Equity in Access Research Grants
The Leukemia & Lymphoma Society’s (LLS) Equity in Access Research Program was created to help ensure more equitable access to care for blood cancer patients and survivors.
Through this program, LLS aims to generate new evidence that can guide policy reform and changes in healthcare practice, in order to mitigate the impact of social, economic and environmental disadvantages and reduce barriers to care. Learn about our 2023 Equity in Access Research Program grantees and their research following this year’s application information.
Application is now closed
LLS invites Letters of Intent for the Equity in Access Research Program under two Requests for Proposals:
Building Evidence for Effective Strategies to Increase Therapeutic Cancer Clinical Trial Accrual: Promoting Access for Patients from Underrepresented Groups
Understanding How Health Insurance Affects Equity in Access to Care for Patients with and Survivors of Blood Cancer
See below for links to the Request for Proposals, Application Guidelines, and Application Templates as well as Key Dates
Informed by a systematic review of the literature, the purpose of this Request for Proposals (RFP) is to fund research studies that will increase our understanding of effective strategies for increasing accrual to therapeutic cancer clinical trials, particularly among underrepresented populations. Specifically, we seek proposals that will implement and evaluate interventions designed to a) mitigate multilevel barriers to therapeutic clinical trial accrual for underrepresented groups and b) quantitatively measure the impact of these interventions on patient accrual. We are particularly interested in proposals that address systemic, institutional, and clinician-related barriers that impede clinical trial participation.
The purpose of this Request for Proposals (RFP) is to fund research studies that will increase understanding of the impact of insurance status and type on equity in access to care for patients with and survivors of a blood cancer, and that yield data to guide policy reform to ensure that patients achieve access to the cancer care and services they need throughout their lives. Studies may focus on any point, or multiple points, in the cancer continuum, from diagnosis through post-treatment survivorship and end-of-life. Studies must be U.S. specific, with a focus on the U.S. health insurance market and populations living within the U.S. and its territories.
Key Dates and Deadlines:
| Deadline to submit Letters of Intent | September 15, 2023 (3PM ET) | |
|---|---|---|
| LLS notifies applicants whether they are invited to submit full proposal | November 3, 2023 | |
| Deadline for receipt of full proposals (invited applicants) | January 26, 2024 (3PM ET) | |
| Notification of awards | April/May 2024 | |
| Grant start dates | July 1, 2024 | |
For questions about these RFPs and the application process, please contact researchprograms@lls.org.
Meet the 2023 Equity in Access Research Program Grantees
LLS has just awarded nearly $3.8M in funding for three-year research grants exploring the relationship between health insurance and equity in access to care for blood cancer patients and survivors.
Jalpa Doshi, PhD
Principal Investigator
Professor, Medicine, Perelman School of Medicine, University of Pennsylvania
Impact of Insurance Type and Cost Sharing on Equity in Access to Oral Anticancer Medications for Blood Cancers
Increases in the number of FDA-approved oral anticancer medications (OAMs) to treat blood cancer have improved quality of life and survival rates. However, the high price of these drugs makes treatment extremely expensive, pointing to the importance of adequate insurance coverage. Even with insurance, many patients face barriers to OAM access such as high out-of-pocket costs and bureaucratic barriers (e.g., prior authorization, step therapy, and other utilization management strategies) that can result in treatment delays and/or abandonment. Knowledge is limited on the prevalence of these barriers and the rates of OAM delays and abandonment among blood cancer patients.
Aims:
Aim 1: Evaluate the association of insurance type with insurer rejection, reasons for rejection, eventual approval, and time to approval of new OAM prescriptions for blood cancers, overall and by sociodemographic factors.
Aim 2: Evaluate the association of insurance type with patient abandonment and delayed fills of insurer-approved new OAM prescriptions, overall and by sociodemographic factors.
Aim 3: Evaluate the association of cost sharing with patient abandonment and delayed fills of insurer-approved OAM prescriptions, overall and by sociodemographic factors, and conduct simulations under alternative cost sharing scenarios among commercially insured enrollees.
Aim 4: Evaluate the effect of cost sharing changes under the Inflation Reduction Act on OOP costs, patient abandonment, and delayed fills of insurer-approved new OAM prescriptions for blood cancers, overall and by sociodemographic factors among Medicare Part D enrollees.
Study Design: This project will use a large national dataset that links detailed information on the prescription life cycle (e.g., insurer approval/rejection, reasons for rejection, out-of-pocket costs for purchased prescriptions, and fill vs. abandonment at the pharmacy) with patient-level race/ethnicity, geographic information, and area-level social determinants of health. The dataset captures 317 million patients across all insurance types (commercial, Medicare, Medicaid, and cash/uninsured) and each U.S. state. Potential access barriers will be examined across insurance types, with specific focus on identifying whether these barriers are worse among vulnerable populations such as racial/ethnic minority patients.
