Commission on Cancer Community Needs Assessment · The Cancer Management Committee met periodically throughout the ... lymphoma and myeloma, breast, colorectal, gynecological, lung,

2017

Commission on Cancer Community Needs Assessment

ACKNOWLEDGEMENTS

This Community Needs Assessment (CNA) was developed by Mount Auburn Hospital’s (MAH)

Community Health Department on behalf of the Mount Auburn Hospital Cancer Center and the

Hoffmann Breast Center under the auspices of the MAH Cancer Management Committee. The MAH

Community Health Department would like to acknowledge the great work and commitment of the MAH

Cancer Management Committee. The Cancer Management Committee met periodically throughout the

assessment in order to develop the assessment’s approach, oversee progress, provide feedback, and

review the final report of findings. This assessment would not have been possible without their guidance

and support.

The MAH Community Health Department would also like to thank the dozens of individuals and

organizations who participated in this assessment by completing surveys or sharing information through

interviews and focus groups. The information gathered as part of these activities was critical to the

assessment, as it allowed the MAH Community Health Department to engage stakeholders and gain a

better understanding of the burden of cancer, service system capacity, strengths, and challenges as well

as barriers to care and underlying determinants of health. Please accept our heartfelt appreciation and

thanks for your participation in this effort.

In addition, the Community Health Department would like to thank John Snow, Inc. (JSI) for their efforts

to compile quantitative and qualitative information for the assessment and for help in developing the

final report. JSI is a public health management consulting and research organization dedicated to

improving the health of individuals and communities throughout the world. JSI helped to ensure that a

rigorous and comprehensive assessment was conducted and we appreciate their assistance.

Finally, Mount Auburn Hospital would like to thank Mary Johnson, RN, Director of Community Health at

Mount Auburn Hospital and Mary DeCourcey, MS, Community Health Specialist. This assessment would

not have been possible without their considerable efforts and guidance.

MOUNT AUBURN HOSPITAL CANCER MANAGEMENT COMMITTEE

John Bridgeman Russell Nauta, M.D. Susan Pories, M.D.

Lisa Weissmann, M.D. Chair Thomas Caughey, M.D. Anthony Abner, M.D.

Mary McCullough Elzbieta Griffiths, M.D.

John Perry, M.D. Jeremy Schiller, M.D.

Paula Falzone, RN Kathy Willey, RN

Beth Loomis Nickie McNally

Beth Roy Meredith Hobson Jennette Paskell

Wei Kwan Margaret Sandin, M.D.

Karen Viscariello Mary Johnson

Michael O’Connell Meg Lotz

Tom Caughey, M.D.

Carol McKenna Emily Lotterhand Sarah Slater, M.D. Lisa Asmar-Abdien Matt Fickie, M.D

Prudence Lam, M.D. Ellen Nason

Nicole Sanders O’Toole Sarah Collins Rita Cosgrove Leslie Joseph

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TABLE OF CONTENTS

About Mount Auburn Hospital ............................................................................................... Page 2

Assessment Purpose and Approach ....................................................................................... Page 4

Community Characteristics .................................................................................................... Page 8

Patient Population ............................................................................................................... Page 16

Burden of Cancer ................................................................................................................. Page 20

Key Findings Related to Barriers to Prevention, Screening, and Navigation ....................... Page 24

Emerging Recommendations ............................................................................................... Page 28

Proposed Strategic Initiatives .............................................................................................. Page 29

Appendices

Appendix A: Data from US Census Bureau & Massachusetts Department of Public Health ........ Page 30

Appendix B: Data from Mount Auburn Hospital Cancer Registry .............................................. Page 41

Appendix C: Review of Current Cancer Management Activities .. .............................................. Page 55

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ABOUT MOUNT AUBURN HOSPITAL

Mount Auburn Hospital is a 217 bed acute-care, Harvard-affiliated community teaching hospital serving

the healthcare needs of residents in Arlington, Belmont, Cambridge, Somerville, Watertown, and

Waltham. Mount Auburn, Incorporated in 1871, was Cambridge’s first hospital, and is a not-for-profit,

charitable teaching hospital whose primary purpose is to maintain the good health of the residents in its

service area by providing high-quality medical services and programs as a means to prevent and cure

disease and to relieve suffering. Medical education and clinical research play an important part in the

hospital’s mission and are considered necessary to maintain high-quality care for patients. The Hospital

offers comprehensive inpatient and outpatient medical, surgical, obstetrical, and psychiatric services as

well as specialized care in bariatrics, cardiology, cardiac surgery, orthopedics, neurology, vascular

surgery, and oncology. In addition, Mount Auburn offers a network of satellite primary care practices in

several surrounding communities, as well as a range of community-based programs, including Mount

Auburn Home Care, outpatient specialty services, and occupational health. Mount Auburn’s dual mission

is to provide excellent and compassionate health care and to teach students of medicine and the health

professions.

MOUNT AUBURN CANCER CENTER AND HOFFMAN BREAST CENTER

Mount Auburn’s dedication to excellent and compassionate care is exemplified in the Hoffman Breast

Center and the Hospital’s Hematology/Oncology and Radiation Oncology departments. Cancer

specialists provide a broad range of outreach, education, prevention, diagnostic, treatment, and disease

management services for those with blood diseases and many different cancers. Thousands of patients

have been expertly cared for and compassionately treated by an extraordinary team of physicians,

nurses, technicians and staff. Patients from the communities the hospital serves benefit from a

multidisciplinary team approach to coordinate the best available treatment options for many cancers

including: blood cancers (chronic leukemia, lymphoma and myeloma, breast, colorectal, gynecological,

lung, pancreatic, prostate, and stomach.

Over the years, as the treatment modalities for cancer have rapidly expand, Mount Auburn Hospital’s

Cancer Center has enhanced the healing environment and further supported the very special level of

care that physicians and nurses provide to patients and families. The care provided by the Cancer Center

is augmented by services and resources provided by the Hospital’s Herzstein Wellness Center, which

provides a broad range of services and resources for patients and their families such as mind-body

medicine, workshops and support groups, integrative therapies, nutrition counseling and education. The

Cancer Center is also supported by the Cancer Genetics and Prevention Program, which supports

patients through genetic testing and treatments as well as counseling on cancer prevention strategies.

The Cancer Genetics and Prevention Program works closely with patients and their caregivers to create

collaboratively-designed, personalized treatment plans and reviews genetic testing possibilities.

Mount Auburn’s Cancer Center is also supported by the Hospital’s Palliative Care Program, which

provides specialized medical care for people with serious illnesses, including cancer. Mount Auburn’s

Oncology Department led the effort to establish the Palliative Care Program, which focuses on providing

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patients with relief from the symptoms, pain, and stress of a serious illness—whatever the diagnosis.

The program includes specialized doctors, nurses, social workers and chaplains, who work with the staff

at the Cancer Center to help patients and families to evaluate their goals, understand treatment options

and make informed decisions about their care.

Finally, the Cancer Center works closely with the Hospital’s Hoffman Breast Center, which provides

convenient, personalized and supportive preventive, diagnostic, counseling and coordination services

specifically for women, including plastic and reconstructive surgery and support for those diagnosed

with breast cancer.

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ASSESSMENT PURPOSE AND APPROACH

PURPOSE AND BACKGROUND Since 1987, Mount Auburn Hospital has been accredited by the American College of Surgeons

Commission on Cancer. The Commission on Cancer (CoC) recognizes cancer care programs around the

Country for their commitment to providing comprehensive, high-quality, and multidisciplinary patient

centered care. The CoC is dedicated to improving survival and quality of life for cancer patients through

standard-setting, prevention, research, education, and the monitoring of comprehensive quality care.

Through the CoC, cancer programs have access to reporting tools to aid in benchmarking and improving

outcomes as well as educational and training opportunities, development resources, and advocacy. Only

a select group of facilities receive this distinguished accreditation through a rigorous evaluation and

review of 36 quality standards. Accreditation by the Commission on Cancer assures patients that they

are receiving the highest quality care in a multidisciplinary setting with advanced services and treatment

options.

In order to maintain this accreditation, the Commission on Cancer requires that oncology departments

conducted a community needs assessment (CNA) at least once every three years. The goal of this

assessment process is to identify the needs of the population being served with respect to: 1)

Community Education and Prevention, 2) Screening, and 3) Navigation Services as a way of ensuring that

the facility is working to improve patient services and reduce health disparities.

APPROACH, METHODS, AND DATA LIMITATIONS The CNA was conducted in two phases, which allowed Mount Auburn Hospital to: 1) Compile

quantitative and qualitative data; 2) Engage and involve key stakeholders - including clinical and

administrative staff, other community based service providers, and the community at-large; 3) Develop

a report, including a summary of the assessment’s approach/methods, key findings, emerging

recommendations and proposed strategic initiatives, and; 4) Comply with all CoC requirements.

FIGURE 1: CHNA APPROACH AND METHODS

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Data sources included a broad array of existing secondary data drawn primarily from the Massachusetts

Department of Public Health, key informant interviews, and focus groups. In parallel to this process, the

Cancer Management Committee also explored the impact and effectiveness of the hospital’s cancer

outreach, prevention, screening, and navigation services that it has implemented over the past three

years so that this experience could inform its strategic activities moving forward.

The goal of Phase I was to gain an understanding of health-related characteristics of the region’s

population, including demographic, socio-economic, geographic, health status, care seeking, and access

to care characteristics. This involved quantitative and qualitative data analysis from existing secondary

data, a survey of internal staff, interviews with key stakeholders, and a series of focus groups. The main

objectives of Phase II of the assessment were to: 1) Review the assessment’s major findings, 2) Review

the Cancer Center’s existing strategies to improve outreach/prevention, screening, and navigation

services, 3) Determine the strategies that should be implemented over the coming years to augment

what the Cancer Center currently does to reduce the burden of cancer, raise awareness, educate, and

reduce barriers to screening and navigation services. During Phase II, JSI reviewed the Cancer Center’s

prior activities, facilitated discussions at the Cancer Committee’s December 2017 meeting, and

developed this report of findings and recommendations.

COMMUNITY SPECIFIC SECONDARY (QUANTITATIVE) DATA JSI characterized the community population, health status/cancer burden, and community need at the

municipal and state levels, as well as for the service area overall when possible. A number of data

sources were utilized to ensure a comprehensive understanding of the issues. JSI produced a series of

tables and graphs to summarize and draw out key findings (see Appendix A). Sources of secondary data

include:

U.S. Census Bureau, American Community

Survey 5-Year Estimates, 2011-2015

Behavioral Risk Factor Surveillance System

(BRFSS), 2007-2009 (CHNA level data)

Massachusetts Hospital Inpatient Discharges

(MA Department of Public Health), 2008-2012

Mount Auburn Hospital Cancer Registry, 2016

Massachusetts Hospital ED Discharges (MA

Department of Public Health), 2008-2012

Massachusetts Cancer Registry (MA

Department of Public Health), 2013

Massachusetts Vital Records (MA Department

of Public Health), 2014

Internal Staff Survey. The Cancer Center conducted internal staff survey with clinical and other patient

support staff at the Center. In total, surveys were collected from 30 clinicians and other patient support

staff, which provided important information related to the burden of cancer and the barriers and service

gaps that the Hospital patient’s face.

Key Informant Interviews. JSI conducted 26 interviews with a representative group of key internal and

external stakeholders with experience and insight on the burden of cancer as well as the barriers to

education, screening, and navigation services that the residents of Mount Auburn’s service area face.

Interviews were conducted using a standard interview guide. Interviews focused on pressing cancer

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concerns related to cancer burden, barriers to care, and service/resource gaps, as well as possible

strategies to address the concerns identified.

Resource Inventory. To understand community need and underlying risks as well as to appropriately

target strategies, JSI worked with staff at the Cancer Center to understand and take stock of the existing,

cancer-related resources in Mount Auburn’s service area. In this regard, JSI reviewed the hospital’s prior

cancer needs assessment and the hospital community benefits needs assessment produced for the MA

Attorney General, which included a listing of partners and other cancer-related resources. The goal of

this process was to identify gaps in resources as well as key partners who may or may not be already

partnering with the hospital.

COMMUNITY INPUT (QUALITATIVE DATA) JSI conducted a series of informal focus groups/community meetings to gather critical community input

from patients/family members, service providers, community leaders, and residents from Mount

Auburn’s service area. These focus groups were organized with a number of the Cancer Center’s

partners to leverage their community connections and help to ensure good participation. During these

focus groups, JSI discussed findings of the data and posed a range of questions that solicited input on

community ideas, perceptions and attitudes, including: 1) Does the data reflect what you see as the

major needs and health issues in your community? Are the identified gaps the right ones? What

segments of the populations are most at-risk? What are the underlying social determinants of health

status? 2) What strategies would be most effective to improving health status and outcomes in these

areas?

Overall, 5 focus groups were conducted.

