Navigating Pennsylvania Cancer Patients (NPCP) Demonstration Project

1. Navigating Pennsylvania Cancer Patients (NPCP) Demonstration Project Appalachia Community Cancer Network Research RoundtableSeptember 28, 2007 Aileen S. Galley, ACSW, LSW

2. Session Objectives overview of MNMC detail types of patient navigation discuss PA DoH funding, FCCC collaboration and shared goals review cancer burden data for Centre region case studies discuss successes and challenges to date

3. Overview of Mount Nittany Medical Center • Founded in 1902 as a not for profit • Moved to State College location in 1972 to PSU Agricultural land • 201 Beds • Full 3 Year Accreditation by the Joint Commission for the Accreditation of Hospitals • Governed by a 16 member Volunteer Board of Trustees • 4th largest employer in Centre County with 1,300 skilled healthcare professionals and support staff • > 240 non-employed physicians in 42 specialties • Volunteers contribute > 54,000 hours/year

4. Cancer Care in the Centre Region • MNMC is Penn State Cancer Institute founding member • Comprehensive Breast Care Center, Breast MRI • PET • RO: Prostate brachytherapy and HDR, IMRT, 1 physician, 1 PA-C; IGRT, stereo-tactic to come • Neuro-oncology: 1 physician, new MICU/SICU • GI: 4 physicians, 2 centers • Surgical oncology: 5 physicians, 2 groups • H&N surgeons: 2 physicians, 2 groups • New cancer center being planned

5. Cancer Program Overview • Accredited by CoC of ACOS as Comprehensive Community Cancer Center • Year 2006: 754 patients accessioned • 15,000 visits each year to Medical Oncology • Over 17,000 treatments each year in Radiation Oncology • Over 500 Sentinel Lymph Node biopsies for breast and melanoma • Over 14,000 patients entered in registry since reference date of January 1, 1976 • dedicated inpatient oncology unit • Expanding rural outreach to neighboring counties – Huntingdon county to have access to clinical trials

6. Patient Navigation Models • Clinical • Disease Specific • Physician practice based • Telephonic • Lay

7. Navigating PA Cancer Patients Program • PA DoH RFA, “Model Patient Navigator System Initiative” • FCCC initiative, Suzanne Miller, PhD, Linda Fleisher, MPH, co-PI’s • focus on underserved populations in Pennsylvania • Compare rural vs. urban differences faced by patients and navigators • Begin at diagnosis – reduce delays in treatment, increase treatment adherence • provide a model paradigm based on an integration of “best practices” in health education, case management and training as well as state-of-the-science behavioral theory and evaluation research

8. Demonstration Project Objectives • enhance patient access to information about cancer diagnosis • facilitate location of health care services • reduce delays and missed appointments • provide information on the location of tangible social services • ultimate goal: improve cancer care among patients in the Commonwealth.

9. Measurement of Outcomes • Demonstration project 18 months in length • # of barriers faced by patients • Amount of time spent by navigator with each intervention • Future recommendations: decrease time between diagnosis and treatment; increase treatment compliance by removing barriers, I.e. reduce # of missed appointments by arranging transportation • ultimate goal: improve cancer care among patients in the Commonwealth.

10. Navigating PA Cancer Patients: Participating Sites

11. Navigating PA Cancer Patients: Why MNMC? Cancer Burden OverviewNew Cases 2006* *(only 5 cervical)

12. Navigating PA Cancer Patients: Why MNMC? Cancer Burden OverviewTop Five Sites 2002-2006

13. Defined as Metropolitan Statistical Area by USDA The Center for Rural PA statistics • Estimated 2005 population 140,561 (vs. 12,429,616 PA) • Land area 1,108 square miles • Population: 123 per square mile • 35.7% rural (vs. 23% for state) year 2000 • Poverty rate 11.5% (2000) • Cancer Death rate low at 1.33% vs. 2.36% state • 256 practicing physicians in county (176 with admitting privileges at MNMC) • 1 acute care facility: Mount Nittany Medical Center 201 beds Navigating PA Cancer Patients: Why MNMC? Cancer Burden Overview

14. Program Implementation • Navigator, Kristin D. Sides, hired 2/26/07 and began orientation at Mount Nittany • Began FCCC navigator training 3/5/07 – 3/16/07 • FCCC project mgr shadowed on-site on 3/29/07 • Meets weekly with cancer program director at MNMC • Weekly conferences with project manager and bi-monthly calls with project manager and navigator at urban site.

15. Quest for Referrals • Medical Center – all departments • Group Practices: outreach to med onc & surg onc groups, rural and “central” pcp sites, specialists (I.e. GI) • Community: CCCHS, CVIM, Tapestry (board), articles in paper • Support groups: Breast, Ostomy, Prostate, Lymphadema • Physical space in RO, sees all new consults, on-treats, follow-ups • Daily visits to med onc office • Seeing inpatients • Reviewing pathology • Cancer Registry “case finding”

16. Quest for Referrals:Successful Strategies Relationships + Results + Response Time Improved Patient Outcomes Increased Patient & Provider Satisfaction Decreased Patient Anxiety

17. Current State – 7 months into project • 11 patients enrolled on study • 39 additional patients either not eligible for study (not one of five sites), not interested/willing – 2 are pending enrollment • Navigator well integrated into program, respected and well liked by staff • Exploring future funding opportunities • Next steps: letter from physicians to patients, physician pocket cards, advertisements – requires IRB approval; clinic visits in neighboring rural county (Huntingdon)

18. Case Studies • Mary - 76 year old female, diagnosed with stage IIIA Lung Cancer in November 2006. • Sue - 83 year old female diagnosed with stage IIIC Ovarian Cancer in 2003. • Jane – 42 year old female diagnosed with StageIIA Breast Cancer in 2000. Metastatic recurrence diagnosed in January 2006. Now stage IV disease.

19. Successes MNMC willingness for 1st grant funded position Background of navigator hired Referral sources agree with need, respect navigator Collaboration with case mgmt, CNS Service not limited to patients of MNMC DoH & FCCC extending study beyond newly diagnosed Relationship with project mgr, PI, FCCC Patient satisfaction Enhanced outcomes for those patients referred Opportunity to create new paradigm for care

20. Challenges • Medical Staff model • Medical Oncology access • Out of site, out of mind • Main practice not willing to refer • Patients with challenges not of 5 study sites • Demographic – MNMC prostate patients with a different profile; almost no cervical cases • Research barriers – need help, don’t want/can’t participate • Urgency of some cases doesn’t allow adequate time to review study goals • Newly diagnosed often overwhelmed with treatment decisions, not prepared to consider study • Patient identification can be reactive, not proactive

21. Recommendations/Discussion Lay vs. Clinical models – future partnerships Navigator intervention at time of abnormal finding Impact of navigation on cost of care Practice based navigation Potential for role overlap: clinical nurse specialists, clinical coordinators, care/case managers, social workers Role for navigation with long term survivorship

22. Aileen S. Galley 814-234-6787 Agalley@mountnittany.org