Findings of the Comprehensive Cancer Needs Assessment Piedmont Health District Presented by: Justine...

Findings of the Comprehensive Cancer Needs Assessment

Piedmont Health DistrictPresented by: Justine A. Young, RN, BSN, MBA

Goal 1: Perform a comprehensive cancer needs assessment in four Health Districts located within the Southside/Southwest Tobacco County area.

Goal 2: Mobilize resources into the Southside and Southwest Counties for which comprehensive cancer needs assessments were performed to address identified needs.

TOBACCO INDEMNIFICATION AND COMMUNITY REVITALIZATION COMMISSION GRANT

Saving Lives and Reducing Suffering and Death from Cancer in Virginia

TOBACCO INDEMNIFICATION AND COMMUNITY REVITALIZATION COMMISSION GRANT

Saving Lives and Reducing Suffering and Death from Cancer in Virginia

Comprehensive Cancer Needs AssessmentGuided by a broad based Advisory CommitteeParameters Assessed:Cancer burden Cancer care services – detection, treatment,

survivorship Community resources for cancer patients & caregiversCommunity physician informationPopulation based information

Behavioral Risk Factor Data

Cancer Screening Behaviors:• Colorectal Screening• Breast and cervical

screening• Prostate Screening

Access to Care:• Insurance• Inability to see a physician • Regular physician visits

Cancer Prevention Behaviors:• Diet• Physical exercise• Weight• Tobacco use

Population Based Information

Focus Group Data

General Population Local perception of health issues Attitudes and barriers to

preventive health behaviors Perceptions of cancer and clinical

trialsCancer Survivors and

Caregivers Experience in HD with diagnosis,

treatment, follow-up care Barriers to detection and

treatment Resources needs of community Clinical trials

Total population = 104,000 7 counties : all designated as medically underserved.

all designated as rural (except Amelia County and parts of Cumberland County)

Demographic Profile of Piedmont Health District

Category SubcategoryPIEDMONT VIRGINIA

count percent count percent

GenderMale 42,788 51% 2,978,956 48%Female 40,700 49% 3,168,391 52%

Age

18-39 30,433 36% 2,432,581 40%40-49 14,817 18% 1,190,020 19%50-64 21,644 26% 1,547,809 25%

65+ 16,594 20% 976,937 16%

Race

White 53,337 64% 4,133,385 67%

Black or AA 27,052 32% 1,135,015 18%

Other 3,099 4% 878,947 14%

Ethnicity

Hispanic or Latino 1,783 2% 426,857 7%

Non-Hispanic or Latino 81,705 98% 5,720,490 93%

Other Factors

Poverty Status 24,024 22.9% 1,967,020 7.2%

Unemployment Rate 4,207 8.9% 276,350 6.5%

Median Income level $39,718 $60,316

Total 83,488 100% 6,147,347 100%





Age

18-39 30,433 36% 2,432,581 40%40-49 14,817 18% 1,190,020 19%50-64 21,644 26% 1,547,809 25%

65+ 16,594 20% 976,937 16%

Race

White 53,337 64% 4,133,385 67%

Black or AA 27,052 32% 1,135,015 18%

Other 3,099 4% 878,947 14%

Ethnicity



Other Factors

Poverty Status 24,024 22.9% 1,967,020 7.2%



Total 83,488 100% 6,147,347 100%





Age

18-39 30,433 36% 2,432,581 40%40-49 14,817 18% 1,190,020 19%50-64 21,644 26% 1,547,809 25%

65+ 16,594 20% 976,937 16%

Race

White 53,337 64% 4,133,385 67%

Black or AA 27,052 32% 1,135,015 18%

Other 3,099 4% 878,947 14%

Ethnicity



Other Factors

Poverty Status 24,024 22.9% 1,967,020 7.2%



Total 83,488 100% 6,147,347 100%





Age

18-39 30,433 36% 2,432,581 40%40-49 14,817 18% 1,190,020 19%50-64 21,644 26% 1,547,809 25%

