2 Hub cancer centers tackle racial inequities

Boston Medical Center is the place many of the city's minority residents go for care, but it has lagged in buying some of the latest technology to diagnose and treat cancer. Dana-Farber Cancer Institute offers the most advanced technology, but some minorities have viewed it as unwelcoming.

Unequal access to high-quality cancer care is one reason blacks and Latinos in Boston and nationwide suffer poorer health than whites, researchers say. But now, both of these Boston institutions are tackling this problem.

Boston Medical Center will open a $119 million cancer center this fall where ``every piece of equipment will be at the highest level in the city," said Peter Healy, vice president of professional services, who is helping oversee the project. ``Our patients will have access to everything available anywhere in the city, and then some. "

The hospital, which has never before run a major fund-raising campaign, appealed to many wealthy business people, including investment guru Peter Lynch and Boston Scientific president James Tobin, arguing that the city needs to ``level the playing field" for minority cancer patients. The hospital quickly met its $51.1 million goal and now is raising another $7.5 million, for cancer support groups, interpreters, patient care packages with wigs and clothes, and other services not covered by insurance.

Dana-Farber is tackling a different issue. Three years ago, the world-renowned cancer center conducted focus groups with about 50 black residents of Roxbury. Some believed that Dana-Farber treated only children, while others thought it catered to rich white patients or was only for people close to death. Other participants had heard that Dana-Farber provided experimental treatments, and were afraid of being mistreated like the black men in the notorious Tuskegee Syphilis Study of the 1930s, who were allowed to die from the disease without treatment.

To change these beliefs and help reduce disparities in care in the city, Dana-Farber in the last several years has begun sending medical vans into minority neighborhoods to screen residents for breast, prostate, and skin cancers. It is dispatching doctors and nurses to churches and community centers to discuss cancer prevention, organizing support groups for minority cancer patients, and hiring ``patient navigators" to help minority patients schedule appointments and obtain test results, and otherwise guide them through the healthcare system.

The cancer center plans to run focus groups again within the next year, to see whether attitudes have changed, but the number of non-white patients has slowly grown. Thirty-five percent of Dana-Farber's Boston patients in 2001 were minorities; now minorities represent 38 percent of patients.

Cancer center officials have ``heard loud and clear they [minorities] don't always feel comfortable coming there, and they're very disturbed by that," said Dr. JudyAnn Bigby, medical director of community health programs at Brigham and Women's Hospital, which has a partnership with Dana-Farber to treat cancer patients. Dana-Farber and the Brigham ``want to be welcoming and open and receptive to the needs of these patients," she said.

The medical community, including all of the city's major hospitals, is increasingly focused on documenting and addressing inequalities in care, which Mayor Thomas M. Menino has called one of Boston's most serious medical problems. The focus is also national, with many organizations, including the Institute of Medicine, pushing for reducing racial disparities in medical care. It's become such a concern that minorities who once were given little attention are coveted for research studies of health inequalities, and as patients.

The Boston Public Health Commission documented widespread racial disparities in a 2003 report, finding that blacks in particular have higher death rates than whites from cancer, heart disease, stroke, diabetes, and AIDS.

Even though black residents are slightly more likely than white residents to undergo screening for breast, prostate, and cervical cancers, they are more likely to die from these diseases, indicating they may not get good follow-up care. The mortality rate for all types of cancer is 12 percent higher for blacks than for whites, but for certain cancers the difference is even greater. Black men, for example, are more than twice as likely to die of prostate cancer, which partly reflects the higher incidence of the disease among black men. Latino residents appear to get screened for cancer less often than black and white residents, which may be because of language barriers.

Access to care is just one possible reason for these mortality differences; researchers are studying how poverty and racism affect health, whether genetic factors influence cancer incidence and response to treatment, and whether cultural attitudes affect patients' willingness to undergo treatment.

Boston Medical Center doctors said that many of their cancer patients are struggling with poverty and single-parenthood and work two jobs, making it difficult for them to follow up on abnormal test results or comply with rigorous chemotherapy and radiation regimens. More than 61 percent of Boston Medical Center's patients are members of a minority group, compared with about 50 percent of the city's population overall.

Executives said the hospital's old and scattered facilities erect even more roadblocks.

``It was not easy for me to get to all of these different places," said Marie Pierre, 36, who traveled from Haiti to live with her family in Randolph while she received chemotherapy and radiation treatment for breast cancer at Boston Medical Center. ``I got lost."

The new building will enable the hospital to concentrate all cancer services in one place. It will have diagnostic and treatment technology that other major cancer centers -- Dana-Farber, Brigham and Women's, Mass. General, Beth Israel Deaconess Medical Center and Tufts-New England Medical Center -- have had for at least several years. This includes a PET/CT scanner, which produces simultaneous images of a tumor's anatomy and metabolic activity and is considered a state-of-the-art tool for diagnosing cancer and monitoring the effectiveness of treatment. Now, a mobile PET/CT van stops at Boston Medical Center on Saturdays.

The hospital also plans to install an Intensity Modulated Radiation Therapy system for administering radiation to patients, which will allow physicists to more precisely target radiation to a patient's tumor and minimize damage to healthy cells surrounding the cancer.

Dana-Farber executives said their efforts also are improving care for minorities in the city, as well as increasing the number of black and Latino residents seeking care at Dana-Farber. ``Addressing disparities is a key part of our mission," said Karen Emmons, deputy director of Dana-Farber's center for community-based research. ``We are really trying to have this goal permeate the whole institution from leadership down."

Debra Grooms is the resident social service coordinator at Madison Park housing development in Roxbury, where Dana-Farber is conducting colon cancer prevention research.

Residents are being trained as ``peer leaders" and paid a small stipend to call neighbors and knock on their doors to make sure they schedule cancer screening appointments. She is also a breast cancer survivor and patient at Dana-Farber.

``I believe the perception of Dana-Farber is changing," she said. ``That they only care for people with money -- that's been the perception. It's changing because they are coming out into the community now."