Addressing Cancer Disparities at the Community Level

Transcript

00:00 --> 00:02Funding for Yale Cancer Answers is
00:02 --> 00:04provided by Smilow Cancer Hospital.
00:06 --> 00:08Welcome to Yale Cancer Answers with
00:08 --> 00:10your host Doctor Anees Chagpar.
00:10 --> 00:12Yale Cancer Answers features the
00:12 --> 00:14latest information on cancer care by
00:14 --> 00:16welcoming oncologists and specialists
00:16 --> 00:18who are on the forefront of the
00:18 --> 00:20battle to fight cancer. This week,
00:20 --> 00:22it's a conversation about cancer
00:22 --> 00:24disparities in the community with
00:24 --> 00:26Doctor Beth Jones and Monique Stefanou.
00:26 --> 00:28Doctor Jones is a research
00:28 --> 00:29scientist and lecturer,
00:29 --> 00:31and epidemiology and Miss Stefanou is
00:31 --> 00:34a community health educator at the
00:34 --> 00:36Yale School of Public Health. Doctor
00:36 --> 00:38Chagpar is a professor of surgical
00:38 --> 00:40oncology at the Yale School of Medicine.
00:41 --> 00:42Beth, maybe we'll start with you.
00:42 --> 00:44Tell us a little bit more about
00:44 --> 00:46yourself and what it is you do.
00:49 --> 00:52I'm trained as a cancer epidemiologist,
00:52 --> 00:55but I have focused primarily on cancer
00:55 --> 00:57disparities and in more recent years
00:57 --> 01:00I've been engaged with with Monique
01:00 --> 01:04and others on our team in what we call
01:04 --> 01:07community outreach and engagement.
01:07 --> 01:10Basically finding ways to translate
01:10 --> 01:12the research findings, not just
01:12 --> 01:13my own of course,
01:13 --> 01:15but from other investigators at
01:15 --> 01:17the Cancer Center and from other
01:17 --> 01:20investigators in other parts of the world
01:20 --> 01:22and nationally into Community Action.
01:24 --> 01:26And Monique tell us a bit more about
01:26 --> 01:29yourself and what you do. Yes, hello,
01:29 --> 01:31my name is Monique Stefano and I
01:31 --> 01:33am a community health educator.
01:33 --> 01:34For the past four years I've been
01:34 --> 01:36working in the greater New Haven area
01:36 --> 01:38and throughout the state of Connecticut
01:38 --> 01:40to talk to community members about
01:40 --> 01:42cancer screening and prevention.
01:42 --> 01:43It's my goal to make sure that
01:43 --> 01:45people understand what that means
01:45 --> 01:48as well as helping people with.
01:48 --> 01:49Lifestyle interventions to make
01:49 --> 01:51sure that they're doing all that
01:51 --> 01:53they can do to stay healthy,
01:53 --> 01:54so that's kind of a little bit.
01:54 --> 01:55In a nutshell about the
01:55 --> 01:56work that I've been doing
01:57 --> 01:59great. So Beth. Back to you,
01:59 --> 02:02you know you mentioned that your work
02:02 --> 02:04really has focused on disparities.
02:04 --> 02:06Tell us a little bit more about what
02:06 --> 02:08you mean by disparities and what
02:08 --> 02:10kind of things fall into that bucket.
02:11 --> 02:14So it's it's a. It's a big bucket,
02:14 --> 02:18so in in terms of cancer disparities, what I?
02:18 --> 02:19Have been interested in what
02:19 --> 02:21many people are interested in.
02:21 --> 02:25Is looking at outcomes in cancer across
02:25 --> 02:28different racial ethnic groups or
02:28 --> 02:31socioeconomic groups and the disparities are
02:31 --> 02:34when we see a difference between groups,
02:34 --> 02:37but there's really, it shouldn't be there.
02:37 --> 02:39In other words, there's really no we
02:39 --> 02:42we try to explain why it's occurring,
02:42 --> 02:46but it's it suggests that there's an
02:46 --> 02:48unfairness or a problem in perhaps
02:48 --> 02:50it's the way we're delivering.
02:50 --> 02:52Healthcare that that benefits
02:52 --> 02:54some groups more advantages,
02:54 --> 02:57some groups and disadvantages, others.
02:57 --> 02:58So that's, in a nutshell,
02:58 --> 03:00sort of thinking about cancer disparities.
03:01 --> 03:04And so. Monique, how? How have you?
03:04 --> 03:07How has your work really tried to
03:07 --> 03:10look at these disparities and and
03:10 --> 03:12potentially ameliorate them? Absolutely
03:12 --> 03:15so we have something that we
03:15 --> 03:17are working on right now where
03:17 --> 03:20we're helping community members.
03:20 --> 03:21First of all, get access to the
03:21 --> 03:23knowledge they need to know what
03:23 --> 03:24it is that we need to do to stay
03:24 --> 03:26healthy as it relates to prevention.
