patient navigation in cancer survivorship and the roles of ... · patient navigation in cancer...
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Patient Navigation in
Cancer Survivorship and
the Roles of CHWs
Chavely Conde, BHS
Kyla Alsman RN, BSN
Objectives
Understand how cancer is a chronic
disease and the impact cancer has
on long term health
Understand how CHW can help
cancer survivors and education on
available resources
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A Cancer Survivor is….
…. anyone who has been diagnosed with cancer – from the time of diagnosis and for the balance of his or her life.
NCCN: National Coalition for Cancer Survivorshiphttp://www.canceradvocacy.org/
What Does a Cancer Survivor
Look Like? Living cancer-free for the
remainder of life
Living cancer-free for many years but experiencing one or more serious, late complications of treatment
Living cancer-free for many years, but dying after a late recurrence
Living cancer-free after the first cancer is treated, but developing a second cancer
Living with intermittent periods of active disease requiring treatment
Living with cancer continuously without a disease-free period
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Survivors Are Not One Size
Fits All
Some draw closer to
family and friends –
Some are
abandoned by family
and friends
Some are young –
some are old
Some are able to
resume normal
activity – some
might benefit from
physical therapy
Some struggle with
depression, anxiety,
fear
MDHHS Focus Groups, 2017
What is a Community Health
Worker (CHW)?
Trusted member of the community
Service to community members regardless of race, age, gender, culture, or religion.
Provide one-on-one tailored services to address health and social needs
Guide and connect community members to needed resources and services
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Understanding Community
Health Workers
Serve as liaison for patients
Provide educational information, emotional support,
and advocacy
Empower community members
Engage with community members at local events
Raise prevention awareness for cancers
Navigate community members to screening
resources
CHWs working and engaging
with their community
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Estimated and projected number of cancer survivors in the United States from 1977 to
2022 by years since diagnosis.
de Moor J S et al. Cancer Epidemiol Biomarkers Prev 2013;22:561-570
Ongoing Survivor Needs
• Monitoring for late effects
• What are late effects?
• Health problems that happen because of cancer and/or treatment
• Can be both physical or psychological
• May not develop until many years after cancer treatment if finished
• Financial Toxicity:
– Medical Bills
– Supportive Care Services are not often a
covered benefit or require specialist copays.
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Survivorship care
Risk of having late effects of treatment is
influenced by multiple factors
– Treatment received
– Health behaviors (both good and bad)
– Pre-existing problems
– Genetics
Physical Consequences of Cancer
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Health Behaviors
• Diet
• Exercise
• Sun
• HPV
• Tobacco
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Programs and Resources
What resources are available
to CHWs for cancer survivors?
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Health Eating Resources
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Truman Medical Center
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Show Me Healthy Women
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LIVESTRONG at the YMCA
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• 12-week program with two 75-90-minute sessions per
week
• Includes cardiovascular conditioning, strength training,
balance, and flexibility exercises
• Evaluation includes fitness and quality of life assessments
before and after participation
• Facilitated by YMCA-certified instructors
• Requires referral and medical clearance from a physician
Genetics
Some cancers are genetic (example: breast cancer in
adults, retinoblastoma in children)
– Could increase risk of developing secondary cancer
Family history
– Example: patient has family history of heart disease and
then receives cancer treatment that increases the risk for
heart problems
Previvor-
– A survivor of a predisposition ( or increased risk) for a
disease such as cancer
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Ongoing Survivors Needs
Physical Well Being
Diet and Exercise
Fatigue/ Pain
Fertility
Monitoring for late effects
Psychological Well Being
Anxiety
Depression
Fear of Recurrence
Cognition/ Attention
Survivor Guilt
Social Well Being
Family Distress
Roles and
Relationships
Isolation
Finances/Work
Spiritual Well Being
Meaning of Illness
Hope
Uncertainty
Inner Strength
Cancer Survivorship
Roles of CHWs
Health care providers can not measure
patient outcomes once they leave the office
CHWs can follow up with patient and
monitor their care plan.
CHWs motivate community members to:
Exercise
Eat healthy
Follow prescription directions
Find ways to help with financial
barriers
Make lifestyle changes
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Community Health Workers
aren’t all alike
Paid CHWs
Hired as CHW- full or part time
Certification
Specific training (extensive)- per hiring organization
Skillsets vary per job description
Volunteer CHWs
Volunteer their time
Limited hours to
serve/work*
Trainings by outreach
organizations
Train the Trainer model
for retention
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Certification
Some states require certification
Certification is necessary for payment
purposes
MO- certification program: 160 hours, 60
service
Kansas
Kansas does not have a certification program
KS Community Health Worker Coalition
Education committee
Symposium committee
Advocacy committee
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Case Study JJ
30 year old woman with a history of Hodgkin’s Lymphoma at the age of 15.
Past treatment includes history of chest radiation and chemotherapy that increases risk for heart problems.
Patient presents with no health insurance and concern for a lump in her breast.
History of smoking 1 pack per day
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Survivorship care is multidisciplinary and take the
whole community to provide care
Follow Up
Based off JJ’s past treatment she would be due for the
following:
– Echocardiogram (ultrasound of heart to check
function)
– Education on Diet and Exercise
– Sun Safety- education
– Smoking cessation Education
– Breast Mammogram and Breast MRI every year
Needs education about resources due to lack of
insurance
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CHW role before, during and
after cancer treatment
BeforeListen to needs of community members
Guide to screening resources
Address barriers to getting screened
Help enroll eligible women into the state Breast and Cervical
Cancer Program/Navigate them to the resource
Show Me Healthy Women in Missouri
Early Detection Works in Kansas
CHW role before, during and
after cancer treatment
During
Assist with medical appointments
Follow-up to ensure they get to their appointment
Transportation needs/ issues
Find medical interpreting services when needed for
diagnostics, and treatment
Connect to social worker if needed
Talk to family about issues and follow-up
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CHW role before, during and
after cancer treatment
After
Follow-up with appointments
Follow-up with family members to see if any issues
Refer to social worker for financial assistance and
psychosocial needs
Guide them to appropriate resources to continue positive
health behaviors
Hispanic Women’s
Survivorship Discussion on
Barriers
Barriers described-
Language
Financial issues
Health Insurance
Emotional Support
Lack of education in
the community/family
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Barriers that CHW try to
eliminate
Social determinants of health
Socioeconomic
Academic/education
Language
Physical
Psychological
Geographical
Cultural
Benefits of CHWs
Health services
Increase access to care
Less ER visits
Decrease no-show appointments
Help to gather data for research projects
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Questions?
Thank you