65+ 16,594 20% 976,937 16%

Race

White 53,337 64% 4,133,385 67%

Black or AA 27,052 32% 1,135,015 18%

Other 3,099 4% 878,947 14%

Ethnicity



Other Factors

Poverty Status 24,024 22.9% 1,967,020 7.2%



Total 83,488 100% 6,147,347 100%





Age

18-39 30,433 36% 2,432,581 40%40-49 14,817 18% 1,190,020 19%50-64 21,644 26% 1,547,809 25%

65+ 16,594 20% 976,937 16%

Race

White 53,337 64% 4,133,385 67%

Black or AA 27,052 32% 1,135,015 18%

Other 3,099 4% 878,947 14%

Ethnicity



Other Factors

Poverty Status 24,024 22.9% 1,967,020 7.2%



Total 83,488 100% 6,147,347 100%





Age

18-39 30,433 36% 2,432,581 40%40-49 14,817 18% 1,190,020 19%50-64 21,644 26% 1,547,809 25%

65+ 16,594 20% 976,937 16%

Race

White 53,337 64% 4,133,385 67%

Black or AA 27,052 32% 1,135,015 18%

Other 3,099 4% 878,947 14%

Ethnicity



Other Factors

Poverty Status 24,024 22.9% 1,967,020 7.2%



Total 83,488 100% 6,147,347 100%

Data source: 2010 Census Summary File 1 - (Virginia) [machine-readable data files]/prepared by the U.S. Census Bureau, 2011

• All population number are for ages 18+• Poverty level uses total population of 104,609• Unemployment rate uses the total population of employable citizens

• High 65+ group-retirement area

• 32% black, 64% white

• Poverty: • 22.9% vs 7.2% state

• Unemployment: • 8.9% vs 6.5% state


Category Subcategory

PIEDMONT VIRGINIA


Gender Male 42,788 51% 2,978,956 48%

Female 40,700 49% 3,168,391 52%

Age

18-39 30,433 36% 2,432,581 40%

40-49 14,817 18% 1,190,020 19%

50-64 21,644 26% 1,547,809 25%

65+ 16,594 20% 976,937 16%

RaceWhite 53,337 64% 4,133,385 67%

Black or AA 27,052 32% 1,135,015 18%

Other 3,099 4% 878,947 15%

Ethnicity Hispanic or Latino 1,783 2% 426,857 7%


Total Population 83,488 100% 6,147,347 100%Data source: 2010 Census Summary File 1 - (Virginia) [machine-readable data files]/prepared by the U.S. Census Bureau, 2011. All population numbers are for ages 18 and over.

Economic Characteristics of counties within Piedmont Health District

Location Amelia Buckingham Charlotte Cumberland Lunenburg Nottoway Prince Edward

Piedmont(average) Virginia

Education3 (25 years and older)

% Less than high school 25.40% 36.80% 29.30% 28.30% 29.40% 27.80% 18.10% 27.87% 14.20%

% High school or GED

41.10% 35.80% 34.50% 40.60% 39.10% 37.30% 44.70% 39.01% 26.30%

% Bachelor’s degree or above

9.60% 12.60% 13.10% 10.50% 9.00% 12.10% 19.00% 12.27% 33.50%







41.10% 35.80% 34.50% 40.60% 39.10% 37.30% 44.70% 39.01% 26.30%


9.60% 12.60% 13.10% 10.50% 9.00% 12.10% 19.00% 12.27% 33.50%







41.10% 35.80% 34.50% 40.60% 39.10% 37.30% 44.70% 39.01% 26.30%


9.60% 12.60% 13.10% 10.50% 9.00% 12.10% 19.00% 12.27% 33.50%

In Buckingham, percentage of population with less than high school education is greater

than 47.8% for the age group 18-24 years old.US Census Burea, American Factfinder

