Milwaukee's African American and Latina breast cancer survivors and African American prostate cancer survivors. They also are launching a healthy eating and exercise program, Every Day Counts, tailored toward women with metastatic breast cancer. Every Day Counts is recruiting 40 women to examine the feasibility of a 12-week diet and physical activity intervention for women whose breast cancer has spread to other organs. The program will offer personalized coaching, text messaging and monthly cooking classes to determine if a plant-based diet, moderate activity and resistance training impact body composition and serum biomarker levels. Prior to this study, interventions had not included women with metastatic disease. This study is being conducted in collaboration with Christopher Chitambar, MD, MCW professor of medicine (hematology and oncology), and Patricia Sheehan, PhD, RD, assistant professor in the Loyola University Marcella Niehoff School of Nursing.

The adaptation of Dr. Stolley's Moving Forward weight loss program to Milwaukee Latina breast cancer survivors is a relatively new effort, and will be conducted in partnership with the United Community Center. She is in the process of assembling an advisory board, then will tweak the tools and conduct a focus group of 24 women. The results will eventually lead to a pilot study of the adapted intervention.

Another program in the planning stages is Men Moving Forward, a healthy eating and exercise program for African American prostate cancer survivors aimed at increasing muscle and decreasing fat.

Additionally, in partnership with the Milwaukee Area Health Education Center, Dr. Stolley helped launch a Summer Cancer Disparities Internship Program, which funds four undergraduate or first-year medical school interns for a 10-week program that exposes them to basic science methodologies and community engagement activities. Topics covered include food deserts in Milwaukee, barriers to HPV vaccine among Latino parents, machismo and cancer screening in Latino men.

Dr. Martin Luther King, Jr., once said that "of all the forms of inequality, injustice in health is the most shocking and inhuman." From the focus of her work, her passion, drive and determination, one can't help but think that Dr. Melinda Stolley agrees. She has assembled a team and reached out to national organizations as well as other MCW researchers to do everything possible to reduce the burden of cancer among underserved populations. "I have an amazing team which helps our efforts so much," shares Dr. Stolley. "There are so many resources available at MCW, within our community and around the country – and we are doing all we can to connect the dots."