TABLE 1: FOCUS GROUPS/COMMUNITY MEETINGS

Event Audience(s)

CHNA 17

September 14, 2017

Community Leaders and Advocates

Patient Family Advisory Council

September 27, 2017

Mount Auburn Internal Staff

Mount Auburn Patients and Family

Members

Elder Services

November 8, 2017

Mount Auburn Internal Staff


SCALE

December 4, 2017


Community Residents

Waltham Family School

December 8, 2017


Community Residents

DATA LIMITATIONS Assessment activities of this nature nearly always face data limitations with respect to both quantitative

and qualitative data collection. With respect to the quantitative data compiled for this project, the most

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significant limitation is the availability of timely data. Relative to most states and commonwealths

throughout the United States, Massachusetts is at the forefront of making comprehensive data available

at the commonwealth-, county- and municipal-level. This data is made available through the

Massachusetts Cancer Registry as well as the Commonwealth’s Behavioral Risk Factor Survey System

and Vital Records system. The breadth of demographic, socio-economic, and epidemiologic data that

was made available was more than adequate to facilitate an assessment of community health need and

support the development of recommendations for the Cancer Center. One major challenge was that

much of the epidemiologic data that is available, particularly at the sub-county, municipal-,

neighborhood-, or zip code-level data was up to 5 years old. The list of data sources included in this

report provides the dates for each of the major data sets provided by the Commonwealth. The data was

still valuable and allowed the identification of health needs relative to the Commonwealth and specific

communities. However, older datasets may not reflect recent trends in health statistics. The age of the

data also hindered trend analysis, as trend analysis required the inclusion of data that may have been up

to ten years old, which challenged any current analysis.

With respect to qualitative data, information was gathered through a staff survey as well as a series of

stakeholder interviews and focus groups/community meetings, which engaged service providers,

community leaders/advocates, and community residents. These interviews and focus groups provided

invaluable insights on cancer-related concerns, barriers to care, service gaps, and at-risk target

populations. However, given the relatively small sample size and the nature of the questioning the

results are not necessarily generalizable to the larger population. While every effort was made to

promote the focus groups/community meetings to the community and to identify a representative

sample of interviewees the selection or inclusion process was not very large, scientific, or random.

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COMMUNITY CHARACTERISTICS

Population characteristics such as age, gender identity, race, ethnicity, and language were examined

to characterize community composition, needs, and health status. Social, economic, and

environmental factors that impact health status and health equity, like income, education, and

housing were also examined. Finally, epidemiologic and morbidity/mortality related data was used to

characterize disease burden and health inequities, identify target populations and health-related

priorities, and to target strategic responses.

The following is a summary of key findings of this review. Conclusions were drawn from

quantitative data and qualitative information collected from through the staff survey, interviews

and focus groups/community meetings. Summary data tables and graphs are included below.

SERVICE AREA Mount Auburn Hospital’s

primary service area includes

the quasi- urban cities of

Cambridge and Somerville and

adjacent towns of Arlington,

Belmont, Watertown and

Waltham. While great efforts

are made to improve the health

status, provide diagnostic

screening, and address access

barriers of all of the residents

of these communities, special

attention is given to address

the needs of diverse and/or low

income, vulnerable segments of

these populations living in

these communities. The

assessment found that the

majority of the residents living

in Mount Auburn’s primary

service area, relative to the

Commonwealth, had few barriers to care and were more likely to be insured, were more affluent,

and were more likely to have a personal vehicle. However, census data and qualitative information

from interviews and focus groups showed that these cities/towns have significant proportions of

low income, racially and ethnically diverse, foreign born, and/or geographically isolated residents.

The challenges that these cohorts face with respect to social determinants of health and access to

care are often intense and are at the root of the challenges and poorer health outcomes faced in

these communities.

FIGURE 2: MOUNT AUBURN HOSPITAL SERVICE AREA

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AGE AND GENDER Age and gender are fundamental factors to consider when assessing individual and community health

status, as the risk for some cancer is related to gender; women are more at risk for breast cancer

and only men have a risk of prostate cancer. Additionally, the risk for many cancers, including

those with identified screening recommendations such as breast, prostate and colorectal cancers,

increases with age. Men tend to have a shorter life expectancy and more chronic illnesses than

women, and older individuals typically have more physical and mental health vulnerabilities and are

more likely to rely on immediate community resources for support compared to young people.1,2 In

Mount Auburn’s service area, gender breakdowns in each of the municipalities mirror that of the

Commonwealth.

Among municipalities in the primary service area, there is variation in demographic make-up. Compared

to Massachusetts and the service area overall, Arlington and Belmont have a higher proportion of

residents under 18 and residents over the age of 65.

FIGURE 3: POPULATION UNDER 18/OVER 65, 2011-2015

Source: US Census Bureau, American Community Survey 2011-2015 5-Year Estimates

RACE/ETHNICITY, LANGUAGE, AND CULTURE There is an extensive body of research that illustrates the complex factors that contribute to cancer

disparities in certain racial/ethnic populations. In most cases, these disparities, which include less

screening and higher rates of cancer incidence, advanced diagnoses, and mortality, are associated

1 Lyons L. Age, religiosity, and rural America. Gallup Web site. March 11, 2013. http://www.

gallup.com/poll/7960/age-religiosity-rural-america.aspx. 2 Harvard Men’s Health Watch. Mars vs. Venus: The gender gap in health. Harvard Health Publications Web

site. January 2010. http://www.health.harvard.edu/newsletter_article/ mars-vs-venus-the-gender-gap-in-health.

http://www/

http://www.health.harvard.edu/newsletter_article/

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with low socioeconomic status, lack of insurance coverage, and living conditions.3 Cultural beliefs

are also barriers that prevent individuals from obtaining effective care. In the United States, African

Americans/Blacks suffer the greatest burden; for all cancers combined, mortality rate is 25% higher

compared to Whites. Looking specifically at breast cancer, White women are more likely to be

diagnosed, though African American/Black women are more likely to die from the disease. African

American/Black men have the highest incidence of prostate cancer among all racial/ethnic groups,

and are twice as likely as Whites to die of the disease. Though genetic factors may account for

some of these differences in survival, research suggests that barriers to early detection and

screening and unequal access to treatment technology are the major factors contributing to these

differences in survival.4

These disparities illustrate the unfair, disproportionate, and often avoidable inequities that exist

within communities and reinforce why it is important to understand the demographic makeup of a

community to identify population segments that are more likely to experience adverse health

outcomes.

Looking at the service area:

Approximately 1 in 4 residents are Non-white; 12% of individuals in the service area are

Asian (unspecified); 7% are Black or African American; and 5% identify as some other

race/two or more races.

Approximately 9% of those in the service area are Hispanic/Latino (of any race).

Compared to the Commonwealth (7%), the percentage of Black or African American

residents is significantly high in Cambridge (11%).

Compared to the Commonwealth (6%), the percentage of Asian residents is significantly

high in all municipalities, with the exception of Watertown.

Research suggests that language barriers contribute to poor health communication and disparities

in health care use and outcomes.5 Individuals with LEP may have lower levels of medical

comprehension, which lead to higher rates of complications attributable to limited understanding

about treatments and side effects, lack of informed consent, and poor comprehension of follow-up

care plans.6,7 Due to the complex nature of cancer care, LEP patients diagnosed with cancer may be

particularly vulnerable to adverse outcomes as a result of communication barriers.

3 Cancer Health Disparities Research. National Cancer Institute Web site. Updated July 24, 2017.

https://www.cancer.gov/research/areas/disparities 4 Cancer Health Disparities. National Cancer Institute Web site. Updated March 11, 2008.

https://www.cancer.gov/about-nci/organization/crchd/cancer-health-disparities-fact-sheet#q2 5 Jacobs EA, Karavolos K, Rathouz PJ, Ferris TG, Powell LH. Limited English proficiency and breast and cervical

cancer screening in a multiethnic population. Am J Public Health. 2005; 95(8): 1410-1416. Doi:

10.2105/AJPH.2004.041418 6 Wilson E, Chen AH, Gumbach K, Wang F, Fernandez A. Effects of limited English proficiency and physician

language on health care compression. J Gen Intern Med. 2005; 20(9): 800-806. Doi: 10.1111/i.1525-

1497.2005.0174.x 7 Coren JS, Filipetto FA, Weiss LB. Eliminating barriers for patients with limited English proficiency. J. Am.

Osteopath. Assoc. 2009; 109(12): 634-640.

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According to quantitative data:

Among all municipalities in the service area, over 2% of the population speaks Spanish or

Spanish Creole; in Somerville, Waltham, and Watertown, over 2% of the population speaks

Spanish at home and have limited English proficiency (LEP).

In Somerville, 6% of the population speaks Portuguese or Portuguese Creole, with 3% of this

population having limited English proficiency.

In Belmont, 6% of the population speaks Chinese (unspecified), with 3% of this population

having limited English proficiency.

FIGURE 4: SPANISH LANGUAGE/LEP, 2011-2015


Broader issues of immigration status and culture were major themes in interviews or community

forums, and many interviewees identified immigrant populations as a cohort that require specialized

health care services and resources; Central and South Americans, Haitians, Chinese (Mandarin),

Russians, Armenians, and those from Arabic speaking countries were referenced specifically.

Immigrants are less likely to visit doctor’s offices and emergency rooms than low-income native

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residents.8 According to the Centers for Disease Control and Prevention (CDC), immigrants are less

likely than the general population to receive breast, cervical, and colorectal cancer screenings due

to limited access to care and cultural barriers.9 Prejudice and discrimination, mistrust, and cultural

differences deter many immigrants and refugees from seeking health services, and it is common for

immigrants and refugees to self-isolate due to trauma and stress.10

According to quantitative data:

The percentage of the population that is foreign born is significantly high in all

municipalities compared to the Commonwealth (15.5%). Rates were highest in Cambridge

(27%), Waltham (26%), and Somerville (25%).

SOCIAL DETERMINANTS OF HEALTH The quantitative and qualitative data show clear geographic and demographic differences related to the

leading social determinants of health (e.g. socioeconomic status, housing, and transportation). These

issues influence and define quality of life for many segments of Mount Auburn’s service area. A

dominant theme from key informant interviews and focus groups was the tremendous impact that

underlying social determinants, particularly housing, poverty, and transportation, have on low-income

and vulnerable segments of the population.

Socioeconomic Status

Socioeconomic status, as measured by education, income and poverty, employment, and the extent

to which one lives in areas of economic disadvantage, is closely linked to morbidity, mortality, and

overall well-being. According to research, individuals in low-education and low-income groups have

higher incidence and mortality rates than affluent individuals, with excess risk particularly marked

for lung, colorectal, cervical, stomach, and liver cancer.11

Education

Higher education is associated with improved health outcomes and social development at the

individual and community level.12 Compared to individuals with more education, people with lower

educational attainment are more likely to experience a number of health issues, including obesity,

8 Ku L, Jewers M. Health care for immigrant families: Current policies and issues. Migration Policy Institute Web

site. http://www.migrationpolicy.org/research/health-care-immigrant-fami-lies-current-policies-and-issues.

Published 2013. 9 Cancer Screening. Centers for Disease Control and Prevention Web site. Updated June 21, 2016.

https://www.cdc.gov/immigrantrefugeehealth/guidelines/domestic/general/discussion/cancer-screening.html 10 Lake Snell Perry Mermin/Decision Research. Living in America: Challenges facing new immigrants and refugees.

Sponsored by the Robert Wood Johnson Foundation. Published January 2006.http://www.rwjf.org/content/dam/farm

/reports/reports/2006/rwjf3807 11 Singh GK, Jemal A. Socioeconomic and racial/ethnic disparities in cancer mortality, incidence, and survival in the

United States, 1950-2014: Over six decades of changing patterns and widening inequalities. J Environ Public

Health. 2017. Doi: 10.1155/2017/2819372 12 Zimmerman EB, Woolf SH, Haley A. Population health: Behavioral and social science insights – Understanding

the relationship between education and health. Agency for Healthcare Research and Quality Website. Agency for

Healthcare Research and Quality, https://www.ahrq.gov/professionals/education/curriculum-tools/ population-

health/ zimmerman.html. Published September 2015.

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substance misuse, and injury.13 The health benefits of higher education typically include better access

to resources, healthier and more stable housing, and better engagement with providers. Proximate

factors associated with low education that affect health outcomes include the ability to navigate the

health care system, educational disparities in personal health behaviors, and exposure to chronic

stress.14 It is important to note that while education affects health, poor health status may also be a

barrier to education.

FIGURE 5: EDUCATIONAL ATTAINMENT, 2011-2015


Despite the overall service area population being highly educated compared to the

Commonwealth, there is slight variation among municipalities: Somerville (89%) and Waltham

(90%) are the only two municipalities that do not have a significantly higher percentage of residents

with a high school degree or higher compared to the Commonwealth (90%).

Employment, Income, and Poverty

All towns in the service area have a high median income compared to the Commonwealth, and the

civilian labor force unemployment is about the same, or significantly lower (Arlington, Cambridge,

and Somerville). However, we know from qualitative findings that there are small but significant

pockets within the service area that live in poverty, are unemployed, and struggle to afford food

and other household items.

