Urban Latino African American Cancer (ULAAC) Disparities Project
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Urban Latino African American Cancer (ULAAC) Disparities Project at Centinela Freeman Regional Medical Center. Michael L. Steinberg, MD, FACR Principal Investigator David Khan, MD Co-Principal Investigator David Huang, MD Co-Principal Investigator Nicole Harada, CCRC

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Urban Latino African American Cancer (ULAAC) Disparities Project at Centinela Freeman Regional Medical Center

Michael L. Steinberg, MD, FACR

Principal Investigator

David Khan, MD

Co-Principal Investigator

David Huang, MD

Co-Principal Investigator

Nicole Harada, CCRC

Clinical Research Coordinator


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Our Team Project

  • Principal Investigator

    • Michael Steinberg, MD

  • Co-Principal Investigators

    • David Khan, MD, Radiation Oncologist, CF

    • David Huang, MD, Radiation Oncologist, CF

    • Nell Forge, PhD, MPH, Assoc. Behavioral Scientist, RAND

    • Allen Fremont, MD, PhD, Assoc. Natural Scientist, RAND

    • Oscar Streeter, MD, Radiation Oncologist, USC

    • Mack Roach, MD, Radiation Oncologist, UCSF


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Cancer Disparities Research Partnership (CDRP) Program Project RTOGToronto, Canada

Program Update

June 2006


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Status of Clinical Trials Project

  • 7 Trials Open

    • 5 NCI Sponsored Trials

    • 1 NCIC Sponsored Trial

    • 1 Community-Based Trial


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Trials Open Project


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Trials Pending Approval by WIRB Project

  • Cancer Post Treatment Survey – Exemption

  • Rand/ULAAC Patient Navigator Survey – In progress

  • RTOG 0123 – In progress

  • RTOG 0214 – In progress

  • RTOG 0116 – In progress

  • S0424 – In progress





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Accrual to Trial by Residence Project

Los Angeles (90008 – 90047) Inglewood (90301 – 90305) Gardena (90249)

Torrance (90250) Culver City (90230) Marina Del Rey (90292)

Sun City (92586)




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Publications and Presentations Project

  • “Implementing a Lay Patient Navigator Program to Reduce Barriers for Minority Patients’ Access to Cancer Care and Clinical Trials: Essential Steps and Initial Challenges”

    • Manuscript resubmitted

  • “National Leadership Summit on Eliminating Racial Disparities in Health”

    • January 9-11, 2006, Washington, D.C.

  • “Prophylactic Post-Operative Antibiotics for Prostate Brachytherapy”

    • Presented at the 2006 ASCO Prostate Cancer Symposium


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Publications and Presentations Project

  • “Developing a Lay Patient Navigator Program Addressing Barriers to Care and Participation in Clinical Trials”

    • Presented at the REACH 2010 Conference, May 17, 2006

  • “Preliminary Results and Evaluation of MammoSite® Balloon Brachytherapy for Partial Breast Irradiation for Pure Ductal Carcinoma in Situ: A Phase II Clinical Study”

    • Presented at the American Society of Breast Surgeons Meeting, April 2006

  • “Using Telesynergy® to Improve Access to Clinical Trials at an Underserved Community Based Hospital”

    • Submitted to ASTRO, November 2006


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Publications and Presentations Project

  • A Lay Patient Navigator Program as Part of a Clinical Trials Infrastructure in a Community Hospital Serving Minority and Low Income Patients

    • Submitted to Cancer Health Disparities Summit 2006, Bethesda, MD,

      July 17-19, 2006

  • The Use of Lay Patient Navigators to Improve Quality of Care and Accrual to Clinical Trials for Radiation Oncology Patients Who Are Minorities or of Low Socioeconomic Status

    • Accepted for oral presentation at ASTRO 2006,   Philadelphia, PA,

      Nov. 5-9, 2006

  • The Urban Latino African American Cancer (ULAAC) Disparities Project: Implementing the NCI-Radiation Research Program Model

    • Cancer in African Americans - Challenges and Opportunities the Cleveland Clinic Taussig Cancer Center, May 11-13, 2006


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Update on Partnership Relations Project

  • Centinela Freeman

  • USC

  • UCSF

  • RAND


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USC/Norris Cancer Comprehensive Center Project

  • Mentoring Institution

    • Guidance and oversight in clinical trial infrastructure

    • Collaboration of clinical trials

      • MammoSite DCIS Trial (completed)

      • P53 Trial ( in development )

      • High Risk Prostate Cancer ( in development )

    • Collaboration of tumor boards and case conferences

      • Weekly combined tumor boards


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Cancer Disparities Research Partnership (CDRP) Program Project RTOGToronto, Canada

Process Evaluation:

Overview

RAND Corporation


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Overview of RAND Activities Project

  • Navigator focus groups

  • Development of patient surveys and interview protocols

  • Fostering research opportunities

    (e.g. ACTION)

  • Assistance on manuscripts

  • Provider and staff interviews


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Process Evaluation Project

  • Assess whether the project’s goals and objectives have been operationalized and implemented as intended.

