Yehoda M. Martei, MD, MSCE

Improving breast cancer outcomes for Black patients by increasing access to care and adherence to treatment.

Impact

Recent advances in breast cancer screening and newer therapies for the treatment of breast cancer have led to a decrease in cancer deaths in the last three decades; however racial and ethnic disparities in breast cancer deaths persist. Black individuals diagnosed with breast cancer have higher risk of death compared to white individuals. Social drivers of health (SDOH) are important factors that positively or negatively influence access to care and partly account for racial and ethnic disparities in health outcomes. SDOH influence access to screening, oncology clinic appointments and treatment retention, which can all lead to disparities in health outcomes. Current data show a higher rate of missed oncology clinic appointments in Black patients compared to white patients, potentially leading to adverse health outcomes for Black patients. Intervening early could lead to improvements in cancer outcomes.

Progress Thus Far

The Penn Individualized Management for Patient-Centered Targets (IMPaCT) model is a standardized community health worker (CHW) program with proven effectiveness in chronic disease management by increasing access to primary care, increasing patient perceived quality of care, and reducing hospitalization and readmission rates. Dr. Martei is evaluating cancer outcomes in patients enrolled in IMPaCT across the University of Pennsylvania Health System from 2013-2023 who received any cancer diagnosis following enrollment in IMPaCT. The cohort included 3111 participants. Of those, 2696 (86.7 percent) successfully completed a CHW program. The patient health identifiers for those who completed the CHW program are currently being matched to EMR data to determine how many of these participants developed any cancer.

Additionally, Dr. Martei and her team are piloting a breast cancer-adapted CHW program. Interventions and resources provided by the CHWs include referrals to support groups, connecting patients to community resources, referrals to transportation assistance, scheduled home visits, and accompanying patients to clinic visits. Thus far, Dr. Martei and her team have successfully recruited and trained 2 CHWs who will be integral to bridging care between the navigation team within the Penn Health system and cancer patients in the community. The CHWs have successfully enrolled 2,696 participants and made 72 participant contacts over the phone or in person. They used The National Comprehensive Cancer Network Distress Thermometer to measure patient distress including childcare, housing, insurance/financial, transportation, depression, fatigue, and substance abuse. On a scale of 0-10 with 0 representing no distress and 10 representing severe distress, the median score of the participants was nine. Additional barriers to care included lack of trust in healthcare providers, fear of diagnosis or treatment, work-related conflicts, and limited health literacy.

What’s next

In the upcoming year, Dr. Martei and her team will conduct an analysis to determine if IMPaCT participants were more likely to enroll in clinical trial than matched patients who did not participate in IMPaCT.