Research Features

New Program to Support Underrepresented Residents in Urology

The Leadership in Education, Achievement and Diversity (LEAD) Program is a new initiative designed to support urology residents from racial and ethnic backgrounds underrepresented in urologic research. Three residents per year will be selected to conduct mentored research training, engage in AUA research education opportunities and be championed through networking events as they develop successful research careers and improve urology patient care.

The LEAD Program will provide comprehensive research support to young urologists by creating a development pathway through existing AUA research programs, beginning with the Residency Research Award program. Program participants will be selected through the Residency Research Award competition, which opens this October. Three new awards have been established that will enable these residents to conduct three to 12 months of mentored research training. In addition, participants will have access to the Urology Care Foundation Scholar Scientific Travel Support Program during their award period, which covers registration and travel costs for investigators to present their work at the AUA Annual Meeting and other scientific conferences. They will also present their work and network with the AUA and Urology Care Foundation Boards of Directors and other urologic research leaders at the Urology Care Foundation Research Honors Program & Reception, which is held during the AUA Annual Meeting.

LEAD Program participants also will be enrolled in the Urology Scientific Mentoring and Research Training (USMART) Academy for two years. This program fosters creative and impactful mentorship by pairing experienced, highly-accomplished physician-scientists and researchers with early-career investigators to provide scientific and career guidance. Now entering its fourth year, and guided by an advisory group of highly accomplished scientists with strong mentoring credentials of their own, this program has already seen measurable success by way of career advancement and successful conflict management, scientific accomplishments, and new research funding.

Finally, the LEAD Program will enable its urology residents to participate in the Early-Career Investigators Workshop (ECIW) once during their residency and once during the research year of their clinical fellowship. The ECIW is held annually to support career development in urologic research by providing participants with a solid foundation for successful grant writing. Activities include one-on-one and small-group mentoring sessions with scientific advisors, learning how to navigate federally-funded grant programs, opportunities to directly interact with funding agency representatives, mock peer review, and guidance on developing a fundable research program.

The LEAD Program is made possible through the Urology Care Foundation by an endowment supported by a generous grant from Urovant Sciences.

AUA’s Policy and Advocacy Team Works to Ensure NIH Grants Remain Effective for Urology Surgeon Scientists and Researchers

The National Cancer Institute (NCI) has been making strides over the past few years to ensure R01 grants and K08 mentored clinical scientist research career development awards continue to be effective support mechanisms for urology surgeon scientists and researchers. Since 2013, the NCI has seen an influx of R01 grant applications; however, due to a very low payline, typically not much above 10% of grant applications receiving funding, many innovative research projects have been left without support. Likewise, there has been a 27 percent decline in the number of surgeon-scientists pursuing research careers with K08 grants due to a requirement for a 75 percent level of effort, leaving only 25 percent for active surgical and clinical duties, which many institutions cannot support.

As urologic research has a history of being chronically underfunded, the AUA collaborated with cancer advocacy organizations to increase funding for the NCI in Fiscal Year 2021 (FY21). In December 2020, Congress approved a FY21 budget increase to NCI of about $120 million. With this increase in funding, NCI Director Dr. Norman Sharpless increased paylines for R01 grants, which have now seen an increase of 35% since 2019. NCI’s FY22 budget further addresses its plan to increase the payline for R01 applications by one percentile each year until it reaches the fifteenth percentile in 2025.

Additionally, the AUA’s Research Advocacy Committee (RAC) and Research Council have collaborated to ensure swift action when opportunities arise for NIH feedback. In January 2021, NCI released a request for information (RFI) on decreasing percent effort requirements for K08 awards, and through collaborative efforts, the AUA submitted a response encouraging the lowering of the surgeon-scientist percent effort requirements for K08 grants. To strengthen the urologic perspective, the AUA launched a grassroots initiative, which resulted in twenty-five additional letters being sent to the NCI encouraging the NCI to lower the percent effort for K08 awards to 50%. As a direct result of this effort, the NCI officially reduced their percent effort requirement to as low as 50% for K08 awards.

The AUA continues to advocate for robust federal program funding increases to support and grow important urologic research needed to help patients with urologic diseases and conditions.

Making an IMPACT

Health Disparities in Bladder Cancer Treatment Outcomes

Valentina Grajales MD, MS is a 2020 Urology Care Foundation Residency Research awardee and current urology resident at the University of Pittsburgh Medical Center applying for a fellowship in urologic oncology. She is part of the Health Services Research group led by Dr. Bruce Jacobs and Dr. Benjamin Davies. Her research focuses on potential health disparities in bladder cancer treatment, hospital readmissions, and outcomes.

The gold standard treatment for bladder cancer patients with at least muscle-invasive disease is radical cystectomy with urinary diversion and neoadjuvant chemotherapy; however, this surgery alone is associated with one of the highest readmission rates of any surgery. Dr. Grajales sought to examine whether specific social determinants of health, such as a patient’s sex, race, insurance status, area of residence, and socioeconomic status, impacted diagnosis and treatment, hospital readmissions, and outcomes.

Using the Pennsylvania Cancer Registry and the Pennsylvania Health Care Cost Containment Council, a statewide, hospital-based database that includes all hospital discharges within the state, the research group arrived at several notable findings. First, nearly half of muscle-invasive bladder cancer patients did not receive definitive treatment during the study period, which spanned from 2010-2016. Second, uninsured patients were less likely to undergo definitive treatment generally and less likely to undergo cystectomy specifically as their definitive therapy. This has important implications since not treating these patients or treating them with non-surgical options is associated with worse survival. Socioeconomically disadvantaged patients were also less likely to receive neoadjuvant chemotherapy, a treatment associated with improved survival. In fact, female sex, public insurance and socioeconomically disadvantaged patients were noted to have increased overall mortality. These findings raise concerns about access to care and existing gaps in outcomes for traditionally underserved patients.

Dr. Grajales has been able to pursue this work thanks to the Urology Care Foundation and its sponsor, The Kahlert Foundation. As part of her ongoing study, the group is now investigating the associations of various social determinants of health with hospital readmissions. Specifically, they are interested in examining which patients are readmitted to the index hospital (i.e., the hospital at which patients received their cystectomy) versus a non-index hospital (i.e., a hospital other than the one where they received their surgery) after their cystectomy. This is important given that patients readmitted to non-index hospitals generally fare worse.