Memorial Sloan Kettering program focuses on cancer disparities among U.S. immigrants

Immigrants are considerably underserved in terms of health care in the United States.

Memorial Sloan Kettering Cancer Center launched its Immigrant Health and Cancer Disparities Service in 2011. The program aims to identify and eliminate disparities in health care and cancer treatment among immigrants and minorities.

Through an array of community-based programs, the initiative provides a gateway to health education, services and access into clinical trials for the medically underserved communities throughout New York City and across the country.

HemOnc Today spoke with Francesca Gany, MD, chief of the Immigrant Health and Cancer Disparities Service program at Memorial Sloan Kettering Cancer Center, about the importance of bridging the gap between immigrants and the U.S. health care system, how the program is unique, and ways in which other institutions can create their own similar programs.

Question: How did the Immigrant Health and Cancer Disparities Service come about?

Answer: I completed my residency training at Bellevue Hospital Center and, at that time, there was a large influx of immigrants — mostly males from the West African nation of Senegal. These men were working very long hours and were all living in a hotel near the hospital. When they began not feeling well, they would come into the ER because it was open at the time they were off from work. Some of the men spoke French, and I spoke French, so I was the one interacting with them. Forty of the men were experiencing the same exact symptoms, but by the time they came back in to see me, their symptoms had gone away and they were no longer ill. I could see that something else was going on within this community that could not be explained by what normal tests revealed. I enlisted the help of someone from West Africa and we went out into the community and asked what they think happened with their illness and what they were doing to take care of it. We learned they were experiencing an illness that is common in Senegal, and that they used specific things to help heal themselves. I worked with them and we contacted healers in Senegal and we would talk on the phone while they were in my clinic. Through all of this, we got to know the community better. With time, their wives started to come over from Senegal, and as their community grew, we had a great linkage with the community and there were few barriers to health care. This got us to think about what was going on with all of the other immigrant groups in New York City. When it was time for me to do my fellowship, I did a fellowship in general medicine and health policy in which I analyzed all of the New York state department of health programs for immigrant accessibility. Through this, I got to know other people who were working in this area, and this led to the first ever symposium on immigrant health. It brought together a lot of like-minded individuals who focused on epidemiological issues, health care access issues, etc. Then, the tuberculosis epidemic surfaced in New York City, and the department of health called upon us to develop a model that would help us work with these communities to decrease their rate of tuberculosis and increase their treatment rate. We use this model worldwide now and it is a very successful model. We decided to apply this model to the cancer setting. We were funded by the NCI to develop the Cancer Awareness Network for Immigrant and Minority Populations. We also launched the patient navigation program to help immigrant patients navigate into and through cancer health care and to end-of-life treatment. This was a very successful model that also expanded to cardiovascular disease. We are now working with a number of communities throughout New York City, and it has become a national model. At this point, Memorial Sloan Kettering became very interested in becoming more engaged in disparities work and becoming more involved in the community.

Q: Can you describe the need for this initiative, as well as its mission?

A: Memorial Sloan Kettering was interested in a community-engaged research approach in order to better understand cancer disparities from a genetic and genomic level, and also through a system like health services research and behavioral sciences. This was 5 years ago, and we are now conducting a lot of work in cancer disparities and a lot of community-engaged work that is both linguistically and culturally responsive. Our initiative at Memorial Sloan Kettering offers a wide range of programs for patients, health care professionals and patient advocates. We use a multidisciplinary approach to address gaps in health care at the local, national and global levels.

Q: What makes this program unique from other initiatives?

