Disparity in Knowledge of Genetic Testing in Head and Neck Cancer (2025-2026)
Background
Racial and ethnic disparities in head and neck cancer (HNC) are a pressing public health concern, with Black patients consistently facing worse survival outcomes. The Black vs. White survival gap in head and neck cancer is the third worst of all cancers and has continued to grow over the last four decades.
These disparities stem from an interplay of factors, including tobacco and alcohol use, human papillomavirus associated malignancies (cancers that develop from an infection with HPV) and rural residency. In addition to known social drivers, recent research suggests tumor genetics may partly explain this inequity.
To deepen the understanding of tumor biology, researchers have utilized genomic sequencing, which maps out the complete DNA code of an organism, to identify mutations associated with HNC. These mutations can be targeted by immunotherapies (treatments that help the immune system fight diseases), promising treatments with improved survival outcomes. However, there is little known about genetic differences in HNC based on race and ethnicity.
A major equity issue in HNC is the lack of diversity in clinical trials and genomic data, which are predominantly derived from white patients, producing treatments based on racially non-diverse data. It is hypothesized that an intersection of factors such as medical mistrust from patients as well as language or cultural barriers in physician patient communication may contribute to the lack of diversity in genetic testing. However, this remains largely unexplored.
Project Description
This project team will conduct a mixed-method study of the genetic testing landscape in head and neck cancer using both local data from Duke and national data. The overarching goal is to investigate the landscape of genomic mutations in HNC to understand why there is a lack of diversity in genetic sequencing of HNC tumors.
Team members will pursue two interconnected research aims:
- Determine the genomic landscape of head and neck cancer tumors and associations with patient outcomes: Team members will utilize Covidence software (a tool that helps organize and analyze research articles) and PRISMA guidelines (rules created to ensure reviews are clear and thorough), to search databases like PubMed, SCOPUS and CINAHL to determine the genomic landscape of HNC tumors and its associations with patient outcomes.
- Examine HNC patient’s knowledge and acceptability of genetic testing and HNC healthcare professionals’ attitudes and beliefs about tumor molecular profiling at a local and national level: Using findings from the meta-analysis, team members will utilize qualitative interviews and surveys to understand how this disparity came to be. This mixed-methods study will examine attitudes toward tumor molecular sequencing in HNC survivors and HNC healthcare providers, including oncologists and surgeons. Both local (Duke Healthcare System) and national (American Head and Neck Society) perspectives will be assessed using interviews and focus groups. Team members will participate in survey development and execution as well as qualitative interviews and data collection and analysis.
Anticipated Outputs
Publications; presentations at national scientific meetings; a study analyzing genetic variations linked to head and neck cancer survival; a study comparing patient and provider views on molecular testing; community interaction
Student Opportunities
Ideally, this project team will include 2-3 graduate students and 3-4 undergraduate students with interests and backgrounds in biostatistics, genetic epidemiology, population health, and medicine.
This project team will operate as a structured mentorship program that equips students with mixed-methods research skills through collaborative projects involving healthcare professionals and patient partners. The project team meet weekly to focus on identifying high-quality scientific sources, statistical analysis, meta-analysis methodology, and both quantitative and qualitative research techniques. Students will participate in team leader-guided education disseminations and gradually transition to student-facilitated team meetings. The team’s monthly journal clubs will provide educational and meaningful discussion about health disparities in head and neck cancer and precision medicine in oncology.
Students will learn about biostatistics, genetic epidemiology, population health, and medicine and have opportunities for practical application in our research. Team members will have the opportunity to learn from experts about technical skills for conducting mixed methods research and performing rigorous statistical analysis. Students will also hear the perspectives of patients and providers firsthand allowing them to learn about the complexities of the healthcare system.
Guest lecturers in genetic epidemiology, population health, and head and neck surgical oncology will equip students with essential insights to foster further study and innovation. Students will also be introduced to research platforms, like Covidence and REDCap, providing tools for further projects.
As the project progresses, undergraduates will lead journal clubs and weekly team meetings, reinforcing their leadership and organizational skills. At the conclusion of the project, undergraduates will design a creative solution that addresses key project findings.
Graduate students will take on a leadership role as project managers. They will support team needs, organize resources, maintain project timelines, and be responsible for the day-to day work of the project. Graduate students will build their mentorship, leadership, and critical thinking skills, equipping student researchers to address complex issues in healthcare from an interdisciplinary lens.
An optional part-time summer opportunity will also be available for team members, requiring 5 hours per week in June and July.
Timing
Summer 2025 – Summer 2026
- Summer 2025 (optional): Conduct literature review; begin systematic review and meta-analysis; seek approval from the Institutional Review Board (2025)
- Fall 2025: Retrieve and organize genomic data through meta-analysis; develop attitude and beliefs surveys; administer attitude and beliefs surveys; organize and plan the healthcare practitioner and patient qualitative interviews at Duke
- Spring 2026: Perform statistical analysis and summarize findings of meta-analysis data; finish collecting attitude and beliefs surveys; aggregate qualitative and quantitate results from the attitude and beliefs surveys and qualitative interviews; prepare manuscript, poster, and oral presentations
- Summer 2026 (Optional): Develop community-based interventions (pamphlet, grand rounds presentation, animations) based on the findings from the duke qualitative interviews on tumor molecular sequencing
Crediting
Academic credit available for fall and spring semesters; summer funding available