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 traveled to local communities around the United States to moderate question-and-answer sessions with patients, survivors, caregivers, and oncology professionals. Providers gave expert answers to patient questions and learned about the vital needs of patients in these communities. Members who participated in these town hall sessions, “ASCO in the Community: Listening and Learning From Our Patients,” shared the knowledge they gained in a series of blog posts over the year.
In this post, Margaret Kemeny, MD, FACS, details key points from discussions that took place at Queens Cancer Center in New York City in March 2019.
Describe your role in the town hall meeting and related discussions at Queens Cancer Center.
MK: Dr. Bertagnolli told me she was traveling around the country talking with doctors and patients, and I was thrilled when she said she wanted to come to Queens Cancer Center to hear directly from our staff and the community. I worked with Linda Bulone, RN, OCN, CCRC, director of clinical research, to arrange meetings with five of our patients and their oncologists. I know all these patients very well, and it was touching to hear them say they consider our staff to be family and that they have such a high level of trust that they’re getting the best possible care. We all got a little emotional.
Our team of doctors, nurses, social workers, and our new psychologist also had an engaging and informative discussion over lunch with Dr. Bertagnolli about the challenges we face as a public hospital. These challenges include meeting the needs of a very diverse community, finding and retaining qualified staff for lower salaries than at private hospitals, covering the high cost of cancer treatments for patients without insurance, and caring for patients whose biggest problem might not be their cancer diagnosis but something else, such as worry about having food or housing for their families. In addition, our patients still present with late-stage disease at a frequency of 1.5 to 2 times the national average. The center sees approximately 2,000 new patients each year and, since 2002, has enrolled almost 1,000 patients on 87 clinical trials.
What is the cancer landscape in the area is served by Queens Cancer Center?
MK: Queens is a borough of New York City that by itself ranks as the fifth largest city in the United States. It is also among the most diverse, with more than 60% of its 2.2 million residents belonging to minority groups and many different languages spoken throughout the borough.
Queens Hospital is one of the 11 hospitals that make up NYC Health + Hospitals, the largest public hospital system in the United States. Ninety-two percent of our patients are minorities. Most patients do not have insurance, and many are undocumented. Our mission is to deliver state-of-the-art cancer care to everyone regardless of their ability to pay, their socioeconomic status, or their immigration status. Currently, 52% of Queens Hospital patients are covered by either Medicaid or Medicaid Managed Care plans, and 17% are uninsured.
I came to Queens Hospital in 2001 to establish a cancer treatment and research program. I saw the great need of this community and decided that I could use my experience as an administrator, clinician, and researcher to make it possible for these patients to be treated in their own community, where they would have a better chance for success. We had to be able to care for people whose biggest problem might not be their cancer diagnosis but something else. Some were homeless. Some worried about having food for their kids or being able to find a job.
The center is also bringing clinical trials to patients who might otherwise have no chance of enrolling. It’s unacceptable not to have the best clinical research available to everyone, particularly minority patients for whom we desperately need more data. I often use this quote from Martin Luther King, Jr.: "Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”
To help both our patients and the hospital find necessary resources, I recruited three social workers and a financial advisor. We also have a patient navigator who makes sure that we don’t lose the people who can’t get through the system on their own, and that’s most of them. Every new patient must meet with both a social worker and the patient navigator during their first visit. This establishes a relationship with a team member who then calls them the day before each scheduled visit to make sure that they remember and have a means of travel to their appointments. With 108 languages spoken by the hospital’s patients, these meetings and calls often require translators.
The center also has a therapy dog. Sometimes we see patients who are afraid or withdrawn, and even if they don’t want to interact with anyone, they will immediately take to the dog. With all the languages spoken among our patients and staff, the dog wordlessly bridges the gap and is a calming and soothing presence.
Shortly after the cancer center opened, we conducted an anonymous survey of clinic patients, asking if they ever either skipped medication doses to buy food, or went without meals to buy medication. We found that 75% of clinic patients were identified as having food insecurity. In response, we added a food pantry, which is a huge benefit for many of our patients.
An ongoing challenge is finding and retaining oncologists, nurses, and other members of the oncology team. We get young people who are just fantastic, and they get even better after they practice for a while in this incredible environment. But then we lose them to other cancer centers because we can’t pay comparable salaries. I don’t blame them, because they have families and educational bills to pay, but it’s very difficult to replace them.
Please tell us a bit about the relationship between Queens Cancer Center and the surrounding community, and the collaborative efforts that the hospital has led for cancer awareness, tobacco cessation, etc. What has made those outreach efforts so successful?
MK: Community outreach efforts through the cancer center have resulted in more people in Queens being screened with mammography, a decrease in the percentage of women diagnosed with late-stage breast cancer—from 33% in 2000 to 12% in 2018, more residents getting colonoscopies, and more people are being advised by their doctors to stop smoking and entering tobacco cessation programs.
To achieve these positive outcomes in the community, we partnered with the Queens Public Library and Memorial Sloan Kettering Cancer Center to create the Queens Library HealthLink. Cancer Action Councils were established in 20 library branches in the poorest communities; a Mammovan was purchased to offer screening at these library branches; outreach programs were conducted at schools, churches, and community centers; and translators were added to our education sessions. We also helped implement best practices for treating tobacco dependence in hospitals and health centers, and we conducted workshops for nursing students, HealthLink staff, school-based health centers, and Korean Community Services.
Dr. Kemeny, a surgical oncologist, is director of the Queens Cancer Center and a professor of surgery at Mt. Sinai School of Medicine.