Before COVID-19 lockdowns halted travel, I attended a community cancer conference in Washington D.C. last year. I had an interesting conversation with a community practice leader, Jessica, about how socioeconomic factors have a big impact on clinical outcomes.
In the last few months, I have been researching value-based care innovations in cancer care. I was encouraged to find multiple examples of value-based care initiatives that also focus on reducing disparities. How are they approaching challenges of inequity in cancer care?
Here are 3 initiatives that I wanted to share given their innovative approaches.
A “side” of cancer screening
Cancer screenings help people lower their risk of dying from cancer by catching it at an earlier stage. Studies have shown that breast cancer screening, for example, can lower the 10-year risk of breast cancer death by 60 percent. Despite the benefits of cancer screenings, not everyone has ready access. Low-income women often forgo mammograms due to transportation costs, inability to take time off work, and other socioeconomic factors.
Dr. Andrew Hwang and his colleagues at the Massachusetts General Hospital (MGH) therefore took a practical approach to improving access for breast cancer screenings. The MGH team identified Medicaid and dual-eligible patients who were admitted to MGH’s General Medicine service and were overdue for mammograms. The women who came to the hospital for unrelated services also received a mammogram, which did not extend their hospital stay.
Grassroot efforts increase awareness
About 1 in 5 people in the United States live in rural areas. Rural populations experience higher mortality rates from cancer than those living in metropolitan areas. The Center for Cancer Health Equity (CCHE), part of the James Cancer Hospital of the Ohio State University Comprehensive Cancer Center (OSUCCC), identified lack of awareness about cancer detection and treatment as a key factor in increased mortality in rural communities.
As a result, the CCHE worked with the local medical community to form community-based coalitions that provide cancer education and information about detection and prevention strategies and encourage clinical trial participation. As an example of the strategy’s success, the community clinical trials program has enabled 32 percent of OSUCCC clinical trial participants to be from rural areas (by comparison, 22 percent of Ohio cancer patients live in rural counties).
Engage local communities in program design
Roswell Park Comprehensive Cancer Center wanted to address the cancer burden in rural areas and Native Nations across New York State, with an emphasis on Western New York. Through a collaboration with the Indian Health Service (IHS) and geographically matched rural federally qualified health centers, Roswell Park is now providing on-site and virtual patient navigation consisting of cancer prevention, screening, treatment and education, as well as available education on clinical trials, palliative care and survivorship. Importantly, the patient navigators are being recruited “in partnership with tribal partners, IHS clinics, IHS regional offices and partnering health centers to ensure that the hiring reflects the unique perspectives of the area.”
The initiative was carefully designed to “incorporate the Two Row Wampum philosophy developed by the Haudenosaunee and based on the Two Row Wampum Belt and the Covenant Chain of Friendship. Historically, this Wampum agreement was used as a guideline between Native Americans and the Dutch, French, British and Canada. Like the Two Row Wampum, this patient navigation collaboration will provide a bridge between two health delivery systems that are functioning in parallel, like two boats in the same river.”
The three-year project expects to reach 3,200 community members. The primary focus is on breast cancer and prostate cancer and secondarily on co-occurring conditions that have high rates in these communities.
Tackling disparities in cancer care is no easy feat. However, communities often have solutions — when they have a seat at the table and are deeply engaged in designing programs. I look forward to more conversations with Jessica and other colleagues at community cancer conferences, virtually and eventually in-person once COVID-19 travel restrictions ease.
As an additional thought, the pandemic increased my own awareness about disparities in cancer care, especially after my company, Canexia Health, was awarded a strategic investment by Canada’s Digital Supercluster to expand access to testing for targeted treatment selection. This consortium-led initiative in Canada, known as Project ACTT, was recently highlighted in The Globe and Mail.
I hope you’ll join me in learning more.