TRANSFORMING
CANCER CARE IN KENTUCKY

Conquering cancer in the Commonwealth requires an all-hands-on-deck approach, not just from researchers and oncologists, but the very people who face the relentless impact of disease every day: the community.

Achieving NCI Comprehensive Cancer Center designation requires robust community outreach and engagement, something UK Markey Cancer Center puts high on its list of priorities. Many Markey researchers, staff and community partners have had a hand in developing and enriching a variety of programs and initiatives across Kentucky’s 120 counties. Among these dedicated individuals, many have been instrumental in propelling Markey to new heights in alignment with the university’s mission of serving everyone in the Commonwealth.

Creating “The Eyes” of Cancer Prevention and Control

The journey into cancer research and epidemiology for Thomas Tucker, Ph.D., M.P.H., took an unconventional path. Having earned a bachelor’s degree in political science, his first job following graduation was at the American Cancer Society – where his passion for cancer prevention and control began.

Tucker’s career ultimately led him to become the senior director for cancer surveillance at Markey, where he established the Kentucky Cancer Registry (KCR), a vital tool providing data to guide cancer treatment, prevention and research efforts in Kentucky and beyond. Tucker was recruited to the University of Kentucky by Dr. Gil Friedell, Markey’s first director. Together, they were instrumental in passing a 1990 law to establish KCR as the official population-based central cancer registry for the Commonwealth of Kentucky.

Subsequently, Tucker’s team secured funding from the Centers for Disease Control and Prevention (CDC) to begin collecting data on all cancer cases not necessarily observed in a hospital. In 2001, KCR became a part of the NCI’s Surveillance Epidemiology and End Results (SEER) program, and it currently operates under both SEER and the CDC’s National Program of Cancer Registries (NPCR).

KCR is also active in the North American Association of Central Cancer Registries (NAACCR).

KCR is one of the world’s most highly regarded population-based cancer surveillance programs. Tucker fondly refers to the registry, which processes more than 1.1 million records annually, as “the eyes” of a cancer prevention and control program.

“It is a critical piece to measuring success,” said Tucker. “This lens helps us to focus and target our limited resources on the cancers that are the highest burden and in the populations that are at greatest risk, all while gauging the effectiveness of our interventions.”

The tangible impact of KCR is evident in the case of colorectal cancer. In 2001, the registry revealed that Kentucky had the highest rate of colorectal cancer incidence in the country and the second-lowest cancer screening rate. Collaborative efforts by Markey’s researchers and partners led to a remarkable grassroots effort through the Kentucky Cancer Program (KCP), resulting in a doubling of colorectal cancer screenings in Kentucky since 2002. This, in turn, led to a more than 30% reduction in both incidence and mortality rates.

KCR, now led by Director Eric Durbin, Dr.PH., continues to play a crucial role in groundbreaking research.

“The registry continues to evolve its data-collection activities to reflect changing technologies in cancer care,” said Dr. Durbin. “For example, KCR is the first registry to collect population next generation sequencing molecular data. We are also leading innovations in machine learning and artificial intelligence to improve registry efficiencies and deliver cutting-edge data that allows Markey to further its impact in research advancement.”

One of Tucker’s latest projects – one of only two in the nation recently funded by the NCI – uses a unique resource from KCR, the population-based Virtual Tissue Repository. This new use for the cancer registry allows researchers to obtain various specimens associated with patients that would otherwise be discarded. Investigators can use these residual tumor specimens to identify unbiased cohorts of historical tumors. This offers researchers the opportunity to substantially elevate the science of their cancer research.

Addressing Health Disparities in Appalachia

When Mark Dignan, Ph.D., M.P.H., a professor in the Department of Internal Medicine at UK, describes the Appalachian region of Kentucky, he can’t help but smile in recognizing the region’s unique charm, characterized by great music, food and people.

He has studied the region and population for nearly his entire professional career, starting with a research project in the ‘80s based in Cherokee, N.C. Nearly 20 years later, Dignan found his new academic home at UK, and he says it was only natural to focus his efforts on Kentucky’s Appalachian community.

On average, Kentucky sees more than 27,000 new cancer cases each year, and the Appalachian community’s unique health care challenges make it particularly vulnerable to high cancer incidence rates.

