Center for Health Equity Research and Promotion

CHERP Investigator and Penn Medicine Fellow Ravi Parikh, MD, MPP, received FY19 CHERP pilot funding to explore disparities in treatment patterns and outcomes for 12,500 men diagnosed with prostate cancer in VISN4 between 2001 and 2011. He is also exploring disparities in survivorship care by assessing five years of care following cancer treatment. CHERP Core Investigator Ravi Jayadevappa, PhD, is his Co-Investigator.

Spotlight on VA CHERP Pilot Funding for Early Career Investigators

Disparities in Treatment Patterns and Survivorship Care Among Veterans with Advanced Prostate Cancer

Ravi Parikh, MD, MPP and Ravi Jayadevappa, PhD, Co-Principal Investigators

Prostate cancer is the most commonly diagnosed cancer among US Veterans, representing one-third of all new cancer diagnoses.  Most prostate cancers are curable – the vast majority of patients with localized prostate cancer die from other illnesses.  Survivors often live for years after diagnosis, but the side effects and frequency of treatment can impair their quality of life.

Among African American (AA) Veterans, however, the impact of prostate cancer is much greater and more dangerous for many reasons, including:
• Prostate cancer represents half of new cancer diagnoses among AA Veterans
• African-Americans are diagnosed at younger ages and with more aggressive disease
• African-Americans have worse outcomes from prostate cancer

CHERP Investigator and Penn Medicine Fellow Ravi Parikh, MD, MPP, received FY19 CHERP pilot funding to explore disparities in treatment patterns and outcomes for 12,500 men diagnosed with prostate cancer in VISN4 between 2001 and 2011.  He is also exploring disparities in survivorship care by assessing five years of care following cancer treatment.  CHERP Core Investigator Ravi Jayadevappa, PhD, is his Co-Investigator.

“We are creating an index to measure essential aspects of survivorship care for these patients,” according to Dr. Parikh.  “We looked at racial differences in how often they saw their primary care provider, had their PSA monitored, were screened for colorectal cancer and high blood pressure, and other items of high-quality survivorship.”

The preliminary results suggest that adherence to established guidelines for survivorship care may vary by race.  For example, Caucasians and African Americans had an annual PSA at almost the same rate (W = 61.3% AA = 61.0%), as well as their annual primary care visit (W= 68.9% AA = 67.8%).  However, the data showed that AA patients received less frequent screening for depression and colon cancer.

“The pilot study began only five months ago and has already sparked specific ideas on how to address these disparities,” says Dr. Parikh.  “With valuable input from CHERP’s Veterans Community Advisory Board (VCAB), we are already considering new approaches to close these gaps in care.”

In the second half of the pilot year, Dr. Parikh will continue statistical analysis of the data and explore how to translate the research into practice.  He plans to pursue VA Research funding on a larger scale in the future to improve equity of care for prostate cancer survivors in the entire VHA patient population. 
The VA Center for Health Equity Research and Promotion (CHERP) funds annual pilot projects for early career health services researchers in VISN4 interested in improving quality and equity of health care for vulnerable Veteran populations. 


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