Rates of cancer are higher in the city of New Haven than for the state of Connecticut overall, according to Beth Anne Jones, PhD, MPH, research scientist at Yale School of Public Health and director of the Smilow Screening & Prevention Program. But many New Haven residents face obstacles to cancer care such as limited access to transportation, minimal experience with health care, and demanding jobs where they may lose pay if they seek care.
The Cancer Disparities Firewall (CDF) project aims to change that, specifically addressing disparities among minorities and people of low socioeconomic status. “Our intention [with this project] is to work across the continuum of cancer care,” says Jones, co-principal investigator of CDF. Minorities and people of low socioeconomic status, she says, are often lost along this continuum of prevention, cancer screening, early detection, treatment, and clinical research.
In New Haven, with 27 percent of the population living below the poverty line and a growing minority population, the task is particularly urgent.
In January of this year, the Bristol-Myers Squibb Foundation awarded Yale Cancer Center (YCC) $1 million to fund the project. Jones and co-principal investigator Roy S. Herbst, MD, PhD, Ensign Professor of Medicine (Medical Oncology) and chief of medical oncology at Yale Cancer Center and Smilow Cancer Hospital, are heading this intervention effort to reduce socioeconomic and racial disparities in cancer care in New Haven.
“Promoting health equity and providing an innovative standard of care for vulnerable populations is a top priority for the Bristol-Myers Squibb Foundation and Yale Cancer Center,” says John Damonti, president, Bristol-Myers Squibb Foundation. “We are proud to support the Cancer Disparities Firewall project and to help improve cancer outcomes for the New Haven community.”
CDF specifically targets breast, lung, colorectal, and prostate cancers. These four “heavy hitters,” says Jones, impact Connecticut residents more than other cancers and offer the best opportunities for prevention, early detection, and treatment.
YCC is collaborating with other Yale entities and community groups, including Yale Center for Clinical Investigation, Yale Center for Research Engagement, the Community Alliance for Research and Engagement at Yale, New Haven Department of Public Health, Smilow Cancer Hospital, and Gateway Community College, with additional funding from Yale School of Public Health.
So far, the team has focused on the prevention and cancer screening portion of the continuum. The award has enabled YCC community health educators to run more community outreach programs, providing community members with educational materials and free screening opportunities. YCC has hosted similar events in the past, but the new funding allows it to scale up these services, says Sakinah Carter Suttiratana, PhD, MPH, MBA, project coordinator.
The program also has piloted two new, cancer-focused patient navigation curricula focused on breast and colorectal cancers at Gateway Community College. These curricula aim to teach students how to guide patients through the cancer health care system as well as managing other aspects of life that can be difficult with a cancer diagnosis or in accessing prevention services. Curricula tailored for two other cancer types, lung and prostate, are planned for the coming academic year.
Even after current funding runs out, Gateway Community College will retain the curricula so that future students can train in cancer-specific patient navigation, too. “It’s one way of building sustainability into our initiative,” says Jones.
In the meantime, the Firewall team is developing a “health navigator” program to implement the next phase of the study. The goal is for newly trained patient navigators to step out of the classroom and engage local residents in health promotion and cancer screening activities. “We’re going to go out and try to effect change in our community,” says Herbst.
Further down the line, Herbst and Jones will implement strategies to retain minorities and people with low socioeconomic status throughout the cancer care continuum, hoping ultimately, to involve more of these populations in treatment and clinical trials. According to Jones, clinical trials often provide the best opportunities for treatment, but health providers have a difficult time enrolling some members of minority groups in these programs due to longstanding distrust of medical research.
The leaders of CDF say first results of the project are encouraging. “The team is focused on best cancer care, best science, and outreach to the community,” says Herbst, and even though the project is in its early stages, “I sense we are already making progress.”