Tag Archives: ACCC 34th National Oncology Conference

Reaching Out: Cancer Program-Community Collaborations for Health Equity

By ACCC Communications

No matter the cancer site or type of treatment, negative outcomes are disproportionately prevalent in underserved communities. For instance, a recent report finds that in the Appalachian Region, cancer mortality rates are 10 percent higher than the national rate, and the cancer mortality rate in that region is 15 percent higher in rural counties than in metro counties.1

To combat cancer disparities in North Carolina, Duke Cancer Institute decided to engage the community and create meaningful, collaborative relationships with local agencies, residents, and cancer care providers. The result was the Office of Health Equity and Disparities (OHED), which developed a five-step blueprint for cancer programs to engage their communities proactively, increase minority engagement, and improve the quality and scope of patient care. For their efforts, Duke Cancer Institute will be honored with a 2017 ACCC Innovator Award during the upcoming ACCC 34th National Oncology Conference in Nashville, Tenn.

ACCCBuzz talked with Nadine J. Barrett, PhD, MA, MS, the Director of OHED and one of the architects of the five-step roadmap, about the importance of community collaboration and vital measures any cancer program can take to address the prevalence of negative outcomes in minority communities.

ACCCBuzz: What is the importance of community collaboration in addressing health disparities and health equity in cancer care?

Nadine J. Barrett, PhD, MA, MS: The community plays a critical part in cancer care across the spectrum—from education and screening to survivorship. The relationships between the community and health systems are critical in terms of access to care and the barriers that may prohibit some from fully accessing services.  Collaborating and engaging with our community partners lets us find what innovative programs and services can be developed or enhanced to improve access to care within in the context of our cancer centers, no matter how small or large.

Typically , we come with this top-down approach with our community and patients, where what’s of value to them—their decision making, their thoughts, their ideas—wasn’t being captured. If we don’t create opportunities to learn from each other and work together toward a solution, then we’re fighting an uphill battle.

ACCCBuzz: So community collaboration is essential to delivering truly patient-centered care?

Dr. Barrett: Absolutely. Focusing on health equity and disparities also helps us to understand and appreciate the social and historical relationship that diverse populations have with their community cancer centers and health systems.  If a patient in the community doesn’t trust the health system or believe that the health system is only advocating on behalf of their own needs and interests, those perceptions will affect how they talk about cancer screening and diagnosis with their families, friends, and loved ones – ultimately impacting the perceptions and screening behaviors of their family, friends and the broader community.   Collaborating with trusted members and organizations with the community is critical to changing this narrative through authentic collaborations and communications.

ACCCBuzz: Why do you think community-based and academic cancer programs make a good partnership in addressing health disparities?

Dr. Barrett: We asked one of our community health centers what our partnership should look like. It was clear to us that there were resources and expertise they had with a given community, and there were resources and expertise we had with degrees of care. The closer we work together and align our priorities, the more we can leverage our expertise toward addressing the needs in their community.

For example, with the Commission on Cancer, when we do community health assessments, we can work together to understand a community’s cancer care needs and implement strategies and research to address them. Large academic centers are able to capture and analyze data. Why not leverage our respective strengths to capture that data? The second part of that is thinking about research, how we can engage our community and patients in research and clinical trials. These collaborations allow us to meet several needs simultaneously. We are able to identify and meet patient and community needs, organizational accreditation, and  institutional needs. A win-win for all.

Watch this video to learn more about the Duke OHED comprehensive program for community engagement.

ACCCBuzz: What can other cancer care programs take away from your work at Duke, in terms of improving health equity and disparity?

Dr. Barrett: With our comprehensive program, any and all parts can be modified to suit the size, needs, and capacity of community cancer program structures. For example:

  • Creating a community advisory council goes such a long way in addressing health disparities. Working together to identify needs, learn from each other, and gain insight into the challenges and opportunities to improve community health in cancer, and to make the appropriate linkages and support programs to address them. A partnership with a community advisory council can go miles in advancing health equity.
  • From there, you have to figure out how to conduct needs assessments in such a way that the patients, community, and organization’s needs are met, based on aligned priorities. You then can use  the assessment as a blueprint to address needs regardless of the size of the organization.
  • The third area is creating sustainable programs, services, and research opportunities that reflect the outcomes from the assessment findings.

All of these components need to be explored and modified based on the individual structure of local cancer programs.

ACCCBuzz: What are you excited to share with the attendees at the ACCC 34th National Oncology Conference this October?

Dr. Barrett: One of the things I’m most excited about sharing is how empowering this experience is. It’s so rewarding to know that the work we are doing is reaching such a diverse population—black, white, Latino, Asian, LGBTQ, Muslim, poor. There’s a generational difference now, too. We have young people advocating at the college level. It’s like we are in the midst of a community culture shift; we are building together across the spectrum of age, race, and ethnicity.etc. to advance health equity in cancer services.

Reference
1. Appalachian Regional Commission. Health Disparities in Appalachia. PDA, Inc., Cecil G. Sheps Center. August 2017. Available online here.


On August 15, 2017, Dr. Barrett was appointed to the Patient-Centered Outcome Research Institute (PCORI) Advisory Panel on Addressing Disparities.

Meet Dr. Barrett and hear more about the Duke Cancer Institute’s five-step process for implementing a health disparities and equity Health Disparities & Equity Program at the 34th ACCC National Oncology Conference in Nashville, Oct. 18-20.  Learn more.

 

Taking Lung Cancer Screening on the Road

Carolinas HealthCare System, Levine Cancer Institute will be honored with a 2017 Innovator Award at the ACCC 34th National Oncology Conference in Nashville, in October, for their development of the first mobile CT unit for lung cancer screening in the U.S., bringing state-of-the-art technology to rural communities. 