The percentage of residents that live below the federal poverty line is significantly high in

Cambridge (14%) and Somerville (15%) compared to the Commonwealth (12%).

13 Health disparities. Centers for Disease Control and Prevention Web Site. Published September 1,

2015.https://www. cdc.gov/healthyyouth/disparities/. 14 Zimmerman EB, Woolf SH, Haley A. Understanding the relationship between education and health: A review of

the evidence and an examination of community perspectives. Agency for Healthcare Research and Quality Web site.

Published 2014.

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Compared to the Commonwealth (24%), a significantly high percentage of residents live

below 200% of the federal poverty line in Somerville (28%).

In Somerville, the percentage of families (10%), those under 18 (23%), and those over 65

(14%) living below the federal poverty line was significantly high compared to the

Commonwealth (8%, 15%, and 9%, respectively).

FIGURE 6: POPULATION LIVING BELOW 200% OF THE FEDERAL POVERTY LEVEL, 2011-

2015


Housing, Transportation, and Food Access

A large body of evidence suggests that poor housing is associated with a range of health conditions,

including asthma and other respiratory conditions, exposure to environmental toxins, injury, and the

spread of communicable diseases.15 These health issues are more common among low-income

segments of the population who struggle to find safe and healthy housing. In Somerville, substantial

numbers of people are “house-poor,” with housing costs that exceed 30% of income. Cambridge

and Somerville are the only municipalities in the service area with overnight homeless shelters,

and have substantial numbers of people that are homeless or unstably housed.

Transportation is a common concern for cancer patients, as treatment often requires many visits.

For example, a course of radiation therapy may require a patient to come to the hospital daily for

many weeks. Research shows that cancer patients may forego treatments in the absence of

available and affordable means of transportation; this issue is perceived more often for

racial/ethnic minorities than for whites.16

15 Hughes HK, Matsui EC, Tschudy MM, Pollack CE, Keet CA. Pediatric asthma health disparities: Race, hardship,

housing, and asthma in a national survey. Acad Pediatr. 2017; 17(2): 127-134. 16 Guidry JJ, Aday La, Zhang D, Winn RJ. Transportation as a barrier to cancer treatment. Cancer Pract. 1997; 5(6):

361-366.

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Key informants and individuals at community forums frequently identified transportation as a major

barrier to care, especially for those that live outside of Cambridge and Somerville and have limited

access to forms of public transport. Transportation significantly impacts one’s ability to access health

resources, but also determines whether an individual or family has the ability to access the basic

resources that allow them to live productive and fulfilling lives, such as work, school, grocery stores,

recreational facilities, and other community resources.17

Issues related to food insecurity, food scarcity, hunger, and the prevalence and impact of obesity are at

the heart of the public health discourse in urban and rural communities across the United States.

Research consistently produces evidence that compared to normal weight individuals, those that

are obese and overweight are at an increased risk for many forms of cancer, including breast, liver,

kidney, pancreatic, colorectal, esophageal, endometrial, and meningioma.18 A 2012 study showed

that approximately 3.5% of new cancer cases in men, and 9.5% of new cancer cases in women,

were due to overweight or obesity.19 While there is limited quantitative data on food access, lack of

access to healthy foods was a common theme in interviews and community forums, particularly for

low-income individuals and families.

17 Syed ST, Gerber BS, Sharp LK. Traveling towards disease: Transportation barriers to health care access. J

Community Health. 2013; 38(5): 976-993. 18 Obesity and Cancer. National Cancer Institute Web site. Reviewed January 17, 2017.

https://www.cancer.gov/about-cancer/causes-prevention/risk/obesity/obesity-fact-sheet 19 Arnold M, Pandeya N, Byrnes G, et al. Global burden of cancer attributable to high body-mass index in 2012: a

population-based study. Lancet Oncology 2015; 16(1): 36-46.

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PATIENT POPULATION THOSE WHO MADE FIRST CONTACT WITH CANCER CENTER IN 2016

DEMOGRAPHICS, LANGUAGE, AND INSURANCE STATUS Of those who made first contact with Mount Auburn’s Cancer Center in 2016:

Approximately 37% of patients were between the ages of 60-69; 23% were between the ages of

70-79, and; 17% were between the ages of 50-59 at age of diagnosis.

Approximately 87% were white; 7% were black, and 3% were Asian (not-specified).

MAH provided over 1000 interpretation encounters to cancer patients: 37% Spanish, 28%

Armenian, 11% Portuguese, 8% Korean, 7% Russian, 6% Mandarin, 2% American Sign Language,

and 1% Haitian Creole

Approximately 48% were privately insured; 47% were covered under Medicare; and 4% were

covered under Medicaid. Approximately 0.3% were uninsured.

PATIENT ORIGIN Looking strictly at the municipalities in Mount Auburn’s primary service area, most patients are from

Cambridge (16.2%), and the fewest are from Waltham (5.5%) (See Table 2). Table 3 (below) lists the top

ten patient origins by zip code, inclusive of municipalities from outside of Mount Auburn’s primary

service area.

TABLE 2: PERCENTAGE OF TOTAL PATIENTS FROM PRIMARY SERVICE AREA, 2016

Municipality Percentage of Patients

Cambridge 16.2%

Arlington 11.1%

Watertown 10.3%

Somerville 7.7%

Belmont 6.0%

Waltham 5.5%

Source: Mount Auburn Hospital Cancer Registry

TABLE 3: TOP 10 PATIENT ORIGINS BY ZIP CODE, 2016

Zip Code/Municipality Percentage of Patients

Watertown (02472) 10.31%

Arlington (02474) 7.33%

Medford (02155) 6.11%

Belmont (02478) 5.97%

Cambridge (02139) 5.83%

Cambridge (02138) 4.61%

Cambridge (02140) 4.34%

Arlington (02476) 3.80%

Somerville (02144) 2.99%

Somerville (02143) 2.44%


17

DIAGNOSTIC CHARACTERISTICS The top 10 Cancer diagnoses at Mount Auburn Hospital are shown below in Figure 7; the most common

diagnoses was breast cancer, accounting for 42% of all diagnoses in 2016. When looking at the top 10

diagnoses by sex, among female patients who made first contact with MAH in 2016, the top sites were

breast (62%), bronchus/lung (10%), and corpus uteri (8%) (Figure 8); among male patients, the top sites

were prostate (26%), bladder (22%), and bronchus/lung (21%) (Figure 9).

FIGURE 7: TOP 10 CANCER DIAGNOSES, 2016


FIGURE 8: TOP 10 SITES BY SEX (FEMALE), 2016


Colon

6%

Bronchus/Lung

14%

Hema/Reti

3%

Breast

42%

Corpus Uteri

6%

Prostate

8%

Kidney

5%

Bladder

10%

Thyroid

3%

Unknown

3%

Colon

5%

Bronchus/Lung

10%

Hema/Reti

2%

Breast

62%

Corpus Uteri

8%

Prostate

0%

Kidney

2% Bladder

5%

Thyroid

4% Unknown

2%

18

FIGURE 9: TOP 10 SITES BY SEX (MALE), 2016


Figure 10 compares the stage of cancer (all sites) of those diagnosed at Mount Auburn in 2015 to the

stage of cancer (all sites) of those diagnosed across Massachusetts in the same year. According to this

figure, Mount Auburn saw nearly 50% more patients with Stage 0 diagnoses and 3% less patients with

Stage IV diagnoses. A breakdown of stage at diagnoses for all sites, breast, lung, colorectal, and prostate

cancer at Mount Auburn is shown in Table 4. Through this data we see that, across sites, most patients

are diagnosed at Stage 0, I, or II. We also can glean that among these four cancer types, lung/bronchus

and colorectal cancer tend to be diagnosed at later stages (Stages III and IV).

FIGURE 10: STAGE AT DIAGNOSIS, 2015


Colon

9%

Bronchus/Lung

21%

Hema/Reti

5% Breast

0%

Prostate

26%

Kidney

10%

Bladder

22%

Thyroid

2%

Unknown

5%

0

5

10

15

20

25

30

35

0 I II III IV NA Unknown

Per

cen

t (%

) D

iag

no

sed

Stage at Diagnosis

MAH

Other

19

Table 4: PERCENT OF DIAGNOSES BY SITE AND STAGE, 2015

Stage 0 Stage I Stage II Stage III Stage IV 88 Unknown

All Sites 14% 37% 14% 9% 13% 6% 7%

Lung/Bronchus 2% 37% 6% 13% 37% 0 5%

Breast 23% 51% 13% 6% 0 0 7%

Colon/Rectal 8% 20% 16% 20% 26% 0 10%

Prostate 0 2% 67% 6% 19% 0 6% Source: Mount Auburn Hospital Cancer Registry

20

BURDEN OF CANCER

RISK FACTORS An important aspect of the CNA is characterizing the extent to which population segments and

communities participate in activities that are considered “high-risk.” It is well understood that certain

health risk factors, such as obesity, tobacco use, lack of physical exercise, poor nutrition, and alcohol use

have effects on the burden of cancer, physical chronic conditions, and behavioral health.

Across indicators, Mount Auburn’s service area fares similarly or better than the Commonwealth. The

rates of current smokers, exposure to environmental tobacco smoke, and overweight/obesity are all

significantly lower than the Commonwealth, and people reported significantly more leisure time

physical activity.

TABLE 5: RISK FACTORS, 2007-2009

Community Health Network Area

(CHNA) 17

Commonwealth of

Massachusetts

Current Smoker

(Currently smokes

some days or

everyday)

10.9 15.8

Former Smoker

(More than 100

cigarettes in lifetime,

but no longer smoke)

26.2 28.3

Exposed to

environmental

tobacco smoke at

their home, work, or

other places

31.8 37.5

Binge Drinking (In

past month : 5+

drinks in one occasion

for men; 4+ drinks

for women in one

occasion for women)

15.8 17.6

Overweight/Obese

(BMI >25) 48.8 58.2

Leisure Time Physical

Activity (Any physical

activity other than

regular job in past

month)

83.6 78.7

Source: Massachusetts Department of Public Health, Health Survey Program

* The MA Department of Public Health no longer reports cancer screening rates at the municipal-level. The most recent data

aggregated at the CHNA level is 2007-2009; this includes all towns in the primary service area with the exception of Waltham.

21

INCIDENCE Looking across Mount Auburn’s service area, the summary incidence rate (SIR) was significantly high in

only two municipalities for two types of cancer: for liver cancer among females in Somerville, and

stomach cancer among females in Watertown. The summary SIR was significantly low in several towns,

for several cancer types (see Table 2 below). For further detail, please see Summary Incidence sheets for

each municipality in the primary service area (Appendix A).

TABLE 5: SUMMARY INCIDENCE RATE (SIR)** HIGHER/LOWER THAN EXPECTED, 2009-2013

Summary Incidence Higher Than

Expected

Summary Incidence Lower Than

Expected

Arlington None None

Belmont None All Sites/Types (Males)

Lung/Bronchus (Males)

Oral Cavity/Pharynx (Males)

Cambridge None All Sites/Types (Males & Females)

Lung & Bronchus (Males and Females)

Kidney/Renal Pelvis (Female)

Colon/Rectum (Female)

Breast (Female)

Bladder (Males and Females)

Somerville Liver (Females) All Sites/Types (Females)

Testis (Males)

Breast (Females)

Melanoma (Females)

Waltham None Prostate (Males)

Melanoma (Females)

Watertown Stomach (Females) None

Source: Massachusetts Cancer Registry, 2009-2013

**A standardized incidence ratio is an indirect method of adjustment for age and sex that describes in

numerical terms how a city/town’s cancer experience in a given time period compares with that of the

state as a whole. For more information, please see pages 2-7 of Massachusetts’ Cancer Incidence Report.

http://www.mass.gov/eohhs/docs/dph/cancer/city/2009-2013/registry-city-09-13-report.pdf

22

HOSPITALIZATIONS Of the six towns in Mount Auburn Hospital’s service area, all-cancer hospitalization rates were

significantly lower than the Commonwealth in Cambridge. Table 6 includes hospitalization rates for all

cancers, and the four leading cancer sites.20 Rates of hospitalization due to lung cancer were significantly

lower than the Commonwealth in Arlington and Belmont, and hospitalizations due to breast cancer

were significantly lower in Somerville.

TABLE 6: AGE-ADJUSTED HOSPITALIZATION RATES (PER 100,000), 2008-2012

All Cancer Lung* Breast Colorectal Prostate

MA 371.30 47.86 39.08 38.41 47.15

Arlington 353.59 33.20 46.17 35.59 59.32

Belmont 305.49 29.51 33.28 30.54 60.69

Cambridge 327.80 41.63 33.53 33.44 51.13

Somerville 382.30 54.19 26.40 34.97 43.39

Waltham 372.43 53.07 38.92 36.38 36.42

Watertown 388.97 52.38 32.24 43.73 47.15

Source: Massachusetts Department of Public Health (Hospitalizations), 2008-2012

EMERGENCY DEPARTMENT (ED) DISCHARGES The rate of ED Discharge related to all cancers and lung cancer were significantly higher in Waltham

compared to Massachusetts. Rates of ED Discharge related to all cancers were significantly lower in

Arlington, Cambridge, and Somerville compared to the Commonwealth.