03:26 --> 03:28But then we also have things where
03:28 --> 03:29there are programs where we try
03:29 --> 03:31to help people with what we call
03:31 --> 03:33social determinants of health needs
03:33 --> 03:35so we know that there are different
03:35 --> 03:36things that also affect somebody's
03:36 --> 03:38health which we may not think about
03:38 --> 03:39when you first think about it.
03:39 --> 03:40For instance,
03:40 --> 03:43getting people access to transportation
03:43 --> 03:45or helping somebody if they need
03:45 --> 03:47help with getting just groceries
03:47 --> 03:48or things like that.
03:48 --> 03:50So we try to get rid of the barriers.
03:50 --> 03:53That might stand in the way of
03:53 --> 03:54somebody living a healthy life.
03:55 --> 03:58And so Beth, can we dive in a little
03:58 --> 04:00bit more into the research you
04:00 --> 04:03had mentioned that your work has
04:03 --> 04:05really focused on taking research,
04:05 --> 04:06hard science and translating
04:06 --> 04:08that into the community?
04:08 --> 04:11So talk a little bit more about some of
04:11 --> 04:14these research areas and and research
04:14 --> 04:17findings that have led to disparities.
04:17 --> 04:20Is it a lack of education or is it really
04:20 --> 04:22these social determinants of health?
04:22 --> 04:24Or is it other things?
04:24 --> 04:26Or is it kind of a mix of everything?
04:26 --> 04:28Well, I think you just hit it on the head.
04:28 --> 04:30It's it's clearly a mix of everything,
04:30 --> 04:33but I think that what we've
04:33 --> 04:35seen over the last few years.
04:35 --> 04:36So when I started off,
04:36 --> 04:39I was really interested in breast cancer,
04:39 --> 04:41an area that you're really familiar
04:41 --> 04:43with and and just trying to figure
04:43 --> 04:45out why it was that some women in this
04:45 --> 04:47case they were black women compared
04:47 --> 04:49to white women were being diagnosed
04:49 --> 04:51at a later stage of their illness.
04:51 --> 04:53And because of that,
04:53 --> 04:55we know that it it affects
04:55 --> 04:57treatment and and and outcomes.
04:57 --> 04:59How how long people you
04:59 --> 05:00know their survivorship.
05:00 --> 05:01So it becomes really important.
05:01 --> 05:04But I think overtime.
05:04 --> 05:08Well, we've always understood that
05:08 --> 05:10that individuals live in a context.
05:10 --> 05:12They live in a society.
05:12 --> 05:12And So what?
05:12 --> 05:14We've been focusing a little bit more on,
05:14 --> 05:17and the work that Monique and I are now
05:17 --> 05:18engaged in focuses a little bit more
05:18 --> 05:20on what we call those upstream factors.
05:20 --> 05:24So while access to care is 1 important issue,
05:24 --> 05:26and there's also other factors
05:26 --> 05:28that contribute to it.
05:28 --> 05:29A disparity in outcome,
05:29 --> 05:32but we actually recognize that it's
05:32 --> 05:34the social determinants of health.
05:34 --> 05:36These racial ethnic differences,
05:36 --> 05:40which at a structural level are are,
05:40 --> 05:43are differ across our groups.
05:43 --> 05:46Different population groups and those
05:46 --> 05:48things actually probably determine
05:48 --> 05:51many of the other factors that
05:51 --> 05:53are closer to the health outcome.
05:53 --> 05:54So so yes,
05:54 --> 05:57it is about in the state of Connecticut.
05:57 --> 05:58We have a lot of residential.
05:58 --> 05:58Segregation,
05:58 --> 06:01we know that in our cities there's
06:01 --> 06:03a concentration of both people of
06:03 --> 06:05color and low socioeconomic groups,
06:05 --> 06:08and we see the cancer burden in the
06:08 --> 06:11state occur mostly in those populations,
06:12 --> 06:14and so Monique it to you.
06:14 --> 06:17I mean, it seems to me that you know
06:17 --> 06:20when we're thinking about these groups.
06:20 --> 06:24These low socioeconomic status groups,
06:24 --> 06:26often of particular racial
06:26 --> 06:27or ethnic minorities,
06:27 --> 06:29people who have been marginalized.
06:29 --> 06:30That some of the things
06:30 --> 06:31that you were mentioning,
06:31 --> 06:33like you know things that
06:33 --> 06:34others might take for granted.
06:34 --> 06:35Like I'm
06:35 --> 06:37going to go pick up groceries
06:37 --> 06:40are often really difficult if you're
06:40 --> 06:43living in an area where there is no
06:43 --> 06:46supermarket or no healthy options for food,
06:46 --> 06:49you might be working several jobs and just
06:49 --> 06:51don't have time to get to a grocery store,
06:51 --> 06:54so your only option is the local
06:54 --> 06:56convenience store, which might not
06:56 --> 06:58have the world's greatest nutrition.
06:58 --> 07:01How do you? Overcome that.
