Addressing Cancer Care Barriers Through Community Outreach and Support

For our Institute for Value-Based Medicine® event cohosted with NYU Langone Health in October 2024, we spoke with Oscar B. Lahoud, MD, clinical associate professor at NYU School of Medicine; section chief, hematology, NYU Langone Health in Brooklyn; and director for strategy and network operations, Hematology/Oncology, the Perlmutter Cancer Center, and Kasey Bond, MPH, executive director, operations, Perlmutter Cancer Center.

In these interviews, we learn how NYU Langone Health and the Perlmutter Cancer Center in Brooklyn work to optimize community relationships and patient outcomes through targeted outreach initiatives.

This transcript has been lightly edited for clarity; captions were auto-generated.

Transcript

How do you work to strengthen community relationships and patient care access?

Lahoud: The vision at NYU, which is the one I share, is that people should not have to travel to access any cutting-edge therapy. Right now, I came here as the section chief of hematology to build a bone marrow transplant and cell therapy program. We have 2.9 million people in Brooklyn, [but] no transplant program, no CAR [chimeric antigen receptor] T-cell program. Everybody has to travel to Manhattan that has less than half the size of the population. Why?

There's like 5 or 6 academic institutions in Manhattan. We're the only ones at NYU in Brooklyn engaging in clinical trials and advancing the field. So I'm hoping that once we build this strong, full-fledged academic infrastructure, where there would be nothing that Manhattan would have to offer that we wouldn't have in Brooklyn, that we'll truly get that real-world population.

There’s conflicting data on this, but for example, with allogeneic bone marrow transplant, there was some data—although not all studies agreed with that—suggesting that the further out you are from the transplant center, the worse the mortality outcomes are from the transplant, and beyond 1 year. So the thought and the rationale could make sense, like you can't follow up as often and people are not keeping as close an eye on you as they could just because of the distance from the transplant center.

The societies recognize that. We have the same with CAR T cells, issues with access, but also follow-up and survivorship afterward. There could be assistance with transportation or various mechanisms, but ultimately the best way is to be right next to them through their entire journey. And I hope that our center and institution will pave the way for others to follow and try and bring that level of care closer to where patients really need [it] without having to worry about the payer mix.

I don't want to be judgmental of others, but there are institutions, say in Manhattan, that are clearly catering or tailored toward a certain privileged population and where these kinds of things don't matter. But here, we've been very fortunate to have philanthropic support from, for example, the Bezos family, here in Brooklyn towards our Beyond Bridges program that Dr Brita Roy discussed at the IVBM.

Really, the idea is to help patients navigate all of this from the get-go. At our cancer center, I have a dedicated hematology nurse manager that basically helps patients navigate everything. Do you need a PET scan? Do you need transportation for that? And social workers, basically, they become part of the care team. The navigators, patient navigators, and community health workers are truly engaged and follow our patients throughout. That's the only way to really address and prevent no-shows and basically collapsing of the treatment plan, because we have to acknowledge that someone cannot just take 2 hours off in the middle of their day if they're caring for their 2 toddlers that don't have daycare, that don't have a nanny.

We have to figure out a way to make it work, and that's what we're addressing through this program and through our patient navigation program as well.

Bond: I could talk about this all day, I think, so I will try to be succinct. We have a really robust community outreach and education program at the Cancer Center that has multiple different initiatives, all of which, though, share common themes.

So we have the B. Welters Breast Cancer Navigation Program that deploys community health workers to communities of Black women to help educate them about breast cancer screening. What's amazing about the program is that it's not just about education, but it's also about navigation to and through screening. We often say with the Welters program that breast cancer screening is not just a mammogram. I think too many institutions look at it as, “OK, what percentage of our patients are getting a mammogram?”, when from our perspective, it's not just the mammogram. It's if you have findings in that mammogram, do you know what your next step is? Are you able to get to that next step? Are you able to get an appointment with diagnostic imaging or with a surgeon if you need to see a surgeon? What's amazing about the Welters program is that it not only educates and introduces these patients into the system, but then it helps navigate through the system and through their treatment if that's something that's needed. So that's one example.

We also have 2 programs in Brooklyn. One is called Stamp Out Cancer Brooklyn, and the other is the Beyond Bridges initiative. These are both philanthropically funded projects that the institution has really bought into and put a lot of support behind in addition to that philanthropy. The sort of cornerstone of these programs is bringing the community to the health care that is needed. And again, not just bringing them in the door, but then helping them through once they get in the door. These are programs where there are a large number of community health workers [CHWs] that are supported. They are multilingual. They cover varying communities in Brooklyn: the Spanish community, Chinese-speaking community, Arabic, Orthodox Jewish. There are many community health workers that are supporting these programs.

It has allowed us to do things like, right now, every new cancer patient that is seen at our Sunset Park location is presented at something that we call navigation rounds. The idea is to identify any health-related social needs that a patient may have at their entry point into the system, instead of waiting until they don't show up for their treatment 2 times a row—and then we understand that they have some kind of transportation issue that we didn't know about at the onset.

These kinds of programs have allowed us to commit CHW resources and nurse navigator resources to review our patients and help address any barriers to their care up front. So that early intervention is a big cornerstone of what we're doing in these programs.

Those are just a couple of examples—the Welters program, the Stamp Out Cancer Brooklyn program, the Beyond Bridges program—where NYU and Perlmutter Cancer Center are really investing in the health of the community and in caring for the whole patient. I think something that I'm very proud of is that our institution really acknowledges that all of these factors that have nothing to do with somebody's blood tests or what their CT scan looks like, all of these other factors affecting their life really have a direct impact on their health outcomes. And we want to take care of both their tumor that needs treatment and we want to help take care of all of these other aspects of their life that are more social determinants of health but still need support.