TABLE 7: AGE-ADJUSTED EMERGENCY DEPARTMENT DISCHARGES (PER 100,000), 2008-2012

All Cancer Lung Breast Colorectal Prostate

MA 15.58 2.66 1.93 0.83 1.18

Arlington 6.58 NA NA NA NA

Belmont 15.01 0.00 0.00 0.00 NA

Cambridge 7.31 NA NA 0.00 NA

Somerville 10.69 0.00 NA NA NA

Waltham 36.83 10.45 NA NA NA

Watertown 15.75 NA NA NA 0.00

Source: Massachusetts Department of Public Health (ED Discharges), 2008-2012

20 American Cancer Society, Cancer Facts and Figures 2017, https://www.cancer.org/content/dam/cancer-

org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2017/cancer-facts-and-figures-2017.pdf

23

MORTALITY Of the six towns in Mount Auburn Hospital’s service area, the all cancer mortality rate is significantly

high in Somerville (194.2) compared to the Commonwealth. Looking at the four leading cancer sites,

service area mortality rates were significantly lower than the Commonwealth in several municipalities.

The colorectal cancer mortality rate was significantly high in Arlington (29.8) compared to the

Commonwealth overall (12.6).

TABLE 8: AGE-ADJUSTED MORTALITY RATES (PER 100,000), 2014

All Cancer Lung* Breast Colorectal Prostate

MA 155.6 47.86 10.2 12.6 7.4

Arlington 150.6 33.20 --1 29.8 --1

Belmont 117.7 29.51 0.0 --1 15.0

Cambridge 137.9 41.63 12.2 7.7 6.1

Somerville 194.2 54.19 --1 10.1 --1

Waltham 176.8 53.07 10.5 8.5 9.1

Watertown 137.7 52.38 --1 --1 --1

Source: Massachusetts Department of Vital Statistics, 2014, *Massachusetts Department of Vital Statistics 2008-2012

SCREENING According to Behavioral Risk Factor Surveillance Survey data on cancer screening for colorectal and

breast cancer, the screening rates in MAH’s service area mirror that of the Commonwealth. However,

qualitative findings suggest that there are major barriers to access and disparities in screening rates for

certain racial/ethnic and enculturated segments of the population.

TABLE 9: CANCER SCREENING RATES (PERCENTAGE OF SURVEY RESPONDENTS), 2007-2009*

Community Health Network Area

(CHNA) 17

Commonwealth of

Massachusetts

Adults 50+ with

Colonoscopy or

Sigmoidoscopy in past

5 years

62.0% 63.5%

Women 40+ with

Mammogram in past 2

years

84.4% 84.5%

Source: Massachusetts Department of Public Health, Health Survey Program (BRFSS

* The MA Department of Public Health no longer reports cancer screening rates at the municipal-level. The most recent data

aggregated at the CHNA level is 2007-2009; this includes all towns in the primary service area with the exception of Waltham.

24

KEY FINDINGS RELATED TO BARRIERS TO PREVENTION, SCREENING, AND NAVIGATION

PATIENT-CENTERED BARRIERS

Insurance Status (No insurance/Under-insured) Access to health insurance that helps to pay for needed preventive, acute, and disease management

services, as well as access to comprehensive, timely accessible primary care has shown to have a

profound effect on one’s ability to prevent disease and disability, increase life expectancy, and perhaps

most importantly, increase quality of life.21 Nationally, disparities in access and health outcomes exist

for many population segments, including those in low income brackets, immigrant populations

(especially new arrivals without permanent resident status), racial/ethnic diverse segments, and LGBT

populations, just to name a few. Due to a range of mostly social factors, these groups are less likely to

have a usual source of primary care, less likely to have a routine check-up, and less likely to be screened

for illnesses, such as breast cancer, prostate cancer, or colon cancer. Data also suggests that those that

face disparities are more likely to use hospital emergency departments and inpatient services for care

that could be avoided or prevented altogether with more accessible primary care services. 22

While Massachusetts has had the lowest rates of uninsurance in the nation for years, reported at 2.8%

in September 2016 based on US Census Bureau estimates, considerable numbers of people still struggle

due to lack of health insurance or health insurance with adequate coverage. This was cited as the

leading barrier by nearly all of the clinical and support staff that participated in the assessment. There

are still large numbers of people in the service area who are uninsured or under-insured with limited

benefits. Charles River Health Center, for example, is a federally qualified health center (FQHC) with

sites in Alston and Waltham that serves large number of low income, underserved residents from Mount

Auburn’s service area. In 2015, approximately 40% of Charles River’s patients were uninsured, which

was the highest rate among all of Massachusetts’ FQHCs.

For the Cancer Center, this is particularly problematic when staff are trying to ensure that patients,

particularly those at high-risk, are able to obtain the diagnostic tests or other personalized services they

need so that they can identify cancer early and obtain appropriate, routine screening and diagnostic

services. Once diagnosed, lack of insurance or adequate coverage is less of an issue but prior to

diagnosis it can difficult, time-consuming, and sometimes impossible to provide certain vital screening

and diagnostic services for patient in need. If the Cancer Center is to make strides to reduce disparities

for the area’s most vulnerable (e.g., low income, certain racial/ethnic segments, non-English speakers,

recent immigrants), than they must be able to screen and provide personalized diagnostic services so

that patients can be diagnosed and provided appropriate treatments in a timely manner.

21 Healthy People 2020. Access to Health Services. https://www.healthypeople.gov/2020/leading-health-indicators/2020-lhi-

topics/Access-to-Health-Services Accessed 6/2/16 22 Institute of Medicine. Coverage Matters: Insurance and Health Care.

http://iom.edu/~/media/Files/Report%20Files/2003/Coverage-Matters-Insurance-and-Health-Care/Uninsurance8pagerFinal.pdf

Accessed 6/2/16

25

Low-Income/Poverty Status (Individuals/Families) Socio-economic status, as measured by income, employment status, and education, has long been

recognized as a critical determinant of health. Research shows that communities with lower socio-

economic status bear a higher disease burden, including cancer burden, and have lower life

expectancy.12 Low income populations, as defined as those living at below 200% of the federal poverty

level (FPL), are less likely to be insured, less likely to have a usual source of primary care for urgent,

routine, and preventive services (including cancer screenings), more likely to delay health care services,

and more likely to use emergency department for both emergent and non-emergent care. Moreover,

children born to low income families are, as they move into adulthood, are less likely to be formally

educated, less likely to have job security, and less likely to rise and move up to higher socio-economic

levels, this perpetuating the barrier.

As discussed above, while residents in the service area are more likely to be in middle- and upper-

income brackets compared to residents of the County and the Commonwealth overall, there are still

substantial segments of the population across all of the service area’s communities that are in low

income brackets, are on fixed-incomes, or who are considered “house poor”, who struggle to pay for

safe housing, transportation, health care services, food, utilities, and other essential items. This issue

was brought up as a major factor and barrier to care in nearly every key informant interview and focus

group. This issue was generally considered to be more important than issues of racism and was often

cited as the underlying issue with respect to some of the other social determinants such as

transportation, education, appropriate child-care, and housing.

Specifically, poverty or low income status, as well as lack of gainful, reliable employment was cited as a

barrier as it was linked to a range of underlying factors such lack of health insurance, inability to pay

health care co-pays, inability to pay for needed medications, inability to pay for childcare service so that

individuals/family members can access health care services, inability to pay for transportation. Cancer

Center clinicians and staff, clearly cited that these issues hindered patient’s ability to access the primary

care, screening, prevention, navigation, and treatment services that they needed to take care of

themselves or their families.

Race/Ethnicity, Immigration Status, and Language While data is not readily available to assess this issue among residents of Mount Auburn’s service area

specifically, national and Commonwealth data shows that there are substantial disparities in health

outcomes for those in certain racial and ethnic categories, for recent immigrants, and for those who do

not speak English or do not speak English well. While these factors can be inter-related they also have

their own unique characteristics that lead to specific challenges and barriers. For example, it is has be

shown that even if you control for other factors such as employment, income, and language status,

African Americans face disparities in access and outcomes relative to their white, Caucasian

counterparts. Racism is a factor in and of itself and has been shown to be at the heart of issues of

access, including access to cancer outreach, preventive, screening and navigation services. Foreign born

residents, especially recent immigrants or refugees and even more specifically those who are not

permanent residents or who are not specifically authorized to be in the United States, face enormous

barriers. These segments struggle to access services due sometimes to lack of health insurance, limited

26

understanding of the local culture, lack of trust, or lack of understanding of the health care system.

Finally, those who speak or read a language other than English or who do not speak or read English well

struggle to access services. These segments struggle because they cannot easily learn about or navigate

the health care system or communicate with staff or clinicians at their service sites.

These issues were discussed as major barriers in all of the interviews and focus groups that were

conducted for this assessment. These issues were particular said to be problematic in Cambridge,

Somerville, Waltham, and Watertown where there are substantial portions of racial/ethnic minorities,

recent immigrants, and non-English speakers. The most frequent comments related to this segment

were related to challenges for recent immigrants who were not acculturated, had limited ability to

communicate in English, often struggled with low income status, did not trust their service providers,

and simply struggled to navigate the health care system. A small number of interviewees said that race

was not a major factor in accessing appropriate cancer services, while others disagreed. One

interpretation of this discrepancy could be that those who are “in care” and are already accessing

primary care services are obtaining cancer-related services but that many are not in care or well

engaged in services.

Transportation Lack of transportation was a theme from the assessment’s key informant interviews and focus groups.

Lack of transportation was cited not only for having a significant impact on access to health care

services, but also as a determinant of whether an individual or family had the ability to access the basic

resources that allowed them to live productive and fulfilling lives; access to affordable and reliable

transportation widens opportunity and is essential to addressing poverty, unemployment, and goals

such as access to work, school, healthy foods, recreational facilities and a myriad of other community

resources, including health care services. Many focus group participants and interviewees identified

transportation issues for those living in Mount Auburn’s service area. While there was variation in the

nature of the issue depending on where you lived and your circumstances, transportation was identified

as an issue by people throughout the service area. Even those living in Cambridge and Somerville, who

have access to a strong public transit system expressed that transportation can be a major barrier to

accessing care; the primary issue being the expense of public transportation, followed by lack of timely,

reliable, flexible, or convenient services. In the more suburban towns in the Cancer Center’s service

area, residents are much more likely to have access to personal cars but there are still large numbers of

people in these communities, especially older adults and low income segments of the population, that

face transportation barriers. In this case, most often people cited the lack of affordable, convenient,

and flexible public transportation, particularly for those who don’t have a personal car, cannot drive

themselves, and don’t always have strong support systems.

It’s important to note that most clinicians or support staff at the Center expressed that transportation

for those who were in care was not an insurmountable problem, in fact, the navigators and case

management staff interviewed said that it was rare that they were not able to address their patient’s

transportation barriers but for those not in care or for those trying to access routine primary care and

preventive services this can hinder access to appropriate and timely care.

27

Other Patient-Related Factors (i.e., Mental Health, Substance Use, Homeless/Unstably Housed, LGBT) According to numerous interviewees many people residents throughout all of the cities/towns in the

service area face life-challenges or have to deal with stigma in the community that can greatly challenge

their ability to access services or to be treated in the same way as other segments of the population. The

segment of the population most often cited in this regard, according to interviewees and focus group

participants was those in the service area who were mentally ill or who were substance users. These

segments were said to face enormous barriers and did not have adequate support networks or

advocates who made sure that they received the care they needed, including cancer education,

screening and navigation services. In this regard there was a great need to provide tailored and

targeted services to ensure adequate access. Similarly, the homeless face tremendous stresses and

challenges that need to be addressed in careful, thoughtful, and proactive ways. Other interviewees

mentioned LGBTQ populations. According to the American Cancer Society, compared to heterosexual

individuals, LGBT people are at a greater risk of late-stage cancer diagnoses due to issues of

discrimination, stigma, and isolation that may hinder access to routine health care services and

screening tests.23

Low Literacy/Limited Health Literacy (Limited Education, Immigrants) Another frequently cited issue was the challenges that many experienced related to low literacy or

specifically low health literacy that challenged many residents ability to navigate the system, learn about

important cancer risk and protective factors, and obtain appropriate screening and treatment services.

PROVIDER-CENTERED BARRIERS

High Patient No-Show Rates and Low Payment Rates Numerous interviewees cited provider or health system barrier related to high no show rates and low

payment rates that indirectly served to limit access for those being seen at outpatient clinics. This was a

significant issue in the high risk/genetics clinic and particularly problematic for the segments of the

population who are most at-risk who tend to underserved (e.g., low income, recent immigrants, non-

English speakers). These populations have higher no-show rates and are more likely to be Medicaid

insured, which has on average lower payment rates. These are just the segments of the population who

are likely to be the target of cancer outreach, prevention, and screening efforts. In order to address

these issues, practices need to reduce no-show rates and explore how to increase payment rates or

somehow increase subsidies so that they can more easily sustain programs or services for these

segments.

