Multidisciplinary COPPER Center Brings a Public Health Lens to Cancer Care

New cancer treatments can look promising in clinical trials. But they do no good if patients don’t receive them. That innovative, purportedly miraculous medication? Are clinicians prescribing it? Can patients afford it? Does it significantly improve patients’ lives? 

Studying cancer treatment outcomes is the mission of the Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, a collaborative effort of the Yale Cancer Center and the Schools of Medicine and Public Health. 

Guided by a big-picture point of view that owes much to public health, COPPER’s researchers shed light on everyday cancer care that takes place outside the controlled setting of a drug trial. 

“A primary goal of cancer research is not just to discover new treatments and come up with new FDA therapies,” said COPPER Director Cary Gross, MD, a professor of medicine (general medicine) and of public health (chronic disease epidemiology). “The real goal is to have an impact on patients’ lives.” 

Gross co-founded COPPER in 2009 with Professor of  Epidemiology (Chronic Diseases) Xiaomei Ma, PhD. 

“Our cancer center really excels with regard to basic science, molecular discoveries, and translational research. But at the time, there was not a lot of focus on looking at the public health impact of these discoveries,” Gross said. “Xiaomei and I were hungry to find more collaborators who were interested in taking a big-picture approach” to cancer care research. 

Associate Director Pamela Soulos, MPH ’09, signed on with COPPER after graduating from YSPH as a newly minted data analyst. 

“It’s blossomed into this wonderful collaboration between the School of Medicine, the School of Public Health, and the Yale Cancer Center. We have over 30 different faculty collaborators,” Soulos said. Any given project could involve physicians of different specialties, data analysts, and PhD-level researchers, she explained. 

“We don’t do projects where one investigator has an idea, one analyst does the analysis, and then it’s done. We really value input from multiple people,” Soulos added. 

Michaela Dinan, PhD, an associate professor in the Yale School of Public Health’s department of chronic disease epidemiology and co-leader of the Cancer Prevention and Control research program at Yale Cancer Center who studies patients’ access to care as well as their long-term health outcomes, can attest to that. She cites COPPER as one of the reasons she came to Yale in early 2021, “specifically, the collaborative nature” of the center. 

Public health faculty like Dinan have been invaluable COPPER collaborators, according to Gross, and not merely for their skill at designing studies that get at the truth. 

They “think of patients thousands or millions at a time,” he said. “They think of the population impact of what we’re trying to do.” 

Getting at that impact means asking fundamental questions about cancer care. Melinda Irwin, MPH, PhD, associate dean of research at YSPH and associate director for population sciences at Yale Cancer Center, said COPPER’s interdisciplinary approach helps researchers address some of the most pressing questions involving cancer outcomes and care. “When you have cancer epidemiologists collaborating with surgeons, medical oncologists, and internists, all asking a similar question but from a slightly different perspective, innovative approaches and solutions occur.” 

One example, Soulos said: “Do treatments that are deemed superior in clinical trials actually turn out to be superior when they’re used in a real world setting, i.e., in patients out in the community?” 

Sometimes the answer is no. 

For one thing, cancer patients who enroll in clinical trials tend to be younger, healthier, and white and are not representative of the cancer community as a whole. Those differences can affect how well trial results apply to most cancer patients. 

In addition, a trial might prove a new drug can shrink a tumor, but overlook the most important outcomes, Gross explained. “We don’t know necessarily whether it’s actually helping people live longer or have a better quality of life.” 

Another key question: Is cancer treatment bankrupting patients? 

Ryan Chow is an MD/PhD candidate trained in tumor immunology. As a future oncologist, Chow decided to look into the economics of cancer care after learning that some effective drugs can cost upwards of six figures a year—what is called cancer’s “financial toxicity.” 

In a research collaboration with Gross, Chow found that the U.S. spends twice as much on cancer care as the average high-income country, yet cancer death rates here are near the average. 

“It became pretty revealing how little of a relationship there was,” Chow said. “There are a number of countries that spend less than the U.S. on cancer, yet they have better cancer outcomes than the U.S.” 

How could the U.S. improve? It might not take “glorious, beautiful headline-grabber things,” Chow said. “It could just be more efforts towards effective screening, effective prevention, and managing lifestyle changes that could reduce your risk of developing cancer in the first place. That’s what COPPER’s mission is about.” 

With hundreds of publications to its credit, findings from COPPER studies can change how clinicians make decisions, Soulos said. Or they may affect a policy decision that ultimately winds up improving patient care. 

“Even if it’s a couple of steps removed from actual translation into practice,” Soulos said, “it still feels like an honor to be part of that process.”