A: Our program is one of the first programs of this type. There are other institutions that are doing a lot of work around cancer disparities; however, I think our model is a very integrated model. We have a language initiative program embedded in our team so we can really address the language diversity translation. We developed a unique interpretation model that can be used for both clinical care, as well as for those patients who want to participate in clinical trials and cancer research. We have a very strong focus on socio-economic determinants of health and disparities and reduction of disparities. Other models do this, as well, but ours has been long-standing and has a lot of depth. For instance, we found that cancer treatment completion rates vary by food security status and that food-insecure patients were less likely to reach treatment. We also have looked at what emergency food resources and other food resources were available to our patients. We found that those resources did not meet the needs of patients with cancer, so we started a food project to co-locate medically tailored food pantries at cancer safety net institutions that are treating the underserved. This has become very successful and impacted patient quality of life. We are now running a randomized controlled trial looking at pantries vs. pantries plus an innovative food system vs. pantries plus home grocery delivery, looking at the impact of each of these treatment arms on the quality of life.

Q: What other successful initiatives have stemmed from the Immigrant Health and Cancer Disparities Service?

A: We have started a New York City housing collaborative because we found there were patients who were getting chemotherapy and other cancer treatments who were losing their jobs because they were not feeling well and were then consequently losing their homes. They were being treated for their cancer while homeless. So, we started this collaborative to try to address this. This is another way we have tried to focus on socioeconomic determinants of cancer treatment completion, risks and quality of life. We really try to bring our services to where the immigrant community is. Another example includes a project where we are focusing on decreasing shared cardiovascular and cancer risks where we are working with a New York City consulate who sees roughly 500 people per day for consulate services. This is a real window of opportunity for education of risk reduction services. We have a number of projects running. One is HPV vaccination and addressing the very low rates of vaccination completion. We have increased vaccination from 30% up to 70%, which is a very high rate for even the U.S.-born population, and we are now taking this model program and disseminating it to other consulates throughout the country. It is a structured institution that allows us to do groundbreaking work at one site and then disseminate it out to other sites. Another initiative is our New York City taxi-driver initiative. We have more than 120,000 taxi drivers and 96% of them are immigrants. This is a very underserved population who have tremendous cardiovascular and cancer risks. We started the taxi network, which is a community-based participatory research program where we are working together with a taxi-driver advisory board to develop, implement and disseminate research projects. We are in 30 taxi garages and do work in the taxi holding lots, where they work. We conduct health care screenings and navigate people into care and into cancer screening and also have risk-reduction programs. We are now working with partners across the country to disseminate best practices.

Q: Is there one cancer type over another that you see more frequently among the underserved community?

A: Cancer risks can sometimes depend upon the community. For example, we do see a lot of oral cancers in the Asian population, and South Asia has the highest rate of oral cancer in the world, which has to do with the use of culturally-linked tobacco products that are chewed or held in the cheek. We have a program that addresses this specific problem. Cervical cancer is one cancer type that is concentrated in the Mexican community. The rates for cervical cancer are very high among Mexican immigrants. Another project we are working on in this specific community is to work on the increasing rates of overweight and obesity. Overweight and obesity is a shared risk factor for cancer and cardiovascular disease rates and we are seeing obesity rates of more than 70% among this population, so it is really a time bomb for diabetes and cancer risk. We are using some culturally linguistic responsive programming and education to try to impact these rates in the Mexican community, and we will then try to roll it out to other communities.

Q: What advice would you offer leaders at other institutions considering starting an initiative like yours?

A: Get to know your community. Reach out to your community leaders and members. Start an advisory board and make a real partnership with community-based immigrant organizations because they know the community and the language and are really at the heart of the community. Another important aspect is to make sure that programs are both culturally and linguistically responsive. Make sure that the program is patient-centered so everybody’s individual culture can be considered.

Q: Is there anything else you would like to add?

A: As the diversity in our country is increasing, it is really important to include the diverse populations in our research that are applicable to the folks who make up our communities. It is also important to make services accessible to everyone so there is equity in cancer treatment, care and outcomes. – by Jennifer Southall

For more information:

Francesca Gany, MD, can be reached at Memorial Sloan Kettering Cancer Center, 1275 York Ave., New York, NY 10065.

Disclosure: Gany reports no relevant financial disclosures.