Abstract
Introduction: Breast cancer is the most commonly diagnosed cancer among nearly every racial and ethnic group. With almost 40,000 fatalities every year, breast cancer is the second leading cause of death among women. Better care in the past 25 years has reduced breast cancer deaths by up to 34% in certain communities, but not all communities are benefiting equally from these improvements. To address these disparities, we launched a navigation-based program as a model to improve outcomes for medically underserved women with breast cancer by reducing barriers to quality care and advancing pioneering treatments for breast cancer. We look at the insurance status of the women educated and navigated over the past two years.
Methods: The program has three objectives: (1) advance an effective and scalable community-based navigation model for reducing disparities in screening and diagnostic follow-up care in medically underserved women; (2) improve access to and use of high-quality breast cancer care and supportive services at Bellevue, Tisch, and NYU Brooklyn hospitals among underserved woman utilizing patient navigation; and (3) increase access to, and participation in, clinical trials for the most promising and innovative therapies for breast cancers among underserved women. Preliminary data were collected between August 2016 and April 2018 from women on their first encounter with the navigator.
Results: Our community navigators have provided outreach to 144 unique sites in New York City, primarily in Brooklyn and lower Manhattan. Community navigators provided health outreach to 8,304 women, of whom 2071 were eligible but not up to date on screening. 887 of these women enrolled in patient navigation and 711 women provided insurance information. 69% of our clients are AA, 25% Hispanic. 24% of our clients were uninsured, 19% had Medicaid, 10% had Medicare, and the remaining women had private insurance. The most salient reported barriers to screening addressed by our navigators included lack of adequate insurance, immigration status, housing and food insecurity, and lack of transportation and child care.
Discussion: Through a combination of outreach, education, and navigation, we have developed a novel interdisciplinary model to reduce barriers for screening and treatment for breast cancer. While many of our clients and patients had insurance, many still had formidable financial challenges. In our experience, comprehensive assessment of financial, social, and logistical barriers is an integral component of the navigation process, and is necessary to overcome the significant roadblocks to high-quality breast cancer screening, diagnosis, and treatment that underserved women face.
Citation Format: Margaret Cheng, Anita McFarlane, Joseph Ravenell, Kathie-Ann Joseph. Community breast health outreach and navigation in medically underserved communities: Insurance status of participants [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A025.
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