07:02 --> 07:04That's I'm so glad that you asked
07:04 --> 07:05that part of the work that I do.
07:05 --> 07:07As I'm a health navigator,
07:07 --> 07:09so 50% of my time I'm a community
07:09 --> 07:10health educator and the other
07:10 --> 07:1150% I'm a health navigator.
07:11 --> 07:15And what I do is I use a system to be able
07:15 --> 07:17to map resources to where somebody lives.
07:17 --> 07:19So a lot of times let somebody
07:19 --> 07:21say they have a need for getting
07:21 --> 07:23healthy foods they may not know,
07:23 --> 07:24even if they live in the community,
07:24 --> 07:26they may not know where in
07:26 --> 07:28my community can I do that?
07:28 --> 07:29Especially if they don't have a place?
07:29 --> 07:31Like maybe there are only corner stores
07:31 --> 07:33that are close to them and that's where
07:33 --> 07:34they do their grocery shopping so.
07:34 --> 07:35As a health navigator,
07:35 --> 07:37I'm able to look at New Haven or
07:37 --> 07:39look at where the person lives
07:39 --> 07:41and let them know you know what.
07:41 --> 07:42There's a local grocery store.
07:42 --> 07:44There's a farmers market over here and
07:44 --> 07:46they come on Saturdays at 10:00 o'clock,
07:46 --> 07:48so I'm able to look at what are their needs.
07:48 --> 07:50And then from my level I can see
07:50 --> 07:52what resources exist to kind
07:52 --> 07:53of help with those barriers.
07:54 --> 07:57And, you know, Beth. Oftentimes,
07:57 --> 08:01I find that the racial ethnic groups and
08:01 --> 08:05the socioeconomic status they kind of get.
08:05 --> 08:07Inflated because so often
08:07 --> 08:09they're they're correlated.
08:09 --> 08:11Do you find that one of those
08:11 --> 08:13drivers is more significant than
08:13 --> 08:16the other in terms of disparities?
08:16 --> 08:21Because certainly you know if you have a
08:21 --> 08:25very affluent African American individual.
08:25 --> 08:28You know they may not have the
08:28 --> 08:30same kinds of barriers that as
08:30 --> 08:33somebody who may be Caucasian,
08:33 --> 08:36but may be in a very low
08:36 --> 08:37socioeconomic status, might have.
08:37 --> 08:39And so trying to kind of weed
08:39 --> 08:40out is this genetics?
08:40 --> 08:42Or is this socioeconomics?
08:42 --> 08:43Any thoughts there?
08:44 --> 08:45Well, it's sort of the $1,000,000
08:45 --> 08:48question and I would just say it's it's.
08:48 --> 08:50It can be a little bit of both,
08:50 --> 08:51but I think generally when
08:51 --> 08:53we think about disparities,
08:53 --> 08:55these are issues that we think.
08:55 --> 08:57Are modifiable we can fix them and
08:57 --> 09:00and so as Monique was just talking
09:00 --> 09:02about our navigation program, it's a.
09:02 --> 09:04It's a smaller.
09:04 --> 09:05You know, relatively small effort,
09:05 --> 09:08but it's certainly an important one.
09:08 --> 09:11If we if we consider that somebody who's
09:11 --> 09:14worried about not having enough food to
09:14 --> 09:17pay to feed their family has a hard time,
09:17 --> 09:18then prioritizing their
09:18 --> 09:19doctor appointment to,
09:19 --> 09:21say get a mammogram or or
09:21 --> 09:23even for care sometimes.
09:23 --> 09:24So that's how it all kind of fits together.
09:24 --> 09:26But in terms of your bigger.
09:26 --> 09:29Question you know.
09:29 --> 09:30Basically,
09:30 --> 09:32I think we generally consider that much
09:32 --> 09:36of this is driven by factors in society,
09:36 --> 09:40which are which has to do with
09:40 --> 09:42the unequal distribution of our
09:42 --> 09:45resources and to the extent that
09:45 --> 09:48in a society where there is racism
09:48 --> 09:50there is sort of at a structural
09:50 --> 09:53levels systems that are set up.
09:53 --> 09:55So some groups benefit and others don't.
09:55 --> 09:57So in that case.
09:57 --> 09:59The the socioeconomic factors
09:59 --> 10:02do kind of come through the
10:02 --> 10:04system and impact individuals.
10:04 --> 10:05You're absolutely correct.
10:05 --> 10:07I think most people you know we
10:08 --> 10:11do know from that that you know.
10:11 --> 10:13That people are more similar across racial
10:13 --> 10:15ethnic groups than they are different.
10:15 --> 10:16We share, you know,
10:16 --> 10:17similarities in DNA.
10:17 --> 10:20So while it's possible that there are
10:20 --> 10:23some factors that are genetic and might
10:23 --> 10:26track more in one group or another,
10:26 --> 10:27my feeling is that most of what
10:27 --> 10:29we deal with in a disparities
10:29 --> 10:31level is really about factors
10:31 --> 10:33that are linked to resources and
10:33 --> 10:35unequal distribution of resources.