Policy Significance: By including blood cancer patients with all insurance types (including the uninsured), study findings will provide strategies for improved OAM access that can be enacted at the state and federal level. The study will also examine how recent legislative changes from the Inflation Reduction Act (IRA) to the structure of the Medicare drug benefit impact these barriers.
Meng Li, PhD, ScM
Principal Investigator
Assistant Professor, Department of Health Services Research, Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center
Christopher Flowers, MD, MS
Co-Principal Investigator
Professor and Chair of the University of Texas MD Anderson Department of Lymphoma and Myeloma
Investigating the Impact of Insurance Coverage on Access to Care and Outcomes among Lymphoma Patients
With the rising costs of cancer care, patients are more likely to experience financial hardship. It is generally understood that a lack of adequate health insurance contributes to this financial hardship among cancer patients, with demographic characteristics such as race, ethnicity, and income playing a role as well. However, there is a lack of specific knowledge on the prevalence of financial hardship, the impact of health insurance, and whether and to what extent hardship affects quality of life and mortality among patients with non-Hodgkin lymphoma (NHL). This work aims to address this gap by exploring the role of insurance coverage in access to care, survival, and financial hardship among patients with NHL and to what extent insurance coverage influences racial disparities in access and outcomes. The hypothesis is that NHL patients without adequate insurance coverage (uninsured and Medicaid) have worse access to care, survival, quality of life, and greater financial hardship. We further hypothesize that lack of adequate insurance coverage partially explains worse access to care and outcomes among minorities and low-income patients and moreover, that greater financial hardship is associated with worse quality of life and survival among patient with NHL.
Aims:
Aim 1: Determine if time from diagnosis to initial treatment, type of initial treatment, financial hardship, quality of life, and survival of patients with NHL differ by individual patient’s type of insurance coverage, race and ethnicity, and household income.
Aim 2: Examine if type of insurance coverage influences disparities in access and outcomes based on patient race, ethnicity, and household income.
Aim 3: Examine if quality of life and survival are associated with financial hardship, and if the associations vary by race, ethnicity, household income, and type of insurance coverage.
Study Design: The study will use data from a large multi-center prospective cohort study of NHL, electronic health records of a safety-net health system integrated with a cancer registry, and administrative claims from a large national private insurer. Our study population are from all 50 states, and include a large number of uninsured, Medicaid-insured, and patients who are Black and Hispanic.
Policy Significance: Findings from this study may provide evidence that policymakers can use to guide to insurance coverage policymaking, particularly for disadvantaged patient groups.
Lori Muffly, MD, MS
Principal Investigator
Associate Professor of Medicine, Division of Blood and Marrow Transplantation and Cellular Therapy, Stanford University
Theresa Keegan, PhD, MS
Co-Principal Investigator
Professor of Medicine, University of California, Davis
Helen Parsons, PhD, MPH
Co-Principal Investigator
Associate Professor, Division of Health Policy & Management, University of Minnesota
Towards Equity in Specialized Cancer Care for Adolescents and Young Adults with Newly Diagnosed Acute Lymphoblastic Leukemia
Research suggests that adolescents and young adults (AYAs) with newly diagnosed acute lymphoblastic leukemia (ALL) in the U.S. experience improved survival when treated at a specialized cancer center (SCC). However, fewer than 50% of AYAs receive front-line ALL treatment at one of these designated sites. Health insurance may play a pivotal role in AYAs ability to access SCC-level care, yet this relationship is poorly understood. This project aims to understand how specific insurance types influence access to specialized ALL care and to provide insight into the costs and health benefits of switching care to an SCC.
Aims:
Aim 1: Examine the relationship between specific types of health insurance coverage and where and when AYA patients receive ALL treatment.
Aim 2: Evaluate the impact of specific types of health insurance coverage on AYA ALL new patient acceptance and wait times across SCC and non-SCC cancer treatment settings.
Aim 3: Conduct a cost-effectiveness (value) analysis examining the extra cost and extra health gain associated with shifting the site of care for all AYA ALL patients to SCCs.
Study Design: In aim 1, this project will use statewide population-based data from California, New York, and Texas to examine associations between specific types of health insurance coverage and receiving ALL treatment at an SCC and evaluate whether specific types of health insurance coverage are associated with delays in initiating ALL treatment. Aim 2 will use a secret shopper design to describe new AYA ALL patient acceptance rates and wait times at SCC and non-SCC institutions based on specific health insurance plans to determine insurance-related access barriers at the institutional level. Finally, aim three will study cost effectiveness (value) using multiple real-world data sources to estimate the extra cost and extra health gain from receiving SCC compared to non-SCC care.