Challenges related to Information Sharing and Health Information Technology (HIT) Many interviewees cited challenges related to information sharing between different components of the

health care system which limited their ability to coordinate care and/or to identify those in need of

screening and diagnostic services. Interventions targeted at enhancing communication, enhancing

provider’s ability to identify and manage care through their electronic medical record systems could

help to increase access, address barriers, and reduce the burden of cancer.

23 American Cancer Society: 2016 LGBT Communities Engagement Guide

28

EMERGING RECOMMENDATIONS

Once all of the assessment’s findings were compiled, the Cancer Management Committee participated

in a strategic planning process (December 15, 2017) that integrated data findings from the full breadth

of quantitative and qualitative sources, including information gathered from census data, the

Massachusetts Department of Public Health, the staff survey, key informant interviews, and focus

groups. Based on this review, the Cancer Management Committee agreed on the following series of

emerging recommendations that the Committee believed should guide their subsequent efforts to

identify the Cancer Center’s strategic initiatives moving forward.

TARGET EDUCATION, NAVIGATION, AND SCREENING

Recent Immigrants at SCALE, Cambridge Learning Center, Waltham Family School, and Charles

River Health Center

Persons with mental health issues, substance users, and/or developmentally disabled with local

partners (e.g., Transitional housing partners, peer recovery coaches, Springwell, outpatient

providers)

Homeless with Cambridge/Somerville Health Care for the Homeless partners

Older adults with elder service providers (e.g., Councils on Aging, Springwell, nursing homes,

assisted-living)

ENHANCE USE OF ELECTRONIC MEDICAL RECORDS

Develop red flags and monitoring tools that allow MAH’s employed/ affiliated providers to

identify and follow-up with those most at-risk

USE TELEMEDICINE FOR GENETIC COUNSELING

Pilot would allow MAH and CHA to perfect operations and explore if program is sustainable and

capable of reducing burden of cancer on at-risk target population

Telemedicine would enhance access and reduce no-show rates, which would promote

sustainability of program

ENHANCE LANGUAGE SERVICES FOR GENETIC COUNSELING CLINIC

Translation of materials would increase understanding of need for genetic counseling to prevent

cancer.

Utilization of interpreter services for appointment reminders would decrease no-show rate for

non-English speaking community members.

PROMOTE SMOKING CESSATION PROGRAMS

Recent immigrants at SCALE, Cambridge Learning Center, Waltham Family School, and Charles

River Health Center

Mentally ill, substance users, and/or developmentally disabled with local partners (e.g.,

Transitional housing partners, peer recovery coaches, Springwell, outpatient providers)

Homeless with Cambridge/Somerville Health Care for Homeless Orgs.

Older adults with elder service providers (e.g., Councils on Aging, Springwell, nursing homes,

assisted living.

29

PROPOSED STRATEGIC INITIATIVES

Once the emerging recommendations were agreed on, the Cancer Management Committee reviewed

the effectiveness of strategic initiatives implemented by the Cancer Center since the last assessment in

2014 (Appendix C). Based on this review and the emerging recommendations outlined above, the

Cancer Management Committee proposed the following three strategic initiatives.

Given the breadth, depth, and complexity of the assessment’s findings, the Cancer Management

Committee was charged with identifying initiatives that would be: 1) Feasible given resource constraints;

2) Effective based on based past experience; and 3) Impactful in light of the assessment findings related

to cancer burden, barriers to care, and target populations most at-risk.

1) Evidence-based smoking cessation programs in Waltham or Somerville targeting at risk groups

such as racial/ethnic minorities, recent immigrants, and other at-risk groups in partnership with

our community partners.

2) Mammography with at risk groups such as racial/ethnic minorities, recent immigrants, and non-

English speakers in Waltham in partnership with Charles River Community Health Center and

the Waltham Senior Center.

3) Multi-facetted, evidence-informed strategies to improve patient engagement in appropriate

genetic screening/counseling targeting at-risk segments of the population (e.g., racial/ethnic

minorities, recent immigrants, non-English speakers) through strategies such as enhanced care

coordination, patient navigation, and remote counseling technologies (e.g., skype-counseling,

telemedicine).

30

APPENDIX A: DATA FROM US CENSUS BUREAU AND MASSACHUSETTS

DEPARTMENT OF PUBLIC HEALTH

KeyStatistically higher than statewide rateStatistically lower than statewide rate

MA Arlington Belmont Cambridge Somerville Waltham Watertown

DemographicsPopulation 6,705,586 44128 25337 107916 78595 62438 33350

Age under 18 (%) 20.8 21.6 24.4 11.8 12.6 13.7 17.3

Age over 65 (%) 14.7 16.1 16.3 10.7 9.4 13.2 14.4

Race / Ethnicity / CultureWhite alone (%) 79.6 84.2 82.9 76.7 75.5 75.3 84.8

Black or African American alone (%) 7.1 2.2 1.8 10.6 7.6 6 3

Asian alone (%) 6.0 9.5 12.6 15 10.1 11.1 7.1

Native Hawaiian and Other Pacific Islander (%) 0 0 0 0.1 0 0 0

American Indian and Alaska Native (%) 0.2 0.3 0 0.2 0.1 0.1 0.2

Some Other Race (%) 4.2 0.8 0.8 2.2 3.3 4.3 2.6

Two or More Races (%) 2.9 3 1.8 4.3 3.3 3.1 2.3

Hispanic or Latino of Any Race (%) 10.6 3.4 5.3 8 9.8 13.3 11.5

Foreign Born (%) 15.5 17.9 21.5 27.1 24.7 26.2 23.1

Language Spoken at Home by Population 5 Years and Older (detailed language data on separate tab)

Speak another language at home and speak English less than "very well" (%) 8.9 5.9 8.4 7.8 11.8 11.7 10.5

Speak Spanish at home (%) 8.4 2.2 5 6.5 7.4 10.5 8.6

Other Indo-European languages (%) 8.8 13.3 13.3 16.8 12.5 14.3

Asian and Pacific Islander Languages (%) 4.0 5.7 9.2 8.7 4.5 7.2 4.5

HouseholdTotal households 2,549,721 18643 9504 43801 32181 24248 14357

Family households (families) (%) 63.6 60.1 70.1 42.2 43.4 52.4 53.8

In married couple family (%) 46.9 50.9 60.2 31.4 29.9 39 42.7

Average family size 3.2 3.02 3.18 2.78 2.97 3.01 3.05

Income and Employment (past 12 months)

Unemployment Rate among Civilian Labor Force (%) 7.6 4.6 4.7 5 5.5 6.1 7.4Median household income (dollars) 68,563.0 93,787 110,685 79416 73,106 75205 87,409Below 200% 24% 12% 10% 21% 28% 20% 19%

Below federal poverty line - all residents (%) 11.6 5 4.5 14 14.7 10 8.5

Below federal poverty line - families (%) 8.2 2.5 3.5 9 10.4 6 6.2

Below federal poverty line - under 18 years (%) 15.2 2.2 4.5 14.9 22.7 11.9 10.6

Below federal poverty line - age 65+ (%) 9.2 10.5 4.6 12.5 14.2 8.3 9.2Below federal poverty line - female head of household, no husband present (%) 25.5 2.1 9.3 22.9 26.8 20.6 34With cash public assistance income (%) 3.0 1.5 1.3 2.1 1.6 1.4 1.5With Food Stamp/SNAP benefits in the past 12 months (%) 12.5 4.6 3.9 7.7 9.3 7.6 6.3Free and Reduced Lunch Enrollment (%) 44.0 12 9 43 64 51 28

Educational Attainment (Population 25 Years and Older)

High school degree or higher (%) 89.8 95.9 97 94.3 89.3 90.1 94

Bachelor's degree or higher (%) 40.5 67.6 73.3 75.1 57.3 48.7 59.6

HousingVacant housing units (%) 9.8 5 6 9.5 3.4 6.3 5.7Owner-occupied (%) 62.1 61 63.5 37.1 34 50.3 52.1

Avg household size of owner occupied 2.7 2.63 2.85 2.2 2.51 2.5 2.32Monthly owner costs exceed 30% of household income (%) 34.5 30.6 30.9 30 40 35.2 36.7

Renter-occupied (%) 37.9 39 36.5 62.9 66 49.7 47.9Avg household size of renter occupied 2.3 1.91 2.27 2 2.27 2.04 2.28

Gross rent exceeds 30% of household income (%) 50.6 39.4 44.2 46.2 39.7 42.5 40.9

Primary Service Area

Source: US Census Bureau, American Community Survey 5-Year Estimates, 2011-2015

31


Source: Behavioral Risk Factor Surveillance System 2007-2009* (MDPH)

*2007-2009 was the last years for which the Massachusetts Department of PublicHealth collected BRFSS data at the Community Health Network Area level

Mass. CHNA 17

Behavioral Risk Factors (percent of respondents)Had a checkup in past year 76.7 73.9Fair/poor health 12.3 8.9

With a disabilityII** 21.3 19.3

Unable to see Doctor due to cost (past 12 months) 6.7 3.1

Current smoker 15.8 10.9

Former smoker 28.3 26.2

Exposed to environmental tobacco smoke 37.5 31.8

Binge drinking 17.6 15.8

Overweight/Obese 58.2 48.8

Any leisure time physical activity in past month 78.7 83.6

Consume 5+ servings of fruit and vegetables/day 26.9 33.5

Had cholesterol checked in past 5 years 84.3 85.4

Adults 65+ with flu vaccine in past 12 months 74.6 81.6

Ever told they had diabetes 7.5 5.9Current asthma 10.1 8.8Ever told they had arthritis 26.2 20.8Ever told they had cardiovascular disease (Adults 35+) 7.7 7.1Had colonoscopy/sigmoidoscopy in past 5 years (Aduls 50+) 63.5 62Had mammogram in past 2 years (Women 40+) 84.5 84.4Ever tested for HIV (Adults 18-64) 42.5 50.1Unintentional fall in past 3 months (Adults 65+) 16.1 13.5Uninsured 4 1.5

Notes:All above estimates are crude prevalence rates. No age-adjusting was done

p g y y y g q1. Are you limited in any way in any activities because of physical, mental, or emotional problems?2. Do you now have any health problem that requires you to use special equipment, such as a cane, a wheelchair, aspecial bed, or a special telephone?3. Are you blind or do you have serious difficulty seeing, even when wearing glasses?4. Because of a physical, mental, or emotional condition, do you have serious difficulty concentrating, remembering ormaking decisions?5. Do you have serious difficulty walking or climbing stairs?6. Do you have difficulty dressing or bathing?

32


Source: Massachusetts Hospital Inpatient Discharges and ED Discharges, 2008-2012 (Accessed through Massachusetts Department of Public Health)


All Types (invasive) 371.3 353.59 305.49 327.8 382.3 372.43 388.97Breast (female only) 39.08 46.17 33.28 33.53 26.4 38.92 32.24Lung 47.86 33.2 29.51 41.63 54.19 53.07 52.38Colorectal 38.41 35.59 30.54 33.44 34.97 36.38 43.73Prostate 58.15 59.32 60.69 51.13 43.39 36.42 47.15

All Types (invasive) 15.58 6.58 15.01 7.31 10.69 36.83 15.75Breast (female only) 1.93 NA 0 NA NA NA NALung 2.66 NA 0 NA 0 10.45 NAColorectal 0.83 NA 0 0 NA NA NAProstate 1.18 NA NA NA NA NA 0

Cancer ED Discharges (per 100,000)


Cancer Hospitalizations (per 100,000)

33


Source: Massachusetts Vital Statistics, 2014


Cancer Mortality (Age-adjusted per 100,000), 2014All Types (invasive) 155.6 150.60 117.70 137.90 194.20 176.80 137.70Bone 0.4 0 0 -1 0 0 0Brain and Central Nervous System 4.3 -1 0 5.8 -1 -1 -1Breast (invasive, female) 10.2 -1 0 12.2 -1 10.5 -1Bladder 4.5 -1 -1 -1 -1 -1 -1Cervical (Cervix Uteri) 0.7 0 0 0 0 0 0Colorectal 12.6 29.8 -1 7.7 10.1 8.5 -1Esophagus 4.8 -1 -1 -1 -1 -1 -1Kaposi's Sarcoma 0.0 0 0 0 0 0 0Kidney & Renal Pelvis 3.5 -1 0 -1 -1 -1 0Larynx 0.8 0 -1 -1 0 -1 0Leukemia 6.0 -1 -1 -1 -1 8.8 -1Liver & Intrahepatic Bile Ducts 6.5 -1 -1 9.8 -1 -1 -1Lymphoma, Hodgkin Disease 0.2 -1 0 0 0 0 0Lymphoma, Non Hodgkin Disease 5.3 -1 0 -1 -1 8.2 -1Melanoma of Skin 2.7 0 -1 -1 -1 0 -1Multiple Myeloma 3.6 -1 0 -1 14.9 -1 0Oral Cavity & Pharynx 2.3 -1 -1 -1 -1 -1 0Ovary 3.8 -1 -1 -1 -1 -1 0Pancreas 11 8.3 18.5 7.7 7.9 25.7 14Prostate 7.4 -1 15 6.1 -1 9.1 -1Soft Tissues 1.1 -1 0 -1 -1 0 0Stomach 3.1 -1 -1 -1 -1 -1 -1Testis 1 0 0 0 0 0 0Thyroid 0.5 0 0 -1 -1 -1 -1Uterine (Corpus Uteri) 2.5 -1 -1 0 -1 -1 0


