Since the signing of the National Cancer Act in 1971 cancer research has produced many concrete gains in cancer prevention, diagnosis and treatment. The four most common cancers in the United States (breast, prostate, lung and colon) have all seen marked improvements in early detection and treatment that have led to gradual and persistent decreases in cancer deaths since 1975.1 However, the fruits of cancer research have not always been equally distributed throughout the US population. Racial/ethnic minorities and the poor, who have historically been medically underserved, continue to suffer disproportionately from cancer.
The National Cancer Institute (NCI) defines cancer health disparities as "adverse differences in cancer incidence (new cases), cancer prevalence (all existing cases), cancer death (mortality), cancer survivorship, and burden of cancer or related health conditions that exist among specific population groups in the United States.”2 These populations may be defined by level of education, race/ethnicity, gender, geographic location, or income and disparities have been well documented in each of these disadvantaged groups. For example, African American patients with breast cancer are more likely to experience delays in initiation of surgery or chemotherapy, are less likely to receive modern surgical techniques, and are less likely to receive recommended radiation or chemotherapy after surgery.3-7 These and other described disparities in care likely contribute to the fact that while African Americans are actually less likely to be diagnosed with breast cancer, they are more likely to die from their cancer.8 The underserved suffer disproportionately from cancer and its associated effects, including premature death and these groups have a higher incidence and mortality for many types of cancer.9
Some specific examples of disparate cancer incidence, treatment and outcomes10-11
Epidemiologic studies suggest that the underlying basis for cancer health disparities is multifactorial and differs among different subpopulations and among different cancers. In prostate cancer, for example, there are well documented disparities in screening, stage at diagnosis and treatment for African American men who ultimately have worse overall survival.11-13 However, even when adjusting for differences in stage and treatment the disparity in survival persists, suggesting that biological factors might account for some of the observed survival disparity.14 Several genetic aberrations have been identified that are associated with the risk of developing prostate cancer, and developing more aggressive cancer. African Americans are more likely to harbor these genetic aberrations, and some studies estimate this could impart a 5-fold increase in risk of developing prostate cancer.15-20 Studies of this type clearly demonstrate the power of laboratory research to identify factors that contribute to cancer health disparities.
Efforts to unravel the causes of persistent health care disparities have been significantly hampered by the low rate at which individuals in underserved populations elect to participate in clinical trials. Cancer clinical trial participation has been very low among the socially disadvantaged and racial/ethnic minority groups that have been historically underrepresented in cancer research, ranging from 3 -20 percent of eligible participants. Many factors appear to negatively impact on clinical cancer research participation. These factors including low socioeconomic status, speaking a primary language other than English, differences in communication styles, mistrust of research and the medical system and lack of knowledge about the origin of cancer.21-23
Although many programs nationally and locally are addressing the issue of health care disparities, more must be done. The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center has teamed up with the Indiana University Simon Cancer Center and The Ohio State James Comprehensive Cancer Center to offer a fellowship entitled Cancer in the Under-Privileged, Indigent or Disadvantaged (CUPID). The mission of this program is to promote the discipline of Oncology among medical students interested in caring for and understanding the needs of under-privileged, indigent or disadvantaged people. It is a 10-week program in which medical students will have the opportunity to conduct laboratory research. In addition, students are assigned clinical mentors in each of the three core oncology fields (surgical oncology, medical oncology and radiation oncology). An 8-week series of didactic lectures and journal clubs will cover the genetic and biological basis of cancer, cancers by site, conventional and emerging strategies for cancer therapy, end-of-life care, health care disparities, and strategies for effective outreach. Students are provided with a stipend and free housing. Our hope is that this program will produce compassionate and informed physicians who will proudly join in the crusade against cancer.
The CUPID Summer Translational Oncology Program is 10-week laboratory-based research experience designed to introduce rising second year medical students to oncology. The program runs for 10 weeks (May 28 - August 2, 2019). Within these dates, students can select an 8-week period that best conforms to their academic calendar of their home medical school. Applicants who will not be available for a full 8-week period will be considered on a case by case basis. The program is jointly administered by the Johns Hopkins University School of Medicine (JHU), Indiana University School of Medicine (IU), and The Ohio State University College of Medicine. The mission of this program is to address the impending shortage of practicing oncologists within the US, and to cultivate an interest in cancer treatment and research among a diverse body of compassionate medical students. US medical students who are interested in both research and health care disparities, and who have demonstrated a sustained commitment to community service are invited to apply. Students may choose their location of preference* in: 1) Baltimore, Maryland, 2) Indianapolis, Indiana, or 3) Columbus, Ohio, and then decide to select an alternative location as back-up. The number of fellowships at each of the sites is limited and admission will be highly competitive. One important goal of the program is to reach out to students at institutions that are not affiliated with an NCI-designated cancer center. Accordingly, such applicants will be prioritized.
