Strengthening cancer care by building trust and community

When Janette Garcia, a bilingual client advocate with Wellness House in Yakima, Washington, arrived at the 10th annual Pathways to Health Symposium on May 15, she had a story to tell. The symposium was hosted by Fred Hutch Cancer Center’s Office of Community Outreach & Engagement, or OCOE.  

Garcia joined Wellness House in 2025 thanks to a $15,000 community grant from OCOE. The grant provided funding to hire Garcia, who surveyed the large Spanish-speaking population in Yakima to help expand needed cancer care services to Spanish speakers in her community. 

For Garcia, the work provided far more than a paycheck.

“I am going through my own cancer journey, and I’m actually a Fred Hutch patient too,” she said. “My care team has been amazing. So now, I get to be that advocate and help other people [access cancer care].”

Wellness House was one of 10 OCOE Community Grant recipients last year, eight of whom were represented at the symposium in a poster session highlighting their achievements. Awardees’ work spanned efforts to support cancer screenings, care referrals and support networks throughout Washington state. 

The Pathways to Health Symposium, held annually , brings together researchers, clinicians, community organization representatives and patient advocates to engage in a theme related to health equity. 

This year’s symposium, which was held off the Fred Hutch campus and in the community for the first time, was attended by 139 health advocates, cancer patients, physicians, nurses, caregivers and researchers from 11 counties dedicated to ensuring equal access for cancer care in the state. The symposium focused on best practices for building trust in the cancer care ecosystem. OCOE’s large banner in the meeting room said it succinctly: The goal of these efforts is “Better Outcomes for Everybody.”

Expanding care to every community

Paul Buckley, PhD, vice president and chief workforce experience officer at Fred Hutch, opened the day by highlighting the importance of OCOE in fostering relationships that lead to improved care.

“Health equity doesn't live in mission statements,” Buckley said. “It lives in partnerships, in community-led solutions, and in our willingness to learn from one another.” 

Buckley emphasized that the role of OCOE is to strengthen health equity throughout the state by meeting communities where they are, supporting partnerships and discovering best practices for empowering local health organizations to support their community members to reduce the burdens associated with cancer care.

‘Mistrust is a rational response to reality’

Keynote speaker Mateo P. Banegas, PhD, an associate professor and co-director of the Center for Health Equity Education and Research (CHEER) at the University of California, San Diego School of Medicine, emphasized that a lack of trust in communities towards the health care system is rooted in lived experience, not paranoia. He said that lived experience, from past discrimination to a lack of health resources in rural communities, can lead to missed cancer screenings, delayed medical appointments and overall worse health outcomes.

Banegas, who earned his PhD in Health Services from the University of Washington, stated that members of marginalized and under-resourced communities have traditionally had good reason to doubt that the health care system was designed to support them. He cited examples including nuclear tests in the Marshall Islands that rendered parts of its population highly susceptible to a lifetime cancer diagnosis, and the theft of cervical cancer cells from patient Henrietta Lacks in the 1950s that have informed decades of research but left the Lacks family uncompensated. 

“Mistrust is a rational response to reality,” Banegas emphasized. 

That mistrust has measurable health implications. Banegas reported that American Indians and Alaska Natives are 2.5 times more likely to die of stomach cancer, and twice as likely to die of liver cancer, than non-Hispanic white populations. Rural residents, who are more likely to lack access to regular cancer screenings, experience a 14% higher rate of cancer deaths when compared to city residents. 

“When people encounter discrimination, when they're excluded or neglected, or whether the neighborhoods where they live are underinvested, that’s when we start to see that trust in [health] institutions is damaged,” Banegas said. “So, the question should not be, Why don't communities trust us? It should be, Have our systems behaved in a way that [they] deserve this trust ?”

Banegas stressed that lack of trust in the healthcare system cannot simply be rectified by asking communities to increase their trust. Rather, the systems themselves need to earn the trust of the communities they serve.

“We have to train change in the system,” he said.

The inequalities that lead to unequal health outcomes, including missed screenings and lack of early detection of infections that could become chronic, could be rectified through targeted, community-specific outreach programs, Banegas said.

Innovative delivery models address persistent challenges    

The afternoon discussion panels highlighted innovative programs to reach people in communities experiencing barriers to cancer care, and how cancer patients throughout the state navigate their health care with the help of patient advocates, community health leaders, and support groups. 

Parth Shah, PharmD, PhD, associate professor in the Public Health Sciences Division, moderated the first panel discussion, titled “I’m ready to get screened. Now what?” Panelists discussed continuing barriers to access for rural, unhoused and other at-risk populations, and the concrete solutions and actions they are taking to address them.  

Panelist Jace Angelly, clinical manager for Odessa Rural Health Clinic in Lincoln County, highlighted the health challenges of small, aging, farming-intensive communities. 

Odessa’s population numbered 732 at last count, with an average age just over 68. Farmers, Angelly said, are often unable to schedule routine screenings because of the intense time commitments required of them on their farms. Skipped screenings and long-distance trips for vital tests such as diagnostic mammograms lead to more serious diagnoses, he said: “I see lots of cancer.” 

One of the innovations Angelly has implemented to address these challenges is the use of home-screening tests known as FIT tests that can identify potential colon cancer markers from a stool sample. “[People] will be able to mail [the test] in, and then we're going to get results, and then hopefully be able to get them to someplace to do a colonoscopy if they have a positive screening come back,” he said. “That's the way we have to innovate.”

Another solution to working with a far-flung and rural population, said panelist Anthony Lyon-Loftus, is mobile care clinics. As the associate medical director of Peninsula Community Health Services on the Kitsap Peninsula, Lyon-Loftus described how his organization expanded care services to previously underserved populations. He oversees mobile medical, dental and soon-to-be-launched mammography services for his organization.

“I have been out in the community trying to find who is struggling to engage care due to isolation, be that geographic, financial, emotional — whether that be folks who are Indigenous or Native American, whether they be immigrants, whether they be involved [in the justice system],” Lyon-Loftus said. “Who is not currently being served? And rather than bringing them to care, we are taking the care to them, which has been a humbling and rewarding experience.” 

Panelist Elizabeth M. Swisher, MD, deputy director of the Fred Hutch/University of Washington/Seattle Children’s Cancer Consortium and holder of the Torkelson Family Endowed Chair, discussed how strategic community partnerships could help identify populations that could be missing critical cancer screenings, such as the test for human papilloma virus (HPV) that can cause cervical and other cancers. Swisher is a gynecologic oncologist at Fred Hutch and UW Medicine.

“Cervical cancers are really preventable cancers,” Swisher said, but some patients, such as those being treated for substance abuse, could be both at higher risk of contracting the virus and have fewer resources for regular screenings.

Swisher described a partnership with We Care Daily Clinics, an opioid treatment program network in the Seattle area, to provide home HPV swab test kits to its patients. The introduction was a fortuitous accident: one of her patients with advanced cervical cancer was receiving treatment from the clinic for a substance use disorder. When the clinic provider called Swisher for approval to treat her patient for another condition, Swisher asked if they could add the home-test HPV kit to their services, and they agreed.

Fellow panelist Tom Hutch, MD, medical director at We Care Daily Clinics, emphasized how critical the need is: only about 9% of the general population tests positive for HPV, but among his patients, the rate of positive tests is 19%. The home HPV test is easy to administer and helps his patients get the follow-up care they need quickly should they test positive.

“We’re doing this in the parking lot of a church in a mobile unit,” he said. “If you have a bathroom, you can do it now.” About 90% of the patients report a positive experience with the test, Hutch said.

“These people aren’t hiding from health care necessarily,” Hutch stressed. “But they’ve had stigmatizing experiences, and when you remove that stigma and give that [testing] option to people in a place they already trust, around providers that they know and trust, it’s highly acceptable and people report a very easy and good experience.”

The second afternoon panel, titled “Breaking Barriers to Cancer Care,” featured community organizations, cancer advocates and patients who discussed how finding — or building — community among cancer patients and advocates leads to better health outcomes. Moderator Shayla Akande, CEO of Seattle-based Cierra Sisters, a community health organization dedicating to supporting Black breast cancer patients in medically underserved communities, noted that many cancer survivors find their own ways to build communities of support. 

Panelists told personal stories of seeking help with everything from developing coping skills through sharing experiences with others undergoing treatment, to having a friend accompany them to oncology appointments to help remember everything that is said during the appointment, to participating in retreats designed to strengthen self-care skills.

“If you can’t find [community], build it,” Akande said.

A call to action  

Megan Shen, PhD, associate professor in Fred Hutch’s Clinical Research Division and deputy associate director of OCOE, closed out the day with a call to action by recapping the themes of the day: equity, partnership, community, connection, small steps and power.

“There are many people and systems in the highest places of power who want us to believe this work cannot or is not being done. But that is not the true story,” said Shen. “There are so many of us who care and are doing this work. It is important that we all gather in these spaces, that we keep showing up, and that we keep doing the work.”

The Office of Community Outreach and Engagement publishes an annual report detailing the projects supported statewide throughout the year. Read the 2025 report here.