Unplanned life events sidelined UAMS researcher Chenghui Li, Ph.D., for two years, but since returning in 2020 she has authored or co-authored 33 published papers, thanks largely to a National Center for Advancing Translational Sciences (NCATS) re-entry grant.
The NCATS re-entry grants, also known as the Clinical and Translational Science Award (CTSA) Program Diversity, Re-training, Re-integration, and Re-entry Supplement, support researchers trying to resume their careers after time away.
Li received the two-year $221,000 grant to support her research into if and why many breast cancer patients in Arkansas are not receiving or adhering to a potentially life-saving hormone treatment known as endocrine therapy.
“I am very thankful for the NCATS supplement. It really helped me restart my career,” said Li, an associate professor in the College of Pharmacy Division of Pharmaceutical Evaluation and Policy, and a member of the UAMS Winthrop P. Rockefeller Cancer Institute’s Cancer Prevention and Population Services program.
Li applied for the grant with support from UAMS Translational Research Institute (TRI) Director Laura James, M.D., and her mentor, Laura Hutchins, M.D., professor emerita.
“Dr. Hutchins and I saw Dr. Li as an ideal candidate for the NCATS re-entry award, and she has exceeded our expectations,” James said. “Her remarkable talent and dedication have not only advanced her research but have also contributed meaningfully to her field. Dr. Li has a promising future, and we are excited to see the far-reaching impact of her work.”
TRI is funded by a CTSA (UM1 TR004909) from NCATS, a program of the National Institutes of Health.
Of Li’s 33 published papers, 22 cite NCATS and TRI support. Of those, she was lead author on six papers and corresponding or senior author on 12.
Her research has involved use the Arkansas All Payer Claims Database and Arkansas Cancer Registry database to assess the disparity of endocrine therapy use for Arkansas women with stage 0-3 estrogen responsive tumors. Patients and providers were also interviewed to determine barriers to endocrine therapy.
According to 2022 estimates, breast cancer mortality in Arkansas exceeds the national average (20.6 deaths per 100,000 compared to 18.8 nationally), especially among Black women, at 27.7 deaths per 100,000 compared to 21.0 for white women.
In her July publication in the journal Clinical Breast Cancer, Li concluded that, within the first year of diagnoses, there was no difference between Black and white women in either initiating endocrine therapy or adherence to treatment. Black women were less likely than white women to discontinue their endocrine therapy within five years of initiation after adjusting for patient sociodemographic and tumor characteristics.
This is a somewhat surprising result, Li said, based on some previous studies. One possible explanation could be that this retrospective study included women who were diagnosed from 2013-2017, and most previous studies of racial disparities in endocrine therapy treatment used data before 2010. Generic, less expensive options for aromatase inhibitors, a type of endocrine therapy to treat breast cancer, became available in 2010.
Li said her study provided a more comprehensive assessment than previous studies. By using the Arkansas All-Payer Claims Database, she was able to access insurance claims from Medicare, Medicaid, commercial plans and state employee plans, covering approximately 80% of Arkansans.
The fact that Black women have a higher mortality rate is likely due to having later diagnoses of their cancers than white women, Li said, noting that her study focused on stages 0-3 for which endocrine therapy are commonly prescribed.
“Black patients are still more likely to be diagnosed at a higher cancer stage, with larger tumors, and higher grades, all of which could increase the risk of mortality,” she said.
Another potential contributor to this finding could be that Arkansas expanded Medicaid through private option in 2014 under the provision of the Affordable Care Act (ACA), which may have increased access to this treatment and reduced cost-sharing of minority patients.
Li also received a $220,000 American Cancer Society grant in 2023, which is supporting her assessment of racial disparities in endocrine therapy use after the ACA, which was enacted in 2010 but fully implemented in 2014.
Greater access to health insurance through the ACA, along with price reductions for aromatase inhibitors, may have increased breast cancer patients’ use of the life-saving treatments, she said.