Abstract A28: Closing the disparity gap: Attributes of patients referred to a community cancer program
Authors: Akindele Ruth N. , Svoboda Ludmila A. , Martins Yolanda , Freedman Rachel A. , Elfiky Aymen , Berlin Suzanne T. , Lathan Christopher S. 
Published: May 2016

Background: Evidence suggests that the experience of cancer differs across racial and ethnic underserved populations. We describe the referral patterns and clinical characteristics of patients receiving care at Dana-Farber Cancer Institute's clinical outreach community cancer program, an initiative established to improve access to quality cancer care across the spectrum of the disease for medically underserved patients.

Methods: Two hundred and twenty five patients, receiving care at our community cancer care site, based within a Federally Qualified Health Center in Boston, were consented to research and enrolled between January 2012 and June 2015. The program accommodates all oncology and hematology referrals from primary care providers (PCP) at the health center. Variables of interest were collected through medical chart review and a patient intake survey that was developed for the program, and included age, gender, ethnicity, health insurance coverage, reasons for referral, presence of co-morbidity (defined by the International Classification of Disease-9th edition codes) and type of resolution attained. Due to the wide range of services provided by the program, resolution was defined as the number of days from the patient's initial appointment with an oncologist at the center until one of the following events occurred: an initial appointment with a medical specialist at the Dana-Farber Cancer Institute/Brigham and Women's Hospital (DFCI/BWH) to establish a treatment plan; establishment of a surveillance plan; or direction back to his or her PCP. Descriptive statistical analysis was performed using JMP Pro (version 11, SAS Institute Inc., Cary, NC)

Results: The mean age of the study population was 52 (SD±13.9) years and 44% were men. The majority of participants (70%) were Blacks/African Americans, 15% were Hispanic Whites, 11% were non-Hispanic Whites and 1% were two or more races. Forty eight percent had Medicaid insurance, 24% had Medicare while 13% and 15% had other public and private insurance, respectively. The reasons for referral include hematologic consultation (22%), evaluation for cancer (20%), cancer genetics counseling and testing (20%), lung cancer screening/smoking cessation counseling (19%), follow up care for cancer (15%), cancer treatment (1%) and others (2%). Of the 54 participants with a cancer diagnosis, 76% were previously diagnosed elsewhere and the most common cancer sites were prostate (35%) breast (13%) and colon/rectum (11%). Hypertension (52%), diabetes (31%) and psychological disorders (22%) were the most frequent co-morbidities in participants with cancer. Surveillance plans were established for 44% of genetic counseling/ testing referrals and 86% of lung cancer screening referrals. Those requiring treatment (33%) and active surveillance (43%) plans for cancer had a median time to resolution of 17 (SD±91.1) days and 12(SD±34.5) days, respectively. Overall, treatment plans were required for 9% of participants, 55% had surveillance plans established while 34% were directed back to their PCP for continued care and only 2% of referrals were unresolved.

Conclusion: Our findings highlight the wide spectrum of cancer care concerns and needs in underserved populations receiving care within the community. Interventions targeted at eliminating cancer disparities should take into account services that span the continuum of care from prevention to survivorship.

Citation Format: Ruth N. Akindele, Ludmila A. Svoboda, Yolanda Martins, Rachel A. Freedman, Aymen Elfiky, Suzanne T. Berlin, Christopher S. Lathan. Closing the disparity gap: Attributes of patients referred to a community cancer program. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr A28.