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

1
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
• Nicole Harada
• Clinical Research Coordinator

2
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

3
Cancer Disparities Research Partnership (CDRP)
Program Program Steering CommitteeJanuary 20,
2006Miami, Florida

• Project Overview

4
Status of Clinical Trials

• 12 Trials Open
• 10 RTOG Sponsored Trials
• 1 Community-Based Trial
• 1 Device Trial

5
Trials Open
Name of Trial Name of Sponsor Date opened
2003-02 DCIS CYTYC (formerly Proxima) 11/30/2004
RTOG 0229 National Cancer Institute 12/29/2004
RTOG 98-13 National Cancer Institute 12/24/2004
Prostate Patient Profiles Project (P4) Louis Warschaw Prostate Cancer Center _at_ Cedars Sinai 09/08/2005
RTOG 0315 National Cancer Institute 12/07/2004
RTOG 0320 National Cancer Institute 01/05/2005
RTOG 0413 National Cancer Institute 09/19/2005
RTOG 0232 National Cancer Institute 11/04/2005
RTOG 0247 National Cancer Institute 12/15/2004
RTOG 98-04 National Cancer Institute 12/07/2004
RTOG 0215 National Cancer Institute 10/10/2005
RTOG 0321 National Cancer Institute 11/22/2005
6
Trials in Development

• Melatonin Trial
• Glutamine Trial
• HDR as Monotherapy

7
Accrual to Clinical Trials
8
Clinical Trial Questionnaire
9
Reasons for Declining Clinical Trials
10
Gender/Ethnicity of Patients of Clinical Trial
11
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 in review
• OMH National Leadership Summit on Eliminating
  Racial Disparities in Health
• January 9-11, 2006 Washington, D.C.
• Lay Patient Navigator Presentation
• Prophylactic Post-Operative Antibiotics for
  Prostate Brachytherapy
• presentation at the 2006 ASCO Prostate Cancer
  Symposium at February 2006
• California Cancer Reach 2010 Conference May
  2006 presentation on Patient Navigation

12
Update on Partnership Relations

• Centinela Freeman
• USC
• UCSF
• RAND

13
USC/Norris Cancer Comprehensive Center

• Mentoring Institution
• Guidance and oversight in clinical trial
  infrastructure
• Collaboration of clinical trials
• MammoSite Trial
• P53 Trial ( in development )
• High Risk Prostate Cancer ( in development )
• Collaboration of tumor boards and case
  conferences
• Weekly Combined Tumor Boards (Telesynergy)

14
USC School of Social Work

• Intern Training in Social Service Management of
  Cancer the Patient and Navigation
• Developed Personal Health Record for Patients
• Support Group Development
• Program Enlarging in 2006/2007

15
University of California, San Francisco

• Primary RTOG Site
• Guidance and oversight in clinical trial
  infrastructure

16
Rand Corporation

• Providing Evaluation Component of the Program
• Program Development Recommendations
• Focus Groups with Stakeholders (Community
  Advisory Board Members, ULAAC Project Staff,
  Patient Navigators, Community Physicians)
• Navigator Focus Groups
• ACTION multi-system collaboration NIH grant

17
Compliance

• Clinical
• Regulatory
• Administrative
• Compliance Process
• Outside Audit

18
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
• Clinical Trials
• Collaboration with other CDRP sites
• Patient consent

19
Navigator Training Program
20
Navigator Training Outline

• The 6-hour training program takes place over
  three days
• Day One
• Brief introduction to the project
• The role of the navigator developed by
  examination of the barriers to health care
  existing in the community
• Vignettes and anecdotes of a typical patient

21
Navigator Training Outline

• Day Two
• Discussion of the navigator/patient relationship,
  including initiating contact, offering services
  and empowering the patient
• Recordkeeping is demonstrated at length, with
  emphasis on the research nature of the project
  and the importance of adequate charting
• Appropriate use of the Intake Form, Hours and
  Mileage Form, the S.O.A.P. Form, and the
  Medications List
• The biology of cancer and common types of
  treatment are discussed
• Overview of clinical trials presented by one of
  the co-investigating physicians, including
  information on the benefits of trials
  participation to patients and the community

