Rare2Care Initiative
Through sustained scholarship, education, and strategic partnerships, the Rare2Care team is dismantling barriers to health equity for patients with rare cancers, providers, and caregivers.
The team has secured consistent funding from federal, foundation, industry, and grassroots sources, fostering local, national, and international collaborations. These partnerships span disciplines, involving clinicians, cancer biologists, engineers, computational scientists, and more, all working together to advance diversity, equity, and inclusion. What started in 2015 as the Duke Inflammatory Breast Cancer (IBC) consortium has grown into a multifaceted rare cancer collective focusing efforts to discover new therapies and diagnostics, reach from and to communities to enhance awareness and understand contributing factors, and teach emerging researchers, providers and educators about these critical rare cancers and best practices toward more equitable health solutions.
Rare cancers, with an incidence of fewer than 6 cases per 100,000 people, are a significant but understudied health disparity. These cancers disproportionately affect marginalized groups and patients of color. These patients often endure a longer diagnostic journey and face poorer survival outcomes compared to their majority counterparts. Despite advances in genomics and digital health, rare cancer patients—particularly those in rural or underserved areas—are often overlooked. The Rare to Care team aims to bridge this gap by addressing the root causes of health disparities across all stages of rare cancer care, from clinical and laboratory research to community outreach.
The team’s research is anchored in a “Bench to Bedside to Curbside and Back” model, which integrates clinical and laboratory findings with community-driven research. This holistic strategy ensures that scientific discoveries have real-world applications that benefit both patients and the broader community.
Dr. Devi discussed cancer health disparities with host Steve O’Bryan on WPTF news. Listen to the conversation here:
Program Directors
Dr. Gayathri Devi
Professor in Surgery
Professor in Pathology
Member of the Duke Cancer Institute
Dr. Anh Tran
Vice Chair of Education, Community Health
Associate Professor in Family Medicine and Community Health
Family Medicine and Community Health, Community Health
Team
Dr. Larry Greenblatt
Professor of Medicine, Medicine, General Internal Medicine 2021
Professor in the Department of Family Medicine and Community Health, Family Medicine and Community Health, Community Health 2020
Sally Taylor
Research Program Leader at Duke Office of Clinical Research
RESEARCH
Stress and Health: Linking Lived Experience to Disease Vulnerabilities
The impact of stress on health can be complex, especially because it doesn’t affect everyone the same way. The way we experience stress is shaped by many different factors, including where we live, our race, our social and economic status, and even our access to things like healthcare and support networks.
Biological
On the biological level, when we feel stress, our bodies go into “fight or flight” mode. This is a natural response that prepares us to face a threat. Our brains release stress hormones like cortisol and adrenaline, which increase our heart rate, raise our blood pressure, and boost our energy. This is helpful in short bursts—like if we’re facing an immediate danger or challenge. But when stress becomes chronic, this system stays activated for too long, and that’s when it starts to cause harm. Allostatic load refers to the accumulation of stress (the “load”) encountered over the lifespan. As allostatic load, or experienced stressors increase, the risk for the development of disease on the biological level and the risk of developing poor health outcomes increases. The biological effects of stress are often worse when someone is exposed to stress for long periods, such as people living in disadvantaged communities or those facing systemic racism or economic hardship.
In the context of cancer, stress-related changes in the tumor microenvironment, and within tumor cells themselves, can facilitate the development of cancer and metastasis. Research suggests that the cellular stress response not only promotes tumor growth but also makes cancer cells more resistant to treatment, thus complicating efforts to combat the disease. Stress-induced inflammation can weaken the immune system, making it less effective in detecting and eliminating abnormal cells before they can form tumors.
Community and Society
On a community level, stress can be amplified by factors like low socioeconomic status, rural location, lack of access to healthcare, and social isolation. These social factors, which are often called “social determinants of health,” can make it harder for people to cope with stress and get the help they need.
The research group, under the direction of Dr. Gayathri Devi, focuses on translational and clinical applications of programmed cell death signaling. Cell death is a critical process in tissue sculpting, adult cell homeostasis, for destruction of damaged cells and in pathobiology. We are, in particular, interested in elucidating molecular mechanisms of stress-induced cell survival/death signaling in normal and cancer cells and how this process regulates immune response.
Our work has identified the dominant role of a class of anti-cell death proteins called Inhibitor of Apoptosis Proteins (IAPs) in cancer cell survival and during development of acquired resistance to extrinsic and intrinsic death signals. Current funded research projects in the lab focus on innovative approaches toward immunosuppressive minimization, in vitro and in vivo tumor biology models, novel approaches toward islet xenotransplantation, and innovative preclinical models and strategies to modulate this anti-cell death.
Press Coverage
- Devi Awarded $1.6 Million for Inflammatory Breast Cancer Research, May 14, 2021
- Rare and Dangerous, October 1, 2017
- DOD Awards $1.2 Million To Study Breast Cancer Metastasis, May 5, 2017
- Study Shows How BPA May Affect Inflammatory Breast Cancer, March 28, 2017
- Devi Interview for her laboratory’s work on repurposing an anti-alcoholism drug for IBC therapy. WRAL June 10, 2015
- Dr. Devi was featured in the Women in STEM. Research Highlight and Interview for Women in Stem, Academic Minute, WAMC NPR affiliate, August 2015
- Dr. Devi – Era of Hope Investigator Highlight presentation
- BPA May Make Breast Cancer Cells Resistant To Treatment. WUNC, June 24, 2014
Advanced Training
Research opportunities available for undergraduates, medical students, PhD candidates, etc.
Contact Us
Sally Taylor
sally.taylor@duke.edu
421 Medical Sciences Building Research Drive, Room 477 Durham, NC 27710
