Decreasing Cancer Disparities by Increasing Patient Understanding of Prognostic Genetics

Ewan K. Cobran, Ph.D.

Assistant Professor, Department of Clinical and Administrative Pharmacy, University of Georgia

Ewan K. Cobran, Ph.D.My passion for science was sparked in my high school chemistry class — I was fascinated by chemical processes and elemental reactions. I followed this passion to the University of Florida, where I completed a Bachelor of Science degree in Health Science. During my undergraduate training, I was selected for the Ronald E. McNair and the University Scholars Program to conduct research evaluating the diffusion of technology within the Florida Medicaid Pharmacy Service.

I then pursued a Ph.D. at Howard University, but paying for graduate school was very difficult. I took on student loans, worked part-time and completed several internships while I was in graduate school. Recently, I received an Extramural Loan Repayment Program (LRP) Award (L60) from the National Institute on Minority Health and Health Disparities. The LRP Award has been a lifeline for me as an early-career investigator, enabling my family to afford both my student loan payments and essential living expenses.

During my second year at Howard University, my grandparents died within months of each other after receiving late-stage cancer diagnoses. Coping with their late diagnoses, consecutive deaths and resulting funerals spurred me to explore the damaging cycle of late diagnosis, lack of prevention, lack of treatment and lack of support that leads to premature death for many minorities. After the second funeral, I realized that I wanted to actively eliminate barriers to early cancer diagnoses and prevention for minorities. I focused on identifying racial and ethnic disparities in cancer survival, screening, and access to prevention and treatment.

After graduating from Howard University, I completed a Cancer Health Disparities Postdoctoral Fellowship at the University of North Carolina at Chapel Hill’s Lineberger Comprehensive Cancer Center. I also used the NCATS Clinical and Translational Science Awards (CTSA) Program Diversity Supplement to obtain personalized training, which included coursework, individualized instruction, seminars and conferences, and supervised research experiences. These research experiences were conducted under the mentorship of seasoned investigators with expertise in genetics, urology, decision making, cancer disparities, health services research and research methods. All of this enabled me to acquire foundational competencies in prostate cancer prognostic genetic technology, genome epidemiology and video-based educational tool assessments. The support, protected time and mentorship I received through my CTSA award led to personal success, culminating in a Mentored Research Scientist Development Award (K01) from the National Cancer Institute (NCI) in 2020.

If I could provide advice to trainees, it would be this: Do not be afraid to reach out to program officers at the National Institutes of Health for advice about your grant proposal, and remember that grant resubmission is often just part of the grant writing process. I, for one, submitted my NCI K01 grant proposal twice. It was funded on the second submission, which had been drastically improved by communications between me and an NCI program officer.

Current Research

The incidence and mortality rates of prostate cancer vary substantially among different geographic areas and ethnic groups. Higher rates of prostate cancer mortality are observed among Black and rural white men in the “prostate cancer belt,” a cluster of states that comprises Virginia, North Carolina, South Carolina, Georgia, Mississippi, Alabama and Louisiana.

In 2016, the National Comprehensive Cancer Network recommended that patients and clinicians consider tissue-based genetic tests for localized prostate cancer to help patients make more informed treatment decisions at the time of diagnosis. Specifically, Oncotype DX®, Prolaris®, ConfirmMDx, ProMark® and Decipher® multi-gene mRNA expression panels offer new platforms for categorizing patients based on their risk for biochemical recurrence or metastasis. Although the burgeoning field of genomic medicine generates much enthusiasm, the use of multi-gene mRNA expression panels raises the potential for further divergence in prostate cancer treatment outcomes by race and socioeconomic status.

My current research explores how men with localized prostate cancer and their caregivers comprehend prognostic genetic technology. I also examine how an educational video about genetics affects patient–caregiver communication related to prognostic genetic technology. The significance of my current research lies in its potential to improve public health by increasing the understanding of prognostic genetics by minority, low-income and rural populations.