10:35 --> 10:37And and to be blunt about
10:37 --> 10:38socioeconomic factors.
10:39 --> 10:42Yeah, and so Monique, you know this
10:42 --> 10:45brings us to the question of poverty.
10:45 --> 10:49I mean the the ultimate issue it
10:49 --> 10:53seems in so many cases is is a
10:53 --> 10:56lack of resources or or simply,
10:56 --> 11:00you know poverty, and so it may not be
11:00 --> 11:03knowing that there's a farmers market,
11:03 --> 11:05but actually having the resources
11:05 --> 11:07to be able to afford the foods
11:07 --> 11:09that are offered at that.
11:09 --> 11:11Farmers market and so you know what
11:11 --> 11:14are people to do in that circumstance?
11:15 --> 11:16That's I'm so glad that you
11:16 --> 11:18brought that up because it is true.
11:18 --> 11:19It's not necessarily about
11:19 --> 11:21knowing that there are resources,
11:21 --> 11:23but then how can you afford the resources?
11:23 --> 11:26And that's why even with our program,
11:26 --> 11:27we look for programs that
11:27 --> 11:29are either free or low cost.
11:29 --> 11:31And we also advocate for the community.
11:31 --> 11:34I remember one of the current
11:34 --> 11:36organizations that we work with as
11:36 --> 11:38far as let's say a physical activity.
11:38 --> 11:39We actually went to that organization
11:39 --> 11:40and said, you know what?
11:40 --> 11:42Would you be able to do a reduced cost
11:42 --> 11:44program for members of the Community?
11:44 --> 11:45Because not everybody can afford to
11:45 --> 11:47go to the gym and they worked with us
11:47 --> 11:50and we were able to actually solidify that.
11:50 --> 11:52So we're both finding resources
11:52 --> 11:53for community members,
11:53 --> 11:55but we're also advocating for these
11:55 --> 11:58resources to be free or low cost so
11:58 --> 11:59that poverty doesn't become a barrier
11:59 --> 12:01for somebody living a healthy life.
12:02 --> 12:05So you know Beth, this is tremendous
12:05 --> 12:09that you and Monique are are doing this
12:09 --> 12:12work in in the greater New Haven area.
12:12 --> 12:15But our our listeners actually hail
12:15 --> 12:18from a larger population than that.
12:18 --> 12:21And So what are people to do when
12:21 --> 12:24they're faced with a cancer diagnosis?
12:24 --> 12:27And that in and of itself, causes a strain,
12:27 --> 12:30both financially in terms of health
12:30 --> 12:32care costs but also an emotional strain.
12:32 --> 12:36In a time strain and just
12:36 --> 12:38an everything strain.
12:38 --> 12:41In terms of dealing with all of these issues,
12:41 --> 12:43are there resources in the
12:43 --> 12:45general community out there? How?
12:45 --> 12:48How do people find things for them
12:48 --> 12:50if they don't have somebody who's
12:50 --> 12:53like a a navigator like Monique?
12:53 --> 12:53Well
12:53 --> 12:55so right, and I think
12:55 --> 12:57actually our this program.
12:57 --> 12:58This navigation program that
12:58 --> 13:00we've started here in New
13:00 --> 13:03Haven and and we'd love to be
13:03 --> 13:04able to expand it statewide,
13:04 --> 13:06but we do sort of work
13:06 --> 13:09through as we can through.
13:09 --> 13:10And the cancer care centers that
13:10 --> 13:12are part of our healthcare system
13:12 --> 13:14and the other thing I would say
13:14 --> 13:16is 1 discusses this with their
13:16 --> 13:18providers and most hospitals do
13:18 --> 13:20have social services available.
13:20 --> 13:23Well, we're going to pick up this
13:23 --> 13:25conversation right after we take a
13:25 --> 13:26short break for a medical minute.
13:26 --> 13:28Please stay tuned to learn more about
13:28 --> 13:30addressing cancer disparities in
13:30 --> 13:31the community with my guests Doctor
13:31 --> 13:33Beth Jones and Monique Stefano.
13:34 --> 13:36Funding for Yale Cancer Answers is
13:36 --> 13:38provided by Smilow Cancer Hospital,
13:38 --> 13:41where you can view videos from their
13:41 --> 13:43integrative medicine team by searching
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13:45 --> 13:47Medicine playlist on YouTube.
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14:41 --> 14:43Welcome back to Yale Cancer Answers.
14:43 --> 14:45This is doctor Anees Chagpar and I'm
14:45 --> 14:47joined tonight by my guests Doctor
14:47 --> 14:49Beth Jones and Monique Stefanou.
14:49 --> 14:51We're talking about cancer
14:51 --> 14:53disparities and cancer,
14:53 --> 14:55and the fact that there's differences
14:55 --> 14:58in terms of healthcare outcomes for
14:58 --> 15:01patients with cancer that aren't really
15:01 --> 15:04due to the cancer itself necessarily,
15:04 --> 15:06but often due to just the social
15:06 --> 15:09circumstances that a patient may find
15:09 --> 15:11themselves in those resources that.