*The Ohio location is limited to medical students who are currently attending The Ohio State University. Ohio residents attending other US Medical Schools may apply to Johns Hopkins or Indiana locations.
Each student is matched with a research mentor who will oversee the student’s laboratory activities for the duration of the program. Individual lab assignments are made by the program’s co-directors, following review of each accepted student’s application materials. Laboratory mentors are volunteers who have been selected based on their enthusiasm for the mission of the program, and their willingness to devise a well-defined translational research project that can be completed during the program’s timeframe.
A didactic lecture series runs for seven weeks. One hour lunchtime lectures are delivered simultaneously to all sites via a live videoconference. Specific topics include the molecular basis of cancer, the pathophysiology of common types of cancer, cancer diagnosis and therapy, cancer epidemiology and biostatistics, horizons in cancer research, future opportunities in the oncology workforce and cancer health disparities. The course varies from year to year, depending on speaker availability and the integration of new speakers and topics, and also by any new developments in cancer research and care.
The students will experience the clinical side of oncology by participating in one half-day rotations with physicians on the medical, surgical, pediatric, and radiation oncology clinical services. Students may shadow clinical faculty members on both inpatient and outpatient services. Preceptors are selected on the basis of their ability to engage students and participate on a volunteer basis to provide a range of perspectives on cancer care. Students may schedule additional time with clinical rotation mentors (e.g. in surgery) as time allows within the program time period.
Other program activities include a journal club and a closing symposium at which students present their projects and research findings. To help build a broad professional network, students from all sites will participate in a two-day joint conference in Washington, DC that is focused on cancer-related advocacy and policy.
While students from any US medical or osteopathic school may apply, students at schools that are not affiliated with an NCI-designated comprehensive cancer center will be prioritized for admission. A list of all comprehensive cancer centers and their university affiliations may be found here: https://www.cancer.gov/research/nci-role/cancer-centers.
* See specific program location.
The online student registration and application process will open on December 17, 2018 at 6:00 AM EST and will close on January 23, 2019 at 12:00 PM EST. Students should register as soon as possible, and then complete their application over the time period allowed. Students who register late will have less time to complete their application.
Program dates are May 28, 2019 - August 2, 2019. Within these dates, students can select an 8-week period that best conforms to their academic calendar of their home medical school. Applicants who will not be available for a full 8-week period will be considered on a case by case basis. Student stipends are pro-rated according to the number of weeks the student is approved to attend.
Students will be notified of acceptance via email by mid-March.
Students interested in applying for CUPID 2019 should first complete an online registration and create a password. Students may update their applications until the submission deadline of 01-23-2019. Students should expect to receive a confirmation email upon registration that will include instructions for requesting their referral letters. Students should complete this step early in the process. The application includes a written personal statement (500 words or less), a personal photograph, two recommendation letters, and a Curriculum Vitae (CV) or resume. Upon acceptance to the program, visiting students will be required to complete the registration requirements for the School they are assigned.
For more information on these requirements, please see the tab for the location you are interested in attending.
Students will spend most of each day -as well as some evenings and weekends as needed -working on a laboratory-based research project under the guidance of their mentor and/or senior lab members. Didactic lectures or journal discussions are held over lunch, which is provided by the program for approximately 7-weeks during the 10-week program. These sessions will be conducted as video teleconferences that connect all three locations. Four half-day clinical rotations in medical oncology, radiation oncology, pediatric oncology, and surgical oncology are scheduled during the 10-week program. Additional rotations may be scheduled depending on the student interest, schedule, and the availability of faculty.
Students will be matched with a host lab/mentor who will oversee the student's research for the duration of the 10-week program. Lab assignments are made by the CUPID Program Co-Directors. Laboratory mentors are responsible for educating the students regarding standard laboratory procedures and safety. Students will spend most of each day - as well as some evenings and weekends as needed - working on their laboratory project, in direct partnership with the primary mentor and under the day to day guidance of experienced trainees in the lab. Upon completion of the 10-week program, students will present their project at an end of program symposium.