Awardees

Maira Castañeda Avila  |  Lemon Lab  |  F31 Award

Monoclonal Gammopathy of Undetermined Significance (MGUS) is an understudied precursor of multiple myeloma (MM), the second most commonly diagnosed hematologic malignancy in the United States. Patients with MGUS progress to MM at a rate of 1% per year throughout their lifetime, resulting in continuous clinical surveillance and associated anxiety. MM patients with a prior MGUS diagnosis may have better prognosis than MM patients without a diagnosis, although the mechanisms are unknown. Gaining a better understanding of overall healthcare utilization by patients with MGUS may provide insight into preventative healthcare measures that may improve their overall health. Therefore, this proposal focuses on investigating the role of an MGUS diagnosis on healthcare utilization practices and gaining insight into the processes involved in managing care for patients with MGUS. The Specific Aims are to: (1) Describe the sociodemographic, clinical characteristics, follow-up patterns, and laboratory value trajectories of patients with MGUS; (2) Determine if an MGUS diagnosis is associated with changes in healthcare utilization that differ according to patients’ sociodemographic and clinical characteristics; and (3) Understand the patient- and provider-level drivers of healthcare utilization in patients with MGUS and the predisposing, enabling, and need factors associated with care-seeking practices. To address these objectives, this proposal will use two data sources. Aims 1 and 2 will analyze a cohort of patients with MGUS (n=429) identified by a novel case-finding algorithm using health claims and electronic health record data, identified from a community-based population of patients seeking care in central Massachusetts. For Aim 3, we will conduct qualitative semi-structured interviews with patients with MGUS diagnosed in central Massachusetts and providers who treat patients with MGUS. The knowledge generated by the successful completion of these Aims will inform stakeholders on the role of an MGUS diagnosis in healthcare utilization and will assess the factors contributing to healthcare utilization in this population. In addition, the results of this study will elucidate potential clinical and sociodemographic characteristics that may lead to improvement in the long-term overall health of patients with MGUS and to the identification of targets for future interventions. This dissertation proposal also includes a multi-faceted, comprehensive training plan that will support Maira A. Castaneda-Avila’s development as an independent investigator, including advanced level training in quantitative and qualitative methods, cancer prevention and control, hematological malignancies, further training in the ethics of conducting research and grant writing, and exposure to national and international cancer epidemiologists through presentations and attendance at national research conferences. The skills gained through the proposed training plan will greatly augment the proposed research plan and ensure the successful completion of the project’s Specific Aims.