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Findings of the Comprehensive Cancer Needs Assessment Piedmont Health District Presented by: Justine A. Young, RN, BSN, MBA.

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Presentation on theme: "Findings of the Comprehensive Cancer Needs Assessment Piedmont Health District Presented by: Justine A. Young, RN, BSN, MBA."— Presentation transcript:

1 Findings of the Comprehensive Cancer Needs Assessment Piedmont Health District Presented by: Justine A. Young, RN, BSN, MBA

2 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

3 Comprehensive Cancer Needs Assessment Guided by a broad based Advisory Committee Parameters Assessed: Cancer burden Cancer care services – detection, treatment, survivorship Community resources for cancer patients & caregivers Community physician information Population based information

4 Physician Information Key Leader Interviews Healthcare needs related to cancer prevention, detection, treatment, and follow-up care Needs of primary care physicians related to cancer detection and follow-up care of patients Physician questionnaire Cancer screening and perspective on patient compliance with screening Care of patient during cancer treatment and follow-up - communication Continuing education needs – screening, follow- up care

5 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 trials Cancer Survivors and Caregivers Experience in HD with diagnosis, treatment, follow-up care Barriers to detection and treatment Resources needs of community Clinical trials

6 Total population = 104,000 7 counties :all designated as medically underserved. all designated as rural (except Amelia County and parts of Cumberland County)

7 Demographic Profile of Piedmont Health District CategorySubcategory PIEDMONTVIRGINIA countpercentcountpercent Gender Male42,78851%2,978,95648% Female40,70049%3,168,39152% Age 18-3930,43336%2,432,58140% 40-4914,81718%1,190,02019% 50-6421,64426%1,547,80925% 65+16,59420%976,93716% Race White53,33764%4,133,38567% Black or AA27,05232%1,135,01518% Other3,0994%878,94714% Ethnicity Hispanic or Latino 1,7832%426,8577% Non-Hispanic or Latino 81,70598%5,720,49093% Other Factors Poverty Status24,024 22.9%1,967,020 7.2% Unemployment Rate 4,207 8.9% 276,350 6.5% Median Income level $39,718 $60,316 Total83,488100%6,147,347100% Demographic Profile of Piedmont Health District CategorySubcategory PIEDMONTVIRGINIA countpercentcountpercent Gender Male42,78851%2,978,95648% Female40,70049%3,168,39152% 18-3930,43336%2,432,58140% 40-4914,81718%1,190,02019% 50-6421,64426%1,547,80925% 16,594976,937 Race White53,33764%4,133,38567% Black or AA27,05232%1,135,01518% Other3,0994%878,94714% Ethnicity Hispanic or Latino 1,7832%426,8577% Non-Hispanic or Latino 81,70598%5,720,49093% Other Factors Poverty Status24,024 22.9%1,967,020 7.2% Unemployment Rate 4,207 8.9% 276,350 6.5% Median Income level $39,718 $60,316 Total83,488100%6,147,347100% Demographic Profile of Piedmont Health District CategorySubcategory PIEDMONTVIRGINIA countpercentcountpercent Gender Male42,78851%2,978,95648% Female40,70049%3,168,39152% Age 18-3930,43336%2,432,58140% 40-4914,81718%1,190,02019% 50-6421,64426%1,547,80925% 65+16,59420%976,93716% 53,3374,133,385 27,0521,135,015 3,099878,947 Ethnicity Hispanic or Latino 1,7832%426,8577% Non-Hispanic or Latino 81,70598%5,720,49093% Other Factors Poverty Status24,024 22.9%1,967,020 7.2% Unemployment Rate 4,207 8.9% 276,350 6.5% Median Income level $39,718 $60,316 Total83,488100%6,147,347100% Demographic Profile of Piedmont Health District CategorySubcategory PIEDMONTVIRGINIA countpercentcountpercent Gender Male42,78851%2,978,95648% Female40,70049%3,168,39152% Age 18-3930,43336%2,432,58140% 40-4914,81718%1,190,02019% 50-6421,64426%1,547,80925% 65+16,59420%976,93716% Race White53,33764%4,133,38567% Black or AA27,05232%1,135,01518% Other3,0994%878,94714% Ethnicity Hispanic or Latino 1,7832%426,8577% Non-Hispanic or Latino 81,70598%5,720,49093% 24,024 1,967,020 Unemployment Rate 4,207 8.9% 276,350 6.5% Median Income level $39,718 $60,316 Total83,488100%6,147,347100% Demographic Profile of Piedmont Health District CategorySubcategory PIEDMONTVIRGINIA countpercentcountpercent Gender Male42,78851%2,978,95648% Female40,70049%3,168,39152% Age 18-3930,43336%2,432,58140% 40-4914,81718%1,190,02019% 50-6421,64426%1,547,80925% 65+16,59420%976,93716% Race White53,33764%4,133,38567% Black or AA27,05232%1,135,01518% Other3,0994%878,94714% Ethnicity Hispanic or Latino 1,7832%426,8577% Non-Hispanic or Latino 81,70598%5,720,49093% Poverty Status24,024 22.9%1,967,020 7.2% 4,207 276,350 Median Income level $39,718 $60,316 Total83,488100%6,147,347100% Demographic Profile of Piedmont Health District CategorySubcategory PIEDMONTVIRGINIA countpercentcountpercent Gender Male42,78851%2,978,95648% Female40,70049%3,168,39152% Age 18-3930,43336%2,432,58140% 40-4914,81718%1,190,02019% 50-6421,64426%1,547,80925% 65+16,59420%976,93716% Race White53,33764%4,133,38567% Black or AA27,05232%1,135,01518% Other3,0994%878,94714% Ethnicity Hispanic or Latino 1,7832%426,8577% Non-Hispanic or Latino 81,70598%5,720,49093% Poverty Status24,024 22.9%1,967,020 7.2% Unemployment Rate 4,207 8.9% 276,350 6.5% Total83,488100%6,147,347100% 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