15:11 --> 15:13Are available to some and may
15:13 --> 15:15not be so available to others.
15:15 --> 15:16So Monique,
15:16 --> 15:18I want to start with you and pick up
15:18 --> 15:20that conversation right before the break.
15:20 --> 15:22We were talking about the fact that
15:22 --> 15:25you and Beth have set up a wonderful
15:25 --> 15:28program and you serve both as a cancer
15:28 --> 15:31educator as well as a cancer navigator.
15:31 --> 15:34Often helping patients to find resources
15:34 --> 15:37in their area that might be helpful.
15:37 --> 15:41Everything from where to find low cost or.
15:41 --> 15:43Options for food or physical
15:43 --> 15:46activity or things that can help get
15:46 --> 15:48them through the day when they're
15:48 --> 15:50faced with a cancer diagnosis.
15:50 --> 15:51You know,
15:51 --> 15:55for people who might be listening to this.
15:55 --> 15:57Are there ways that they can find
15:57 --> 15:59some of these resources without
15:59 --> 16:02necessarily connecting to your program?
16:02 --> 16:04Where where can people find
16:04 --> 16:06these types of resources?
16:06 --> 16:09I think it's really important to
16:09 --> 16:10recognize that hospital systems,
16:10 --> 16:12even throughout the nation.
16:12 --> 16:15They all have a social work or
16:15 --> 16:17some type of navigation service
16:17 --> 16:19where somebody could call and find
16:19 --> 16:21out what resources is available.
16:21 --> 16:23A lot of times people simply
16:23 --> 16:24do not know what's available.
16:24 --> 16:25Yes, there are.
16:25 --> 16:27Some systems that may have
16:27 --> 16:29more resources than others,
16:29 --> 16:30but that's a good starting point,
16:30 --> 16:32is to call either the Cancer
16:32 --> 16:33Center where they're getting
16:33 --> 16:35treatment or the local hospital
16:35 --> 16:36system to find out what types
16:36 --> 16:38of social services are offered,
16:38 --> 16:39what types of navigation
16:39 --> 16:41support may be offered?
16:41 --> 16:43A lot of times different
16:43 --> 16:44systems use different words,
16:44 --> 16:46so one system may use patient navigator.
16:46 --> 16:49Another person may say coordinator,
16:49 --> 16:51so just to have that initial
16:51 --> 16:52conversation would be important
16:52 --> 16:55and Beth are there other kind of
16:55 --> 16:56national organizations perhaps?
16:56 --> 17:01Philanthropic organizations or other
17:01 --> 17:03societies where patients can turn if
17:03 --> 17:06they have cancer that might be able
17:06 --> 17:07to provide things like you know,
17:07 --> 17:10even things like transportation to get
17:10 --> 17:13to your your appointments or assistance
17:13 --> 17:16when you need help paying the rent right?
17:16 --> 17:18So certainly in the state of Connecticut,
17:18 --> 17:20and I believe it's nationwide.
17:20 --> 17:22There's a 211 system and this is
17:22 --> 17:25not just for patients, but they can.
17:25 --> 17:26People can dial 211 and
17:26 --> 17:28get a lot of information.
17:28 --> 17:29About availability of services
17:29 --> 17:32that they can access locally and
17:32 --> 17:34then you know if you're for a
17:34 --> 17:36patient just to just to share.
17:36 --> 17:38Certainly if one of the first
17:38 --> 17:40things when one is diagnosed is
17:40 --> 17:42just learning about that about what
17:42 --> 17:44they're facing and knowing how to
17:44 --> 17:45interact with their physicians.
17:45 --> 17:47What kinds of questions they ask?
17:47 --> 17:51And so there are websites such as the
17:51 --> 17:53American Cancer Societies website,
17:53 --> 17:54the National Cancer Institute,
17:54 --> 17:57where there's a lot of information
17:57 --> 17:57one has to be.
17:57 --> 17:58You know,
17:58 --> 17:59I would strongly advise that
17:59 --> 18:00people go to those.
18:00 --> 18:03Organizations where the information
18:03 --> 18:06is well vetted by scientists and
18:06 --> 18:08be careful about just reading
18:08 --> 18:10anything on the Internet.
18:10 --> 18:12Because as we know there's a lot
18:12 --> 18:13of information on the Internet
18:13 --> 18:15which is not accurate.
18:15 --> 18:18Monique, the other question that a lot of
18:18 --> 18:20people might have and this goes back to,
18:21 --> 18:23you know, kind of those socio demographics
18:23 --> 18:25that we were talking about and the fact that
18:25 --> 18:28you know some people might have healthcare
18:28 --> 18:30insurance and it might be very robust and.
