Transcript Cultural Sensitivity and Patients with Cancer

Cultural Sensitivity
and
Cancer Patients
Darryl L. Jordan, M.D.
Assistant Professor
Liaison Medical Director for Veteran
Affairs at Meharry
Disclaimer
In accordance with accreditation counsel for
continuing medical education (ACCME) guidelines, I
disclosed that I have no financial relationship with
any pharmaceutical or medical manufacturing
companies that would pose a conflict of interest to
this presentation.
Objectives
 Review variation in cancer mortality rates
among various populations via sociodemographic factors
 Identify barriers to cancer assessment and
treatment of underserved minority populations
 Review program designed to eliminating health
disparities
March on Poverty June 1968
Summary Statement of the
American Cancer Society1989:
Cancer in the Poor
Findings
1. Poor people endure greater pain an suffering from cancer than other
Americans
2. Poor people and their families must make extraordinary personal
sacrifices to obtain and pay for care.
3. Poor people face substantial obstacles in obtaining and using health
insurance and often do not seek care if they cannot pay for it.
4. Current cancer education programs are culturally insensitive and
irrelevant to many poor people.
5. Fatalism about cancer is prevalent among the poor and prevents them
from seeking care.
Summary Statement of the
American Cancer Society1989:
Cancer in the Poor
Challenges for the Nation
1.
2.
Establish patient advocate and referral services to help poor
patients navigate the health system and manage personal
problems that result from cancer treatment.
Involve community organizations serving the poor and poor
people themselves in cancer education and patient advocacy
programs.
Patient Navigator Outreach and Chronic Disease
Prevention Act of 2005
Requires the Secretary of Health and Human Services acting
through the Administrator of the Health Resources and Services
Adminstration (HRSA) to make grants to eligible entities for the
development and operation of demonstration programs to provide
patient navigotor services to improve health care outcomes.
Requires the Secretary to coordinate with, and ensure the
participation of, the Indian Health Service, the National Cancer
Institute, and of the Office of Rural Health Policy..
Reasons for Cancer Disparities
Environment
Social and Systemic Factors
Genetics
Biology/ Patient \Tumor Factors
Gabram S et. Al Cancer 2008
Lifestyle
Behavioral/Patient Factors
Impact of Socioeconomic Status on Survival
after Cancer in the U.S
Method: Review of medical records, diagnosis stage, treatment
and
5-yr mortality and SES, across 7 cancer registries within the U.S.
from 1996-1997
4,844 women with breast cancer
4332 men with prostate cancer
4422 men and women with colorectal cancer
Results: For all 3 cancer sites, low SES was a much stronger
predictor of mortality among individuals aged < 65 yrs and
among individuals from racial/ethnic minority groups.
Byers et. Al Cancer 2008
Byers et. Al Cancer 2008
Byers et. Al Cancer 2008
Byers et. Al Cancer 2008
Impact of Socioeconomic Status on Survival
after Cancer in the U.S
Conclusion: The current results indicate that low SES is a risk
factor for all-cause mortality after a diagnosis of cancer.
These findings support the need to focus on SES as an underlying
factor in cancer disparities by race and ethnicity.
Byers et. Al Cancer 2008
Effects of an outreach and internal navigation program on Breast cancer
diagnosis in an urban cancer center with a large African-American
population
Method: Cross-sectional study was an analysis of all women with breast cancer who
were diagnosed and/or treated 2001 and 2004 intervention with 125 community
health advocates (CHAs), educational programs and
Patient Navigators communicated directly with patients to encourage screening,
diagnostic procedures and treatment.
Results: 487 patients were diagnosed/treated from 2001 and 2004 with 1148
community interventions by CHAs with est. > 10,000 participants,
proportion of stage 0 ( in situ ) breast cancers increased from 12.4% to 25.8%
stage IV invasive breast cancer declined from 16.8% to 9.4%
Grabam S et. Al Cancer 2008
Effects of an outreach and internal navigation program
on Breast cancer diagnosis in an urban cancer center
with a large African-American population
Conclusions: The outreach initiatives and internal patient
navigation appear to have improved stage at diagnosis.
Similarly, prospective data are being collected to determine whether
Patient Navigators influence treatment and appointment adherence
as well as the underlying reasons for barriers to specific
interventions in this underserved minority population.
Grabam S et. Al Cancer 2008
Racial Differences Pertaining to a Belief about Lung Cancer
Surgery
Results of a Multicenter Survey
Mitchell L. Margolis, MD; Jason D. Christie, MD, MS; Gerard A.
Silvestri, MD; Larry Kaiser, MD; Silverio Santiago, MD;
and
John Hansen-Flaschen, MD
Objective: To assess the prevalence of the belief that air
exposure during lung cancer surgery might cause tumor
spread
Setting: Philadelphia VAMC, Los Angeles VAMC and Medical
University of South Carolina
Patients: 626 consecutive patients in pulmonary and lung
cancer clinics
Ann Intern Med 2003; 139:558-563
Results:
38% of patients
61% of whom were AA and
29% whom were Caucasians) stated that they believed
air exposure at surgery causes tumor spread;
19% of AA stated that they would oppose surgery
because of this belief.
14% would not accept their physicians assertion
that the belief was false.
Ann Intern Med 2003; 139:558-563
Conclusion:
Belief in accelerated tumor spread at surgery is
prevalent among pulmonary outpatients and lung cancer
patients facing lung surgery, particularly African
Americans. This finding may pertain to key racial
disparities in lung cancer.
Ann Intern Med 2003; 139:558-563
Solutions
Role of The Patient Navigator
Founder of Navigational Approach
1989 American Cancer Society, Report to the Nation
Cancer in the Poor
2005 Patient Navigator Outreach and Chronic Disease
Prevention Act
June 2007 Harold P. Freeman Patient Navigation Institute opened
Harold P Freeman, M.D.
Associate Director of NCI
Director of the NCI Center to
Reduce Cancer Health
Disparities
Conclusion
Socio-economic factors and cultural sensitive play a
important role in health disparities among minority
populations
Patient Navigator programs have proven benefit in
reducing the impact of health disparities
Additional studies are need to evaluate the financial
impact of such programs on future health care cost
References
Byers T, Wolf H, Bauer K, Bolick-Aldrich S, The Impact of Socioeconomic
Status on Survival After Cancer in the United States, Cancer 2008;113; 582590.
Gabram S, Lund M, Gardner J, Hatchett N, Effects of an Outreach and
Internal Navigation Program on Breast Cancer Diagnosis in an Urban Cancer
Center With a Large African-American Population, Cancer 2008; 113; 602607.
Margolis M, Christie J.D., Silvestri G, Kaiser L., Santigo S., Hansen-Flaschen J,
Annual of Internal Medicine 2003: 139; 558-563