8 Data source: 2010 Census Summary File 1 - (Virginia) U.S. Census Bureau, 2011

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11 Demographic Profile of Piedmont Health District Category Subcategory PIEDMONTVIRGINIA count percentcount percent Gender Male42,788 51% 2,978,956 48% Female40,700 49% 3,168,391 52% Age 18-3930,433 36% 2,432,581 40% 40-4914,817 18% 1,190,020 19% 50-6421,644 26% 1,547,809 25% 65+16,594 20% 976,937 16% Race White53,337 64% 4,133,385 67% Black or AA27,052 32% 1,135,015 18% Other3,099 4% 878,947 15% Ethnicity Hispanic or Latino 1,783 2% 426,857 7% Non-Hispanic or Latino 81,705 98% 5,720,490 93% 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.

12 Economic Characteristics of counties within Piedmont Health District Location AmeliaBuckinghamCharlotteCumberlandLunenburgNottoway Prince Edward Piedmont (average) Virginia Education 3 (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% % Bachelors degree or above 9.60%12.60%13.10%10.50%9.00%12.10%19.00%12.27%33.50% Economic Characteristics of counties within Piedmont Health District Location AmeliaBuckinghamCharlotteCumberlandLunenburgNottoway Prince Edward Education 3 (25 years and older) 25.40%36.80%29.30%28.30%29.40%27.80%18.10% % High school or GED 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% Economic Characteristics of counties within Piedmont Health District Location AmeliaBuckinghamCharlotteCumberlandLunenburgNottoway Prince Edward Education 3 (25 years and older) 25.40%36.80%29.30%28.30%29.40%27.80%18.10% % High school or GED 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% 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

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

14 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.

15 Percent of Cases Identified at Cancer Stages – Piedmont vs. Virginia 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. Percentages calculated out of cases with reported cancer stage (unstaged/unknown cases were omitted in the calculations). All rates calculated based on populations including all ages. Data Source: Virginia Cancer Registry (1999-2008) HD = Piedmont VA = Virginia

16 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 admissionsCharges Hospitals within patient health district3714.2% $ 526,209 SOUTHSIDE COMMUNITY HOSPITAL INC.3714.2% $ 526,209 Hospitals outside of patient health district22385.8% $ 10,075,236 UNIVERSITY OF VIRGINIA MEDICAL CENTER4617.7% $ 2,642,416 CJW MEDICAL CENTER - CHIPPENHAM4617.7% $ 2,780,594 MEDICAL COLLEGE OF VIRGINIA4115.8% $ 2,311,778 CENTRA HEALTH, INC.197.3% $ 430,600 BON SECOURS ST. FRANCIS MEDICAL CENTER155.8% $ 447,378 HALIFAX REGIONAL HEALTH SYSTEM INC.145.4% $ 265,591 COMMUNITY MEMORIAL HEALTHCENTER135.0% $ 255,453 HENRICO DOCTORS' HOSPITAL - FOREST114.2% $ 426,766 BON SECOURS ST. MARY'S HOSPITAL83.1% $ 315,849 MARTHA JEFFERSON HOSPITAL72.7% $ 113,754 SOUTHSIDE REGIONAL MEDICAL CENTER20.8% $ 27,124 MEDICORP AT STAFFORD, LLC10.4% $ 57,932 Grand Total260100.0% $ 10,601,445

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18 Facility Survey Takeaways

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

21 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 MDs r/t pain control for Hospice patients Inconsistencies on screening guidelines Key leader and physician perspective

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23 Behavioral Risk Factor Surveillance System Analysis Data Source: BRFSS datasets – aggregated years 2006-2010. * - indicates a significant statistical difference;

24 Behavioral Risk Factor Surveillance System Analysis Data Source: BRFSS datasets – aggregated years 2006-2010. * - indicates a significant statistical difference; (ref) - indicates reference group; & - indicates standard error > 5

25 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 Behavioral Risk Factor Surveillance System Analysis

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

27 Behavioral Risk Factor Surveillance System Analysis * - 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.

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29 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. Im 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. Im 18 now. Id say 80% of my friends smoke. General Population Focus Groups Takeaways

30 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 dont know where it is. Someplace far away, Boston. New York, Mayo Clinic… Cancer Survivors Focus Groups Takeaways

31 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

32 District Task Force Incorporating the healthcare facilities and organizations, local government, the school systems, and the available expertise at VCU Cancer Patient Navigator/Resource CenterSummation


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