22
Navigator Training Outline

• Day Three
• Presentation on the Emotional aspects of cancer,
  sensitizing the trainees to the fears and
  uncertainties cancer patient may face
• Presentation on the Barriers to trials
  participation in this community are gathered from
  the participants point of view
• Discussion about the benefits to trials
  enrollment are reaffirmed as the trainees learn
  how to appropriately speak to their assigned
  patients about participation.
• HIPAA presentation on patient confidentiality

23
Navigator Training
Three training programs were conducted during the
months of March (Group 1), June (Group 2), and
September (Group 3), 2005. A total of 39
Navigators were trained.
24
Active Navigators
25
Ethnicity of Active Navigators
26
Navigators Who Are Survivors
27
Patient Navigation Data
28
Reasons for Declining Navigation
29
Patient Navigator Case Load
30
Chart Audit Barriers to Care
31
Barriers to Care Chart Audit
PT ID Dx Barriers Navigator Assigned Date of Review Date closed Days open Resources Identified Did ULAAC staff assist Navigator?
009 Colon 1. Transportation RJH 04/29/05 04/30/05 2 Taxi voucher program No
2. Financial RJH 04/29/05 04/30/05 2 Beckstrand Cancer Foundation No
32
6 Most Common Barriers
33
Assessment and Effectiveness of Quality Assurance

• Navigator Focus Groups (Rand source protected
  feedback)
• Patient Satisfaction Survey, compatibility and
  does the navigation process meet patient needs
  (patient perception of effectiveness)
• Clinical Trials Questionnaire
• Telephone interviews with patients
• Compliance interviews (5)

34
CHALLENGES AND OPPORTUNITIES

• Evaluation of effect on trials
• Pushing navigation earlier in the process of care
  (surgeons, primary care, screening)
• Using army of navigators in community outreach
• Using navigator for disaster preparedness
• Testimonial method in training and in
  presentation of clinical trials

35
CHALLENGES AND OPPORTUNITIES

• Ongoing Evaluation Will Provide Practical
  Information
• Elimination of barriers to care
• Quality assessment
• Effects of navigation on accrual to clinical
  trials

36
Spawned from the ULAAC Grant

• Cancer Committee
• ACoS Accreditation with 7 commendations
• Tumor Boards case conferences weekly
• Community Outreach and health screenings
• Navigators outreach educating the community about
  the benefits of clinical trials
• Development of a Spanish Support Group

37
Media Coverage

• La Opinion article, November 11, 2005
• To Navigate Services in a Health System The
  Patient Navigator Program Helps Sort Through
  Obstacles that Make it Difficult to Treat Cancer
• Inglewood Today article, October 12, 2005
• Taking Care of Business The Urban Latino African
  American Cancer (ULAAC) Disparities Project
• KCAL 9 news station (CBS) December 7, 2005 200
  PM, 300 PM, and 400 PM news ULAAC New cancer
  Program Helps Patients Navigate System
• http//cbs2.com/video/?id11126_at_kcbs.dayport.com

38
Centinela Freeman Community Foundation

• Mission Statement
• The mission of the Centinela Freeman
  Community Foundation is to enhance the health and
  healthcare of South and Southwest Los Angeles by
  developing and supporting healthcare education,
  medical research, and programs which improve
  access to healthcare for the citizens of our
  community.

39
Centinela Freeman Community Foundation

• Leveraging Off Previous Community Based
  Foundations Formed New Foundation
• Establishing Infrastructure to Support Access to
  Care and Clinical Research in the Community
• Current Activities
• Recruited Executive Director
• Diabetes Screening/Navigator Program
• Cancer Screening Program
• High School Sports Trainer Funding
• Nursing Academy
• Low cost insurance supplement collaboration

40
Still Too Separate, Not Yet Equal
A. Epstein

• Describing And Explaining Disparities Is Much
  Easier Than Devising Strategies To Reduce
  Disparities