Educational Attainment’ 2006-2010, 5 year estimate

All Other Sites

Brain, Nervous System, Eye

Oral Cavity, Pharynx

Heme-malignancies

Urinary System

Gynecological*

Respiratory

GI

Female Breast*

Male Genital System*

All Sites

0 25 50 75 100 125 150 175 200

56.2

10.8

10.5

34.3

32.9

46.1

72.8

84.0

155.2

168.1

41.0

10.8

11.0

29.6

34.2

47.3

80.9

91.3

152.6

182.9

Age-Adjusted Incidence Rate by Cancer Site - Piedmont vs. Virginia

Piedmont Virginia

Age-adjusted Incidence Rate per 100,000 Population

Ca

nce

r S

ite

* Rate for Male Genital System is shown per 100,000 males; Rates for Gynecological and Female Breast are shown per 100,000 females.Data Source: Virginia Cancer Registry(averaged rates for1999-2008) – all rates calculated based on populations including all ages.

All Sites0 100 200 300 400 500

486.9

Age-Adjusted Incidence Rate by Cancer Site – Piedmont vs. Virginia

Average Annual Number of Cancer Cases (1999-2008)

Cancer Site Piedmont

All Sites 566

GI 107

Male Genital System* 97

Respiratory 95

Female Breast* 91

Urinary System 39

Heme-malignancies 33

Gynecological* 28

Oral Cavity, Pharynx 12

Brain, Nervous System, Eye 11

All Other Sites 46

Male Genital System: includes prostate and all other genital cancers.Gynecological: includes cervical, ovarian, uterus NOS, and all other gynecological cancers.Heme-malignancies: includes lymphomas, myelomas, leukemia.Respiratory: includes lung/bronchus, and other respiratory cancers.GI: includes colon/rectum and other gastrointestinal cancers.

All Other Sites

Oral Cavity Cancer

Brain, Nervous System, Eye

Urinary System

Heme-malignancies

Gynecological*

Female Breast*

Male Genital System*

GI

Respiratory

0 10 20 30 40 50 60 70

28.0

1.7

3.9

8.3

15.1

13.5

24.6

25.3

39.0

53.8

28.2

2.6

4.5

11.4

12.4

15.3

27.5

28.4

42.8

63.1

Age-Adjusted Mortality Rates by Cancer Site - Piedmont vs. VirginiaPiedmont Virginia

Age-adjusted Mortality Rate per 100,000 Population

Canc

er S

ite

All Sites0 50 100 150 200

199.2

Age-Adjusted Mortality Rate by Canceer Site – Piedmont vs. Virginia

* Rate for Male Genital System is shown per 100,000 males; Rates for Gynecological and Female Breast are shown per 100,000 females.Data Source: Vital Statistics Department, VDH (averaged rates 2005-2009) – all rates calculated based on populations including all ages.

Male Genital System: includes prostate and all other genital cancers.Gynecological: includes cervical, ovarian, uterus NOS, and all other gynecological cancers.Heme-malignancies: includes lymphomas, myelomas, leukemia.Respiratory: includes lung/bronchus, and other respiratory cancers.GI: includes colon/rectum and other gastrointestinal cancers.

Average Annual Number of Cancer Deaths (2005-2009)

Cancer Site Piedmont

All Sites 244

Respiratory 78

GI 53

Female Breast* 17

Heme-malignancies 15

Urinary System 14

Male Genital System* 14

Gynecological* 10

Brain, Nervous System, Eye 5

Oral Cavity Cancer 3

All Other Sites 35

Table G – medical oncology admissions

Piedmont Resident Inpatient Medical Oncology Admissions to hospitals within and outside of health district (CY2010)

