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

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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

our team
Our Team
  • 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
cancer disparities research partnership cdrp program rtog toronto canada

Cancer Disparities Research Partnership (CDRP) Program RTOGToronto, Canada

Program Update

June 2006

status of clinical trials
Status of Clinical Trials
  • 7 Trials Open
    • 5 NCI Sponsored Trials
    • 1 NCIC Sponsored Trial
    • 1 Community-Based Trial
trials pending approval by wirb
Trials Pending Approval by WIRB
  • 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
accrual to trial by residence
Accrual to Trial by Residence

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

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

Sun City (92586)

publications and presentations
Publications and Presentations
  • “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
publications and presentations14
Publications and Presentations
  • “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
publications and presentations15
Publications and Presentations
  • 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
update on partnership relations
Update on Partnership Relations
  • Centinela Freeman
  • USC
  • UCSF
  • RAND
usc norris cancer comprehensive center
USC/Norris Cancer Comprehensive Center
  • 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
cancer disparities research partnership cdrp program rtog toronto canada18

Cancer Disparities Research Partnership (CDRP) ProgramRTOGToronto, Canada

Process Evaluation:

Overview

RAND Corporation

overview of rand activities
Overview of RAND Activities
  • Navigator focus groups
  • Development of patient surveys and interview protocols
  • Fostering research opportunities

(e.g. ACTION)

  • Assistance on manuscripts
  • Provider and staff interviews
process evaluation
Process Evaluation
  • 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.
process evaluation methods and stakeholders
Process Evaluation: Methods and Stakeholders
  • Focus Groups
    • Patient Navigators
  • Face to Face Interviews
    • Patients
  • Semi-Structured Interviews
    • Community Providers
    • DFMH/ULAAC Staff
focus group sessions content areas
Focus Group Sessions:Content Areas
  • Patient Navigator
    • Role
    • Motivation
    • Skills
  • Needs
    • Patient
    • Navigator Training
  • Clinical Trials
    • Perceptions
patient instrument key domains
Patient Instrument:Key Domains
  • Patient Needs and Barriers
  • Perceived Satisfaction
    • Navigator Support
    • Provider Care
  • Self-Efficacy
    • Cancer knowledge
    • Empowerment
update on telesynergy telemedicine
Update on Telesynergy/Telemedicine
  • 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
cancer disparities research partnership cdrp program rtog toronto canada25

Cancer Disparities Research Partnership (CDRP) ProgramRTOGToronto, Canada

Patient Navigator Program

patient navigation data
Patient Navigation Data

67% accepted navigation

ethnicity of patients approached
Ethnicity of Patients Approached

Percentage Breakdown:

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

ethnicity of patients accepting navigation
Ethnicity of Patients Accepting Navigation

Percentage Breakdown:

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

solutions for barriers
Solutions for Barriers
  • 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
solutions for barriers37
Solutions for Barriers
  • 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
cancer post treatment survey
Cancer Post-Treatment Survey

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?
cancer post treatment survey39
Cancer Post-Treatment Survey

Source:

RTOG A-5 Demographic Survey

FACIT and Model Questions

Domains Evaluated

Spiritual

Social/Family

Physical

Emotional

Functional

Patient Centered Questions

Relationship Based Questions

cancer disparities research partnership cdrp program rtog toronto canada40

Cancer Disparities Research Partnership (CDRP) ProgramRTOGToronto, Canada

Milestones

and

Lessons Learned

centinela freeman community foundation
Centinela Freeman Community Foundation
  • 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
msw intern s role
MSW Intern’s Role
  • 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
lessons learned
Lessons Learned
  • 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