Each day, 3,400 people in the United States are diagnosed with cancer and another 1,500 die from the disease. And while these numbers are disturbing, they also harbor a fundamental inequity: racial and ethnic minority groups form a larger percentage of these totals than their proportions in the general population.
Since its inception in 1999, the Siteman Cancer Center, a part of Washington University School of Medicine and Barnes Jewish Hospital, has implemented highly successful strategies for reducing such disparities in cancer care. In fact, from 2000 to 2004, African American participation in Siteman breast cancer studies went from 10 percent to 28 percent. In the St. Louis metro area, African Americans comprise about 18 percent of the population.
On the basis of Siteman’s success in increasing participation of underserved groups in its research and medical services, the National Cancer Institute (NCI) has awarded the center a $1.25 million, five year grant to support its Program for the Elimination of Cancer Disparities (PECaD). Siteman was one of 25 institutions nationwide to receive a grant from NCI’s Community Networks Program.
In addition, Siteman’s Breast Imaging Team recently received recognition from the American Society of Clinical Oncology (ASCO), the world’s leading professional organization representing physicians who treat cancer. ASCO has presented the Breast Imaging Team with one of its twelve annual Clinical Trials Participation awards because of its outstanding success in recruiting minority members to clinical trials, which are vital to improving cancer care.
Siteman’s strategies are based on enhancing awareness among underserved patients by expanding working partnerships with local community organizations. These organizations help the center spread the word about cancer risks, screening options, funding programs and referral centers in non-threatening ways. Siteman has made this grassroots model one of the most successful efforts in the country at reducing cancer-care disparity.
Siteman’s efforts to reduce disparities in care are now coordinated by PECaD. PECaD is directed by Katherine Jahnige Mathews, M.D., assistant professor of obstetrics and gynecology and physician at ConnectCare, part of the St. Louis region’s health-care safety net, and Dione Farria, M.D., assistant professor of radiology and a radiologist at the Breast Health Center in the Center for Advanced Medicine.
PECaD monitors Siteman’s research, clinical and policy initiatives as well as overseeing outreach programs. Siteman strives to improve cancer care for underserved people in general—in the St. Louis area that includes rural, low-income and immigrant populations as well as minority populations.
“We build relationships with people by working within existing community networks,” Farria says. “By making personal connections, we are beginning to establish the trust that attracts patients to our clinical trials. At the same time, we disseminate health information, and we help people get the care they need.”
As it developed outreach strategies, Siteman began with a focus on breast cancer. It introduced breast-cancer programs that involved local church groups and other community-based organizations and used a mammography van to reach underserved people in their neighborhoods. Siteman staff members distributed health information in accessible and innovative ways and mined sources of funding on behalf of women of limited means.
As a result of Siteman’s initiatives, for example, 3,500 uninsured women were screened for breast cancer. Subsequently, one hundred of these women were diagnosed with breast cancer and received treatment at Siteman.
The NCI grant will enable expansion of PECaD’s infrastructure, which in addition to adding staff will include forming a corps of volunteers who go out into the community. It will also allow PECaD to add new and enhance existing community partnerships and to educate staff, researchers and clinicians about health-care disparities.
The funding also provides an opportunity to collaborate even more closely with other NCI-funded institutions such as Saint Louis University School of Public Health’s Center of Excellence in Cancer Communications Research headed by Matt Kreuter, Ph.D.
A program to reach those living in rural areas of Missouri’s Bootheel region has begun, and Siteman researchers are studying whether personal “navigators” who guide patients through the steps involved in cancer treatment will aid in reducing disparities by making the process less intimidating.
“Breast cancer outreach has provided a prototype,” Farria says. “From what we’ve learned from our experience we plan to expand our outreach in the areas of prostate, lung, colorectal and cervical cancers.”
Washington University School of Medicine’s full-time and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children’s hospitals. The School of Medicine is one of the leading medical research, teaching and patient care institutions in the nation, currently ranked third in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children’s hospitals, the School of Medicine is linked to BJC HealthCare.