DIVERSITY: The Mass General Brigham Prostate Cancer Outreach Clinic: Tackling Disparities by Providing More Equitable Access to Care

By: Genevieve Benoit, MPH; Muhieddine Labban, MD; Katherine Merport, BA; Quoc-Dien Trinh, MD, MBA | Posted on: 01 Dec 2022

Mortality rates for prostate cancer are disproportionally higher for Black men relative to their White counterparts.1 While studies suggest that biological factors may contribute to the higher incidence of prostate cancer in men of color, racial disparities in prostate cancer may predominantly be driven by differences in access to care.2 Even in Massachusetts, a state with near-universal health coverage since 2006, Black men are more than 20% less likely to receive treatment for intermediate- and high-risk prostate cancer. Thus, health coverage alone is insufficient to eliminate these disparities.2

Racial/ethnic minorities, who currently constitute a third of the United States population, will represent half the population by 2050. As the largest health care system in New England, Mass General Brigham (MGB) recognizes the central role it can play in reducing racial and socioeconomic health care disparities in New England. In 2018, MGB launched the United Against Racism initiative, a long-term, multimillion dollar commitment to address and dismantle aspects of structural racism throughout the health care system.3 One of the pilot programs to come out of the initiative is the Prostate Cancer Outreach Clinic (PCOC). The PCOC serves as a catalyst to increase access for marginalized communities through high-quality, accessible, and affordable prostate cancer care in MGB’s flagship hospitals.

The creation of the PCOC was informed by case studies we conducted as part of an American Cancer Society grant aiming to understand the drivers of Black-White unequal receipt of definitive prostate cancer treatment in Massachusetts.4 We found that barriers in accessing prostate treatment among minoritized populations are threefold: (1) mistrust of specific health care systems including MGB, (2) affordability and health care coverage, and (3) travel burden in accessing health care facilities. To address the mistrust issue, the PCOC has teamed up with community-based organizations like the AdMeTech Foundation to organize patient engagement and educational events. For example, during the Juneteenth Celebration of Freedom community event held by MGB, PCOC team members organized a men’s health outreach educational stand in collaboration with the Roxbury community in Boston. Attendees had the opportunity to sign up for clinical visits to establish contact with a urologist, receive prostate cancer screening, or schedule posttreatment follow-ups.5 Community events represent an opportunity to build trust with prospective patients in a nonthreatening environment surrounded by their families, and empower them to make informed decisions regarding their care.

To help patients navigate the fragmented and often complicated health care system, the PCOC leverages dedicated community health care workers to chaperone patients across the prostate cancer continuum of care. In parallel, MGB prostate cancer providers have allocated dedicated time for the PCOC. Thus, our clinic has mobilized a multidisciplinary team of specialists, navigators, community health care workers, and nurses to optimize the patient experience.

An important mechanism of referrals to the PCOC is the ambulatory safety net at Brigham and Women’s Hospital. The Department of Quality and Safety at the Brigham identifies approximately a hundred patients per month who have an elevated serum prostate-specific antigen and did not receive appropriate follow-up. Through the PCOC, we have established a prostate cancer safety net workflow where patient information is routed monthly from the Department of Quality and Safety to us. Our community health care workers contact patients to ensure that they have not fallen through the cracks. Within the first 6 months of operation, 52% of men lost to follow-up were scheduled for a visit. Among men who received care at our clinic, half had limited English proficiency, and a third were referred for definitive treatment. Our experience through the PCOC’s safety net workflow demonstrated that regular communication with patients ensures patient retention.

In the next phase of our work, we are assembling a multidisciplinary advisory board of stakeholders including clinicians, health equity officers, and transportation planners to pilot ridesharing services at the PCOC. Access to care is multidimensional. It includes: (1) availability of services, (2) affordability or insurance coverage, (3) travel burden, (4) accommodation, or the convenience to the patient for obtaining the service, and (5) acceptability, or the patient’s comfort with how they are treated, which may vary based on cultural, political, and socioeconomic factors.6 While previous initiatives have attempted to address the availability and affordability of care, we recognize that the 5 dimensions of access form a chain that is no stronger than its weakest link.7 Preliminary findings from our case studies, along with survey analysis using the Department of Transportation, suggest that minoritized and socioeconomically vulnerable populations disproportionately face a higher burden of travel for health care visits.8,9 This is particularly relevant for prostate cancer. For instance, men who opt for radiation must come for at least 28 visits to complete their treatment. Thus, the travel burden could directly impact treatment completion resulting in worse outcomes. We hope to launch our rideshare pilot within the next fiscal year. This work will serve as a proof of concept that transportation barriers could be addressed by subsidizing costs or improving travel convenience by offering vouchers, ridesharing services, or shuttles to and from medical facilities.10

The PCOC, recently featured in STAT, is an early phase initiative to tackle disparities by providing more equitable access to care.11 We hope that the PCOC will one day serve as a model for other such programs, and not just in the world of prostate cancer. We plan for the PCOC to provide 500 new consultations annually by 2024, and our long-term ambition is to decrease prostate cancer mortality for men of color in Massachusetts. We are excited about what the future holds in this space. The PCOC is a great opportunity for us to operationalize the inequity research we have done over the past decade.

Conflicts of Interest

QDT reports personal fees from Astellas, Bayer, and Janssen outside the submitted work and research funding from the American Cancer Society, and Pfizer Global Medical Grants.

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