34

Arlington Observed and Expected Case Counts, with Standardized Incidence Ratios, 2009-2013

Obs Exp SIR 95% CI Obs Exp SIR 95% CI

Bladder, Urinary Melanoma of Skin

Male 43 45.9 93.7 (67.8-126.2) Male 25 29.8 83.9 (54.3-123.8)

Female 16 17.8 89.9 (51.3-145.9) Female 26 25.4 102.3 (66.8-149.9)

Brain and Other Nervous System Multiple Myeloma

Male 8 9.0 89.1 (38.4-175.7) Male 10 9.3 107.8 (51.6-198.2)

Female 9 7.7 117.1 (53.4-222.3) Female 4 8.0 nc (nc-nc)

Breast Non-Hodgkin Lymphoma

Male 0 1.6 nc (nc-nc) Male 19 26.7 71.2 (42.8-111.2)

Female 212 195.0 108.7 (94.6-124.4) Female 33 24.9 132.4 (91.1-185.9)

Cervix Uteri Oral Cavity & Pharynx

Male 19 21.3 89.4 (53.8-139.6)

Female 2 6.9 nc (nc-nc) Female 15 10.5 142.9 (79.9-235.8)

Colon / Rectum Ovary

Male 43 50.2 85.7 (62.0-115.4)

Female 45 54.8 82.1 (59.9-109.9) Female 16 17.4 91.8 (52.4-149.1)

Esophagus Pancreas

Male 13 12.0 108.5 (57.7-185.5) Male 18 16.1 111.8 (66.2-176.8)


Hodgkin Lymphoma Prostate

Male 3 3.5 nc (nc-nc) Male 149 149.8 99.5 (84.1-116.8)

Female 5 2.8 175.9 (56.7-410.5)

Kidney & Renal Pelvis Stomach

Male 29 25.3 114.7 (76.8-164.8) Male 9 10.9 82.9 (37.8-157.5)

Female 13 15.3 84.8 (45.1-145.1) Female 5 7.1 70.4 (22.7-164.3)

Larynx Testis

Male 4 7.0 nc (nc-nc) Male 8 6.6 120.8 (52.0-238.0)

Female 3 2.3 nc (nc-nc)

Leukemia Thyroid

Male 16 18.6 85.9 (49.1-139.5) Male 12 11.8 101.6 (52.5-177.6)

Female 11 14.5 75.6 (37.7-135.3) Female 35 36.9 94.7 (66.0-131.7)

Liver and Intrahepatic Bile Ducts Uteri Corpus and Uterus, NOS

Male 17 15.7 108.0 (62.9-173.0)


Lung and Bronchus All Sites / Types

Male 69 80.8 85.4 (66.4-108.1) Male 554 599.8 92.4 (84.8-100.4)

Female 87 90.7 95.9 (76.8-118.3) Female 670 663.6 101.0 (93.5-108.9)

Obs = observed case count; Exp = expected case count;

SIR = standardized incidence ratio ( (Obs / Exp) X 100);

95% CI = 95% confidence intervals, a measure of the statistical significance of the SIR;

Shading indicates the statistical significance of the SIR at 95% level of probability;

nc = The SIR and 95% CI were not calculated when Obs < 5;

35

Belmont Observed and Expected Case Counts, with Standardized Incidence Ratios, 2009-2013



Male 26 26.9 96.6 (63.1-141.6) Male 16 16.9 94.6 (54.1-153.7)

Female 5 9.9 50.4 (16.3-117.7) Female 8 14.1 56.7 (24.4-111.8)


Male 7 5.1 137.8 (55.2-284.0) Male 6 5.3 113.7 (41.5-247.6)



Male 2 0.9 nc (nc-nc) Male 16 15.2 105.3 (60.1-171.0)

Female 130 109.9 118.3 (98.8-140.5) Female 10 13.9 72.2 (34.5-132.7)


Male 5 11.8 42.5 (13.7-99.1)



Male 21 28.8 73.0 (45.2-111.6)

Female 25 30.3 82.5 (53.4-121.8) Female 10 9.6 103.7 (49.7-190.8)

Esophagus Pancreas

Male 5 6.8 73.1 (23.6-170.6) Male 10 9.3 107.3 (51.3-197.3)



Male 2 1.9 nc (nc-nc) Male 84 85.2 98.6 (78.6-122.0)



Male 13 14.2 91.5 (48.7-156.5) Male 4 6.2 nc (nc-nc)

Female 5 8.7 57.5 (18.5-134.2) Female 5 3.9 128.2 (41.3-299.1)

Larynx Testis

Male 1 3.9 nc (nc-nc) Male 4 3.4 nc (nc-nc)


Leukemia Thyroid

Male 4 10.8 nc (nc-nc) Male 7 6.3 110.4 (44.2-227.4)

Female 5 8.2 61.1 (19.7-142.6) Female 26 20.7 125.5 (81.9-183.8)


Male 2 8.6 nc (nc-nc)



Male 32 47.1 68.0 (46.5-95.9) Male 293 342.3 85.6 (76.1-96.0)

Female 41 51.6 79.5 (57.0-107.8) Female 354 371.7 95.2 (85.6-105.7)






36

Cambridge Observed and Expected Case Counts, with Standardized Incidence Ratios, 2009-2013



Male 46 74.4 61.8 (45.3-82.5) Male 56 51.6 108.5 (81.9-140.8)

Female 17 30.0 56.7 (33.0-90.9) Female 44 49.7 88.5 (64.3-118.8)


Male 20 17.6 113.8 (69.5-175.7) Male 18 15.0 119.7 (70.9-189.2)

Female 12 15.2 78.9 (40.7-137.8) Female 7 13.6 51.5 (20.6-106.2)


Male 4 2.5 nc (nc-nc) Male 42 46.1 91.2 (65.7-123.2)

Female 299 338.6 88.3 (78.6-98.9) Female 34 43.8 77.6 (53.7-108.4)


Male 37 35.3 104.7 (73.7-144.4)

Female 9 13.7 65.5 (29.9-124.4) Female 16 18.2 88.0 (50.3-142.9)


Male 71 80.9 87.7 (68.5-110.7)

Female 69 90.6 76.1 (59.2-96.3) Female 21 31.2 67.3 (41.7-102.9)

Esophagus Pancreas

Male 14 19.7 71.1 (38.9-119.4) Male 32 26.1 122.5 (83.8-172.9)

Female 5 5.9 85.4 (27.5-199.3) Female 26 30.1 86.5 (56.5-126.7)


Male 7 10.2 68.5 (27.4-141.1) Male 247 250.3 98.7 (86.7-111.8)



Male 33 42.4 77.8 (53.6-109.3) Male 11 17.6 62.5 (31.2-111.9)

Female 14 27.1 51.6 (28.2-86.6) Female 8 11.7 68.2 (29.4-134.4)

Larynx Testis

Male 4 11.4 nc (nc-nc) Male 26 22.7 114.7 (74.9-168.1)


Leukemia Thyroid

Male 26 32.8 79.2 (51.7-116.1) Male 27 23.3 115.7 (76.2-168.4)

Female 18 26.6 67.8 (40.1-107.1) Female 78 80.6 96.8 (76.5-120.8)


Male 18 25.5 70.5 (41.7-111.4)

Female 13 9.7 133.8 (71.2-228.9) Female 67 76.7 87.3 (67.7-110.9)


Male 106 132.7 79.9 (65.4-96.6) Male 901 1018.5 88.5 (82.8-94.4)

Female 103 158.1 65.1 (53.2-79.0) Female 940 1176.9 79.9 (74.8-85.1)






37

Somerville Observed and Expected Case Counts, with Standardized Incidence Ratios, 2009-2013



Male 38 49.9 76.2 (53.9-104.6) Male 30 35.8 83.9 (56.6-119.8)

Female 19 19.7 96.3 (58.0-150.5) Female 20 34.6 57.8 (35.3-89.2)


Male 8 12.5 64.1 (27.6-126.3) Male 11 10.2 107.7 (53.7-192.7)

Female 13 10.5 124.4 (66.2-212.7) Female 11 8.9 123.0 (61.3-220.2)


Male 0 1.7 nc (nc-nc) Male 40 31.9 125.2 (89.5-170.5)

Female 176 227.3 77.4 (66.4-89.8) Female 21 29.4 71.5 (44.2-109.3)


Male 25 24.0 104.3 (67.5-154.0)

Female 10 10.1 99.3 (47.5-182.7) Female 11 12.0 91.7 (45.7-164.0)


Male 52 56.1 92.6 (69.2-121.5)

Female 48 61.4 78.2 (57.7-103.7) Female 23 20.7 110.9 (70.3-166.5)

Esophagus Pancreas

Male 11 12.9 85.6 (42.6-153.1) Male 19 17.3 109.7 (66.0-171.3)

Female 5 3.8 130.7 (42.1-304.9) Female 21 19.8 106.1 (65.6-162.2)


Male 11 7.5 146.9 (73.3-262.9) Male 144 157.2 91.6 (77.2-107.8)



Male 36 29.1 123.8 (86.7-171.3) Male 15 12.0 125.1 (70.0-206.3)

Female 24 18.3 131.5 (84.2-195.7) Female 14 7.9 178.0 (97.3-298.7)

Larynx Testis

Male 11 7.6 145.6 (72.6-260.5) Male 7 17.5 40.1 (16.1-82.6)


Leukemia Thyroid

Male 16 22.7 70.5 (40.3-114.5) Male 14 17.0 82.2 (44.9-137.9)

Female 20 18.1 110.2 (67.3-170.2) Female 50 58.7 85.1 (63.2-112.3)


Male 26 17.1 152.4 (99.5-223.3)

Female 16 6.3 252.3 (144.1-409.8) Female 48 49.4 97.2 (71.7-128.9)


Male 105 87.5 120.0 (98.1-145.2) Male 669 683.0 97.9 (90.7-105.7)

Female 100 103.8 96.3 (78.4-117.1) Female 723 792.0 91.3 (84.8-98.2)






38

Waltham Observed and Expected Case Counts, with Standardized Incidence Ratios, 2009-2013



Male 61 52.5 116.2 (88.9-149.3) Male 25 35.8 69.9 (45.2-103.2)

Female 21 20.2 104.0 (64.3-158.9) Female 14 30.7 45.6 (24.9-76.6)


Male 15 11.4 132.0 (73.8-217.8) Male 9 10.7 83.8 (38.3-159.1)



Male 2 1.8 nc (nc-nc) Male 26 31.7 82.0 (53.5-120.1)

Female 234 221.2 105.8 (92.7-120.2) Female 32 28.6 111.8 (76.4-157.8)


Male 16 25.4 63.1 (36.0-102.4)

Female 9 8.2 109.7 (50.1-208.3) Female 8 11.9 67.0 (28.9-132.1)


Male 60 57.2 104.8 (80.0-134.9)

Female 56 60.8 92.1 (69.6-119.6) Female 18 20.1 89.4 (52.9-141.3)

Esophagus Pancreas

Male 13 14.1 92.1 (49.0-157.4) Male 21 18.7 112.5 (69.6-171.9)



Male 4 5.6 nc (nc-nc) Male 146 181.6 80.4 (67.9-94.5)

Female 5 4.8 104.2 (33.6-243.1)


Male 36 30.1 119.6 (83.7-165.5) Male 18 12.5 144.2 (85.4-227.9)

Female 16 17.8 89.9 (51.4-146.1) Female 9 7.9 114.2 (52.1-216.9)

Larynx Testis

Male 5 8.3 60.1 (19.4-140.2) Male 12 11.3 105.8 (54.6-184.8)


Leukemia Thyroid

Male 19 22.2 85.5 (51.4-133.5) Male 17 15.2 112.1 (65.3-179.5)

Female 13 17.3 75.3 (40.1-128.8) Female 53 46.6 113.7 (85.1-148.7)


Male 19 18.6 102.0 (61.4-159.3)

Female 5 6.4 77.6 (25.0-181.2) Female 41 50.5 81.2 (58.3-110.2)


Male 93 95.6 97.3 (78.5-119.2) Male 667 715.5 93.2 (86.3-100.6)

Female 109 105.4 103.4 (84.9-124.7) Female 750 765.7 98.0 (91.1-105.2)






39

Watertown Observed and Expected Case Counts, with Standardized Incidence Ratios, 2009-2013



