Use of partnership strategies to build radiation oncology disparities research programs in five Western Pennsylvania communities: an organizational case study.

Many cancer treatment and prevention trials as well as surveillance programs suffer from a disproportionately low rate of accrual and a high rate of noncompliance or dropouts of racial minorities and the poor. One suggested strategy to help remediate this trend is to directly involve those targeted populations within the development, implementation, and evaluation of these services. The Radiation Oncology Community Outreach Group (ROCOG) and Neighborhood Cancer Care Cooperative (NCCC) are designed based upon this type of highly collaborative organizational structure, consistent with the general principles of community-based participatory research. Funded by the National Cancer Institute Cancer Disparities Research Partnership program, ROCOG/NCCC provide oncology-focused, community hospital-based initiatives intended to help close the cancer disparities gap. This article presents a descriptive case study of the organizational and political process that preceded our grant proposal submission, the potential benefits and difficulties associated with our extensive collaborative model, and an example of how highly competitive health care organizations can become partners in narrowly focused initiatives aimed at a greater social good.

Creation of community-based research capabilities in the neighborhood cancer care cooperative: administrative infrastructure, program initiatives, and evaluation priorities.

The Radiation Oncology Community Outreach Group (ROCOG) and the Neighborhood Cancer Care Cooperative (NCCC) were developed to address oncology-related health disparities utilizing a community-based, collaborative organizational design. Funded in 2003 by the National Cancer Institute's Cancer Disparities Research Partnership program, ROCOG/NCCC has focused on reducing barriers to care and enhancing the health care system's responsiveness to minority and indigent populations within Southwestern Pennsylvania. This article will describe the component programs that have been developed under this umbrella, as well as the evolved administrative, governance, and evaluation infrastructure that supports these initiatives.

Evaluation of formative development in the neighborhood cancer care cooperative.

The Radiation Oncology Community Outreach Group (ROCOG) and Neighborhood Cancer Care Cooperative (NCCC) were funded by the National Cancer Institute Radiation Research Program Cancer Disparities Research Partnership program in September 2003. ROCOG/NCCC provides customized, community hospital-based initiatives intended to help close the cancer disparities gap. In our two preceding articles in this issue, we have explored contextual and organizational development, described infrastructure and component programs, and outlined early evaluation strategies. This article will conclude the series of publications describing our early development by evaluating the formative implementation phase of the project. Our first 12 months were initially evaluated through a survey designed to assess staff and key stakeholders' perception of progress. An assessment of the level of completion of key project tasks was conducted 6 months after the survey. This combination has allowed ROCOG/NCCC to determine areas of success and also illustrate those in need of improvement. Our evaluation strategy can also serve as an efficient and inexpensive model for other similar community-based start-up programs to replicate.

Factors associated with patient navigators' time spent on reducing barriers to cancer treatment.

Patient navigator programs were established to mitigate barriers to cancer care, especially among underserved populations in 3 community hospitals in western Pennsylvania. This study was designed to determine and compare the time spent to enroll patients recently diagnosed with any type of cancer, the characteristics of enrolled patients, the types of barriers to treatment and the time it took patient navigators to address barriers. At enrollment, 253 (85%) of 299 enrollees reported barriers, most frequently problems with insurance and out-of-pocket expenses (31.5%) and transportation (24.6%). Navigators spent an average of 2.5 hours per patient. They spent significantly more time helping uninsured than insured patients and helping patients at the inner-city site. The most time was spent on financial problems (169 minutes), transportation problems (74 minutes), end-of-life issues (65 minutes), arrangement for dependent care (60 minutes), scheduling of appointments (34 minutes) and assistance with activities of daily living (24 minutes). Overall, financial barriers were the most often reported and the most time consuming. Patient navigators assisting cancer patients, especially the poor and underserved, will require significant time to address patients' financial and other barriers to care. This information will be helpful in the allocation of staff time and case loads for future programs.

Novel method for benchmarking recruitment of African American cancer patients to clinical therapeutic trials.

PURPOSE: The National Cancer Institute (NCI) has historically evaluated the participation of underserved minorities within University of Pittsburgh Cancer Institute (UPCI) clinical trials in relation to the proportion of African Americans in the general population of the UPCI primary service area of Allegheny County (12%). This standard seemed to be unrealistically high as a result of a younger age distribution of African Americans within the county. METHODS: The proportions of African Americans within the following four separate county populations were compared using data from 2000 to 2004: general population; invasive cancer patients; invasive cancer patients diagnosed or treated at UPCI-affiliated facilities; and patients enrolled onto UPCI's clinical therapeutic trials. RESULTS: Although the proportion of African Americans within the general population was approximately 13%, only 9.8% of patients diagnosed with invasive cancers were African American. Approximately 9.5% of all cancer patients diagnosed or treated at UPCI facilities were African American, which is comparable to the county-wide percentage of African American cancer patients. Recruitment rate of African Americans to oncology clinical trials from within the UPCI patient population was 7.6%. The NCI benchmark did not reflect the actual invasive cancer incidence rate in African American patients. By comparing the percentage of African Americans contributing to cancer incidence with the percentage of African American cancer patients treated at research-affiliated institutions, a more appropriate benchmark was derived. CONCLUSION: The method developed by UPCI is recommended as a useful mechanism for benchmarking recruitment of African American cancer patients to clinical therapeutic trials at other cancer centers.

Breast cancer risk assessment in socioeconomically disadvantaged urban communities.

During 2005, a risk assessment tool based on the Gail model was used to calculate the five-year risk of developing breast cancer for 445 women who live in socioeconomically disadvantaged urban communities in western Pennsylvania and who attended health fairs and other community-sponsored activities. This tool allowed us to evaluate each woman and advise her of her risks in a process lasting 15-20 minutes. Of the 445 women, 71.7% were black and 21.6% had a higher than average risk. The proportion of white women at high risk was significantly greater than the proportion of black women at high risk (33.3% vs. 16.9%; P < 0.01). The Gail model assessment tool for use in low-income and minority populations holds promise because it is noninvasive, is easy to use and provides immediate data about risk. This risk communication may help encourage minority and low-income women to receive screening mammography. It has the potential to improve breast cancer screening rates.