Dec 20, 2023
By Jimmy O’Hara, Conquer Cancer
Native Hawaiian and Other Pacific Islander (NHPI) communities have some of the lowest rates of inclusion in clinical trials and cancer research. The resulting lack of NHPI cancer data leads to poorer health outcomes and fewer supportive resources for patients from these populations.
“Our stories and data are often overshadowed, affecting public policy, federal funding, and access to resources aimed at improving these disparities,” said Kekoa Taparra, MD, PhD, of Stanford University. For Dr. Taparra, advancing research equity and improving cancer prevention for NHPI communities are more than academic pursuits: They are profoundly personal. Born and raised on O‘ahu, Hawai‘i, Dr. Taparra’s dedication to cancer disparities research is deeply intertwined with his Native Hawaiian identity and the lived experiences of his family.
“I carry vivid memories of my younger cousin, frail and weakened by neuroblastoma treatment; of my mother, carrying my cachectic aunty who was dying of breast cancer; and of the anguished cries from another aunty, suffering from endometrial cancer, that filled our home and left an indelible mark on our family,” Dr. Taparra recalled. “This trauma is not unique to my ‘ohana (family) but is a common experience for many Native Hawaiians in my community. As the first Kanaka ‘Ōiwi (Native Hawaiian) physician-scientist seen in my community, I am both humbled and driven by a profound sense of kuleana (responsibility) to address the unique health disparities that plague the NHPI community, including my own ‘ohana.”
According to the 2020 U.S. Census, many NHPI families are leaving Hawai‘i for the continental U.S. This geographic shift, Dr. Taparra explained, is caused by a high cost of living and scarce financial support for local and Indigenous communities. Such trends reflect the urgent need for cancer research that addresses the numerous disparities that NHPI patients face.
“There is more work to be done specifically looking at these patterns, which will ultimately illuminate where Pacific Islander health resources could be best directed in the future,” Dr. Taparra said.
Addressing Disparities With Artificial Intelligence
Supported by a 2023 Young Investigator Award (YIA) from Conquer Cancer, the ASCO Foundation, Dr. Taparra launched an ongoing research project using machine learning to investigate the various drivers of NHPI cancer disparities. He is specifically exploring how factors related to multiraciality, comorbidity, and geography impact the inequities experienced by NHPI patients.
The YIA grant enables Dr. Taparra to partner with the University of Hawai‘i Cancer Center, allowing him access to data from the Multiethnic Cohort Study. This rich resource includes an ethnically diverse range of data on populations who have been structurally excluded from clinical cancer research, including NHPI communities.
Dr. Taparra employs a well-established and innovative technique known as XGBoosting, which involves iteratively computing new models of patient data to help correct and minimize errors made by existing models. This machine learning approach, Dr. Taparra explained, can be leveraged to navigate the complex and overlooked multiethnic data sets that are often characteristic of NHPI communities.
“This nuanced approach,” Dr. Taparra said, “allows us to unmask the intricate layers of health disparities that are otherwise lost in broader categorizations.”
The Meaningful Impact of Mentorship
YIA support enabled Dr. Taparra to connect with key collaborators like Loïc Le Marchand, MD, PhD, MPH, and Naoto T. Ueno, MD, PhD, both thought leaders in the field of NHPI cancer research. Such partnerships help Dr. Taparra to enrich his data sets and enhance the robustness of his YIA study to better reflect the communities he wishes to serve. Additionally, collaborating with his mentors Manali I. Patel, MD, MPH, MS, and Erqi Pollom, MD—experts in public health, epidemiology, and clinical oncology—has been pivotal in shaping the direction and quality of Dr. Taparra’s research project.
“I’ve had the privilege to build my own research agenda, one that is deeply rooted in personal and cultural values, and to forge collaborations with esteemed researchers who understand me and share my mission,” said Dr. Taparra, who also received a Conquer Cancer Medical Student Rotation (MSR) Award in 2018.
Furthermore, he has engaged in collaborative efforts with Jacqueline B. Vo, PhD, RN, MPH, and Jaimie Shing, PhD, MPH, both from the National Institutes of Health (NIH), to evaluate geographic patterns in cancer mortality across the nation. Together, Dr. Taparra and his NIH collaborators are uncovering significant differences between Hawai‘i and the continental U.S. Their findings might help to guide policy measures and clinical improvements in cancer prevention and overall survival for NHPI patients.
“Our research,” Dr. Taparra said, “aims to unravel the complexities of multiraciality and its impact on clinical outcomes like cancer survival. This is not just an academic exercise: It has the potential to guide policy decisions that could significantly improve the lives of the NHPI community.”
Understanding these complexities, he continued, could help researchers answer critical questions and determine whether multiracial NHPI data should be gathered into a single category to improve visibility, statistical power, and accuracy. “I am filled with hope and anticipation for what these findings could mean for our community,” Dr. Taparra said.
Patient Stories Inform Next Steps
In addition to vivid memories of loved ones with cancer, Dr. Taparra’s experiences with patients also drive his commitment to research. He recently provided care for a Pacific Islander patient whose circumstances reminded Dr. Taparra of an older relative. Their shared cultural background, he recalled, fostered a unique sense of trust and understanding that enhanced the patient’s overall care.
“My patient’s situation closely mirrored the experiences I observed in my own Native Hawaiian grandfather, making me particularly cautious about his treatment trajectory,” Dr. Taparra said. “This enhanced my patient’s engagement in his health care and encouraged him to openly discuss the challenges he faced during cancer treatment, particularly his multiple comorbidities.”
His patient’s heightened involvement resulted in timely interventions that ultimately helped ensure his treatment success.
“Witnessing firsthand how my research positively impacts the holistic care of my patients fills me with a profound sense of purpose, both as a physician and as a member of the NHPI community,” Dr. Taparra said. “Moreover, many of the principles that my team and I are investigating with my Conquer Cancer YIA can be applied to other marginalized populations as well, and future studies may implement our approaches in their work.”
As Dr. Taparra progresses toward completing his residency in radiation oncology, he’s also working to complete his YIA study and hopes to apply these findings toward subsequent clinical projects that include and focus on NHPI patients. Elevating health equity for marginalized populations is at the heart of all he does to conquer cancer.
“Funding and support from ASCO and Conquer Cancer have not only elevated the methodological rigor of my research but have also lent a sense of true urgency and credibility to the often-overlooked issue of NHPI health disparities,” Dr. Taparra said. “I am deeply grateful for this support, as it amplifies the impact of our work and brings us closer to achieving health equity for NHPI communities.”