Dignan’s passion for addressing these challenges deepened when the story of cancer turned personal. One of Dignan’s loved ones faced a breast cancer diagnosis in their 20’s, a case that he says could have been detected earlier.

“I dove even deeper into disparities work, looking at reasons why minority, lowincome and rural populations are not the main focus of efforts to increase screening, early detection and treatment,” he said. “There are so many factors that govern this, including geographic isolation, limited access to health care and a cultural stigma about seeking care.”

Since joining UK in 2001, Dignan has led a series of NCI-funded cancer control investigations focused on Appalachian populations, collaborating with primary care practices, public health departments and Area Health Education Centers (AHEC). His experience has allowed him to learn firsthand about the specific needs, interests and values of the Appalachian population regarding cancer prevention and control.

Dignan is currently collaborating on two NCI-funded research projects to support the development, implementation and evaluation of multi-level interventions for colorectal and cervical cancer in Appalachia. He also co-leads with Nancy Schoenberg, Ph.D., an NCI-funded training grant, Addressing Rural Cancer Inequities through Scientific Excellence (ARISE), which supports postdoctoral training to translate knowledge of cancer risk factors into behavioral interventions implemented in rural communities.

Dignan credits Dr. Mark Evers as the catalyst for Markey’s transformation and evolution into an NCI Comprehensive Cancer Center, noting a major culture shift under Dr. Evers’ leadership.

“We were working in fourth gear and when Dr. Evers came, we downshifted to third and put our foot to the floor.”

Mark Dignan, Ph.D.

“He was like a football coach that created a winning team,” said Dignan.

Modeling a Commitment to Community

Impact. It’s a word central to the mission of Markey’s Community Impact Office and the reason why Pamela Hull, Ph.D., associate director of Population Science and Community Impact at Markey, wakes up excited to work each day.

“Everyone on our team is passionate and really cares about what we’re doing to make a difference,” said Hull. “That’s why I’m so excited to work at Markey. We have the leadership, infrastructure and partnerships in place to be able to make an impact in Kentucky for a positive future.”

Hull moved to UK in 2020 and formed the Community Impact Office to consolidate Markey’s existing community outreach and engagement programs. The goal of the office is to partner with communities, researchers and practitioners to accelerate health equity and reduce the burden of cancer in the state. Hull and her team have been successful in creating meaningful change. For example, regional staff under the KCP emphasize the importance of listening to and collaborating with local communities to understand their unique needs, priorities and potential solutions.

“People are the experts of their own communities, and they have the answers that can help solve those problems.”

Pamela Hull, Ph.D.

“We can collaboratively work to bring them different tools, like research and evidencebased practices, and choose what makes sense for their community. We focus on cultivating and maintaining mutually beneficial partnerships,” said Hull.

One example of the Community Impact Office’s success is the 2021 Kentucky Cancer Needs Assessment (KY CNA). The comprehensive KY CNA – which combined data and community perspectives – illustrated how social determinants of health, behaviors and biology intersect to tell the current story of cancer in Kentucky and highlighted opportunities to rewrite that story. The KY CNA guided research priorities within Markey and has influenced the new Kentucky Cancer Action Plan. This is a blueprint for the state developed by Kentucky Cancer Consortium, which is managed by the Community Impact Office.

Additionally, Hull’s Research Integration Team, which led the KY CNA, also created and launched Cancer InFocus: Kentucky, an online data mapping application that allows users to explore cancer incidence and mortality data alongside population demographics, social determinants of health and behavioral risk factors at various geographic levels across Kentucky. This tool not only supports researchers and partners in Kentucky but has also been adopted by 21 cancer centers across the United States to inform their cancer research priorities.

Hull recently expanded the Community Impact Office team by recruiting Justin Moore, Ph.D., M.P.H., to serve as assistant director of Community Impact. Moore will contribute valuable expertise on cancer health equity and strengthen partnerships in Kentucky’s racially/ethnically diverse and underserved communities.

“It has been exciting to see others looking to Markey as a model of community outreach and engagement,” said Hull. “We are poised to continue growing our impact even more in the next five to 10 years through initiatives that will ultimately enable us to strengthen our focus on health equity and addressing disparities for unique populations across the state.”