Findings of the Comprehensive Cancer Needs Assessment

1. Findings of the Comprehensive Cancer Needs Assessment Piedmont Health District Presented by: Justine A. Young, RN, BSN, MBA

2. Goal 1: Perform a comprehensive cancer needs assessment in four Health Districts located within the Southside/Southwest Tobacco County area. Goal 2: Mobilize resources into the Southside and Southwest Counties for which comprehensive cancer needs assessments were performed to address identified needs. TOBACCO INDEMNIFICATION AND COMMUNITY REVITALIZATION COMMISSION GRANTSaving Lives and Reducing Suffering and Death from Cancer in Virginia

3. Comprehensive Cancer Needs Assessment Guided by a broad based Advisory Committee Parameters Assessed: • Cancer burden • Cancer care services – detection, treatment, survivorship • Community resources for cancer patients & caregivers • Community physician information • Population based information TOBACCO INDEMNIFICATION AND COMMUNITY REVITALIZATION COMMISSION GRANTSaving Lives and Reducing Suffering and Death from Cancer in Virginia

4. Focus Group Data General Population • Local perception of health issues • Attitudes and barriers to preventive health behaviors • Perceptions of cancer and clinical trials Cancer Survivors and Caregivers • Experience in HD with diagnosis, treatment, follow-up care • Barriers to detection and treatment • Resources needs of community • Clinical trials • Behavioral Risk Factor Data • Cancer Screening Behaviors: • Colorectal Screening • Breast and cervical screening • Prostate Screening • Access to Care: • Insurance • Inability to see a physician • Regular physician visits • Cancer Prevention Behaviors: • Diet • Physical exercise • Weight • Tobacco use Population Based Information

5. Total population = 104,000 7 counties : all designated as medically underserved. all designated as rural (except Amelia County and parts of Cumberland County)

6. High 65+ group-retirement area • 32% black, 64% white • Poverty: • 22.9% vs 7.2% state • Unemployment: • 8.9% vs 6.5% state • All population number are for ages 18+ • Poverty level uses total population of 104,609 • Unemployment rate uses the total population of employable citizens

8. In Buckingham, percentage of population with less than high school education is greater than 47.8% for the age group 18-24 years old. US Census Burea, American FactfinderEducational Attainment’ 2006-2010, 5 year estimate

9. Age-Adjusted Incidence Rate by Cancer Site – Piedmont vs. Virginia Male Genital System: includes prostate and all other genital cancers. Gynecological: includes cervical, ovarian, uterus NOS, and all other gynecological cancers. Heme-malignancies: includes lymphomas, myelomas, leukemia. Respiratory: includes lung/bronchus, and other respiratory cancers. GI: includes colon/rectum and other gastrointestinal cancers.

10. Age-Adjusted Mortality Rate by Canceer Site – Piedmont vs. Virginia Male Genital System: includes prostate and all other genital cancers. Gynecological: includes cervical, ovarian, uterus NOS, and all other gynecological cancers. Heme-malignancies: includes lymphomas, myelomas, leukemia. Respiratory: includes lung/bronchus, and other respiratory cancers. GI: includes colon/rectum and other gastrointestinal cancers. * Rate for Male Genital System is shown per 100,000 males; Rates for Gynecological and Female Breast are shown per 100,000 females. Data Source: Vital Statistics Department, VDH (averaged rates 2005-2009) – all rates calculated based on populations including all ages.

13. Facility Survey Takeaways Cancer-Related Services Not Available in Piedmont • Imaging Services • Radiation treatment • CT colonography • Surgical Services • Breast reconstruction • GI-liver/pancreas • Lung • Counseling • Oncology certified dietician to provide nutritional counseling specific to cancer patients • Cancer patient navigator • Desired Programs • No established clinical trial programs • No Palliative Care programs

15. Key Leader Physicians stated they are unsure of narcotic dosages and uncomfortable with end of life drug issues. Physicians Survey Takeaways

16. Key leader and physician perspective • Lack of financial resources • Uninsured/Underinsured • Underutilization of EWL and other programs • Lack of integrated system between GP, oncologist, HH and hospice • No Cancer Support Services • No support groups • Hospice underutilized • Lack of specialists • MD recruitment issues • Recent loss of multiple specialists • Two oncologists part-time for the district • Education • Knowledge deficit of MD’s r/t pain control for Hospice patients • Inconsistencies on screening guidelines

18. Behavioral Risk Factor Surveillance System Analysis • Data Source: BRFSS datasets – aggregated years 2006-2010. * - indicates a significant statistical difference;

19. Behavioral Risk Factor Surveillance System Analysis - Black population less likely to exercise - Low wage earners exercise less - Less educated not likely to exercise * - indicates a significant statistical difference; (ref) - indicates reference group; & - indicates standard error > 5 Data Source: BRFSS datasets – aggregated years 2006-2010. Racial category “All Other Races” not shown due to low sample number of survey respondents (n<20), weighted sample (<6000) Racial category “White” includes white non-Hispanic population, racial category “Black or African American” includes black non-Hispanic population.

20. Behavioral Risk Factor Surveillance System Analysis • Data Source: BRFSS datasets – aggregated years 2006-2010. * - indicates a significant statistical difference

21. Behavioral Risk Factor Surveillance System Analysis * - indicates a significant statistical difference; (ref) - indicates reference group; & - indicates standard error > 5 Data Source: BRFSS datasets – aggregated years 2006-2010. Racial category “All Other Races” not shown due to low sample number of survey respondents (n<20), weighted sample (<6000) Racial category “White” includes white non-Hispanic population, racial category “Black or African American” includes black non-Hispanic population.

22. General Population Focus Groups Takeaways • Clinical Trials: • “Pharmaceutical profit” • Logistics: • “I have to go all the way to South Hill for a mammogram. Over an hour away!” • Financial: • “Me, without insurance. I’m not going to get the treatment.” • Environmental: • “They put up signs about a year ago not to drink the water at work.” • “I had 9 people within a 3 mile radius of my home with cancer. 7 had breast CA.” • Lifestyle: • “They make processed food look so much more appealing.” • “Eating healthy is expensive.” • “The community is not geared toward exercise.” • “I’m 18 now. I’d say 80% of my friends smoke.”

23. Cancer Survivors Focus Groups Takeaways • Barriers to care: • limited facilities • travel logistics • cost of treatment • Support Service: • “I needed more coordination of events. I was drowning.” • “I needed the facts.” • “I had to put my faith in God and the doctors. • “There is no support besides my family. Nothing, no one.” • Research: • “It is happening somewhere, but I don’t know where it is.” • “Someplace far away, Boston. New York, Mayo Clinic…”

24. Research / Intervention Needs • Resources: • Utilization of Programs (EWL) • Mental health support • Development of support groups • Mobilization of the Faith Community • Identifying/writing grants • Environmental Issues: • Identification of hazards • Toxic waste • Aerial spraying • Bio-solids • Education: • Promotion of exercise • Promotion of healthy diets (Farmers markets) • Stop smoking campaign • Educational Programs targeting early development • MD Education: • Clarification of screening guidelines • Narcotic usage in hospice • Local resources

25. Summation • District Task Force • Incorporating the healthcare facilities and organizations, local government, the school systems, and the available expertise at VCU • Cancer Patient Navigator/Resource Center