Admitting Hospital # of admissions % of admissions Charges

Hospitals within patient health district 37 14.2% $ 526,209

SOUTHSIDE COMMUNITY HOSPITAL INC. 37 14.2% $ 526,209

Hospitals outside of patient health district 223 85.8% $ 10,075,236

UNIVERSITY OF VIRGINIA MEDICAL CENTER 46 17.7% $ 2,642,416

CJW MEDICAL CENTER - CHIPPENHAM 46 17.7% $ 2,780,594

MEDICAL COLLEGE OF VIRGINIA 41 15.8% $ 2,311,778

CENTRA HEALTH, INC. 19 7.3% $ 430,600

BON SECOURS ST. FRANCIS MEDICAL CENTER 15 5.8% $ 447,378

HALIFAX REGIONAL HEALTH SYSTEM INC. 14 5.4% $ 265,591

COMMUNITY MEMORIAL HEALTHCENTER 13 5.0% $ 255,453

HENRICO DOCTORS' HOSPITAL - FOREST 11 4.2% $ 426,766

BON SECOURS ST. MARY'S HOSPITAL 8 3.1% $ 315,849

MARTHA JEFFERSON HOSPITAL 7 2.7% $ 113,754

SOUTHSIDE REGIONAL MEDICAL CENTER 2 0.8% $ 27,124

MEDICORP AT STAFFORD, LLC 1 0.4% $ 57,932

Grand Total 260 100.0% $ 10,601,445

Facility Survey Takeaways

CANCER-RELATED SERVICES Not Available IN PIEDMONT

Imaging Services• Radiation treatment• CT colonography

Surgical Services• Breast reconstruction• GI-liver/pancreas • Lung

Counseling• Oncology certified dietician to provide nutritional counseling specific to cancer

patients• Cancer patient navigator

Desired Programs• No established clinical trial programs• No Palliative Care programs

Other

Too busy

Lack of screening facilities

Don't believe they are necessary

Afraid of being diagnosed with cancer

Lack of transportation

Apprehension about the test

Financial constraints

Lack of insurance

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

7%

11%

14%

36%

46%

50%

64%

82%

89%

Most common reasons patients choose not to have recommended cancer screenings as identified by physicians

Percentage of responding physicians *_________________________________________________________________________________________________* - Percentage is calculated based on the total number of responses for each reason selected out of the total number of physicians that completed the questionnaire and identi-fied their practice area as part of health district.

Physicians Survey Takeaways

Key Leader Physicians stated they are unsure of narcotic dosages and uncomfortable with end of life drug issues.

Pain Management

Surveillance of cancer recurrence

Long-term cancer treatment effects: monitoring and palliation

Wellness and prevention of cancer recurrence

Genetic counselling for family members of cancer patients

End-of-life care and planning

Post-cancer treatment care topics on which physicians are interested to receive more information

Less Interested Interested Highly Interested

Physicians Survey Takeaways

Lack of financial resources Uninsured/Underinsured Underutilization of EWL and other programs

Lack of integrated system between GP, oncologist,

HH and hospice

No Cancer Support Services No support groups Hospice underutilized

Lack of specialists MD recruitment issues Recent loss of multiple specialists Two oncologists part-time for the district

Education Knowledge deficit of MD’s r/t pain control for Hospice patients Inconsistencies on screening guidelines

Key leader and physician perspective

0

10

20

30

40

50

60

70

80

32.024.7

69.6

23.0 23.622.426.7

61.4

18.424.3

LifestylePIEDMONTVA

Perc

ent a

ge (%

)

Behavioral Risk Factor Surveillance System Analysis

Data Source: BRFSS datasets – aggregated years 2006-2010.* - indicates a significant statistical difference;

Whi

te

(ref

)

Bla

ck

or A

A *

<$2

5K *

$25K

≤ H

I ≤ $

50K

>$5

0K (r

ef)

Hig

h Sc

hool

/ G

ED o

r le

ss *

Som

e Co

llege

or

high

er

(ref

)

Race/Ethnicity

Household Income

Education

0

5

10

15

20

25

30

35

40

45

50

27.8

47.6

36.4 35.8

19.2

39.4

23.5

% of Adults With No Exercise in the past 30 daysPe

rcen

t age

(%)

* - indicates a significant statistical difference; (ref) - indicates reference group; & - indicates standard error > 5

Data Source: BRFSS datasets – aggregated years 2006-2010.Racial category “All Other Races” not shown due to low sample number of survey respondents (n<20), weighted sample (<6000)Racial category “White” includes white non-Hispanic population, racial category “Black or African American” includes black non-Hispanic population.