By Mellisa Wheeler, BSW, MHA, and Derek Raghavan, MD, PhD

As the oncology community is well aware, despite improvements to the early diagnosis, systemic immunotherapies, and gene-directed treatments of lung cancer, mortality rates remain high for this disease. A number of factors underlie this high death rate: the nature and natural history of the disease itself, poor access to care among continuing and recent smokers, lack of health education, fiscal and cultural issues, social stigma, and geographical isolation, among others. When patients present with Stage 1 (localized) lung cancer, surgical cure is possible in more than 50% of cases; when patients present with metastatic disease, for practical purposes, cure is highly unlikely.

Given that geographical isolation and barriers to care access are such important determinants of outcome, the Levine Cancer Institute sought to develop a program that would help to identify and eliminate barriers in high-risk and underserved communities.

Supported by a grant from the Bristol-Myers Squibb Foundation and in collaboration with Samsung and Frazerbilt, Levine Cancer Institute has developed the first mobile CT lung cancer screening unit in the United States.

Our mobile screening vehicle consists of a conventional low-dose Samsung CT unit mounted onto a robust, well-sprung truck body, with a built-in clinical space.  Initial testing has demonstrated the fidelity of the unit, as well as the lack of impact of on- and off-road transportation on the functionality and image quality of the scanner.

We have also created a mechanism for electronic image transfer for reporting at a central location by the staff of partner radiology groups like Charlotte Radiology, Stanly Imaging, and Shelby Radiological Associates. Watch our video and learn more.

The entire program, one of several lung cancer projects of different types supported by the Bristol-Myers Squibb Foundation, is directed toward underserved and under-privileged populations. Our program includes several social components, including outreach and education on lung cancer screening for local physicians, nurse navigation and education, patient outreach with smoking cessation programs, and meticulous follow-up to avoid the loss of patients with identified lesions. Carolinas HealthCare System, the largest safety-net health organization in the Carolinas, has committed to providing optimal care to any patients shown to have lesions requiring further investigation, irrespective of their ability to pay; this care includes follow-up and repeat scanning; biopsy; and surgical, radiation, or systemic treatment.

We have already identified cases of early stage disease that have been directed towards definitive and hopefully curative treatment. In addition to the potential to improve patient outcomes, surgical treatment of early stage lung cancer is far less costly to the community than palliating the disease via systemic therapy. Through our program, we anticipate much improved outcomes for lung cancer treatment at a substantially reduced cost in the community.


Mellisa Wheeler, BSW, MHA, is Disparities & Outreach Manager, Levine Cancer Institute, and Derek Raghavan, MD, PhD, FACP, FRACP, is President, Levine Cancer Institute, Carolinas HealthCare System.

Hear details on the Levine Cancer Institute lung screening program and see their mobile CT unit at the ACCC 34th National Oncology Conference in Nashville, Oct. 18-20. Browse the full agenda.

 

Desperately Seeking Oncology Nurses?

Stressed by nurse staffing shortages? Learn how 2017 ACCC Innovator Award winner Loma Linda University Cancer Center tackled this challenge.

By Lexine Thall, MN, RN-BC, AOCN, and Kristina Chase, BSN, RN, OCN

FinalSeal

One of the most challenging issues in healthcare is the ongoing balancing act of staffing and retention. For specialty areas, such as oncology, staffing presents an even more difficult challenge. Finding those perfectly qualified individuals with all the right experience to fill open positions can be a taxing, time-consuming task. As a result, cancer programs may find themselves dealing with lengthy vacancies, which can cause some real strains on a growing clinic and may led to an unhappy environment for nurses and patients. When our cancer program encountered this understaffing dilemma, chemotherapy skilled and oncology experienced (CS-OE) RNs in our cancer center began facing increased workloads, which put them at risk for potential burn out, being vulnerable to making errors, and causing longer wait times for patients.

Our cancer program leadership team had to think outside of the box and create a road map to alleviate some of these staffing strains. An analysis of appointment types and RN skill level needed for each visit type revealed that 40 percent of our supportive care therapies (e.g., hydration, blood transfusions) did not require a CS-OE RN. Given this information, we decided to pilot a program that would fill RN vacancies with experienced non-oncology nurses and create a pathway for these RNs to attain the ONS Chemotherapy/ONCC Chemotherapy Biotherapy Certificate. Our aim was to provide a mentorship program in conjunction with vetted education tools to develop these RNs professionally and alleviate our staffing crisis. The pilot program launched in 2014, and to date, 17 nurses have been accepted into the mentoring program. All RNs who opted to pursue the ONS/ONCC Chemotherapy Biotherapy Certificate (7 of 7) have attained their goal and 86 percent (6 of 7) of the RNs who attained this certification have remained with our organization.

Our mentorship program has drastically decreased the length of time we have unfilled RN positions posted—from an average of 113 days down to 29 days. It has also given many nurses an opportunity to gain focused experience in a specialty area for which many employers may not be willing to bear the educational costs. In addition to the benefit for the non-oncology nurse, the program has provided professional satisfaction and role expansion for the CS-OE RN mentors. A win-win for all parties involved.

At the ACCC 34th National Oncology Conference, October 18-20, 2017, in Nashville, TN, we’ll be sharing the details of our mentorship journey, “how to’s” for developing a program like ours, and some lessons we’ve learned along the way.  I hope you can join us in Nashville!

Hear more from all the 2017 ACCC Innovator Award winners at the ACCC 34th National Oncology Conference, Oct. 18-20, 2017, in Nashville, TN. Learn more.


Lexine Thall, MN, RN-BC, AOCN, is Director, Patient Care, Loma Linda University Cancer Center; Medical Oncology/Hematology; Women’s Cancer/Surgical Oncology; and Kristina Chase, BSN, RN, OCN, is Patient Care Supervisor.