Policy Significance: Understanding the implications of insurance coverage on ALL cancer care at an SCC in young adults, particularly issues of insurance acceptance and financial implications of shifting care, will inform ongoing legislative efforts seeking to improve specialty care access by requiring expanded options for referrals to and insurance network coverage of designated cancer centers as part of their care.
Oreofe Odejide, MD, MPH
Principal Investigator
Hematologic Oncologist at the Dana-Farber Cancer Institute, Assistant Professor of Medicine at Harvard Medical School
Gregory Abel, MD, MPH
Co-Principal Investigator
Director, Older Adult Hematologic Malignancy Program at the Dana-Farber Cancer Institute, Associate Professor of Medicine, Harvard Medical School
Health Insurance and End-of-Life Care for People with Hematologic Malignancies
Timely hospice use and avoiding overly intensive care are essential components of quality end-of-life (EOL) care. Research suggests that blood cancer patients, and especially those from racial and ethnic minority groups, are more likely to receive sub-optimal EOL care. While some data has suggested that barriers related to insurance access and type have been found to contribute to poorer quality of EOL care among blood cancer patients, this relationship needs to be better understood, particularly among patients from racial and ethnic minority groups who may experience greater adverse impact.
Aims:
Aim 1: Characterize the association of insurance status and type with quality of EOL care in a cohort of blood cancer decedents.
Aim 2: Identify the association of insurance type with quality of EOL care using a national sample.
Study Design: For aim 1, using the Blood Cancer Decedent Discussion Cohort dataset and integrating a new insurance status component, the relationship between insurance status and type and (a) intensity of healthcare utilization in the last month of life; (b) hospice enrollment; and (c) goals of care discussions will be assessed. For aim 2, the MarketScan Research Database be will used to examine potential associations between insurance type with (a) intensity of healthcare utilization in the last month of life; (b) hospice enrollment; and (c) advance care planning claims.
Policy Significance: The findings of this research may provide evidence to guide policy interventions to expand high-quality EOL care.
Helen Parsons, PhD, MPH
Associate Professor, Division of Health Policy & Management, University of Minnesota
Robin Yabroff, PhD, MBA
Co-Principal Investigator
Scientific Vice President, Health Services Research, American Cancer Society
Cathy Bradley, PhD
Co-Principal Investigator
Associate Dean for Research in the Colorado School of Public Health, Deputy Director of the University of Colorado Cancer Center
The Impossible Choice: The Role of Insurance Design on Financial Toxicity and Access to Care for Individuals with Blood Cancer
The cost of cancer care has been steadily rising, and patients are bearing more of the financial burden, paying increasingly larger portions out of their own pockets for their care. The financial hardship associated with these increased costs can lead to poor treatment adherence and outcomes. Additional research is needed to understand the relationship between insurance design, financial hardship, and treatment outcomes among blood cancer patients over time. This project will explore the relationship between insurance design and financial hardship among blood cancer patients compared to those with solid tumors or no history of cancer. Additionally, the influence of financial hardship on the relationship between insurance design and treatment outcomes will be explored, while also evaluating potential geographic and racial/ethnic disparities.
Aims:
Aim 1: Estimate the relationship between insurance plan type (e.g., high deductible, managed care) and risk of financial hardship after diagnosis in individuals with blood cancer relative to individuals without a cancer history.
Aim 2: Estimate the relationship between insurance plan type and time to treatment, receipt of guideline-concordant treatment, and survival among individuals with leukemia and lymphoma.
Aim 3: Evaluate geographic and racial/ethnic disparities in financial hardship and treatment outcomes (time to treatment, guideline-concordant treatment, and survival) by insurance plan type in individuals with leukemia and lymphoma.
Study Design: A longitudinal cohort study will be conducted using a unique and innovative linkage of the 2012-2020 Colorado Central Cancer Registry (CCCR) to the 2013-2021 Colorado All-Payer Claims Database (APCD) and the LexisNexis Social Determinants of Health (SDOH) data. Aim 1 will examine financial hardship across multiple dimensions (using the LexisNexis SDOH data) within one and five years of diagnosis across insurance plan types (e.g., high deductibles, managed care) in individuals with blood cancer relative to those without a cancer history. Aim 2 will estimate the relationship between insurance plan type and cancer care outcomes (time to treatment, guideline-concordant care, survival) in individuals with leukemia and lymphoma based on information in the cancer registry and insurance claims. Aim 3 will examine whether the relationship between insurance plan types and financial and treatment outcomes varies by geography and race/ethnicity.
Policy Significance: This research will significantly contribute to understanding of how increased cost-sharing for cancer care affects patient outcomes and financial security, which pose higher financial risk to working aged adults undergoing treatment for blood cancer. These findings will inform development of policy-relevant solutions related to benefit design in individuals with blood cancer, including state and federal policies governing insurance regulations.
Support for this program provided by:
