Abstract A18: Development and implementation of a community-based clinical cancer outreach initiative.
Authors: Waldman Laura T. , Young Brian F. , Svoboda Ludmila A. , Lathan Christopher S. 
Published: August 2014

Background: Research has described widespread racial disparities in cancer outcomes across the spectrum of prevention, screening, diagnosis, and treatment. A recent study suggested treatment disparities were mediated when patients were treated at NCI cancer centers. Participation of underserved groups in these centers, however, has been historically poor. In January, 2012, Dana-Farber Cancer Institute (DFCI), in conjunction with Whittier Street Health Center (WSHC), a federally qualified health center in Roxbury Massachusetts, initiated a clinical outreach program as part of a comprehensive Cancer Care Equity Program. A conceptual model was developed to combine prevention, diagnosis, education, and treatment interventions.

Methods: The intervention was developed inductively through the identification of several contributing factors to cancer disparities derived from observations during clinical practice. Most importantly, the lack of integrated cancer care spanning the continuum from prevention to treatment and end of life, in community health centers that predominately cared for the underserved. These observations were confirmed by review of the clinical literature, indicating that there were few clinical cancer outreach programs in the urban community; moreover, no program providing comprehensive cancer care was identified within an established community health center. The development and integration of services between the community health care center and cancer center, including medical, administrative, financial, interpreters, and social support, was achieved by incorporating clinical and administrative stakeholders from each institution into working group sessions through a structured facilitation process.

Results: The intervention, funded by philanthropic support, incorporates a community cancer clinic, staffed by DFCI personnel, within a primary health care center. Primary care providers refer patients to the clinic for diagnostic evaluation, abnormal screening, and selected non-chemotherapy follow-up. Patients with previous cancer histories are also referred to re-establish connections with oncology. The integrated evaluation service is provided on-site at the community cancer clinic. All medical records are maintained within the primary health care center's database so that the primary care providers can track their patients. Patients with an active cancer-related issue are then referred to the Dana-Farber Cancer Institute, with patient navigation and access management services to facilitate a smooth transition. To promote collaborations between the primary health care center and community cancer clinic, formal and informal provider-provider consultations, didactic sessions, and community-level educational sessions have also been established. The conceptual model details the patient referral pathways and services across institutions.

Conclusion: The intervention's impact is currently being evaluated. The formation of this model demonstrates collaboration between academic centers and a primary health care center, focused on eliminating cancer disparities and emphasizing a cohesive clinical service in a novel manner.

Citation Format: Laura T. Waldman, Brian F. Young, Ludmila A. Svoboda, Christopher S. Lathan. Development and implementation of a community-based clinical cancer outreach initiative. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr A18.