18:30 --> 18:33Other people may not have healthcare
18:33 --> 18:35insurance and that might be
18:35 --> 18:37a barrier not only for them.
18:37 --> 18:39You know, paying for care,
18:39 --> 18:43but even seeking care to begin with.
18:43 --> 18:45Any advice for people in terms of
18:45 --> 18:48how to manage health care costs?
18:48 --> 18:49Because these days,
18:49 --> 18:51even if you do have insurance,
18:51 --> 18:53the bill can be hefty and it still
18:53 --> 18:55is one of the leading causes
18:55 --> 18:57of bankruptcy in this nation.
18:57 --> 19:00So how do people address healthcare costs?
19:00 --> 19:02Whether it's cost to see the doctor
19:02 --> 19:05or or cost to cover treatments,
19:06 --> 19:08that's a a really great question and I
19:08 --> 19:11would say a couple of things on that one.
19:11 --> 19:13For somebody who has been.
19:13 --> 19:15Diagnosed with a cancer diagnosis
19:15 --> 19:17like I mentioned before,
19:17 --> 19:19going back to the hospital system
19:19 --> 19:21where the Cancer Center and asking
19:21 --> 19:22them what resources are available
19:22 --> 19:24for somebody who actually hasn't had
19:24 --> 19:26a diagnosis and is just looking to
19:26 --> 19:28stay healthy and at the same time
19:28 --> 19:30manage maybe a chronic illness.
19:30 --> 19:31It's important to also develop
19:31 --> 19:34relationships with the primary care system.
19:34 --> 19:36There are programs for helping people all
19:37 --> 19:39along the structure more than they meet.
19:39 --> 19:42Be a patient with a cancer diagnosis,
19:42 --> 19:43or if somebody who's overcoming
19:43 --> 19:44a chronic illness.
19:44 --> 19:47So to find out from either
19:47 --> 19:49primary care providers or even
19:49 --> 19:51local community organizations,
19:51 --> 19:53often also are aware of what
19:53 --> 19:55resources may be able to help
19:55 --> 19:57individuals in these situations.
19:57 --> 20:00You know, I would just add to
20:00 --> 20:02that that certainly the federally
20:02 --> 20:04qualified health centers are are
20:04 --> 20:07wonderful resources for primary care.
20:07 --> 20:09So, as Monique alluded to,
20:09 --> 20:11one of the things we're really
20:11 --> 20:12interested in is preventing cancer
20:12 --> 20:14or finding it early. So cancer.
20:14 --> 20:16Screenings and that usually
20:16 --> 20:18depends on sort of an interaction
20:18 --> 20:20with the primary care provider,
20:20 --> 20:22but we often find that people don't
20:22 --> 20:25don't have a designated primary care
20:25 --> 20:28provider and they think that they they
20:28 --> 20:32need resources or insurance to do so.
20:32 --> 20:34But a good starting point is to
20:34 --> 20:37contact a local FQHC federally
20:37 --> 20:38qualified Health Center.
20:38 --> 20:40They're in all of our throughout
20:40 --> 20:42the state of Connecticut and
20:42 --> 20:43also throughout the country.
20:43 --> 20:45And Beth, do you find those?
20:45 --> 20:46How do you find those?
20:46 --> 20:47I mean, if you're a patient,
20:47 --> 20:49you're listening to this show
20:49 --> 20:50and you're thinking well, geez,
20:50 --> 20:52you know I really need to see somebody.
20:52 --> 20:53I really need to get my screening.
20:53 --> 20:55I I don't have insurance,
20:55 --> 20:57which is one of the reasons why
20:57 --> 20:58I haven't seen anybody but man.
20:58 --> 21:01If I can get started by seeing somebody
21:01 --> 21:04and maybe getting some screenings for free
21:04 --> 21:06at a federally qualified Health Center,
21:06 --> 21:07that sounds pretty good,
21:07 --> 21:09but I don't know where that
21:09 --> 21:10is or what that is.
21:10 --> 21:11How?
21:11 --> 21:12How do I find that?
21:12 --> 21:15Well, so just to clarify,
21:15 --> 21:18FQHC's do take insurance and many
21:18 --> 21:21patients have insurance so so they don't.
21:21 --> 21:23So I think there is a mechanism
21:23 --> 21:24where they would work with people
21:24 --> 21:26who don't have any insurance,
21:26 --> 21:28but certainly they do take
21:28 --> 21:29insurance which is important,
21:29 --> 21:32but I would you know go to the
21:32 --> 21:34Internet and look up federally
21:34 --> 21:36qualified Health Center primary care
21:36 --> 21:38at a local level and that's probably
21:38 --> 21:40a good way to just get started.
21:40 --> 21:43And they're also wonderful centers with.
21:43 --> 21:45You know a lot of expertise.
21:45 --> 21:47Often the the physicians are are
21:47 --> 21:49dealing or you know their patient
21:49 --> 21:52load is actually from your same
21:52 --> 21:54community in which you're living,
21:54 --> 21:57so they have a lot of expertise and and
21:57 --> 22:00do know the safety net services that
22:00 --> 22:02might be available to help patients
22:02 --> 22:04with the other aspects of their life.