Male 35 33.3 105.2 (73.2-146.3) Male 14 21.7 64.6 (35.3-108.5)

Female 9 13.1 68.7 (31.4-130.4) Female 21 19.0 110.8 (68.5-169.3)


Male 10 6.5 153.1 (73.3-281.7) Male 5 6.7 74.3 (23.9-173.4)

Female 9 5.6 161.1 (73.5-305.7) Female 5 5.9 85.2 (27.4-198.7)


Male 0 1.1 nc (nc-nc) Male 20 19.3 103.7 (63.3-160.1)

Female 149 141.2 105.5 (89.2-123.9) Female 21 18.4 114.4 (70.8-174.9)


Male 15 14.8 101.5 (56.8-167.4)



Male 45 36.2 124.3 (90.6-166.3)

Female 38 39.0 97.5 (69.0-133.8) Female 15 12.7 118.3 (66.2-195.1)

Esophagus Pancreas

Male 9 8.4 106.9 (48.8-202.9) Male 12 11.4 105.4 (54.4-184.1)



Male 4 2.8 nc (nc-nc) Male 92 102.0 90.2 (72.7-110.7)



Male 23 17.9 128.2 (81.2-192.3) Male 8 7.8 102.4 (44.1-201.8)


Larynx Testis

Male 5 5.0 100.8 (32.5-235.2) Male 5 5.8 86.4 (27.9-201.7)


Leukemia Thyroid

Male 12 13.4 89.3 (46.1-156.0) Male 12 8.6 139.2 (71.9-243.2)

Female 10 10.4 95.8 (45.8-176.1) Female 24 28.1 85.5 (54.8-127.2)


Male 10 11.0 90.8 (43.5-167.1)

Female 6 4.1 146.0 (53.3-317.7) Female 26 31.9 81.5 (53.2-119.4)


Male 52 58.7 88.7 (66.2-116.3) Male 417 427.2 97.6 (88.5-107.4)

Female 61 70.1 87.1 (66.6-111.8) Female 470 487.1 96.5 (88.0-105.6)






40

41

APPENDIX B: DATA FROM MOUNT AUBURN HOSPITAL CANCER REGISTRY

12/1

9/2

017

3:3

5 P

M

Su

mm

ary

by

Bo

dy

Sy

ste

m a

nd

Be

st

CS

/AJ

CC

Sta

ge

Re

po

rt

MO

UN

T A

UB

UR

N H

OS

PIT

AL

Filte

r(s):

Q

uic

k F

ilte

r: Y

ear:

DIA

GN

OS

IS Y

EA

R 2

016-2

016 A

ND

( C

aseS

tatF

lag

= `

C`

):

Pri

mary

Sit

eS

tg 0

Stg

IS

tg II

Stg

III

Stg

IV

88

Un

kB

lan

k/In

vT

ota

l%

%%

%%

%%

%%

1.2

%O

RA

L C

AV

ITY

& P

HA

RY

NX

0 2

0 4

0 1

2 0

90.0

%0.7

%1.0

%0.0

%4.1

%0.0

%3.8

%

Tongue

0.1

% 0

0 0

1 0

0 0

0 1

0.0

%0.0

%0.0

%0.0

%1.0

%0.0

%0.0

%

Saliv

ary

Gla

nds

0.3

% 0

1 0

0 0

0 1

0 2

0.0

%0.4

%0.0

%0.0

%0.0

%0.0

%1.9

%

Naso

phary

nx

0.1

% 0

0 0

0 0

1 0

0 1

0.0

%0.0

%1.0

%0.0

%0.0

%0.0

%0.0

%

Tonsi

l0.4

% 0

1 0

2 0

0 0

0 3

0.0

%0.0

%0.0

%0.0

%2.0

%0.0

%1.9

%

Hyp

ophary

nx

0.3

% 0

0 0

1 0

0 1

0 2

0.0

%0.4

%0.0

%0.0

%1.0

%0.0

%0.0

%

12.3

%D

IGE

ST

IVE

SY

ST

EM

0 1

0 2

32

17

10

15

4 9

03.8

%5.6

%9.9

%27.0

%32.7

%4.5

%18.9

%

Eso

phagus

0.8

% 0

2 0

1 2

0 1

0 6

0.0

%0.4

%0.0

%3.2

%1.0

%0.0

%3.8

%

Sto

mach

1.0

% 0

0 0

4 1

0 2

0 7

0.0

%0.7

%0.0

%1.6

%4.1

%0.0

%0.0

%

Sm

all

Inte

stin

e0.3

% 0

1 0

0 1

0 0

0 2

0.0

%0.0

%0.0

%1.6

%0.0

%0.0

%1.9

%

Colo

n E

xclu

din

g R

ectu

m4.9

% 0

3 0

10

7 7

8 1

36

1.0

%3.0

%6.9

%11.1

%10.2

%0.0

%5.7

%

4C

ecu

m 0

0 0

0 1

2 1

0

1A

ppendix

0 0

0 0

1 0

0 0

9A

scendin

g C

olo

n 0

1 0

1 2

2 3

0

2H

epatic

Fle

xure

0 0

0 2

0 0

0 0

3T

ransv

ers

e C

olo

n 0

0 0

2 0

0 1

0

4S

ple

nic

Fle

xure

0 0

0 2

1 1

0 0

1D

esc

endin

g C

olo

n 0

0 0

1 0

0 0

0

12

Sig

moid

Colo

n 0

2 0

2 2

2 3

1

Rect

um

& R

ect

osi

gm

oid

1.9

% 0

2 0

3 3

1 2

3 1

42.9

%0.7

%1.0

%4.8

%3.1

%0.0

%3.8

%

7R

ect

osi

gm

oid

Junct

ion

0 0

0 2

1 0

1 3

7R

ect

um

0 2

0 1

2 1

1 0

Anus,

Anal C

anal &

Anore

ctum

0.3

% 0

0 0

0 1

1 0

0 2

0.0

%0.0

%1.0

%1.6

%0.0

%0.0

%0.0

%

Liv

er

& Intr

ahepatic

Bile

Duct

0.8

% 0

1 2

0 1

0 2

0 6

0.0

%0.7

%0.0

%1.6

%0.0

%4.5

%1.9

%

Gallb

ladder

0.4

% 0

0 0

1 1

1 0

0 3

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42

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©2017 National Cancer Data Base (NCDB) / Commission on Cancer (CoC) / Wednesday, December 20, 2017

45

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47

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4 0

110 (

1.4

%)

7N

HL -

Nodal

0 0

3 4

0 0

3N

HL -

Ext

ranodal

0 0

2 0

0 1

MY

ELO

MA

0 0

5 3

0 0

8 (

1.1

%)

Mye

lom

a 0

0 5

3 0

08 (

1.1

%)

LE

UK

EM

IA 2

0 3

5 0

010 (

1.4

%)

Lym

phocy

tic L

euke

mia

2 0

3 3

0 0

8 (

1.1

%)

7C

hro

nic

Lym

phocy

tic

Leuke

mia

2 0

3 2

0 0

1O

ther

Lym

phocy

tic L

euke

mia

0 0

0 1

0 0

Mye

loid

& M

onocy

tic

Leukem

ia 0

0 0

2 0

02 (

0.3

%)

1A

cute

Mye

loid

Leuke

mia

0 0

0 1

0 0

1C

hro

nic

Mye

loid

Leuke

mia

0 0

0 1

0 0

ME

SO

TH

ELIO

MA

0 0

3 0

0 0

3 (

0.4

%)

Meso

thelio

ma

0 0

3 0

0 0

3 (

0.4

%)

MIS

CE

LLA

NE

OU

S 0

0 1

0 8

1 0

19 (

2.6

%)

Mis

cella

neous

0 0

10

8 1

019 (

2.6

%)

Tota

l 7

37

2 1

357

349

2 2

6

0.3

%0.3

%47.4

%3.5

%48.4

%0.1

%

48

49

Race 1

1:26PM11/30/2017MOUNT AUBURN HOSPITAL

Filter(s): Quick Filter: Year:1ST CONTACT YEAR 2016-2016 AND ( CaseStatFlag = `C` ):

Count (N) Percent (%)Race 1

640(01) **INVALID** 86.84%

53(02) **INVALID** 7.19%

2(04) **INVALID** 0.27%

2(06) **INVALID** 0.27%

2(08) **INVALID** 0.27%

1(10) **INVALID** 0.14%

1(14) **INVALID** 0.14%

3(15) **INVALID** 0.41%

2(17) **INVALID** 0.27%

17(96) **INVALID** 2.31%

3(98) **INVALID** 0.41%

11(99) **INVALID** 1.49%

Total 100.00% 737

50

Postal Code at Diagnosis



Count (N) Percent (%)Postal Code at Diagnosis

7602472 10.31%

5402474 7.33%

4502155 6.11%

4402478 5.97%

4302139 5.83%

3402138 4.61%

3202140 4.34%

2802476 3.80%

2202144 2.99%

1802143 2.44%

1702145 2.31%

1502148 2.04%

1502452 2.04%

1401801 1.90%

1402453 1.90%

1302421 1.76%

1202149 1.63%

1102176 1.49%

1002141 1.36%

1002451 1.36%

702458 0.95%

601730 0.81%

601803 0.81%

601876 0.81%

501821 0.68%

501890 0.68%

502151 0.68%

502152 0.68%

502459 0.68%

402420 0.54%

402465 0.54%

301742 0.41%

302129 0.41%

302131 0.41%

302135 0.41%

302136 0.41%

302174 0.41%

302178 0.41%

302445 0.41%

302467 0.41%

201460 0.27%

201701 0.27%

201720 0.27%

201749 0.27%

201773 0.27%

201778 0.27%

201810 0.27%

201843 0.27%

201844 0.27%

201863 0.27%

201867 0.27%

201906 0.27%

201940 0.27%

201960 0.27%

202026 0.27%

202111 0.27%

51



202119 0.27%

202124 0.27%

202127 0.27%

202128 0.27%

202130 0.27%

202150 0.27%

202169 0.27%

202180 0.27%

202190 0.27%

202215 0.27%

202493 0.27%

101226 0.14%

101462 0.14%

101463 0.14%

101478 0.14%

101532 0.14%

101702 0.14%

101719 0.14%

101731 0.14%

101752 0.14%

101754 0.14%

101760 0.14%

101772 0.14%

101775 0.14%

101776 0.14%

101830 0.14%

101832 0.14%

101835 0.14%

101845 0.14%

101851 0.14%

101862 0.14%

101864 0.14%

101880 0.14%

101887 0.14%

101902 0.14%

101945 0.14%

101950 0.14%

101969 0.14%

102021 0.14%

102043 0.14%

102045 0.14%

102050 0.14%

102072 0.14%

102090 0.14%

102108 0.14%

102109 0.14%

102110 0.14%

102113 0.14%

102114 0.14%

102118 0.14%

102121 0.14%

102132 0.14%

102134 0.14%

102142 0.14%

102156 0.14%

102172 0.14%

102194 0.14%

102210 0.14%

102333 0.14%

52



102352 0.14%

102368 0.14%

102375 0.14%

102446 0.14%

102454 0.14%

102461 0.14%

102468 0.14%

102482 0.14%

102536 0.14%

102543 0.14%

102563 0.14%

102720 0.14%

103051 0.14%

103060 0.14%

103103 0.14%

103244 0.14%

103801 0.14%

103833 0.14%

103841 0.14%

104348 0.14%

104444 0.14%

117837 0.14%

185375 0.14%

Total 100.00% 737

53

Age at Diagnosis (in years)



Count (N) Percent (%)Age at Diagnosis (in years)

6 0 - 29 0.81%

1530 - 39 2.04%

8040 - 49 10.85%

12750 - 59 17.23%

22660 - 69 30.66%

16670 - 79 22.52%

9980 - 89 13.43%

1790+ 2.31%

1Unknown 0.14%

Total 100.00% 737

Range:

Mean:

22 to 93

65

54

APPENDIX C: REVIEW OF CURRENT CANCER MANAGEMENT ACTIVITIES

55

Appe

ndix

Cur

rent

Can

cer M

anag

emen

t Act

iviti

es

Stan

dard

CYPr

ogra

m

Can

cer M

anag

emen

t Goa

lsC

ance

r Man

agem

ent E

valu

atio

n of

Effe

ctiv

enes

sC

omm

ents

Prev

entio

n20

15Sm

okin

g Ce

ssat

ion

At le

ast 1

0 Co

mm

unity

Mem

ber A

tten

d.

Clas

ses

Yes,

Apr

il - 1

0 en

rolle

d, S

epte

mbe

r -12

en

rolle

d

Onl

y pr

ogra

m in

are

a. S

mal

l enr

ollm

ent

how

ever

com

mun

ity m

embe

rs e

xpre

ss

desir

e to

con

tinue

.

