May 2010: The Hawaii Society of Clinical Oncology (HSCO) serves 92 members, including physicians, nurses, pharmacists, and patient advocates. Past HSCO President William S. Loui, MD, discussed with ASCO Connection the organization’s efforts to reach out to underserved groups in the diverse population of the Hawaiian islands. Some of these efforts were funded by an ASCO State Affiliate Grant, which HSCO used to create patient education materials for patients who speak Tagalog and Ilokano.

AC: What are some of the unique challenges faced by oncologists living and working in Hawaii? How has the society worked to address those challenges?

Dr. Loui: Since Hawaii is at the crossroads to the Pacific Ocean, there is a tremendous diversity of cultures and ethnic groups here. This diversity is a strength in that there is a spirit of welcoming others and an accepted tolerance of others—this is often called the “Aloha Spirit.”

The numerous ethnic groups present a great challenge in effective communications. We have first-generation immigrants whose native language is not English, so we struggle in regards to informed consent.

I like the metaphor of trying to discuss Einstein’s Theory of Relativity in another language (like French) and then asking people to make an important choice when the options are not always clear.

AC: How and when did the society identify a need for patient education materials in Tagalog and Ilokano?

Dr. Loui: It came from daily clinical experience. Since Filipinos are the third largest ethnic group and the fastest growing ethnic group [in Hawaii], we struggle with being able to talk meaningfully about the diagnosis, prognosis, treatment options, side effects of therapy, and goals of treatment. Although Tagalog is the official language in the Philippines, Ilokano [the third most spoken language in the Philippines] is the most common dialect spoken in Hawaii (due to immigration patterns). We developed written material in cooperation with the University of Hawaii Language Department. These were reviewed by community volunteers, including medical students at the John A. Burns School of Medicine, University of Hawaii.

Creating a DVD was the most significant suggestion that came out of community focus groups run by the Asian American Network of Cancer Awareness, Research and Training (AANCART). It also meant that the project would be more complex, expensive, and time-consuming than translating pamphlets. The DVD project ended up costing four times more than our original estimates. It reminded me of the advice I got about a kitchen remodel: that it would take twice as long and cost three times as predicted. Fortunately, other community groups helped out when approached. We had additional funding from the American Cancer Society, Friends of the Cancer Center, The Queen’s Medical Center in Honolulu, and Hawaii Pacific Health Care System. Truly, the project was embraced by our community in Hawaii.

The DVD has three major sections: patient stories of struggle and success (which address the concerns brought forth from patient focus groups); discussion of treatment options (surgery, radiation, chemotherapy, and clinical trials); and information about the six most common cancers in Filipinos in Hawaii (breast, lung, colon, prostate, liver, and thyroid). We included a section about clinical trials in the DVD, as there’s great confusion about them.

AC: How did the 2007-2008 ASCO State Affiliate Grant help you get the project underway?

Dr. Loui: The ASCO grant was critical in jumpstarting the project. We had many people agree that it was a good idea, but many others who thought it was impossible to do. Once we got the grant, we got serious about the project goals, timelines, and deliverables. One doctor questioned why we should create these materials and predicted that “they’ll just end up in the landfill.”

But when ASCO provided the grant, all of a sudden, people focused on the task and on what needed to be done.

AC: How has the society proceeded from the original patient materials project? Has there been a continued focus on health disparities?

Dr. Loui: We tried to answer this major problem of health care disparity by working with our community partners. We have finished the final edits on the DVD and are pushing to the distribution phase. We plan to distribute it to patient, doctors, clinics, and cancer programs. We are planning to utilize it for health education initiatives, patient navigator programs, and treatment programs.

We will be making a special effort to reach the underserved in rural areas on each of the islands of Hawaii (which poses special problems with water barriers to travel and access to care), and Guam (where there is a substantial Filipino population). At times, it seems that we are so far away from the continental United States (Honolulu is actually closer to Tokyo, Japan, than to Washington, DC!). Yet we’ve made tremendous progress from the plantation medicine in the past.

Finally, we plan to put all of the material on various websites to provide the widest access to the information.

Health care disparities continues to be a passion of mine, and  I've agreed to serve on ASCO Health Care Disparities Advisory Group starting this year.

AC: What else is happening in cancer care in Hawaii?

Dr. Loui: Last year, the Minority-based Community Clinical Oncology Program (CCOP) in Hawaii won an award from ASCO for its active participation in clinical trials. Two hospital-based cancer programs achieved Level 1 ratings from the American College of Surgeons (ACOS) Commission on Cancer; one won the Outstanding Achievement Award even though the hospital was in bankruptcy. One of the breast center programs in Honolulu scored a perfect score on the evaluation visit from the National Accreditation Program of Breast Centers (NAPBC).

This year, an innovative cross-cultural patient navigator program at Queen’s Medical Center was awarded the Harold Freeman Award from the American Cancer Society. Paul Morris, MD, the previous HSCO president and Board Member, was named the Principal Investigator for a National Cancer Institute (NCI) Community Cancer Center Program (NCCCP) award of  $3.3 million at the Queen's Medical Center. This was a very competitive award and only 14 sites around the nation received one. As chief of the Oncology Department, I'm delighted that it'll fund projects to address health care disparities, enlarge our cancer survivorship program, and encourage clinical trial enrollment, as well as fund information technology efforts and help to establish a biospecimen repository.

AC: What are the society’s major priorities and initiatives for the remainder of 2010?

Dr. Loui: HSCO continues to provide continuing medical education (CME) with nationally renowned speakers, to promote community service projects, to support cancer treatment and prevention trials, and to help members stay alert to the many changes in health care legislation. We also participate in national trials through the Southwest Oncology Group (SWOG), National Surgical Adjuvant Breast and Bowel Project (NSABP), North Central Cancer Treatment Group (NCCTG), Eastern Cooperative Oncology Group (ECOG), and Cancer Trials Support Unit (CTSU) networks.

We strive to provide excellent medical care in a culturally sensitive fashion, and we do good work.