Moffitt Onco Update

Researcher Spotlight: Dr. Clement Gwede & Health Disparities

May 23, 2018

fit-test.jpg Studies have shown that providing FIT kits helped to increase the number of people who completed the colorectal cancer screening process (source: National Cancer Institute)

Meet Dr. Gwede

Clement Gwede, PhD, MPH, RN, FAAN Moffitt Researcher, Health Outcomes and Behavior Program
Clement Gwede, PhD, MPH, RN, FAAN

I am a behavioral scientist in the Moffitt Department of Health Outcomes and Behavior. My work focuses on developing and implementing community-based interventions to reduce the burden of cancer among medically underserved populations in Moffitt's catchment area with the sole purpose of reducing cancer health disparities and increasing health equity. I have been at Moffitt since 1993 and started as a clinical trials coordinator.

How did you choose cancer research as a line of work? (Did you choose the job or did the job choose you?)

A little bit of both. I chose this job largely driven by a passion to address cancer health disparities. On the other hand, the job chose me as I could not work in other areas once I began to appreciate the startling disparities present among cancer patients.

What aspect of cancer research had the biggest impact on you?

If you look at the mortality rates from prostate cancer, you’ll find that black men die 2.5 times more when compared to white men. The rate increases to 6 times greater when comparing black men to Asian men. This is a startling difference. Similarly, when we look at colorectal cancer, the mortality rate is 40% greater for black males. These disparities fuel my passion for research in prevention and early detection of colorectal cancer.

Would you say it is because black males are not getting screened as often or is there another reason?

It’s a lot more complicated than that. In part, we think there may be a genetic and biological basis for the higher incidence. I only told you about the mortality but the incidence rates are about 60% higher. We think there is something that drives both the incidence as well as the access to care. Part of this may be that black men may tend to have more aggressive prostate cancer and may also tend to have inadequate access to care. This drives both late stage diagnosis as well as quality of treatment.

Who is your biggest inspiration and why?

I am inspired by many people, but especially by cancer patients who die prematurely or disproportionately from preventable or treatable cancers. My own father is among those who passed away prematurely. I am also inspired regularly by Dr. Martin Luther King, Jr.'s words about the inequalities and injustices in health care. If we go back to the 1800’s there’s writings about healthcare injustice and how it varies across ethnic groups. This reminds me that more work needs to be done as disparities persist more than 50 years after Dr. Martin Luther King, Jr. said, “Of all the forms of inequality, injustice in healthcare is the most shocking and inhumane.” He said this in in 1966 and today more than 50 years later, we are still seeing startling disparities that affect racial and ethnic minorities particularly black populations. In some areas, it is really unabated.

If you look at the data for colorectal cancer, for example we see two trends: we see very good news in terms of redaction in both incidence and mortality across all groups, but we see the gap between black and white men maintained despite the good results in redaction and mortality. There is a lag in benefits for underserved populations. It’s those gaps that are consistently maintained over time that we are trying to address with our research.

 

What kind of success have you seen as a result of your preventive research? 

When my research showed success rates of over 80%, my colorectal cancer screening intervention was adopted by many clinics in our catchment area. This illustrates the impact of the work. We work with local members in a variety of community and cultural settings such as clubs, barber shops, and churches to try and access individuals who are not ordinarily seeking care in healthcare facilities. We provide access to a low-cost convenient form of colorectal screening called the fecal immunochemical test (FIT) which can be done at home with the sample mailed back to the cancer center to get the results. We had an 80% return rate from men and women on the sample kits, and we followed up for two years. We found the participation rate fell off as time went on. This told us we need to educate the community of the benefit of an annual screening.

What does it take to work in health disparities research? What advice do you have to other researchers interested in this work?

Health disparities work is not for everyone. It takes a scientist with a special nuance and a passion to alleviate health inequality to be successful. Scientists have to be willing to work directly in communities and establish relationships. They would have to be committed to doing what it takes to develop the necessary relationship to be trusted and to be able to have the community’s collaboration and cooperation.