2018-2019 ASCO President Monica M. Bertagnolli, MD, FACS, FASCO, is putting the words of her presidential theme—Caring for every patient, learning from every patient”—into action. During her term, she and other ASCO leaders will travel to local communities around the United States to moderate question-and-answer sessions with patients, survivors, caregivers, and oncology professionals. Providers will provide expert answers to patient questions and learn about the vital needs of patients in these communities. Members who participate in these town hall sessions, “ASCO in the Community: Listening and Learning From Our Patients,” will share the knowledge they’ve gained in a series of blog posts throughout the year.
In this post, Eduardo Miranda, MD, details key points from patient-focused discussions that took place in Laredo, TX, in October 2018 in conjunction with a breast cancer public forum and fashion show. Read takeaways for patients on the Cancer.Net Blog.
What was your role in the discussions that took place during Laredo patient and survivor events?
EM: The participating cancer survivors wanted to have their treating physicians join them, their family members, and friends. I treated most of these survivors, so it was important for me to be there to greet them. I wanted to share their moments of celebration and be by their side during the conversation on challenges to quality cancer care and ways to meet them.
What is the cancer care landscape in Laredo?
EM: Laredo is located on the very edge of the southern U.S. border in Texas. The population is about 90% Hispanic, and many families have a history in this area that dates back 300 years. It’s a predominantly young community; the median age is 27. Here, patients with cancer tend not to feel alone or neglected because family ties are very strong and they often have a very supportive circle of friends. In general, patients have a great respect for the treating physicians and trust that we’re always doing our best to help them. However, our city has 300,000 people and only three medical oncologists. Two are employed by a hospital, and I’m an independent medical oncologist.
Each of the two hospitals in Laredo has a radiation center, but we rely heavily on surgical specialists from San Antonio, TX, 160 miles away, to perform many cancer-related procedures. Many patients are uninsured. In addition, some health insurers are placing restrictions on the authorization of standard-of-care tests and treatments for their members affected with cancer. Despite these challenges, working as an oncologist in this community has a very special meaning. Our patients place all of their hopes for a good outcome on us because they want to be close to their loved ones while receiving care. I always feel compelled to find the best strategies to deliver the same quality cancer care they may find in larger centers.
In many areas of the United States, language and cultural barriers can make it hard for Hispanic patients to access quality cancer care. However, Laredo isn’t ethnically diverse. The majority of health care providers and their staff are bilingual, so the language barrier isn’t an issue. The strong support from family members and friends of patients also mitigate cultural barriers that physicians in other communities may face. One important point is that these supporters often attend appointments, taking notes and helping our patients follow our recommendations. Whether physicians are working in underserved or diverse areas or not, they should encourage this kind of participation. It can help reduce a patient’s stress and anxiety and allow them to more accurately review information after the appointment.
In Laredo, patients without insurance can be directed to our county indigent health care program. If they qualify, they’re given vouchers to cover visits, tests, and treatments at Medicaid rates. Also, our staff helps patients apply for free or reduced-cost medications through the pharmaceutical companies’ patient assistance programs. Undocumented patients are seen at a local Catholic institution staffed by nurse practitioners. We also see those patients and help them apply for financial and practical assistance through various local and nationwide foundations.
What were your key takeaways for medical professionals from the discussions?
EM: Everyone deserves quality cancer care. In my office waiting room, you’ll find patients from all walks of life. They all share something in common—their desire to fight a difficult disease. Our community pulls together with various support programs, and families also help a lot. It’s just a matter of not feeling intimidated to initiate the care of someone without the best insurance plan or no insurance plan.
What role do events like the fashion show and related discussions play in building community in Laredo?
EM: Events like these help people see how well patients with cancer are doing after going through cancer treatment in our community. They learn that it’s possible to access quality cancer care right here at home. These types of events also raise awareness and confidence among our referring physicians. In addition, they allow us to hear about real-world cancer barriers from both the patient and provider perspective, which helps provide direction on what solutions need to be implemented.
Dr. Miranda is a board-certified specialist in medical oncology, hematology, and internal medicine. He operates a community cancer center in Laredo, TX, and is the chair of the Cancer Committee at Doctor’s Hospital Laredo. Since 1999, Dr. Miranda and his staff have worked to improve care for people with cancer in Laredo and the surrounding communities of Webb, Hebbronville, Zapata, and Hidalgo.