- Black population less likely to exercise- Low wage earners exercise less- Less educated not likely to exercise



No health insurance *

1

Unable to see doctor

because of cost *2

Visited doctor last year

3

Have a primary physician

4

0

2

4

6

8

10

12

14

16

18

20

17.8 18.4

11.4 12.0

Health Care Access

PIEDMONT

VA

Perc

enta

ge (%

)

Data Source: BRFSS datasets – aggregated years 2006-2010.* - indicates a significant statistical difference

White(ref)

Blackor AA *

<$25K *

$25K ≤ HI ≤

$50K

>$50K (ref)

18-39 *

40-49 50-64 65+ (ref)

Race/Ethnicity

Household Income Age

0

5

10

15

20

25

30

35

40

13.7

29.634.7

14.1

5.9 26.5

17.3 14.8

8.1

% Not Able To See Doctor Because of Cost in the Past YearPe

rcen

tage

(%)


* - indicates a significant statistical difference; (ref) - indicates reference group; & - indicates standard error > 5

Data Source: BRFSS datasets – aggregated years 2006-2010.Racial category “All Other Races” not shown due to low sample number of survey respondents (n<20), weighted sample (<6000)Racial category “White” includes white non-Hispanic population, racial category “Black or African American” includes black non-Hispanic population.

Clinical Trials: ◦ “Pharmaceutical profit”

Logistics: ◦ “I have to go all the way to South Hill for a mammogram. Over an hour away!”

Financial:◦ “Me, without insurance. I’m not going to get the treatment.”

Environmental: ◦ “They put up signs about a year ago not to drink the water at work.”◦ “I had 9 people within a 3 mile radius of my home with cancer. 7 had breast CA.”

Lifestyle:

◦ “They make processed food look so much more appealing.” ◦ “Eating healthy is expensive.”◦ “The community is not geared toward exercise.”◦ “I’m 18 now. I’d say 80% of my friends smoke.”

General Population Focus Groups Takeaways

Barriers to care: ◦ limited facilities◦ travel logistics◦ cost of treatment

Support Service: ◦ “I needed more coordination of events. I was drowning.”◦ “I needed the facts.”◦ “I had to put my faith in God and the doctors.◦ “There is no support besides my family. Nothing, no one.”

Research: ◦ “It is happening somewhere, but I don’t know where it is.”◦ “Someplace far away, Boston. New York, Mayo Clinic…”

Cancer Survivors Focus Groups Takeaways

Resources: ◦ Utilization of Programs (EWL)◦ Mental health support◦ Development of support groups◦ Mobilization of the Faith Community◦ Identifying/writing grants

Environmental Issues: ◦ Identification of hazards ◦ Toxic waste◦ Aerial spraying◦ Bio-solids

Education: ◦ Promotion of exercise◦ Promotion of healthy diets (Farmers markets)◦ Stop smoking campaign◦ Educational Programs targeting early development

MD Education: ◦ Clarification of screening guidelines ◦ Narcotic usage in hospice◦ Local resources

Research / Intervention Needs

District Task Force ◦ Incorporating the healthcare facilities and

organizations, local government, the school systems, and the available expertise at VCU

Cancer Patient Navigator/Resource Center

Summation

Findings of the Comprehensive Cancer Needs Assessment Piedmont Health District Presented by: Justine...

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