22:04 --> 22:07And I would just make another point and sort
22:07 --> 22:10of why we are thinking about navigation.
22:10 --> 22:12Certainly I when you when we
22:12 --> 22:13started this conversation.
22:13 --> 22:14You're asking me,
22:14 --> 22:14you know,
22:14 --> 22:17I started off as a researcher and then
22:17 --> 22:18started thinking about not just myself
22:18 --> 22:21but the you know with this wonderful team.
22:21 --> 22:24And I should say it's not just Monica myself.
22:24 --> 22:25We have a team of folks,
22:25 --> 22:28but how to translate what we know
22:28 --> 22:30about cancer into Community Action.
22:30 --> 22:35But but there are many,
22:35 --> 22:38many resources and programs
22:38 --> 22:41that help us sort of.
22:41 --> 22:44The idea is that if if somebody's really.
22:44 --> 22:47Preoccupied by their the barriers that
22:47 --> 22:50they face just in day to day life,
22:50 --> 22:52it's going to be hard for them to
22:52 --> 22:54prioritize their health and so our goal
22:54 --> 22:55is really to address those issues.
22:57 --> 23:01You know Monique getting back to kind of
23:01 --> 23:04some of the issues that people may face.
23:04 --> 23:06One of the things and and Beth I,
23:06 --> 23:07I think you'll corroborate this,
23:07 --> 23:10is that a lot of science has found
23:10 --> 23:12that there are differences in terms
23:12 --> 23:14of outcome based on insurance status,
23:14 --> 23:17where people who have insurance controlling
23:17 --> 23:20for all other factors tend to do worse
23:20 --> 23:22than people who don't have insurance.
23:22 --> 23:24So when people are listening to this,
23:24 --> 23:27if they don't have insurance,
23:27 --> 23:28and that may be because.
23:28 --> 23:30Either they are scared about how much
23:30 --> 23:33money cost to get insurance or they
23:33 --> 23:35don't know how to get insurance.
23:35 --> 23:38Or perhaps they have a pre-existing
23:38 --> 23:40condition and they're worried
23:40 --> 23:43that that may have ramifications
23:43 --> 23:46in terms of their insurance.
23:46 --> 23:48How do how do we kind of get around that?
23:48 --> 23:50Do you have advice for people on that?
23:51 --> 23:53That's another great question.
23:53 --> 23:55I would say a couple of things of that
23:55 --> 23:58and then I will also defer back to Beth.
23:58 --> 24:01I think it's really important for all of us,
24:01 --> 24:03and even for those that may be listening
24:03 --> 24:05to be very connected to what's actually
24:05 --> 24:07happening within your community,
24:07 --> 24:09there are a lot of times where people
24:09 --> 24:11who might have been afraid of addressing
24:11 --> 24:13insurance or even going through that
24:13 --> 24:14have found community members who
24:14 --> 24:16have gone through the same issue,
24:16 --> 24:18and because of their connectedness
24:18 --> 24:19to their community,
24:19 --> 24:21they were able to find resources and I.
24:21 --> 24:23Would say that for all those
24:23 --> 24:24that may be listening,
24:24 --> 24:25it's really important to
24:25 --> 24:27stay connected to community.
24:27 --> 24:28There are local organizations
24:28 --> 24:29throughout the nation where they're
24:29 --> 24:31doing the same thing that we're having.
24:31 --> 24:33The same conversations that we're having
24:33 --> 24:35and pulling together these resources,
24:35 --> 24:37and that's another way in which you
24:37 --> 24:38could find somebody and a like minded
24:38 --> 24:40situation who might also be able
24:40 --> 24:42to help you through the process,
24:42 --> 24:44but also point you to the right direction
24:44 --> 24:45and encourage you along the way.
24:46 --> 24:50And what I would just add to that is
24:50 --> 24:52that they there's also sort of an issue.
24:52 --> 24:54Sometimes of you know what we kind
24:54 --> 24:57of refer to as insurance literacy,
24:57 --> 24:59so not too long ago,
24:59 --> 25:02actually there was a an individual
25:02 --> 25:05came through our program and and
25:05 --> 25:07on her own before she came to us,
25:07 --> 25:10was looking for help with
25:10 --> 25:12tobacco treatment and was.
25:12 --> 25:14She just, you know somebody mentioned
25:14 --> 25:17the word copay just about insurance and
25:17 --> 25:20she immediately sort of thought that she
25:20 --> 25:22wouldn't be able to manage the copay,
25:22 --> 25:25and in fact you know with the
25:25 --> 25:28navigator's help she was able to.
25:28 --> 25:30Find out that had that explained to
25:30 --> 25:32her that the copay did not explain to
25:32 --> 25:34her did not apply to her situation.
