In a new colocation model for cancer diagnostic services, researchers have found that a new program installed at a community health center that cares for historically underserved populations was able to reduce the time to cancer diagnosis from a median of 32 days to 12 days, according to an article published by Stockman et al in the JCO Oncology Practice.
“The primary goal of this intervention was to decrease the time it took to complete cancer diagnoses,” explained senior study author Christopher Lathan, MD, MS, MPH, Associate Professor of Medicine at Harvard Medical School, and Chief Clinical Access and Equity Officer and Associate Medical Director at the Dana-Farber Cancer Institute. “We got it down to 12 days, which was surprising and amazing,” he added.
Cancer disparities are well documented among patients who identify as Black, American Indian/Native American, and People of Color in the United States. According to the American Cancer Society, Black patients have lower 5-year cancer survival rates than White patients, and are more likely to be diagnosed with advanced-stage cancer—when treatment is more difficult and less successful.
Creating an In-House Cancer Diagnostic Clinic to Address Disparities
In the new study, the researchers initiated a program in 2012 in partnership with a federally qualified community health center offering primary care and other health services to a predominantly Black community. They designed the program to bring oncology diagnostics and cancer-specific patient navigation services from the Dana-Farber Cancer Institute—a National Cancer Institute–designated cancer center—into the community health center in order to provide cancer diagnostic services.
Such colocation models have been successful before in other areas of medicine, such as cardiology, but this is the first to attempt to provide cancer diagnostics. The program was designed to be iterative and responsive. For instance, over time, the community health center developed a lung cancer screening program and an oral health program.
“By being present in the clinic day in and day out, year in and year out, you build trust with the providers and the patients,” highlighted Dr. Lathan. “We were able to listen to the practitioners and develop programs over time that support their needs,” he underscored.
At the start of the program, five oncologists at the Dana-Farber Cancer Institute and the oncology nurse navigator would see patients referred by primary care providers at the community health center and evaluate abnormal laboratory values, scans, symptoms such as sudden weight loss, family history of cancer, follow-up care after a previous cancer diagnosis, and other matters related to solid tumors or hematologic malignancies. Because the entire program was built with clinical nurse navigation at its foundation, the oncology diagnostics team did not provide direct cancer treatment. Instead, they worked with the nurse navigator to help direct patients to the appropriate next steps—such as prevention services, diagnostic tests, or care at a treatment center. For instance, patients who were in need of scans may have been directed to a local hospital with the proper scanning equipment or to the Dana-Farber Cancer Institute on the basis of the patients’ history, preference, and insurance.
“This was a clinic set up to help primary care providers with any cancer-related question,” noted Dr. Lathan. “Our goal was to respond with a reasonable and sensible plan as quickly as possible,” he emphasized.
The researchers found that 10% of the patients who were involved in the study enrolled in clinical trials—doubling the historical rate of 5% for marginalized populations. Among the subset of patients seen at the community health center who were diagnosed with cancer, the enrollment rate for clinical trials was even higher.
Conclusions
“The clinical trial numbers are intriguing, but more research is required to understand this change. We don’t want to overgeneralize and say we have a solution for the complex challenge of disparities in cancer care delivery,” Dr. Lathan stressed. “But I do think this is a model that could be further evaluated and hopefully utilized and adjusted in many different ways to specifically improve the diagnosis of all cancers,” he concluded.
The researchers noted that further studies may be needed to understand the cost-effectiveness of the intervention, its scalability, and to get a qualitative sense of how patients responded to the colocation model—which is now in operation at two other federally qualified community health centers.
Disclosure: The research in this study was funded by a grant from the Robert and Myra Kraft Family Research 20 Foundation’s Kraft Family Research Fund at the Dana-Farber Cancer Institute. For full disclosure of the study authors, visit ascopubs.org.