Prev

entio

n20

15Ed

ucat

iona

l Ses

sions

at E

SOL

prog

ram

s and

hom

eles

s sh

elte

rs

Offe

r bre

ast p

reve

ntio

n an

d ea

rly

dete

ctio

n in

form

atio

n to

at l

east

30

stud

ents

at l

ocal

ESO

L pr

ogra

ms a

nd

hom

eles

s she

lters

.

Yes,

Ove

r 130

com

mun

ity m

embe

rs

reac

hed

Valu

ed b

y co

mm

unity

par

tner

s.

Nav

igat

ion/

Bar

riers

2015

Tran

spor

tatio

n As

sista

nce

Prov

ide

tran

spor

tatio

n w

hen

it is

a ba

rrie

r for

scre

enin

g or

trea

tmen

t.

Yes,

tra

nspo

rtat

ion

to c

ance

r tr

eatm

ents

pro

vide

d th

roug

h co

mm

unity

reso

urce

s.

Cont

inue

Nav

igat

ion/

Bar

riers

2015

Tran

slatio

n of

New

Bre

ast

Dens

ity L

ette

r

Tra

nsla

tion

into

Spa

nish

, Por

tugu

ese,

W

este

rn A

rmen

ian

and

Kore

an

lang

uges

.Ye

sCo

mpl

eted

Nav

igat

ion/

Bar

riers

2015

Hoffm

an B

reas

t Cen

ter a

nd

Inte

rpre

ter S

ervi

ces

Com

mun

icat

ion

Wor

k Gr

oup

Iden

tify

path

way

of c

omm

unic

atio

n be

twee

n Ho

ffman

Bre

ast C

ente

r (HB

C)

Staf

f and

Inte

rpre

ter S

ervi

ces

Yes,

Pat

hway

com

plet

ed.

Inte

rpre

ters

w

ill p

riorit

ize H

BC c

ases

whe

n po

ssib

le.

Com

plet

ed

Nav

igat

ion/

Bar

riers

2015

Acce

ss o

ver-

the-

phon

e in

terp

rete

rs in

Hof

fman

Bre

ast

Cent

er

Hoffm

an B

reas

t Can

cer s

taff

com

plet

e co

mpe

tenc

y on

util

izing

ove

r-th

e-ph

one

inte

rpre

ter

Yes,

incr

ease

d ov

er-t

he-p

hone

ut

iliza

tion.

Com

plet

ed

Nav

igat

ion/

Bar

riers

2015

Lung

Can

cer S

cree

ning

Eval

uate

nee

d fo

r lun

g ca

ncer

scre

enin

g pr

ogra

m

Low

rate

of L

ung

Canc

er S

cree

ning

id

entif

ied.

De

velo

ped

Lung

Nod

ule

Prog

ram

Scre

enin

g20

15Ba

rron

Cen

ter M

en's

Clin

ic

Prov

ide

at le

ast 3

free

clin

ics f

or Jo

seph

M

. Sm

ith C

omm

unity

Hea

lth C

ente

r pa

tient

s (no

w) C

harle

s Riv

er C

omm

unity

He

alth

(CRC

H) re

quiri

ng p

rost

ate

canc

er

scre

enin

g/ev

alua

tion.

Yes

, 5 c

linic

s hel

d w

ith n

avia

gtio

n fo

r 3

patie

nts.

Jose

ph M

. Sm

ith C

omm

unity

Hea

lth

(CRC

H) h

as id

entif

ied

path

way

to

urol

ogy

depa

rtm

ents

at o

ther

hos

pita

ls to

mee

t thi

s nee

d.

Scre

enin

g20

15

Hoffm

an B

reas

t Cen

ter

Colla

bora

tion

With

Jose

ph M

. Sm

ith C

omm

unity

Hea

lth

Cent

er (C

RCH)

Prov

ide

brea

st c

ance

r scr

eeni

ng a

nd

follo

w u

p di

agno

sitc

eval

uatio

n fo

r Jo

seph

M. S

mith

Com

mun

ity H

ealth

(C

RCH)

pat

ient

s.

Yes,

174

scre

enin

g m

amm

ogra

ms a

nd

116

diag

nost

ic m

amm

ogra

ms p

rovi

ded

Jose

ph M

. Sm

ith (C

RCH)

staf

f con

tinue

to

iden

tify

need

for t

hese

serv

ices

.

56

Appe

ndix

Cur

rent

Can

cer M

anag

emen

t Act

iviti

es

Stan

dard

CYPr

ogra

m

Can

cer M

anag

emen

t Goa

lsC

ance

r Man

agem

ent E

valu

atio

n of

Effe

ctiv

enes

sC

omm

ents

Prev

entio

n20

16Ed

ucat

iona

l Ses

sions

at E

SOL

prog

ram

s and

hom

eles

s sh

elte

rs

Offe

r bre

ast p

reve

ntio

n an

d ea

rly

dete

ctio

n in

form

atio

n to

at l

east

30

stud

ents

at l

ocal

ESO

L pr

ogra

ms a

nd

hom

eles

s she

lters

.

Yes,

ove

r 200

com

mun

ity m

embe

rs

reac

hed

Valu

ed b

y co

mm

unity

par

tner

s.

Nav

igat

ion/

Bar

riers

2016

Tran

slatio

n of

Hof

fman

Bre

ast

Cent

er d

ocum

ents

. T

rans

latio

ns o

f at l

east

the

top

10

docu

men

ts i

nto

Span

ish.

16 d

ocum

ents

tran

slate

d.

Com

plet

ed

Scre

enin

gs20

16

Hoffm

an B

reas

t Cen

ter

Colla

bora

tion

With

Cha

rles

Rive

r Com

mun

ity H

ealth

(fo

rmer

ly) J

osep

h M

. Sm

ith

Com

mun

ity H

ealth

Cen

ter

Prov

ide

brea

st c

ance

r scr

eeni

ng a

nd

follo

w u

p di

agno

sitc

eval

uatio

n fo

r Ch

arle

s Riv

er C

omm

unity

Hea

lth

(form

erly

) Jos

eph

M. S

mith

Com

mun

ity

Heal

th p

atie

nts.

Yes,

41

scre

enin

g m

amm

ogra

ms a

nd

37 d

iagn

ostic

mam

mog

ram

s pro

vide

d

Char

les R

iver

Com

mun

ity H

ealth

staf

f ha

ve id

entif

ied

decr

ease

d v

olum

e ho

wev

er th

ese

serv

ices

are

still

nee

ded.

Nav

igat

ion/

Bar

riers

2016

Tran

slatio

n of

Dist

ress

Sca

le T

rans

latio

n in

to S

pani

sh, P

ortu

gues

e,

Wes

tern

Arm

enia

n an

d Ko

rean

la

ngug

es.

Yes

Com

plet

ed

Nav

igat

ion/

Bar

riers

2016

Lung

Can

cer S

cree

ning

Hire

RN

Nav

igat

orN

avig

ator

Hire

dCo

mpl

eted

Prev

entio

n20

16Sm

okin

g Ce

ssat

ion

Goal

: At l

east

10

Com

mun

ity M

embe

rs

to a

tten

d cl

asse

sYe

s, J

anau

ary

12 e

nrol

led,

Apr

il 6

enro

lled

Plan

to c

hang

e m

odel

to p

ilot m

ontly

se

ssio

ns w

hich

had

low

enr

ollm

ent.

Prev

entio

n20

16Pr

osta

te C

ance

r Disp

artiy

Su

ppor

t Cam

brid

ge H

ealth

Alli

ance

's ef

fort

s to

addr

ess P

rost

ate

Canc

er

inci

dece

in B

lack

Men

Yes,

supp

ort p

rodu

ctio

n an

d tr

ansla

tion

of c

omm

unity

edu

catio

n vi

deos

.Co

ntin

ue

Nav

igat

ion/

Bar

riers

2016

Tran

spor

tatio

n As

sista

nce

Prov

ide

tran

spor

tatio

n w

hen

it is

a ba

rrie

r for

scre

enin

g or

trea

tmen

t.

Yes,

tran

spor

tatio

n to

can

cer

trea

tmen

ts p

rovi

ded

thro

ugh

com

mun

ity re

sour

ces.

Cont

inue

and

doc

umen

t whe

re p

atie

nts

are

bein

g se

en.

Prev

entio

n20

17Sm

okin

g Ce

ssat

ion

Pilo

t Fre

edom

from

Sm

okin

g Cl

ass.

At

leas

t 10

com

mun

ity m

embe

rs to

att

end.

Yes,

2 st

aff t

rain

ed a

s lea

ders

8

atte

nded

the

first

cla

ss.

Low

att

enda

nce.

Con

tinue

to e

valu

ate.

Prev

entio

n20

17Pr

osta

te C

ance

r Disp

artiy

Pr

ovid

e at

leas

t tw

o ou

trea

ch e

vent

s to

incr

ease

aw

aren

ess a

bout

pro

stat

e ca

ncer

in B

lack

men

Yes,

2 e

vent

s com

plet

ed a

nd g

rant

pr

ogra

m fo

r mor

e pr

ogra

ms i

n Ca

mbr

idge

and

Som

ervi

lle d

esig

ned

Eval

uate

d ef

fect

iven

ess o

f Cam

brid

ge

and

Som

ervi

lle g

rant

pro

gram

.

Prev

entio

n20

17Br

east

Can

cer C

omm

unity

Ed

ucat

ion

Wor

k w

ith im

mig

rant

wom

en in

So

mer

ville

to d

esig

n ed

ucat

ion

prog

ram

ab

out e

arly

det

ectio

n of

bre

ast c

ance

r.

Yes,

Bre

ast H

ealth

Aw

arne

ss v

ideo

cr

eate

d an

d re

cord

ed in

Eng

lish

and

Span

ishCo

mpl

eted

57

Appe

ndix

Cur

rent

Can

cer M

anag

emen

t Act

iviti

es

Stan

dard

CYPr

ogra

m

Can

cer M

anag

emen

t Goa

lsC

ance

r Man

agem

ent E

valu

atio

n of

Effe

ctiv

enes

sC

omm

ents

Nav

igat

ion/

Bar

riers

2017

Lung

Nod

ule

Nav

igat

ion

Desig

n a

prog

ram

to c

onne

ct to

prim

ary

care

pat

ient

s ide

ntifi

ed w

ho h

ad l

ung

nodu

le fi

ndin

g on

a C

T in

201

6 an

d do

no

t hav

e a

prim

ary

care

phy

sicia

n.

Yes,

pro

gram

des

igne

d an

d be

ing

impl

emet

ed.

Cont

inue

nav

igat

ion.

Nav

igat

ion/

Bar

riers

2017

Tran

spor

tatio

n As

sista

nce

Prov

ide

tran

spor

tatio

n w

hen

it is

a ba

rrie

r for

scre

enin

g or

trea

tmen

t.

Yes,

tran

spor

tatio

n to

can

cer

trea

tmen

ts p

rovi

ded

thro

ugh

com

mun

ity re

sour

ces.

59%

to M

D ap

poin

tmen

ts, 3

7% to

can

cer

trea

tmen

ts.

Cont

inue

Prev

entio

n20

17O

utre

ach

to L

GBT

Com

mun

ity

Prov

ide

smok

ing

educ

atio

n to

LGB

T yo

uth.

N

o, 2

sess

ions

pro

vide

d in

com

mun

ity

sett

ings

with

low

enr

ollm

ent.

Disc

ontin

ue

Prev

entio

n20

17Ed

ucat

iona

l Ses

sions

at E

SOL

prog

ram

s and

hom

eles

s sh

elte

rs

Offe

r bre

ast

and

lung

can

cer p

reve

ntio

n an

d ea

rly d

etec

tion

info

rmat

ion

to a

t le

ast 3

0 st

uden

ts a

t loc

al E

SOL

prog

ram

s an

d co

mm

unity

mem

bers

at h

omel

ess

shel

ters

.

Yes o

ver 1

20 c

omm

unity

mem

bers

re

ache

d Va

lued

by

com

mun

ity p

artn

ers.

Nav

igat

ion/

Bar

riers

2017

Lung

Nod

ule

Surv

ellie

nce

Prog

ram

Deve

lop

Nod

ule

Net

pro

gram

to tr

ack

patie

nts w

ith p

oten

tial b

arrie

rs to

car

e.Ye

s, p

rogr

am in

itiat

edCo

ntin

ue

Scre

enin

g20

17

Hoffm

an B

reas

t Cen

ter

Colla

bora

tion

With

Cha

rles

Rive

r Com

mun

ity H

ealth

Ce

nter

Prov

ide

brea

st c

ance

r scr

eeni

ng a

nd

follo

w u

p di

agno

sitc

eval

uatio

n fo

r Ch

arle

s Riv

er C

omm

unity

Hea

lth

patie

nts.

Data

not

ava

ilabl

e un

til Ja

nuar

y 20

18TB

D

Scre

enin

g20

17Fr

ee M

amm

ogra

phy

Even

t

Prov

ide

brea

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58

Documents

Commission on Cancer Community Needs Assessment · The Cancer Management Committee met periodically throughout the ... lymphoma and myeloma, breast, colorectal, gynecological, lung,