25:34 --> 25:36Since then she's gotten tobacco treatment
25:36 --> 25:39and quit smoking and just kind of
25:39 --> 25:41really wonderful story and speaks to
25:41 --> 25:43the role that navigators can play in
25:43 --> 25:45helping people understand their insurance.
25:45 --> 25:48But we I think there's not one among
25:48 --> 25:50us who wouldn't say that understanding
25:50 --> 25:52their full insurance coverage is not,
25:52 --> 25:55you know, a bit of a a difficulty in the
25:55 --> 25:57challenge at times here in Connecticut,
25:57 --> 25:58though we do have,
25:58 --> 26:01you know when you say.
26:01 --> 26:05We we are in our non insured group is
26:05 --> 26:07actually smaller than in some States
26:07 --> 26:09and an important thing to remember is
26:09 --> 26:11that when it comes to cancer prevention,
26:11 --> 26:14those screening tests are actually covered.
26:14 --> 26:16There is not charges that go along with
26:16 --> 26:18them and as long as an annual physical
26:19 --> 26:21yeah so important right?
26:21 --> 26:24And and I think that in in every state in
26:24 --> 26:27the Union there are now federal exchanges.
26:27 --> 26:30Often that are governed on the state basis.
26:30 --> 26:33Where people can sign up for insurance
26:33 --> 26:35and it doesn't matter if you've had
26:35 --> 26:38preexisting conditions and. And as you say,
26:38 --> 26:40screenings are covered by those.
26:40 --> 26:43I I do want to come back to screening though,
26:43 --> 26:45which is so important.
26:45 --> 26:47Oftentimes, people may not
26:47 --> 26:50know what screenings they need,
26:50 --> 26:52may not know where to get them or
26:52 --> 26:54have a lot of information about that.
26:54 --> 26:57So Beth Monique, maybe I'll,
26:57 --> 27:00I'll start with Beth and Monique.
27:00 --> 27:01You can chime in.
27:01 --> 27:03How do you address that?
27:03 --> 27:04Well,
27:04 --> 27:05we actually. I mean,
27:05 --> 27:06if somebody has a primary care provider,
27:06 --> 27:08their primary care providers
27:08 --> 27:10should certainly be aware of the
27:10 --> 27:13cancer screenings that they need.
27:13 --> 27:15And as you, as we all it,
27:15 --> 27:18it's often depends on your age.
27:18 --> 27:19It also sometimes depends
27:19 --> 27:21on your family history,
27:21 --> 27:23whether you're just an average
27:23 --> 27:24risk person for specific cancer,
27:24 --> 27:26or you might have a heightened
27:26 --> 27:29risk based on that cancer or
27:29 --> 27:31a similar or different cancer
27:31 --> 27:33being prevalent in your family.
27:33 --> 27:34And so your doctor may want.
27:34 --> 27:37Just start that cancer screening early.
27:37 --> 27:38One of the things that is changing
27:38 --> 27:40and it's a great opportunity to
27:40 --> 27:42get the word out is recently,
27:42 --> 27:44you know we've always advocated.
27:44 --> 27:48We meaning the the medical
27:48 --> 27:49professions starting colorectal
27:49 --> 27:52cancer screening at age 50,
27:52 --> 27:55but in the last year the guideline has
27:55 --> 27:58been changed to starting that at age 45,
27:58 --> 28:00and that's a really important
28:00 --> 28:02cancer screening that could
28:02 --> 28:04prevent a lot of cancer.
28:04 --> 28:06Illness and as well as death.
28:07 --> 28:09Yeah Monique. Any last minute words on
28:09 --> 28:12getting your cancer screening. Yes,
28:12 --> 28:14lastly I would just say.
28:14 --> 28:16To encourage everyone to talk
28:16 --> 28:17to their provider and ask them
28:17 --> 28:19you know what cancer screenings
28:19 --> 28:21may be eligible for it.
28:21 --> 28:23A lot of times we wait for
28:23 --> 28:25the providers to speak to us,
28:25 --> 28:26but I would just advocate for
28:26 --> 28:28patients to also ask the question.
28:29 --> 28:31Monique Stefano is a community
28:31 --> 28:33health educator and doctor Beth
28:33 --> 28:35Jones is a research scientist
28:35 --> 28:36and lecturer and epidemiology at
28:37 --> 28:39the Yale School of Public Health.
28:39 --> 28:41If you have questions,
28:41 --> 28:43the address is canceranswers@yale.edu
28:43 --> 28:44and past additions
28:44 --> 28:47the program are available in audio
28:47 --> 28:49and written form at yalecancercenter.org.
28:49 --> 28:51We hope you'll join us next week to
28:51 --> 28:53learn more about the fight against
28:53 --> 28:55cancer here on Connecticut Public
28:55 --> 28:56Radio. Funding for Yale Cancer Answers
28:56 --> 29:00is provided by Smilow Cancer Hospital.

Information

Addressing Cancer Disparities at the Community Level with guests Dr. Beth Jones and Monique Stefanou July 3, 2022 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095