Hutch News

Overcoming the barriers to equitable care

Nov. 6, 2003
Dr. Hannah Linden leads a panel discussino

Participants at center co-sponsored conference on cancer disparities listen as Dr. Hannah Linden facilitates a panel discussion. According to panelist Dr. Maxine Hayes, outreach can make a major impact on eliminating the cultural barriers to preventive cancer screening and treatment.

Photo by Katherine J. Briant

More than 90 cancer researchers, health-care professionals and community members enhanced their awareness of the racial and ethnic disparities that affect cancer care and research at an Oct. 18 symposium co-hosted by the center.

The "Reducing Cancer Disparities: Meeting the Needs of the Community" symposium, held at the Bell Harbor Conference Center in Seattle, featured some of the nation's leading experts on topics including the influence of bias on health care and research, breast-cancer incidence and survival among African-American women and disparities in cancer clinical trials. The symposium was held in conjunction with the annual University of Washington Breast Cancer Continuing Medical Education (CME) meeting.

Collaborators and coordinators

In addition to Fred Hutchinson, the event was sponsored by the UW, Seattle Cancer Care Alliance and the Puget Sound affiliate of the Susan G. Komen Breast Cancer Foundation and funded in part by the Avon Foundation and Novartis Pharmaceutical Corporation. Winona Hollins Hauge, community-outreach manager in the External Relations Department; Carrie Nass, a program manager with the CIS Pacific region office at Fred Hutchinson; and Cherie Minear, program manager at the Puget Sound affiliate of the Susan G. Komen Breast Cancer Foundation, coordinated the event along with Dr. Hannah Linden, an associate professor of medicine at UW who co-chaired the CME meeting and the disparities conference.

Examples of health-care inequality among racial and ethnic groups in the United States abound, including access to medical care, outcome after disease diagnosis and participation in clinical trials to test new treatments or disease prevention strategies. Dr. Brian Smedley, a senior program officer of the Institute of Medicine and a speaker at the symposium, cited numerous studies that support these conclusions.

The inequality is often closely linked with poverty, said Dr. Hannah Linden, who specializes in breast-cancer care. Her practice is divided between the Alliance and Harborview Medical Center, where a large proportion of her patients are members of underserved populations. She said too often she has seen women avoid regular mammographic screening or even chemotherapy after cancer diagnosis because they are unable to miss work, find child care or obtain transportation to the hospital.

"I think anyone who reads the newspapers knows this is a problem," said Linden. "But it's a challenging problem and we need to come up with creative ways to address these issues that involve multiple institutions and different intervention strategies." Relatively small financial investments could overcome some of the barriers to care, she said.

"At Harborview, thanks to support from the Avon Foundation, we have a 'safety net' program that provides money for taxi rides, grocery coupons and child-care vouchers so that women can get to the hospital for preventive screening or cancer treatment," she said. "It's often the little things that make a difference in whether a person is able to access medical care." Linden also commended the local Breast and Cervical Health Program and the generosity of the Puget Sound affiliate of the Komen Foundation for their support of patients who lack insurance but do not qualify for state funding, making it possible for poor women to have access to breast-cancer care.

Equal access

Access to cancer information is another area where racial and ethnic differences exist, said Nass, program manager for CIS' partnership program. CIS, a free public service of the National Cancer Institute, offers the latest cancer information to patients, their families and community members through a telephone hotline and the Internet. The partnership program seeks to ensure equal access to cancer information for diverse populations.

"The partnership program was established because the majority of people who called the 1-800-4-CANCER information service were white, middle-class women," Nass said. "But cancer affects every group. Our goal is to partner with representatives of racial and ethnic communities to ensure that cancer information is accessible by these communities and is culturally appropriate.

"The goal of the conference was to bring awareness of cancer disparities and to use lessons learned to address those barriers through education and outreach."

Outreach can make a major impact on eliminating cultural barriers to seeking preventive cancer screening, said Dr. Maxine Hayes, health officer of the Washington State Department of Health. "Cancer is not freely talked about in some communities-in some cases, not even among family members," she said. "I'm encouraged by what I've seen at the meeting-groups such as Cierra sisters, an African-American breast-cancer support group-that outreach and education for communities with disproportionately poor outcomes for cancer can make a difference."

Health-care network

Besides providing data and perspectives on the impact of racial and ethnic bias on cancer care and research, a key outcome of the conference was to build a network of scientists, physicians and community-group members who encounter and address these issues in their own work, said Dr. Christopher Li, an epidemiologist in the Public Health Sciences Division and a symposium panelist. Li's research has focused on racial and ethnic disparities in breast-cancer diagnosis, treatment and outcome.

"Addressing disparities in cancer is still in its infancy," he said. "The conference brought together people from diverse backgrounds and provided a forum for us to learn what others are doing and what resources are out there. I expect that the meeting will lead to future research collaborations."

Following the symposium, Dr. Otis Brawley, a professor of medicine at Emory University and speaker at the symposium, and Arlene Stevens, a participant in the Study of Tamoxifen and Raloxifene, shared a dialogue in the Sze conference room with more than 40 community physicians, civic leaders, cancer survivors and members of the center's Community Advisory Council. Fred Hutchinson, the Washington State Association of Black Professionals in Health Care and CIS sponsored the reception.

"This conference offered us a forum to build on the vision of center leadership and increase collaboration with diverse community partners," Hollins Hauge said.

Community resources

Hollins Hauge said that center researchers and physicians who work with diverse communities can access information and resources on Fred Hutchinson's Web site, centernet.fhcrc.org/CN/science/minority_portal/. In addition, she and Dr. George Counts, senior adviser on special populations for the HIV Vaccine Trials Network, are available to collaborate with investigators with open clinical trials who wish to build relationships with community organizations. Hollins Hauge also will work with the Institutional Review Boards to ensure diverse community representation on committees. Contact Hollins Hauge at whauge@fhcrc.org and Counts at gcounts@fhcrc.org.

Other organizations that helped to plan the meeting included the American Cancer Society, the Center for Multicultural Health, Cierra Sisters, the Health Justice Network, International Community Health Services, Spirit of EAGLES-AI/AN Leadership Initiative on Cancer and Verbena.

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