Abstract PR04: Functional mobility disparities in older African American women with cancer in a multisite lay navigation program in the Deep South
Authors: Taylor Richard , Acemgil Aras , Meneses Karen , Rocque Gabrielle , Pisu Maria , Wang Xin , Demark-Wahnefried Wendy , Partridge Edward 
Published: October 2015

The purpose of this abstract is to (1) describe the incidence of functional mobility impairments among African American (AA) females enrolled in the Patient Care Connect Program (PCCP); (2) report the impact of a lay navigation program (LNP) on identifying and resolving problems with functional mobility in the PCCP population; and (3) explore the future potential of a LNP in oncogeriatrics (65 years of age or older with cancer).

Background: The geriatric (65 years of age or older) population in the United States (US) is estimated to increase from 16% in 2013 to 20% by 2030, when 70% of all cancers are expected to be diagnosed in this population. By 2050, 14% of the US geriatric population is predicted to be AA. The PCCP is a Centers for Medicare & Medicaid Services (CMS) LNP located in twelve cancer programs across five states in the Deep South (AL, MS, TN, FL, GA). The LNP is used to identify and intervene early in patient's self-reported distress and barriers to care.

Methods: Thirty-nine lay navigators (LNs) were educated about the fundamentals of oncogeriatrics, communication, and use of the Distress Thermometer (DT) to guide patient conversations. The National Comprehensive Cancer Network (NCCN) DT was modified with a focus on collecting patients' self-reported global distress level on a thermometer image and distress items in 7 domains (i.e., practical, family problems, information, cognitive, physical, emotional, and spiritual/religious problems or concerns). Based on the items identified from the DT tool, the LN identifies resources to address these items and empowers the patient to access the resources. For each patient, the LN also records all associated high-risk diseases (i.e., congestive heart failure, diabetes mellitus, stroke, chronic obstructive pulmonary disease, emphysema, interstitial lung disease, renal disease).

Findings: Interim data from 3,500 participants completing the DT tool in the PCCP indicates that mobility is the third highest ranked distress item after pain and fatigue. Of females, 18 % of the AAs report mobility problems compared to the 12% in the Caucasian population. Of these females, 40% of the AAs have at least one or more high risk disease compared to 37% of the Caucasian population. Of the females with mobility problems, 2.6% of the AAs have 3 or more high-risk diseases compared to 1.4 % of the Caucasians. In the females reporting mobility problems, 27.4% of them requested assistance from the LN to address this problem and 86% of the time the patient reported back that the LN's assistance resolved the problem.

Conclusions: AA oncogeriatric females have a greater number of high risk diseases and functional mobility limitations that affect their health, compared to Caucasians. By identifying functional mobility limitations early, proactive interventions can be implemented, monitored, and adjusted to modify or resolve mobility problems that can lead to disability and health disparities in oncogeriatric females. LNs can effectively use the DT to identify functional mobility problems and empower female oncogeriatrics to resolve them; improving health and decreasing health disparities. Data will be used to continue expanding the knowledge base in the area of oncogeriatrics and lay navigation, refine the oncogeriatric conceptual model within the PCCP, and translate the findings into clinical practice; improving health and decreasing health disparities.

This publication was made possible by Grant Number 1C1CMS331023 from the Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies.

This abstract was also presented as Poster A9.

Citation Format: Richard Taylor, Aras Acemgil, Karen Meneses, Gabrielle Rocque, Maria Pisu, Xin Wang, Wendy Demark-Wahnefried, Edward Partridge. Functional mobility disparities in older African American women with cancer in a multisite lay navigation program in the Deep South. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr PR04.