  • Identify areas where adjustments are needed to increase the program’s effectiveness and efficiency.


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Process Evaluation: Project Methods and Stakeholders

  • Focus Groups

    • Patient Navigators

  • Face to Face Interviews

    • Patients

  • Semi-Structured Interviews

    • Community Providers

    • DFMH/ULAAC Staff


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Focus Group Sessions: Project Content Areas

  • Patient Navigator

    • Role

    • Motivation

    • Skills

  • Needs

    • Patient

    • Navigator Training

  • Clinical Trials

    • Perceptions


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Patient Instrument: Project Key Domains

  • Patient Needs and Barriers

  • Perceived Satisfaction

    • Navigator Support

    • Provider Care

  • Self-Efficacy

    • Cancer knowledge

    • Empowerment


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Update on Telesynergy/Telemedicine Project

  • Tumor Boards

    • USC – Every Monday

    • CFHS – Every Wednesday

  • Training Sessions

    • ULAAC Navigator Training Programs

  • Meetings

    • Investigator Meeting – Quarterly

    • Medical Advisory Board – Quarterly

    • ULAAC – Every Wednesday

    • Increased participation with mentoring institutions

    • Increased participation with CDRP sites

  • Clinical Trials

    • Collaboration with other CDRP sites

    • Patient consent (Speaking)

  • Abstract submitted to ASTRO


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Cancer Disparities Research Partnership (CDRP) Program Project RTOGToronto, Canada

Patient Navigator Program





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Navigators Who Are Cancer Project Survivors


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Patient Navigation Data Project

67% accepted navigation


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Ethnicity of Patients Approached Project

Percentage Breakdown:

71% African Americans, 13% Latinos, 11% Caucasians, 4% Asians, 1% Other


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Ethnicity of Patients Accepting Navigation Project

Percentage Breakdown:

67% African Americans, 71% Latinos, 55% Caucasians, 70% Asians, 33% Other





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Solutions for Barriers Project

  • Transportation

    • Taxi vouchers

    • Variety of van services to accommodate patients with special needs

    • Work with patients’ insurance carrier to provide transportation

    • Navigators who are willing to drive patients to and from treatment

  • Psychosocial

    • Match patients with navigators who are cancer survivors (matching type of cancer when possible)

    • Increase frequency of comfort calls

    • Referral to patient/family support groups and/or counseling

  • Financial

    • Financial assistance organizations

    • Food vouchers

    • Salvation Army and Catholic Charities

    • Utilities assistance

    • Housing assistance and referral


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Solutions for Barriers Project

  • Fear of Cancer

    • Provide linguistically appropriate, cancer-specific educational materials

    • Accompany patients to cancer-related medical visits

    • Encourage support group participation

  • Caregiver

    • Referral to In Home Supportive Services

    • Referral to Multipurpose Senior Services Program

    • Referral to Comfort Keepers

  • Language

    • Assign navigators who are culturally and linguistically appropriate

    • Make sure translator is available at patients’ appointments

    • ALAS Para tu Salud – a translation program based in Los Angeles, CA


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Cancer Post-Treatment Survey Project

Study Questions:

  • Are there quantitative differences between patients who received navigation versus those who did not in various QOL domains?

  • Are there patient perceived quality differences in the two groups?


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Cancer Post-Treatment Survey Project

Source:

RTOG A-5 Demographic Survey

FACIT and Model Questions

Domains Evaluated

Spiritual

Social/Family

Physical

Emotional

Functional

Patient Centered Questions

Relationship Based Questions


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Cancer Disparities Research Partnership (CDRP) Program Project RTOGToronto, Canada

Milestones

and

Lessons Learned





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Centinela Freeman Community Foundation Structured Interview

  • Established Community Health Foundation

  • Mission: Establish Infrastructure to Support Access to Care and Clinical Research in the Community

  • Current Activities

    • Recruited Executive Director

    • Diabetes Screening and Care/Navigator Program

    • High School Sports Trainer Funding

    • Centinela Freeman Research Institute

    • Nursing Academy

      • Trains 72 RNs per year


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MSW Intern’s Role Structured Interview

  • Provided navigation

  • Conducted various in-services for navigators (basic training/orientation, self disclosure guidelines)

  • Developed prototype Patient Tracking Notebook

  • Built resource guide for navigators

  • Laid groundwork for Latino Cancer Support Group

    • Spanish


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Lessons Learned Structured Interview

  • It takes 15 months to start navigating patients

  • It takes at least 1 year to gather enough data for analysis of navigation

  • It takes 18 months to start clinical trials

  • Clinical trials applicable to our institution and patient population are not plentiful

  • Community hospital infrastructure was not initially conducive to grant support…we had to create our own


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